Transcript Community NUR 410 The Global Community: International Health Concerns Kelli Shugart RN, MS

Community NUR 410
The Global Community:
International Health Concerns
Kelli Shugart RN, MS
Summer 2007
Systems Theory
•
What happens in one country
affects many others in important
ways.
In New York fall 1999, sixty-one severe
cases and seven deaths were
reported from a mysterious viral
illness later identified as the West
Nile Virus. Researchers now
speculate that the virus traveled to
the US in smuggled exotic birds.
Global Health
• Global health issues become ours:
1. When they spread within our
borders,
2. When we commit resources to a
country in need,
3. When we make a personal
commitment to improve the health
of a population beyond our shores.
4. When we import or export food.
Introduction
• “International public health is the
application of the principles of public
health to health problems and challenges
that effect low- and middle- income
countries and to the complex array of
global and local forces that influence
them.”
Merson, M., Black, R., Mills, A (Eds.) (2006).
International Public Health :Disease,
Programs, Systems, and Policies (2nd. ed).
MA, Jones and Bartlett Publishers.
Introduction
• IS “GLOBAL HEALTH” DIFFERENT FROM
“INTERNATIONAL HEALTH”?
YES…As stated by Globalhealth.gov
“Global health” is different from
“international health”.
The word “international” is literally defined
in terms of national borders, whereas
“global” encompasses the entire world.
International Health
Care Systems
• Pluralistic medical systems
Found in practically all
developing countries.
Consist of traditional healing
systems, lay practices,
household remedies,
transitional health workers, and
Western medicine (Kloos, 1994)
International Health
Care Systems
• Traditional healing may be all that is
available to populations in most
rural areas and in some cities.
• It is not common for national health
systems to integrate traditional
healing into the national health
system, except in the US, China,
India, and some African countries.
International Health
Care Systems
• Western Medicine introduced
during colonial times.
• After independence, health
systems varied in development.
• Some cont colonial practice.
• Others followed tax-financed
government insurance or
• Socialist health care systems
International Health
Care Systems
• Curative health care expanded
rapidly in urban areas, and the
level of health care was raised
in those locales.
• In late 1970’s the Primary
Health Care (PHC) approach
was adopted in almost all
developing countries
A countries health care system is
based on its political economy.
• Roemer (1993), developed the
first typology of health
systems based on political
ideology.
1. Entrepreneurial
2. Welfare-oriented
3. Comprehensive
4. Socialist
A countries health care system is
based on its political economy.
• Each was then categorized by
the type of country it was in.
1. Industrialized
2. Transitional
3. Very poor
Entrepreneurial
• Found in industrialized
countries
• Have free market economies
• Abundant resources
• Large amounts of money
allocated for health care
• Decentralized governments
• US health care delivery
Welfare-oriented
• Driven by statutory programs that support
the cost of medical care for all, or almost
all.
• Typically called, “national health
insurance”.
• More than half of the health-related
expenditures are from government
sources.
• Most physician and dentist remain in
private practice.
• Western Europe, Japan, and Australia
Comprehensive
• Substantial modifications in delivery
and financing that result in universal
entitlements.
• This system abandons the separate
and complex sources of financing
that are found the previous two
systems
• Scandinavian countries, Great
Britain, and New Zealand
Socialist
• The social revolution totally
abolished free market
economies and replaced them
with socialism.
• Socialist health care system
views health services as a
social entitlement and a
government responsibility,
Socialist
• Emphasizes prevention
• Engages in central planning for
health resources and services with
one central health authority
• Gives priority to industrial workers
and children
• Bases health care work on scientific
principles.
• Nonscientific and cultist practices
are not permitted.
International Health
Care Systems
These four health systems apply
to Industrialized countries
1.
2.
3.
4.
Entrepreneurial
Welfare-oriented
Comprehensive
Socialist
International Health
Care Systems
• Countries that are in the
process of development are
referred to transitional
• The GNP of these countries is
$1500 per capita.
International Health
Care Systems
• Very poor countries are even
less economically developed
and have lower per-capita
GNPs.
• Ethiopia, Kenya, Ghana,
Myanmar, Sri Lanka,
Mozambique, and China
History of International
Public Health
• 400 BC- Hippocrates presents causal
relationship between environment and
disease
• First Century AD- Romans introduced
public sanitation and organized water
supply systems
• Fourteenth Century- “Black Death”
epidemic leads to quarantine and cordon
sanitaire
• Middle Ages- Colonial expansion spreads
infectious diseases around the world
History of International
Public Health
• 1750-1850- Industrial revolution results in
extensive health and social improvements
in cities in Europe and US
• 1850-1910- Great expansion in knowledge
about the causes and modes of
transmission of communicable diseases
• 1910-1945- Reduction on child mortality;
establishment of schools of public health
and international foundations and
intergovernmental agencies interested in
public health
History of International
Public Health
• 1945-1990- Creation of World Bank and
other UN agencies; WHO eradicates
smallpox; HIV/AIDS epidemic begins; Alma
Ata Conference gives emphasis to primary
health care; UNICEF leads efforts for
universal childhood immunizations; greater
attention to chronic diseases
• 1990-2000- Priority given to health sector
reform, cost-effectiveness, public-private
partnerships in health, and use of
information and communications
technologies
Global Health Agencies
1. Nongovernmental
Organizations (NGOs)
2. Private voluntary
Organizations (PVOs)
3. Intergovernmental
Organizations
A. Multilateral Agencies
B. Bilateral Agencies
Multilateral Agencies
These agencies are Multinational
organizations that support
development efforts of governments
and organizations in less developed
nations of the world
• The United Nations (UN)
• The World Health Organization
(WHO)
• World Bank (WB)
Bilateral Agencies
Usually deal directly with other
governments.
• The United States Agency for
International Development (USAID)
• American International Health
Alliance (AIHA)
• The Peace Corps
• The Center of Disease Contol (CDC)
Nongovernmental
Organizations (NGOs)
• In contrast NGOs are not under
government control or
sponsorship.
• Designated Private voluntary
organizations (PVOs)
• Include humanitarian and
professional organizations
concerned with global health.
NGOs/PVOs
• Global Health Council (GHC)
• Center for International Health and
Cooperation (CIHC)
• The Cooperative for American
Remittances to Europe (CARE)
• The Carter Center
• International Council of Nurses (ICN)
• Bill and Melinda Gates Foundation
World Health
Organization
• Acts as the directing and
coordinating authority for
international health work and
maintaining effective
collaboration with United
Nations specialized agencies
and other national and
international bodies responsible
for health development
World Health
Organization
Goals
Fostering equitable human
development
Lifting populations out of
poverty
Assisting men and women to
realize their potential
World Health
Organization
History
 1945
 3 Physicians (Brazil, China, & Norway)
serving as delegates to the founding
General Assembly of the United Nations
met at a San Francisco restaurant
 Discussed global health as a peace
keeping strategy
 One year later WHO constitution was
adopted.
World Health
Organization
Closely associated with UN
Headquarters in Geneva,
Switzerland
 Smallpox eradication is one of
the greatest achievement
World Health
Organization
21st century programs:
Eradication/elimination for polio,
leprosy, guinea worm, and
measles
Reducing transmission and
incidence of HIV/AIDS
Launching a “Roll Back Malaria”
program
World Health
Organization
Stopping the transmission of TB
Increase access to
Pharmaceuticals
Reducing poor quality of some
pharmaceuticals
Preventing and Treating iron
deficiency
World Health
Organization
Reducing maternal morbidity
and mortality
Promoting healthy lifestyles
Establishing “Health Promoting
Schools”
Global Health Council
• The world's largest membership
alliance dedicated to saving lives by
improving health throughout the
world.
• The Council works to ensure that all
who strive for improvement and
equity in global health have the
information and resources they need
to succeed.
Health For All
• 1977 World Health Assembly- all people by
2000 should have a level of health that
would allow them to lead productive lives.
• Comprehensive approach to serving the
most needy and remote populations
• Partnership with local communities and
national health services
• Communities responsible for identifying
own priority health concern
Health For All
• Local communities implement
primary health care (PHC)
service
• PHC include:
1. Prevention
2. Health promotion
3. Curative and rehab care
ALMA-ATA
Declaration of Alma-Ata in 1978
• Produced by a WHO/UNICEF
conference in Kazakhstan, in the
former Soviet Union
• Promoted an ecologic/social concept
of health and offered political and
economic guidelines for achieving
primary health of all
 In the US, Healthy People, 2010
based on concept
PHC Achievements and
Deterrents
• Worldwide infant mortality rate
decreased from 90 per 1000 live
births in 1975 to 59 per 1000 in
1995 a 34% decrease
• Immunization coverage for
younger than 1 year rose from
20% to 80% between 1980 and
1990
Global Burden of
Disease (GBD)
• WHO’s study on GBD verified
disparities in the burden of
disease worldwide, especially in
children. (Murray & Lopez,
1997)
98% of all deaths in children
younger than 15 are in
developing countries.
Global Burden of
Disease (GBD)
 83% of deaths of those aged 15 to
59 are in the developing world.
 The probably of death before age 15
ranges from 22% in sub-Saharan
Africa to only 1.1% in countries with
established market economies.
 5 of the 10 leading causes of death
are communicable, perinatal, and
nutritional maladies that largely
affect children.
Global Burden of
Disease (GBD)
• In addition to causes of mortality,
the GBD study quantified the burden
of disease with a measure that could
be used for cost-effective analysis.
In order to compare across
conditions and risk factors, a
measure called the disabilityadjusted life year (DALY) was
developed.
Disability-adjusted Life
Year (DALYs)
• DALYs are the combination of
years of life lost due to
premature mortality and years
of life lived with disability
adjusted for the severity of
disability.
Global Health Concern
• Eradication- interruption of person
to person transmission and
limitation of the reservoir of
infection.
• Elimination- disease has been
interrupted in a defined area.
• Control-indicates that a specific
disease has ceased to be a public
health concern.
•
1.
2.
3.
4.
5.
Comparison of the Ten
Leading Causes of Death
Worldwide, 1990 &1998
1990 (Murray
&Lopez, 1997)
Ischemic heart
disease
Cerebro-vascular
disease
Lower respiratory
tract infection
Diarrheal
diseases
Perinatal
disorders
• 1998
(Shannon,2001)
1. Ischemic heart
disease
2. Cerebro-vascular
disease
3. Lower respiratory
tract infection
4. HIV/AIDS
5. Chronic
obstructive
pulmonary disease
Comparison of the Ten
Leading Causes of Death
Worldwide, 1990 &1998
•
1990 (Murray
&Lopez, 1997)
6. Chronic obstructive
pulmonary disease
7. Tuberculosis
(excluding HIVseropositive
individuals)
8. Measles
9. Road traffic
accidents
10. Malaria
• 1998
(Shannon,2001)
6. Diarrheal diseases
7. Perinatal
conditions
8. Tuberculosis
9. Cancer of the
trachea, bronchus,
and lung
10.Road traffic
accidents
Diseases
• Poliomyelitis
• Guinea Worm (Dracunculiasis)
• River Blindness
(Onchocerciasis)
• Leprosy
• Measles
• Malaria
Diseases
• Human Immunodeficiency Virus
Infection and Acquired
Immunodeficiency Syndrome
• Tuberculosis
• Diarrheal Diseases
• Acute Respiratory Tract
Infection
Diseases
• The Carter Center
http://www.cartercenter.org/homepage.html
Lymphatic Filariasis
• Lymphatic filariasis, a parasitic disease
transmitted by mosquitoes, is a leading cause
of permanent and long-term disability. In its
severest form, lymphatic filariasis leads to
elephantiasis — a crippling condition in which
limbs or other parts of the body are
grotesquely swollen or enlarged. In
communities endemic with lymphatic filariasis,
as many as 10 percent of women can be
affected with swollen limbs and 50 percent of
men can suffer from mutilating genital disease.
These conditions have a devastating effect on
the quality of life of those affected, impacting
them not only physically but also emotionally
and economically.
Other Global Health
Concerns
• Immunizations
• Maternal and Perinatal
Morbidity and Mortality
• Tobacco-Related Morbidity and
Mortality
• Chronic Disease
• Environmental Illness
Other Global Health
Concerns
• New and Emerging Diseases
• Armed Conflicts and Political
Upheavals
• Human Development and Health
st
21
Century Challenges
At the turn of the 21st century:
• More than 11 million children below
age 5 die each year from preventable
causes such as pneumonia, diarrhea,
malaria, malnutrition, and measles,
HIV/AIDS; 98% of these deaths occur
in developing countries.
• More than 120 million woman want
to space or limit childbearing , but
do not have access to modern
contraceptives.
st
21
Century Challenges
• Nearly 600,000 woman 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
tuberculosis, malaria, or HIV/AIDS
st
21
Century Challenges
• Worldwide, 1.2 Billion people do not
have access to clean water.
• More than 300 Million adults
worldwide are obese, putting them
at significantly increased risk for
cardiovascular diseases, diabetes,
hypertension, cancer, stroke, and
musculoskeletal disorders.
st
21
Century Challenges
• Developed countries (United States statistics)
1. U.S. spends less than 1% of GNP on Health
Care.
2. It is estimated that 800 Million persons are
chronically undernurished. (WHO,1998a)
3. Nearly 3 Billion persons (half of humanity)
subsist on less than US$2 per day.
(WHO,1998a)
4. In the U.S. 17 Billion dollars are spent annually
on pet food.
5. It is estimated that basic nutrition for all poor
people in developing countries would cost 13
Billion dollars.
Determinants of Health
• Main determinants of health:
1.Socioeconomic
2.Cultural
3.Environmental
4.Political
Barriers to Health
• Developing countries barriers to health:
1. Underdevelopment
2. Lack of production capacity
3. Inflation
4. Poor health
5. Lack of access to education, housing,
food, and health services
6. Distribution of income-high to low-5% of
the people have the most wealth
Role of Nurse
Policy maker/Volunteer
US Peace Corps
Religious and lay organizations
Private and governmental agencies
Health Volunteers Overseas (HVO)
President Carter described such
works, “satisfying, a joy, a pleasure,
a challenge, and an adventure.”
 Global Nursing can be all of those
things……..
Leininger
• She held that care was the essence of
nursing or what made nursing what it is or
could be in healing, wellbeing, and to help
people face disabilities and dying.
• Care is nursing, care is health, care is
curing, and care is wellbeing
• She further believed and predicted that
there could be no curing without caring,
but caring could exist without curing.
(Leininger 1988a/b/c, 1991a/b; Leininger &
McFarland, 2002)
Culture Care Theory
• The goal of the Culture Care Theory
has been to use culture care
research findings to provide specific
and-or general care that would be
culturally congruent, safe, and
beneficial to people of diverse or
similar cultures for their health,
wellbeing, and healing, and to help
people face disabilities and death
(Leininger, 1963, 1991a/b,1994a,
1995; Leininger &Mcfarland, 2002)
Shared Problems, Shared
Solutions
• All countries can both learn
from other countries and also
share their own experiences
and information.
• An enlightened new definition of
global health paints the picture
of a two-way street: Shared
problems, sharing solutions.
Shared Problems,
Shared Solutions
Quote
• Social Justice and Equity Thought:
“Try
to Live Simple so
that others can Simply
Live”
Author Unknown.
References
Clark, N., & Johnson, D.C. (2005). The global community:
International health concerns. In J.A. Allender& B.W.
Spradley (Eds.), Community health nursing: Promoting
and protecting the public’s health (6th ed. pp. 468-491).
Philadelphia: Lippincott, Williams & Wilkins.
Kloos, H. (1994). The poorer third world: Health and health
care in areas that have yet to experience substantial
development. In D.R. Phillips & Y. Verhasselt (Eds). Health
and development (pp. 199-215). New York: Routeledge.
Leininger, M. (2002). The theory of culture care and the
ethnonursing research method. In M. Leininger, & M.
Mcfarland (Eds.), Transcultural nursing: Concepts,
theories, research, and practices (3rd ed., pp. 71-116).
New York: Mcgraw-Hill.
References
Leininger, M., & Mcfarland, M. (2006). Culture care
diversity and universality: A worldwide nursing
theory. Sudbury, Massachusetts: Jones and Bartlett
Publishers, Inc.
Merson, M., Black, R., Mills, A (Eds.) (2006).
International Public Health : Disease, Programs,
Systems, and Policies (2nd. ed). MA, Jones and
Bartlett Publishers.
Roemer, M.I. (1993). National health systems of the
world (vols. I&II). New York: Oxford University
Press.