Global Health 12 hour elective

Planning an international health elective

Goals of 12 hour elective

     Consider benefits and challenges Steps in planning Choice of site Goal setting Minimize risks  Check list

The Global Village

 If we could shrink the earth’s population to a village of exactly 100 people, with all the existing human ratios remaining the same, the village would look like this…….

Then in this Global village

….

    There would be 57 Asians, 21 Europeans, 14 from North and South America, and 8 Africans 51 would be female:49 male 70 would be non-white and 30 white 50% of the entire world’s wealth would be in the hands of only 6 people and those 6 would be from the US

In this Global village

….

 80 would live in sub-standard housing      70 would be unable to read 50 would suffer from malnutrition 1 would be hear death: 1 would be near birth only one would have a college education no one would own a computer

March 8 Anne Fanning, Lory Laing, Daniel Roth  Hour 1-global burden of disease and health systems-AF    Hour 2- opportunities and experiences at UA-LL Hour 3-ethical considerations-some case senarios, based on personal experience-DR Assignment for March 15, Goal setting

schedule    March 15 Stan Houston, Lynora Saxinger, Walter Kipp • Goal setting • Assignment for March 22 fill in the cross culture information on your chosen country March 22 • Examining different health care settings and Cross cultural issues • Assignment Fill in the check list and set time lines March 29-all facilitators • Check list

introduction to global health issues Goals Health determinants Burden of disease Health systems Essential programs

1. Poverty and disparity

  1.3 billion live in Extreme poverty (<$1USD/d) unable to afford adequate food water and shelter (and other 1 billion in relative poverty, <$2/day). 95% of the worlds resources are controlled by 5%

2. Education, particularly of the mother impacts child health

(% reduction in Child mortality )

80% 70% 60% 50% 40% 30% 20% 10% 0% Pe ru -4-6 yr Pe ru >7yr D R 4-6 yr D R >7 Ph il.4-6 yr Ph il> 7yr years of schooling mother father

3. Social disruption

   Migration-over 1 million cross borders daily War or civil strife (emergency defined as >1 death/10,000/d) introduces issues of food security, psychological trauma as well as need for essential health services Urbanization • 45% live in cities • 41 cities have >5 million • increase industry, increase pollution

4. Climate impact

     Agriculture Global warming: Optimal temperature for mosquitos is 25-27degree C, a few degrees in average temp can transform a no fly zone into malaria breeding ground Water access: 3 billion have limited access to clean water Pollution: CO 2 emissions range from 0.8metric tons /capita in ssAfrica to 12.3 in high income countries (WB 2000) Sun exposure

Global Burden of disease causing death

        53.9 m deaths each year 31% CV 25% infectious( in low income 45%, <4 years 63%) 13% cancer 11% injury 9% resp and GI 5% maternal 6% other

Causes of Death in 1990

Gwatkin Lancet1999;354: 586

60% 50% 40% 30% 20% 10% 0% gl ob al p oor es t w or ld av er age gl ob al r ic he st communicable diseases non-communicable diseases injuries

DALY lost

80% 70% 60% 50% 40% 30% 20% 10% 0% w or ld s p oor es t20 w or % ld av Wor ld er s r age ic he st 20 % communicable diseases non-communicable diseases injuries

Causes of 11.6 million deaths among children <5, 1995

measles 6% malaria 4% diarrhoea 16% pneumonia 21% Malnutrition other 54% 53%

Global Health

Health of the poor, those living on less than $2 a day

Global Mortality due to infectious

Disease

diseases

#deaths (mil)

WHO 1997

% all deaths Acute Resp Inf TB Diarheal dis HIV/AIDS Malaria Measles HepB Pertussis Neonatal tetanus Dengue Fever 3.745

2.91

2.455

2.3

1.5-2.7

.96

.605

.41

.275

.14

7.2

5.6

4.7

4.4

2.9-5.2

1.8

1.2

0.8

0.5

.3

Cost of Effective interventions (assuming use is consistent and correct, Heymann,director CD cluster, WHO)

intervention Cost USD TB 6 mo 20 Anti-malarials 0.05 One year supply of condoms Rehydration salts for diarrhea Treat STDs 14 0.33 5 days antibiotics for pneumonia Measles (1 dose vacc administered) 0.27 0.26 Effect’nes 95% Annual cost/pers 0.60 99% 95% ? 1.70 1.60 Highly efficac 90% 98% 0.80 ? 0.50

5. Access to Health care

A.

Public health services B.

Clinical care

        

Principles of health delivery:

POLITICAL WILL Set priorities, Agree on essentials Central planning for country- wide delivery Essential management unit the District to assure ease of access Enlist inter-sector support from education, social services, industry Create partnerships between public, military, private, NGO, Missions, industry Build community with participation, consultation, feedback Training and supervision evaluation

Cost effective interventions

Clinical services

 Management of sick child      Prenatal and delivery care Family planning Short course chemotherapy for TB Treatment of STD Limited care (assess, advise, alleviate pain, treat infection, minor trauma, and complicated as resources permit)

Cost $12/capita in low income and 21.5 in middle income depending on salaries

Public Health package

 EPI Plus((DPTpolio BCG, Measles) =+hepB, yellow fever, Japanese encephalitis+ micronutrient supplement iron, iodine, vit A     School health program Tobacco and Alcohol control AIDS prevention Other public health (information, education communication about the above, when to seek care and vector control, +SURVEILLANCE

In Africa...

  Life expectancy is 48.9 years and falling in countries with high rates of HIV, compared with the world life expectancy of 66.7

in Zambia life expectancy has fallen from 61 years in 1990 to 38 in 1999!

70 60 50 40 30 20 10 0 life expectancy Africa World

In Africa...

 public expenditure on health as % of GDP

6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% health %GDP Africa World

Doctors per 100,000

 The world has 122 doctors per 100,000 and Africa has 16

140 120 100 80 60 40 20 0 MDs /100,000 Africa World

Foreign Aid to Africa

 Foreign aid to Africa has decreased in all but three countries of Africa

16 15.5

15 14.5

14 13.5

13 12.5

USD billions Africa 1991 Africa 1997

Village Health Center Village health center Village Health Center District health center with hospital and clinic and district officer Management Unit Population about 100,000 Village Health Center Village Health Center

Lets talk about elements of a useful elective  Supervision by someone who knows your needs  What are they? • To see health problems of the area and how they are managed • To do so in safety • To learn the best practice and priorities

Measures of health system

CND Malawi GNP/capita Life expectancy Infant mortality/1000 Maternal mortality/10 6 live Literacy Daily caloric supply Doctors /100,000 19,170 210 79 39 6 134 97% 3056 221 620 56% 2000

•     Where –LL lists, -IHMEC news When How long Urban/rural Health center/hospital

References

     Bobadilla JL et al Design content and financing of an essential national package of health services . Bull WHO 1994;72:653-662 World Guide New Internationalist IHMEC guide www.talcuk.org

http://www.ih.ualberta.ca/