Course introduction fundamentals of global health 2014
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  • Global health is emerging as an “area for study, research and practice” integrating traditional elements of public health and international health with a broader scope. Its current agenda includes infectious disease control, maternal and child health, family planning, neglected tropical diseases, nutrition and primary health care. However, given shifting patterns of morbidity and mortality due to development, urbanisation, ageing populations, and environmental changes,call for inclusion of chronic conditions such as hypertension, diabetes, CVD, cancer, COPD, cancer, mental health.What is needed to achieve the ‘new’ global health agenda? 1. Multidisciplinary research and multi-sectoral research beyond the traditional public health and tropical medicine focus2. Increased funding opportunities for global health research3. New research and development models may need to be developed4. Institutional capacity strengthening in LMIC5. Multilateral partnerships for setting agendas for research and implementation mainly based in LMIC
  • According to the United Nations, ("2010 Revision of the World Population Prospects") world population has reached 7 Billion on October 31, 2011 (refer to the U.N. frequently asked questions for more information about this estimate) The US Census Bureau made a lower estimate, for which the 7 billion mark was only reached on March 12, 2012June 20, 2011|By the CNN Wire StaffSyrian refugees in a Turkish Red Crescent camp in the Yayladagi district of Hatay, close to the Syrian border, on June 19, 2011.The number of people forced from their homes worldwide has risen to 43.7 million, the highest level in 15 years, according to a U.N. refugee agency report released Monday.That's up from 43.3 million people a year earlier, said UNHCR's 2010 Global Trends report, which was released to coincide with World Refugee Day.Of those displaced, the report classified 15.4 million people as refugees forced to flee their country and 27.5 million as displaced persons within their own country, forced to leave their home because of conflict or natural disaster, the report said.
  • AFR – AfricaSACA – South and Central America MENA – Middle East and North Africa NAC –Northern America EUR – Europe SEA – South East AsicaWP Western Pacific

Course introduction fundamentals of global health 2014 Course introduction fundamentals of global health 2014 Presentation Transcript

  • FUNDAMENTALS OF GLOBAL HEALTH Fundamentals of global health Course Introduction
  • COURSE COORDINATOR Kerstin Klipstein-Grobusch, MSc, PhD Associate Professor of Global Health, University Medical Center Utrecht, Utrecht University, The Netherlands Visiting Associate Professor, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa k.klipstein-grobusch@umcutrecht.nl www.globalhealth.eu Fundamentals of global health Course Introduction
  • Course Aim • Introductory global health course • Principles of global health, addressing – global health governance, health-related development strategies and health advocacy – health indicators and burden of disease – social determinants of health and health (in)equity – epidemiologic transition & migration – ethics in global health – methodological approaches in global health research Fundamentals of global health Course Introduction View slide
  • Course Format & Venue • • • • Lectures, exercises, readings, group work and assignments. Self-study is an important aspect of this course. Active participation is encouraged. Course credits based on completion of – compulsory assignments of learning units (50%) – individual assignments (25%) – final group work presentation (25%) • Course credits: 1.5 ECTS Fundamentals of global health Course Introduction View slide
  • Course Faculty • • • • • • • • • • Dr. Charles Agyemang, University of Amsterdam Joyce Browne, Julius Center, University Medical Center Utrecht, Utrecht Dr. Yme Berg, Royal Tropical Institute, Amsterdam Prof. Dr. van Delden, Julius Center, University Medical Center Utrecht, Utrecht Dr. Ama de Graft-Aikins, University of Ghana, Ghana Dr. Kerstin Klipstein-Grobusch, Julius Center, University Medical Center Utrecht, Utrecht Dr. Anne Poorta, Ministry of Foreign Affairs Prof. Dr. Robert Pool, University of Amsterdam Prof. Dr. Huub Schellekens, Utrecht University Rineke van Dam, SUMAVI Fundamentals of global health Course Introduction
  • Course Program The course consists of 13 Learning Units (LU), spread over three weeks: • LU 1 – Introduction to global health
 • LU 2 – Global health governance
 • LU 3 – Health indicators and burden of disease
 • LU 4 - Mixed methods approaches in global health research
 • LU 5 – Social determinants of health
 • LU6 – Health transition
 • LU 7 – Migration and health
 • LU 8 – Health equity
 • LU 9 - Development strategies – sustainable development goals beyond 2015 Fundamentals of global health Course Introduction
  • Course Program continued • • • • • LU 10 - Time to work on presentation
 LU 11 - Health advocacy
 LU 12 - Sustainability and health
 LU 13 - Ethics in global health research
 LU14 - Group work presentation Fundamentals of global health Course Introduction
  • What is global health? What are global health issues? Fundamentals of global health Course Introduction
  • Fundamentals of global health Course Introduction
  • Global Context of Public Health • Population: > 7 billion people worldwide, > 200 000 people added daily; in 8 countries > 30% of the populations is under age 15 • Civil Society: Civil and foreign wars, > 43 million displaced persons and refugees • Poverty: 1.2 billion people live on less that US$1 per day; 2.8 billion live on less than US$2 per day; 1 in 6 are chronically hungry • Environment: Environmental changes such water shortages, air pollution, increases in temperature Fundamentals of global health Course Introduction
  • The Challenge • One billion of the more than 7 billion alive enjoy a long and healthy life • The challenge ahead is to find ways to help the other six billion people to live longer and healthier lifes as well Fundamentals of global health Course Introduction
  • 2011 Basic Indicators by Level of Income Population (millons) Average Per Capita Income ($) Population living on < 2 US$ Life Expectancy (y) Infant Mortality/ 1000 births Least Developed Coutries 860 1220 77% 59 76 Less Developed Countries (excl China) 4399 5000 56% 66 59 More Developed Countries 1241 32470 N/A 78 55 Population Reference Bureau, 2011 World Population Sheet Fundamentals of global health Course Introduction
  • Impact of disease on economic growth • Reduced years of healthy life expectancy and productivity due to chronic illness or early death • Direct and indirect medical costs • Reduction in returns to business and society, political stability Fundamentals of global health Course Introduction
  • Relation between life expectancy and economic growth • Each 10 percent increase in life expectancy at birth, holding all other factors constant, is associated with a rise in economic growth of around 0.3 – 0.4% per year WHO Macroeconomic Report 2011 Fundamentals of global health Course Introduction
  • Global burden of disease Fundamentals of global health Course Introduction
  • Fundamentals of global health Course Introduction Juliuscenter.nl
  • Fundamentals of global health Course Introduction
  • Global expenditure on health, 2010 as a percentage of GDP Fundamentals of global health Course Introduction WHO, 2011
  • Fundamentals of global health Course Introduction WHO, The Global Burden of Disease – 2004 Update
  • Fundamentals of global health Course Introduction WHO, The Global Burden of Disease – 2004 Update
  • Leading Causes of Mortality and Burden of Disease World, 2004 Mortality 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. DALYs % Ischaemic heart disease Cerebrovascular disease Lower respiratory infections COPD Diarrhoeal diseases HIV/AIDS Tuberculosis Trachea, bronchus, lung cancers 2.3 Road traffic accidents Prematurity, low birth weight 2.0 12.2 9.7 7.1 5.1 3.7 3.5 2.5 2.2 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. % Lower respiratory infections Diarrhoeal diseases Depression Ischaemic heart disease HIV/AIDS Cerebrovascular disease Prematurity, low birth weight 2.9 Birth asphyxia, birth trauma Road traffic accidents Neonatal infections and other 6.2 4.8 4.3 4.1 3.8 3.1 2.7 2.7 2.7 Fundamentals of global health Course Introduction WHO, The Global Burden of Disease – 2004 Update
  • Public Health Agendas • The unfinished agenda: Infectious Diseases • The upcoming epidemic: Chronic Diseases • The unnecessary epidemic: Injuries, violence and environmental threats • Disparities in health • Health systems Fundamentals of global health Course Introduction
  • Global burden of infectious* disease • 9 519 000 of total global deaths (16.2%) • 19.8% of global DALY’s • 4 849 000 = deaths in Africa • 2 674 000 = deaths in Asia in LMIC Infectious/parasitic disease, WHO 2004 Fundamentals of global health Course Introduction
  • Infectious diseases – the unfinished agenda • HIV/AIDS – 33.4 million HIV+ people worldwide – 22.4 million in Africa – 2 million deaths Fundamentals of global health Course Introduction MDG Report 201,0, WHO
  • Infectious diseases – the unfinished agenda • TB – Prevalence worldwide 11 million cases – In 2008: 9.4 million new cases diagnosed – 1.8 million deaths in 2008, 50% in HIV+ – Emerging drug resistance • Malaria – Worldwide 243 million cases – 863000 deaths of which 89% in Africa – Emerging drug resistance • Respiratory and Diarrheal Diseases • Emerging Infections Fundamentals of global health Course Introduction MDG Report 2010, WHO
  • The coming epidemic of chronic disease: the demographic transition Fundamentals of global health Course Introduction IBRD, World Bank 2000
  • Proportion of population aged 60 years and older: world and developmental regions 1950-2050 Fundamentals of global health Course Introduction UN, World Population Aging, 2009
  • Population change (2005 equals 100) Population change 250 Least developed 200 Less developed 150 100 More developed 50 1950 60 70 80 90 2000 10 20 30 40 2050 Years (Adapted from “World Population Prospects: The 2004 Revision”, Population Newsletter, UN Population Division, June, 2005 Fundamentals of global health http://www.un.org/esa/population/publications/popnews/Newsltr_No_79.pdf) Course Introduction Juliuscenter.nl
  • The coming epidemic of chronic disease The epidemiologic transition • • • • Obesity and Diabetes Cardiovascular Disease and Stroke Cancer Neuro-psychatric disease and dementias Fundamentals of global health Course Introduction
  • Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Fundamentals of global health Course Introduction
  • Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Fundamentals of global health Course Introduction
  • Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Fundamentals of global health Course Introduction
  • Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Fundamentals of global health Course Introduction ≥20
  • Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% Fundamentals of global health Course Introduction 25%–29% ≥30%
  • Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% Fundamentals of global health Course Introduction 25%–29% ≥30%
  • Type 2 diabetes: The coming co-epidemic • 366 million cases in 2011 (8.3% prevalence) • 4.6 million deaths in 2011 • 465 US$ health care expenditure • 566 million cases expected in 2030 Fundamentals of global health Course Introduction
  • Fundamentals of global health Course Introduction
  • Global impact of cardiovascular disease • Non-communicable disease contribute 60 % of deaths and 43 % of the global burden of disease. Already 79% of these NCDs are occurring in developing countries. • By 2020 these will account for 73% deaths and 60% of the disease burden. • Half of the deaths are attributable to cardiovascular diseases. • There are more CVD deaths in India or China than in all developed countries added together. Fundamentals of global health Course Introduction Juliuscenter.nl
  • Cancer burden in developed and developing countries - Men Fundamentals of global health Course Introduction
  • Cancer burden in developed and developing countries - Women Fundamentals of global health Course Introduction
  • What are the main reasons for increasing rates of NCD’s globally? Fundamentals of global health Course Introduction
  • Increase in NCD risk factors The major modifiable risk factors for cardiovascular disease are known, and their impact is similar in most regions of the world • Tobacco Smoking • Unhealthy diet • Physical inactivity • Alcohol consumption Fundamentals of global health Course Introduction
  • What are the main distal drivers of a changing risk factor profile? Underlying socioeconomic, cultural, political and environmental determinants • Globalization • Urbanization • Poverty Fundamentals of global health Course Introduction
  • Global burden of mental illness DALY’s 13.1%; Deaths 2.1% (mental Illness) Fundamentals of global health Course Introduction WHO, 2001
  • Community-based treatment of depression, psychosis and epilepsy • Depression, bipolar disorder and schizophrenia represent 13% of the global disease burden – Approx. 20% can be treated by drugs in primary care settings – Costs per year of life saved is affordable in all middleincome and some low-income countries Fundamentals of global health Course Introduction
  • The unnecessary epidemic: Injuries • Most rapidly rising burden in developing countries • > 3000 killed/d • > 130 000 injured/d WHO, Global Status Report on Road Safety, 2009 Fundamentals of global health Course Introduction
  • Global health disparities Life expectancy • Malawi 47 years • Afghanistan 48 years • Sierra Leone 49 years • Switzerland 82 year • Singapore 82 years • Japan 83 years World Health Statistics 2012 Fundamentals of global health Course Introduction
  • Health systems • High priority of Developing Country Ministers of Health – Workforce • Capacity: training, technical and managerial • ‘Brain drain’ – Institutions – linkages/partnerships – Sustainable drug acquisition and delivery – Financing and resource allocation – Equitable distribution of services – Need for ‘Implementation Research’ and Up-Scaling Fundamentals of global health Course Introduction
  • The Challenge • The challenge of global health is to find ways to help the other six billion people to live longer, healthier lives. Fundamentals of global health Course Introduction
  • Further Readings • Koplan JP et al. Towards a common definition of global health. Lancet 2009; 373:1993-5. • Beaglehole R & Bonita R: What is global health? • Global Health Action 2010 – DOI:10.3402/gha.v310.5142 Fundamentals of global health Course Introduction