Dr. Mohamed Dahir

1. The preamble to the WHO Constitution lists nine health
principles.
1. Health is a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity.
2. The enjoyment of the highest attainable standard of health is one of the
fundamental rights of every human being without distinction of race,
religion, political belief, economic, or social condition.
3. The health of all peoples is fundamental to the attainment of peace and
security and is dependent upon the fullest cooperation of individuals and
states.
4. The achievement of any State in the promotion and protection of health is
of value to all.
5. Unequal development in different countries in the promotion of health and
control of disease, especially communicable disease, is a common danger.
6. Healthy development of the child is of basic importance; the ability to live
harmoniously in a changing total environment is essential to such
development.
7. The extension to all peoples of the benefits of medical, psychological, and
related knowledge is essential to the fullest attainment of health.

2. • Ethical principle of health as global citizenship.
1. Health as a global public good.
• Implies ensuring the value of health, Understanding health
as a key dimension of global citizenship, and keeping it high
on the global political agenda.
• Defining common agendas, increasing the importance of
global health treaties, and increasing pooling of control by
nation states in the area of health.
2. Health as component of global security
• Implies an extensive global health surveillance role and
expanded international health regulations with
interventionist power for the WHO.
• The reliable financing of a global surveillance infrastructure
and a rapid health response force.

3. 3. Global health governance for interdependence
Strengthening the WHO and giving it a new and
Strengthening the WHO and giving it a new and stronger
mandate.
• WHO must have the constitutional capability to ensure
agenda coherence in global health and be able to strengthen
its convening capabilities, ensure transparency and
accountability in global health governance.
The goals of Global Health Diplomacy are:
a. To support the development of a more systematic and pro-
active approach to identify and understand key current and
future changes impacting global public health.
b. To build capacity among Member States to support the
necessary collective action to take advantage of
opportunities and mitigate the risks for health.

4. • Globalization It is now a worldwide assertion that
emerging infectious and non-infectious diseases are
a global problem requiring a global strategy.
• The traditional distinctions between national and
international political, social and economic
activities are losing their importance.
Globalization is about the process of international
integration arising from the interchange of world
views, products, ideas, and other socio-economic
aspects.

5. Specific Public Health Issues include:
• Infectious disease control
• Food safety
• Tobacco
• Environment
• Access to drugs
• Food security
• Emerging issues (biotechnology….)
• Health services

6. Types of Globalization (examples)
• Technological: IT, Biomedical, Green, Robotics
• Population: Growth, Aging, Youth Bulge, Women, Labor, Ethnic
mixing (hybridization)
• Economic: Commercial, Industrial, Communications, Services
• Financial: Investments, Banking, Exchange Rates, Black Markets,
Money Laundering
• Cultural: Ideational, Ideological, Educational, Civilization, Pop
Culture
• Political: Democratic, Multinational Organizations, International
Law and Governments, Rule of Law, Civil Society

7. Different Aspects/ Dimensions/ perspectives
of Globalization
• The political aspect
• Aspect of Global Threats
• Aspect of International Organized Crime
• Aspect of Corruption
• Aspect of Socio-Economic Inequality
• Aspect of population
• Aspect of Environmental Threats
• Aspect of Weapons of Mass Destruction
• Aspect of Resource Wars….,and etc
Health systems are increasingly interdependent
• Global health market of good and services
• Global standards, codes, agreements
• Health workforce mobility
• Patient mobility

8. Two key drivers of globalization are largely:
1. Economic (the global economy as reflected by the
ultimate triumph of capitalism over socialism).
2. Technology, communication and transportation
technologies in particular.

9. Global Health Approach
• Global Health approach must be based on three fundamental values;
to protect and improve health as
1. As a human right,
2. As a key dimension of human security and development and
3. As a global public good.
• Globalization and Emerging Infectious Diseases
•Globalization is reintroducing infectious diseases into high-income
regions and introducing chronic diseases into low-income regions.
•Emerging infections, the development of antimicrobial-resistant
infections, and potential acts of terrorism are creating new health
threats.

10. • EMERGING INFECTIOUS DISEASES
• emerging infectious disease is an infectious disease whose incidence has increased in the
past 20 years and threatens to increase in the near future.
• This includes diseases caused by:
– A newly identified microorganism or
– Newly identified strain of a known microorganism (e.g, SARS, AIDS),
– New infections resulting from change or evolution of an existing organism (e.g,
influenza),
– A known infection which spreads to a new geographic area or population (e.g, West Nile
virus),
– Newly recognized infection in an area undergoing ecologic transformation (e.g, Lyme
disease), and
– Pre-existing and recognized infections reemerging due to drug resistance of their agent
or to a breakdown in public health (e.g tuberculosis)”.

11. • Mechanisms of emergence & re-emergence
1. Microbial adaptation; e.g. genetic drift and genetic shift in influenza A.
2. Changing human susceptibility e.g, mass imuno-compromisation with HIV/AIDS
3. Climate and weather; e.g. diseases with zoonotic vectors such as West Nile
Disease (transmitted by mosquitoes) are moving further from the tropics as the
climate warms;
4. Change in human demographics and trade; e.g, rapid travel enabled SARS, bird
flue and swine flue to rapidly propagate around the globe;
5. Economic development; e.g, use of antibiotics to increase meat yield of farmed
animals leads to antibiotic resistance;
6. Breakdown of public health; e.g., negligence to public health (cholera outbreak
in Zimbabwe in 2009);

12. • The Institute of Medicine, one of the National Academies of
the US has identified thirteen specific risk factors for
emergence of new health threats. These are:
1. Microbial adaptation and change,
2. Human susceptibility to infection,
3. Climate and weather,
4. Changing ecosystems,
5. Economic development and land use,
6. Human demographics and behavior,
7. Technology and industry,
8. International travel and commerce,
9. Breakdown of public health measures,
10. Poverty and social inequality,
11. War and famine,
12. Lack of political will, and
13. Intent to harm (Bioterrorism).

13. • In the United States, potential bioterror agents are classified into three
categories:
– Category A agents: presents high-priority agents that pose a high risk because
they can be easily transmitted from one person to another or have high
mortality rates.
• Category A agents include anthrax, smallpox, plague, botulism, tularemia,
and viral hemorrhagic fevers like Ebola and Marburg virus.
– Category B agents: are moderately easy to spread, have a moderate illness
rate, and cause few deaths. Examples of Category B agents include:
• Brucellosis, ricin (a toxin from Ricinus communis, which is found in
castor beans), Q fever, typhus fever, and viral encephalitis infections.
• This category also includes food safety threats such as Salmonella,
shilgella, or E. coli 0157:H7 and water supply threats such as cholera and
cryptosporidium.

14. • Category C agents: are emerging infectious agents like
hantavirus, Nipah virus that are potential threats because they
are unknown.
– The best defense against a biological attack is early
detection so that an outbreak can be contained and exposed
people can receive medical treatment.
– Treatment will include, when possible, post-exposure
prophylaxis or immunization.

15. • Article 25 states that:
“every one has the right to a standard of living adequate for the
health and wellbeing of himself and of his family including,
food, clothing, housing, and medical care and necessary social
services, and the right to security in the event of
unemployment, sickness, disability, widowhood, old age or
other lack of livelihood in circumstances beyond his control

16. The UN suggests using four basic criteria to evaluate access
to health:
1. Availability:- There are an adequate number of medical and
public health facilities that are functioning, staffed, and stocked
with the necessary supplies.
2. Accessibility:- Everyone has access to health care and health
information and health care is economically accessible
(affordable).
3. Acceptability: Health care practices adhere to the standards of
medical ethics and are respectful of cultural, gender, and life-
cycle requirements. Confidentiality is always maintained and
health care practitioners treat all patients with respect and dignity.
4. Quality: Health facilities, goods, and services are
scientifically and medically appropriate and of good quality

17. • Top 10 Global Health Priorities
1. Ensure healthier mothers and children
2. Stop the AIDS pandemic
3. Promote good nutrition
4. Curtail the tide of tuberculosis
5. Control malaria
6. Reduce the toll from cardiovascular diseases
7. Combat tobacco use
8. Reduce fatal and disabling injuries
9. Ensure equal access to quality health care
10. Forage strong, integrated, effective health systems

18. The 12 Principles of the Ethical Practice of Public Health
1. Public health should address principally the fundamental causes of disease and
requirements for health, aiming to prevent adverse health outcomes.
2. Public health should achieve community health in a way that respects the rights of
individuals in the community.
This Principle identifies the common need in public health to weigh the concerns of
both the individual and the community.
3. Public health policies, programs, and priorities should be developed and evaluated
through processes that ensure an opportunity for input from community members.
4. Public health should advocate and work for the empowerment of disenfranchised
(marginalized) community members, aiming to ensure that the basic resources and
conditions necessary for health are accessible to all.

19. Disaster
“A disaster is a serious disruption of the functioning of society,
causing widespread human, material or environmental losses
that exceeds the local capacity to respond, and calls for
external assistance”.

20. Types of hazards
1. Slow onset
• Flood
• Drought
• Famine
• Chemical spill
• Epidemic

21. 2. Sudden onset
• Earthquake
• Cyclone
• Flash flood
• Road traffic accident
• Conflict

22. Examples of different types of disasters
• Natural Disasters:
– Earthquakes
– Extreme Heat
– Floods
– Drought
– Tropical cyclones
– Landslides
– Tornadoes
– Tsunamis
– Volcanoes
– Wildfires
– Winter Weather
– Infectious disease outbreaks

23. • Effects of disasters
A key aspect to remember is that a natural or human-induced
event becomes a disaster only if it reaches a scope that is
beyond the local capacity to handle the emergency and
requires the assistance of external organizations.
• A hazard may lead to a disaster when it interacts with
vulnerable human populations
• Often times, the hazard by itself might not be devastating.
– For example, a tropical cyclone that occurs in the middle of an ocean is
purely a weather event and does not cause much damage.

24. • Disaster-related health effects and public health implications
Several factors determine the public health effects of a disaster,
including:
– The nature and extent of the disaster itself,
– Population density,
– Underlying health and nutritional conditions of the affected
population,
– Level of preparedness, and the pre-existing health infrastructure.
1. Direct health effects:
• Caused by the disaster’s actual, physical forces.
– Examples of a direct health effect include drowning during a
tsunami or injury caused by flying debris during a hurricane or
tornado.
– These health effects typically occur during the event.

25. 2. Indirect health effects:
• Caused by unsafe/unhealthy conditions that develop due to
the effects of the disaster or events that occur from
anticipating the disaster.
• Some indirect health effects may not appear until several
weeks following a disaster while other indirect health effects
may occur immediately after, or even prior to the disaster.

26. • Leading causes of death
– Trauma
– Diarrheal diseases and dehydration
– Communicable diseases like measles, malaria, ARI
– Malnutrition
• Phases/ cycle of disaster management
• Disasters management are often thought of as happening
in a cyclical manner, consisting of four phases:
– Preparedness,
– Response,
– Recovery, and
– Mitigation
• It is important to note that the activities that take place
within the disaster cycle are interrelated and may happen
concurrently.

27. Four phases of an RNA
• The four phases of an RNA are the following:
1. Prepare the Assessment
2. Conduct the Assessment
3. Analyze the Data
4. Write the Report

28. THE PRIMARY HEALTH CARE STRATEGY (1978-1982)
• Disease -oriented curative care was not available for many of the new diseases in the rich countries.
• In poor countries curative treatment existed for most of the infectious diseases , but could not be
afforded.
• At the end of 1970s the time had come to change the vertical approach as it , for different reasons
,was failing across the world.
THE GOBI-FFF COMPONENTS (The Golden Bullets)
The ‘golden bullets’ of the selected PHC policy include:
• Growth monitoring: for monthly monitoring of the weight increase of infants and young
children.
• Oral rehydration: against the dehydration caused by watery diarrhea.
• Breastfeeding: to improve nutrition and protect against infectious diseases.
• Immunization: against Tb, polio, tetanus, diphtheria, Whooping cough and measles.
• Female education: mainly to increase primary school for girls.
• Feeding program: especially dietary supplements to vulnerable groups.
• Family planning: provision of both education and anti-conception methods.

29. PHC in Rich Countries
• The PHC strategy led to a new focus on general practitioners
as the backbone of health services.
• Family medicine developed as a specialty for physicians in
many countries which increased public investments to achieve
better coverage by family doctors.
• A focus on preventive aspects could also be found with rich
countries.

30. • The Three Fs of GOBI-FFF
1. Feeding program : the feeding program of children based on screening of
malnutrition by growth monitoring has failed due to measurable effects
2. Female education: remains a major priority, but slow to implement.
• The rights of girls’ education remains top priority, although it is difficult to
measure the health impact of this core dimension of social development ,
in isolation.
3. Family Planning: has been adopted rapidly in most middle-income
countries
 HEALTH SYSTEM REFORMS (1993-2000)
• The economic constraints of the least developed countries were found to
be severe.
• The achievements of selective PHC strategy could only be sustained by
continued external financing of recurrent costs (costs of vaccine,
refrigerator, transport, allowances for PHC staff, etc).

31. MAJOR COMPONENTS OF HEALTH SYSTEM REFORMS
1. An increase and diversification of fees in the public system.
2. A decentralization of management and financial responsibility in the
public system from national to local level.
3. A shift of the public-private mix of services to more privately financed
and privately provided services.
4. An improved cost awareness and use of cost-benefit analysis
Child mortality:
• Under-five mortality rate has fallen by 52% from 179 deaths/1,000 live
births in 1990 to 86/1000 in 2015.
• Even though sub-Saharan Africa still has the highest child mortality rate,
the rate of decline was over five times faster during 2005–2013 than it
was 1990–1995.

32. Maternal health:
• The maternal mortality ratio declined by 49% over the past two decades, from 990 maternal
deaths/100,000 lb in 1990 to 510 in 2013.
Infectious Diseases:
• The incidence of HIV was declined steadily in the region, new infections of people aged 15 to 49 declined
more than 50%.
• NORTHERN AFRICA
Poverty:
• Northern Africa reached the target of halving the extreme poverty rate five years ahead of the 2015
deadline.
• The proportion of people living on less than $1.25 a day, fell from 5% in 1990 to less than 1% in 2015.
Hunger:
• Northern Africa is close to eradicating severe food insecurity, having attained an overall level below 5
percent.
• The region also reached the target of halving the proportion of undernourished children, The proportion
of underweight children under age five declined from 10% to 4% from 1990 to 2015.

33. Caucasus and Central Asia
Hunger:
• The region has achieved the goal of halving hunger by 2015.
• Also, the proportion of undernourished children was halved.
• The proportion of undernourished people in the total population has
decreased to 7.0% in 2014–2016.
Child mortality:
• Under-five mortality rate was reduced by 55% between 1990 and 2015,
from 73 deaths/1,000 live births in 1990 to 33 in 2015.
Western Asia
Poverty:
• The absolute poverty rate dropped from 5.3% in 1990 to 1.5% in 2011.
• However, there has been a resurgence of poverty after years of progress.
• The poverty rate was estimated to increase from 1.5 to 2.6% between
2011 and 2015.

34. Hunger: in Asia
• The region has made significant progress in improving child under nutrition.
• The proportion of underweight children under age five declined from 14% to 4% from
1990 to 2015.
• However, due to war, civil unrest and the increase in refugees, the prevalence of
undernourishment was estimated to increase by 32% between 1990–1992 and 2014–
2016.
Eastern, South-Eastern and Southern Asia
Poverty:
• By 2011, Asia had met the target of halving the proportion of people who live in
extreme poverty.
• As a result of progress in China, the extreme poverty rate in Eastern Asia has dropped
from 61% in 1990 to only 4% in 2015.
• Since 1990, the extreme poverty rate has been reduced by 66% and 84% in Southern
Asia and South- Eastern Asia, respectively.

35. Latin America and the Caribbean
Poverty:
• Latin America and the Caribbean reached the target of halving the extreme poverty rate.
• The proportion of people living on less than $1.25 a day fell from 13% in 1990 to 4% in 2015.
Hunger:
• The proportion of undernourished people in the total population has decreased from 15% in 1990–1992
to 6% in 2014–2016.
• While in 2014–2016 the prevalence of undernourishment in Latin America was less than 5%, and in the
Caribbean it was 20%.
Oceania
Hunger:
• limited progress on reducing the prevalence of undernourishment from 1990–1992 to 2014–2016.
• The proportion of undernourished people decreased from 15.7% in 1990–1992 to 14.2% in 2014–2016.
• The progress had been slow because of heavy dependence on food imports by the small islands that
constitute the majority of countries in that region.