Global Health 101
Deepti Thomas- Paulose MD, MPH
July 14th 2011
WHO Definition of Health
“Health is a state of complete physical,
mental and social well-being and not
merely the absence of disease or
infirmity.”
Outline
 Define Public Health and International
Public health
 Define major principles
 Understand major issues in global public
health
 History of Global Health
 Current Challenges
 Future Challenges
Public health
 The science and practice of protecting
and improving the health of a community
through:
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Preventative medicine
Health education
Control of communicable diseases
Application of sanitary measures
Monitoring of environmental health
hazards
John Snow- The father of
modern public health
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Cholera outbreak in London
during 1848-1848
Different water sources were the
basis for illness
“The Ghost Map”
Multitude of sciences
 Epidemiology and Biostatistics
 Biological sciences concerned with
humans, microorganisms and vectors
 Social and behavioral scienceseconomics, psychology, anthropology
and sociology
Social Justice
 Central pillar of public health
 Equity in health to all groups in any
society
 Impeded by differences in gender, social
class, ethnicity, and race
International Public
Health
 Application of principles of public health
to health challenges that affect low and
middle-income countries and to the
complex array of global and local forces
that influence them including:
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Urbanization
Migration
Information technology
Expanding global markets
Improving health requires
understanding characteristics:
 Social
 Cultural
 Behavioral
 Economic
 Environmental
What are the issues you
should understand in
International Public Health?
1)Main causes of Morbidity and
Mortality in the world today and in
the future in view of :
 The demographic transition- many
countries are transitioning from high to
low fertility rates
2)The cultural diversity
of population groups
within countries and
regions
Values, belief systems and
responses to illness and death
3)The causes and
consequences of human
population growth and the
beneficial effects for women and
children of reproductive health
programs.
4) The complex
relationship between
nutritional status and
disease patterns, including
the importance of
micronutrient deficiencies.
5)The main infectious agents and
vectors responsible for
communicable diseases
6) The increasing rates of non-communicable or chronic
diseases.
7) The increasing burden of mortality and
morbidity attributable to non- intentional and
intentional injuries.
8) The various approaches to the design,
financing, organization, and management
of preventative and curative services in
countries with diverse economies and
resources
9) The appropriate responses to complex humanitarian
emergencies, especially those involving large displacements
of populations within a country and between neighboring
countries
10) The importance of health for the
economic development of a nation and
the productivity of its population, and the
reciprocal impact of development, as
reflected by such factors as educational
levels and economic growth, on health
status
11) The roles of national, regional,
international and intergovernmental
development agencies, as well as
non-governmental and private
volunteer agencies in delivery of
preventive and care services
A Summarized History
of International Public
Health
400 BC
Hippocrates presents
causal relation between
environment and disease
1st Century AD
Romans
introduce
public
sanitation and
organized
water supply
system
14th century
Black Death
leads to
quarantine
and cordon
sanitaire
Middle Ages
 Colonial expansion spreads infectious
diseases around the world
 Many cities in Europe build hospitals and
other institutions to provide medical care
and social assistance
1750-1850 (Age of
Enlightenment)
Industrial revolution results in
extensive health and social
improvements in cities in
Europe and the US
 Outbreaks
of cholera and other
epidemic diseases that resulted
in high rates of child mortality
1850-1910
 Great expansion in the knowledge about
the causes and transmission of
communicable diseases
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Louis Pasteur’s proof of germ theory
Robert Koch’s discovery of tubercle
bacillus
Walter Reed’s demonstration of the role of
the mosquito in transmitting yellow fever
1850-1910
 Discoveries in the sciences of
physiology, metabolism, endocrinology,
and nutrition
 Dramatic decreases in child and adult
mortality through improvements in social
and economic conditions, discovery of
vaccines and implementation of
programs in health education
1910-1945
 Reductions in child mortality
 Establishment of schools of public health
and international foundations and
intergovernmental agencies interested in
public health
 League of Nations
1945-1990
 End of WWII beginning of current era of
international public health
 Creation of World bank, IMF and other
UN agencies; WHO eradicates smallpox;
HIV/AIDS pandemic begins; Alma Ata
Conference gives emphasis to primary
health care; UNICEF leads efforts for
universal childhood immunization;
greater attention to chronic diseases
Alma-Ata Conference in 1978
 Switch in paradigm
from control of
specific diseases to
strengthening the
capacities of low and
middle income
countries to extend
their health services
to populations with
poor access to
prevention and care
1990-present
 Priority given to health sector reform,
equity, health and development, impact
of and responses to globalization, costeffectiveness, public-private partnerships
in health, and use of information and
communications technologies
Ottawa Charter of 1986
 Health as a resource for development not
merely as an outcome
 Importance of structural factors that affect
health on a societal level
 Shift from “risk behavior to “risk environment”
 Prerequisites for health
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Peace, shelter, education, food, income, a stable
ecosystem, sustainable resources, social justice
and equity
The success of global health
 Life expectancy is around 80 in many countries
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around the world
Life expectancy in developing countries has
climbed to about 65 from 41 in the early 1950s
Elimination of smallpox (certified in 1979)
Almost elimination of polio and measles
Decline in global child mortality from 192
(1950s) to 79 per 1000 live births by 2004
Immunization coverage approximately 75-80%
worldwide.
Current Challenges in
International Public
Health
 Nearly 11 milllion children below age 5
die each year from preventable causes
such as
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Pneumonia
Diarrhea
Malaria
Malnutrition
Measles
HIV/AIDS
98 % of these deaths occur in
developing countries
More than 120
million women
want to space or
limit childbearing,
but do not have
access to modern
contraceptives
Nearly 600,000 women die
annually from complications
of pregnancy and childbirth,
and another 30 million suffer
pregnancy related health
problems that can be
permanently disabling
 Each year 13 million persons die
from infectious diseases, most of
which are preventable or curable;
half of these deaths are in adults
and are due to TB, malaria, or
HIV/AIDS
Worldwide 1.2 billion
people do not have
access to clean water
More than 300 million adults
are obese, putting them at
significantly increased risk for
cardiovascular diseases,
diabetes, HTN, cancer, stroke
and musculoskeletal disorders
There is a broad consensus that
poverty is the most important
underlying cause of preventable
death, disease and disability
More people live in poverty today than 20 years ago
Literacy, access to housing, safe
water, sanitation, food supplies
and urbanization are
determinants of health status
that interact with poverty
Globalization
 Economic globalization, driven by
increasing world trade, greater openness
of national economies to world markets
and the vast expansion of information
technology, has contributed to uneven
economic growth, increased economic
inequality, and concerns about
subordination of human and labor rights
Millennium Declaration by the
UN in September 2000
 Address inequities that have been created or
worsened by globalization
 Form new international linkages to achieve and
protect peace, disarmament, poverty
eradication, gender equality, the environment,
human rights, and good governance
 The goals dealing specifically development and
poverty eradication have become known as the
Millenium Development Goals (MDGs), three of
which explicity refer to health
Millennium Development
Goals by 2015
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MDG 4 - Reduce under 5 mortality by twothirds
MDG 5 - Reduce maternal mortality by
three-quarters
MDG 6 - Reverse the spread of HIV/AIDS,
malaria, TB and other major diseases
Future Public Health Challenges
 Emergence and reemergence of infectious
disease- MDTB, SARS, influenza, West Nile
Virus, etc
 Dual burden in low and middle income
countries of communicable and noncommunicable diseases
 Global forces that have imported Western
lifestyles such as tobacco smoking and
increased consumption of processed foods
have hastened the increase of chronic
diseases in these countries
Future Public health
Challenges
 Mental illnesses and depressive
disorders remain a largely ignored and
major source of death and disability
worldwide
 Complex and multifaceted issues
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Human Migration and displacements
Bioterrorism
Disaster preparedness, nuclear threats
Future Public health Challenges
Motor vehicle safety
 Road traffic accidents are the second
leading cause of death worldwide among
persons aged 5 to 29 years
Occupational Workplace safety
 In 2002, 2 million work-related deaths per
year
Coronary artery disease and stroke
 In 2005, 80% of all CVD deaths worldwide
took place in developing low and middleincome countries
Future Public health
Challenges
 Landmines
 Population growth and shifts
 World hunger and poverty
 Environmental Issues
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Global warming
Indoor air pollution
Water pollution
Important crossroad in
international public health
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Confront global forces while at
the same time promote local,
evidence-based, cost-effective,
public health programs that deal
with disease-specific problems
and more general issues such
as poverty
More public health research is
needed to gain a better
understanding of the
Summary
 Public health strives to maximize the well-
being of an entire population
 Chronic diseases are becoming more
prevalent with aging populations
 Global health is improving in general but
there are parts of the world that lag behind
 Other factors play a role in health like poverty,
nutrition, education, water and sanitation
 Health is central to global development
objectives
Back to you!
 International public health practitioners
can make a big difference by being well
trained in their disciplines and highly
sensitive to the beliefs, culture, and value
systems of the populations with whom
they collaborate or serve