The document discusses how social determinants and structural interventions outside the health sector can influence health outcomes. It provides evidence that factors like gender inequality, poverty, and lack of social cohesion negatively impact health. Strategic investments in areas like gender equality, education, and building social capital can improve health as seen in examples that reduced HIV, TB, and increased bed net use. The document argues for an integrated health and development approach to achieve multiple targets and synergies across sectors to renew progress on global health goals.
Noncommunicable diseases (NCDs) - mainly cardiovascular disease, diabetes, cancer and chronic respiratory disease - are not just one of the world’s most pressing health concerns but also a significant development challenge. They impede social and economic development and are driven by underlying social, economic, political, environmental and cultural factors, broadly known as ‘social determinants’.
Working alongside specialist health partners, actors outside the health sector are uniquely well positioned to address the social determinants of NCDs.
Western Pacific Updates on Noncommunicable DiseasesAlbert Domingo
Western Pacific Updates on Noncommunicable Diseases - a presentation delivered by Dr Albert Francis Domingo (Consultant, WHO Regional Office for the Western Pacific) at the Philippines' DOH NCRO Operational Planning Workshop for Local Strategic Plans on Noncommunicable Diseases Prevention and Control Programs, 2-4 December 2015. (Adapted from an earlier presentation by Dr Susan Mercado, Director, DNH/WPRO.)
LIFESTYLES AND NCDS IN UGANDA - ROLE OF SCHOOL HEALTH EDUCATION PROGRAMMES IN...Pascal Olinga
Lifestyle factors contribute significantly to the high prevalence of non-communicable diseases in Uganda. Unhealthy behaviors like heavy alcohol consumption, tobacco use, poor diets, sedentary lifestyles, and certain sexual practices have been linked to increased risk of diseases. Motor vehicle accidents have also risen substantially due to greater automobile usage. School health programs can play an important role in educating the public about risk factors and promoting healthier choices to control the growing burden of non-communicable diseases in Uganda.
Kenya has one of the worst HIV/AIDS epidemics in the world, with an estimated 1.5 million people living with HIV. While HIV prevalence peaked in 2000 at around 6.3%, access to treatment has increased, with over half a million adults now receiving antiretroviral therapy (ART). However, access remains low for children, with only 20% of the estimated 170,000 children eligible for treatment receiving it. The Kenyan government aims to further increase access to treatment and reduce new infections through its National HIV/AIDS Strategic Plan.
The document discusses the importance of addressing gender equality in Global Fund proposals and responses to HIV, TB, and malaria. It notes that women often have less access to health services and information than men due to social and economic inequalities. It provides examples of how diseases like HIV, malaria, and TB disproportionately impact women. The document advises applicants to involve gender experts and conduct a gender analysis to ensure their proposals address the specific needs of women, men, girls and boys. It also recommends integrating gender-sensitive and transformative interventions that promote human rights and reduce health inequalities.
Cameroon has a HIV prevalence rate of 4.3% nationally, ranging from 1.2-7.2% by region. Women have a higher prevalence of 5.6% compared to 2.9% for men. Challenges include stigma and discrimination faced by 70% of PLWHA, stockouts leading to only 33% of eligible adults and 34% of children accessing ARVs, and underfunding with only 55% of needed resources mobilized from 2011-2013. Priority interventions include behavior change communication, condom usage, voluntary counseling and testing, PMTCT, STDs, and expanding access to ARVs. Some progress has been made with increased condom distribution, 57% coverage of PMTCT among
Aharona glatman freedman social determinants sept 4-5 2013 -Rosella Anstine
1) Non-biological factors like social, economic, and political determinants significantly impact the success of immunization programs. These include factors like parental education, access to healthcare, gender inequity, and governance.
2) When a new vaccine for tuberculosis becomes available, factors like public acceptance, financing, and sustainability will determine its adoption in immunization programs.
3) A study on factors influencing the introduction of new vaccines in African countries supported by GAVI found that better governance indicators, like political stability and control of corruption, were a stronger predictor of adoption than financial healthcare indicators. Addressing social and behavioral determinants is important for effective vaccine introduction and implementation.
Noncommunicable diseases (NCDs) - mainly cardiovascular disease, diabetes, cancer and chronic respiratory disease - are not just one of the world’s most pressing health concerns but also a significant development challenge. They impede social and economic development and are driven by underlying social, economic, political, environmental and cultural factors, broadly known as ‘social determinants’.
Working alongside specialist health partners, actors outside the health sector are uniquely well positioned to address the social determinants of NCDs.
Western Pacific Updates on Noncommunicable DiseasesAlbert Domingo
Western Pacific Updates on Noncommunicable Diseases - a presentation delivered by Dr Albert Francis Domingo (Consultant, WHO Regional Office for the Western Pacific) at the Philippines' DOH NCRO Operational Planning Workshop for Local Strategic Plans on Noncommunicable Diseases Prevention and Control Programs, 2-4 December 2015. (Adapted from an earlier presentation by Dr Susan Mercado, Director, DNH/WPRO.)
LIFESTYLES AND NCDS IN UGANDA - ROLE OF SCHOOL HEALTH EDUCATION PROGRAMMES IN...Pascal Olinga
Lifestyle factors contribute significantly to the high prevalence of non-communicable diseases in Uganda. Unhealthy behaviors like heavy alcohol consumption, tobacco use, poor diets, sedentary lifestyles, and certain sexual practices have been linked to increased risk of diseases. Motor vehicle accidents have also risen substantially due to greater automobile usage. School health programs can play an important role in educating the public about risk factors and promoting healthier choices to control the growing burden of non-communicable diseases in Uganda.
Kenya has one of the worst HIV/AIDS epidemics in the world, with an estimated 1.5 million people living with HIV. While HIV prevalence peaked in 2000 at around 6.3%, access to treatment has increased, with over half a million adults now receiving antiretroviral therapy (ART). However, access remains low for children, with only 20% of the estimated 170,000 children eligible for treatment receiving it. The Kenyan government aims to further increase access to treatment and reduce new infections through its National HIV/AIDS Strategic Plan.
The document discusses the importance of addressing gender equality in Global Fund proposals and responses to HIV, TB, and malaria. It notes that women often have less access to health services and information than men due to social and economic inequalities. It provides examples of how diseases like HIV, malaria, and TB disproportionately impact women. The document advises applicants to involve gender experts and conduct a gender analysis to ensure their proposals address the specific needs of women, men, girls and boys. It also recommends integrating gender-sensitive and transformative interventions that promote human rights and reduce health inequalities.
Cameroon has a HIV prevalence rate of 4.3% nationally, ranging from 1.2-7.2% by region. Women have a higher prevalence of 5.6% compared to 2.9% for men. Challenges include stigma and discrimination faced by 70% of PLWHA, stockouts leading to only 33% of eligible adults and 34% of children accessing ARVs, and underfunding with only 55% of needed resources mobilized from 2011-2013. Priority interventions include behavior change communication, condom usage, voluntary counseling and testing, PMTCT, STDs, and expanding access to ARVs. Some progress has been made with increased condom distribution, 57% coverage of PMTCT among
Aharona glatman freedman social determinants sept 4-5 2013 -Rosella Anstine
1) Non-biological factors like social, economic, and political determinants significantly impact the success of immunization programs. These include factors like parental education, access to healthcare, gender inequity, and governance.
2) When a new vaccine for tuberculosis becomes available, factors like public acceptance, financing, and sustainability will determine its adoption in immunization programs.
3) A study on factors influencing the introduction of new vaccines in African countries supported by GAVI found that better governance indicators, like political stability and control of corruption, were a stronger predictor of adoption than financial healthcare indicators. Addressing social and behavioral determinants is important for effective vaccine introduction and implementation.
HIV Epidemiology: Progress, challenges and Human Rights implications Vih.org
This document summarizes trends in the global HIV/AIDS epidemic and discusses the link between epidemiology and human rights. It finds that while new infections and deaths have decreased due to prevention efforts, human rights abuses continue to impede epidemiological understanding and response. Vulnerable groups like migrants, men who have sex with men, and injecting drug users face disproportionate risks due to criminalization and lack of targeted programming. Strengthening health information systems and promoting universal human rights access are seen as essential to further containing the epidemic.
Ghia foundation strategy document v4.dec.17.2015 (ab)Ghia Foundation
GHIA FOUNDATION WAS FOUNDED IN 2013 by a team of kind-heated Professionals.
VISION: A World where women in developing Countries live healthier , longer lives
MISSION – To reduce morbidity and mortality among women in developing Countries by strengthening Health Systems to deliver high quality, comprehensive health services.
This document provides an overview of the HIV situation in the Middle East and North Africa region. Some key statistics presented include that in 2010 there were 34 million people globally living with HIV, including 3.4 million children. There were also 2.7 million new HIV infections that year. The document then shows data on HIV prevalence rates in various countries in the region and among key populations like men who have sex with men. It also discusses challenges to addressing HIV in the region like stigma, low testing rates, and limited funding and political leadership for HIV programs.
Human Rights and Counting Everyone - Dr. Beth RivinLauren Johnson
The document discusses how counting and data collection are essential to achieving universal health coverage and the UN Sustainable Development Goals. It outlines how human rights principles support health and access to healthcare. Specifically, it describes the four criteria that define the right to health according to international law: availability, accessibility, acceptability and quality of healthcare. The document argues that respecting human rights in data collection and health programs helps promote early diagnosis, treatment and equitable access to care for all.
This document discusses several strategies for managing health risks like aging populations, depression, obesity, diabetes, malaria, and HIV/AIDS. It examines how differing management approaches have led to varying outcomes. Effective management of these issues requires awareness of why some risks are harder to address, like those indirectly caused by modern lifestyles. Both short-term and long-term strategies across multiple levels are needed to control risks and their impacts on public health.
The UN established UNAIDS in 1994 to coordinate the global response to the HIV/AIDS epidemic. UNAIDS aims to prevent the spread of HIV, provide care and support to those living with HIV, reduce vulnerability to HIV, and alleviate the impact of the epidemic. Through UNAIDS' efforts and partnerships with other organizations, deaths from AIDS-related illnesses have declined significantly from 2.3 million in 2005 to 1.6 million in 2012, treatment access has increased dramatically, and millions of lives have been saved due to reduced prices for antiretroviral drugs.
This document summarizes healthcare challenges in South Africa. It notes that while South Africa has made efforts to provide universal healthcare since 1994, key health indicators have stagnated or declined. South Africa faces a major challenge from HIV/AIDS, with the highest prevalence in the world. Nearly half of TB cases are co-infected with HIV. Other issues include high infant, child, and maternal mortality rates. The document calls for integrated primary healthcare services that address the needs of vulnerable populations and achieving health-related UN Millennium Development Goals.
Gender inequality poses significant barriers to women's ability to prevent and manage HIV infection. Women face higher biological and social vulnerability to HIV due to unequal power dynamics and lack of control over sexual decision making. Violence against women and girls is widespread in many parts of the world, increasing vulnerability. Fear of violence also prevents women from accessing HIV testing, treatment and support services. Addressing gender inequality is critical to effectively respond to the HIV/AIDS epidemic.
The document discusses how HIV/AIDS disproportionately affects women and girls globally. It outlines that nearly half of all HIV cases worldwide are among women, and young women ages 15-24 are most at risk. Factors like gender inequality, lack of education, poverty, and violence against women increase women's vulnerability to infection. Effective prevention requires empowering women through education, access to healthcare and protection methods, and eliminating discrimination.
Attitude of the youth towards voluntary counselling and testing (vct) of hiv ...Alexander Decker
This document summarizes a study on the attitudes of youth in Accra, Ghana toward voluntary counseling and testing (VCT) for HIV/AIDS. The study found that while knowledge of HIV/AIDS was high, awareness and use of VCT services was low. Most respondents were unaware that VCT services existed or where they could access them. Of those aware of VCT, very few had utilized the services themselves. Fear of knowing their HIV status appeared to be a major barrier preventing youth from seeking VCT. The study concluded that efforts must be made to increase awareness and use of VCT, especially among youth, through expanded information and education campaigns.
The document discusses gaps in life expectancy and factors contributing to inequities in health across European countries. It finds that differences in access to healthcare, financial security, living conditions, social capital, and employment explain gaps in health status and life satisfaction between the richest and poorest populations. Closing these gaps could provide economic benefits ranging from 0.3-4.3% of GDP for countries. Reducing inequities is achievable through "equity-proofing" policies and empowering communities to identify local health issues and solutions. The document advocates putting individuals' lived experiences and knowledge at the center of policymaking to promote equitable health and development.
Social Determinants and Economic Burden of Non Communicable Diseases (NCD) on...Ruby Med Plus
India is home to almost one fifth of world’s population living in different states and differ in their ethnic origin, culture and various other ways that influence their health status.
National Health Policy 2017 address the issue of NCDs.
There exist dual burden of NCDs and Infectious and maternal-child disease across different states of India.
This puts challenging situation to Indian Health Care System which must be tackled by larger health investments and a balanced approach in reducing infectious and maternal-child diseases and also blunt the rising tide of NCDs and Injuries.
Since 1990’s, the contribution of most of the major non-communicable disease groups like cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, cancers, musculoskeletal disorders, and chronic kidney disease to the total disease burden has increased all over India.
In 2016, three of the five leading individual causes of disease burden in India were non-communicable diseases, with ischaemic heart disease and chronic obstructive pulmonary disease as the top two causes and stroke as the fifth leading cause.
In 2016, the NCD burden across India was 9-fold for ischaemic heart disease, 4-fold for chronic obstructive pulmonary disease, and 6-fold for stroke, and 4-fold for diabetes.
Risks factors like unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight, which mainly contribute to ischaemic heart disease, stroke, and diabetes.
This document discusses gender dimensions of HIV/AIDS among young girls in the context of achieving the Millennium Development Goals. It provides background on MDG 6, which aims to combat HIV/AIDS, malaria, and other diseases. It notes that young women ages 15-24 are particularly vulnerable to HIV infection due to various biological and socioeconomic factors. Statistics about HIV prevalence, condom use, and access to treatment in Bangladesh are presented. The document also discusses programs and interventions supported by various organizations to prevent HIV and achieve universal access to treatment.
This document provides an overview and analysis of progress towards universal access to reproductive health and family planning based on key indicators. Some key points:
- Globally, contraceptive use has increased to two-thirds of married women, but 12% still have unmet need. The most common methods are female sterilization and IUD.
- Over 80% of married women's family planning needs are satisfied globally, but less than half in Africa.
- 15.3 million adolescent girls give birth each year. Adolescent contraceptive use and access to family planning services lag behind other age groups.
- Disparities exist based on location, education, and wealth. Rural, less educated and poorer
Millennium Development Goal 6 aims to combat HIV/AIDS, malaria, and other diseases. Progress has been made in combating HIV/AIDS, with the number of new infections declining and access to antiretroviral therapy increasing. However, more needs to be done as many people still lack access to treatment. Polio has also been combated successfully and is now epidemic in only four countries, though neglected tropical diseases still affect over 1 billion people annually.
This presentation will give you a brief overview about the history of AIDS in Africa. It inlcudes also the view of the govermental side and the public health. You will see that there exist a huge gap between access to the medicine and the prevention for new infections.
Madridge Journal of AIDS (ISSN: 2638-1958); HIV-related stigma is a global issue. Its perpetuation varies in magnitude across and within countries, and serves as a major barrier to HIV prevention efforts.
Male circumcision should be promoted in developing countries as a major means...Felipe Mejia Medina
Male circumcision should be promoted in developing countries as a major means of HIV prevention according to studies showing it reduces HIV infection risk by 50%. However, male circumcision programs require consideration of social, cultural and religious factors. Neonatal circumcision performed in health facilities by trained professionals seems to be a safer and more cost-effective approach, but resources, willingness, and integration with other prevention strategies must be considered.
Pan American Health Organization (PAHO) Strategic Plan 2014-2019. Learn more about PAHO's core functions, health initiatives, goals and challenges in finding solutions to health problems throughout the Americas.
Barry Adam, "The biomedical and the social in HIV prevention"CBRC
The document discusses different approaches to HIV prevention, including biomedical and social approaches. It notes that biomedical approaches have focused on technologies like vaccines, circumcision, and treatment as prevention, but these have had limited effectiveness. In contrast, social approaches like community mobilization have led to the most impactful prevention strategy of increased condom use. It argues we need prevention strategies that address the social organization and networks driving the epidemic.
The document provides information about HIV/AIDS in India, including modes of transmission, evolution of HIV to AIDS, approaches to prevention, and key aspects of India's National AIDS Control Program Phase III (NACP III). It notes that sexual transmission accounts for most HIV infections in India, and that NACP III aims to expand prevention, care, and treatment efforts to curb the epidemic and achieve international goals.
HIV Epidemiology: Progress, challenges and Human Rights implications Vih.org
This document summarizes trends in the global HIV/AIDS epidemic and discusses the link between epidemiology and human rights. It finds that while new infections and deaths have decreased due to prevention efforts, human rights abuses continue to impede epidemiological understanding and response. Vulnerable groups like migrants, men who have sex with men, and injecting drug users face disproportionate risks due to criminalization and lack of targeted programming. Strengthening health information systems and promoting universal human rights access are seen as essential to further containing the epidemic.
Ghia foundation strategy document v4.dec.17.2015 (ab)Ghia Foundation
GHIA FOUNDATION WAS FOUNDED IN 2013 by a team of kind-heated Professionals.
VISION: A World where women in developing Countries live healthier , longer lives
MISSION – To reduce morbidity and mortality among women in developing Countries by strengthening Health Systems to deliver high quality, comprehensive health services.
This document provides an overview of the HIV situation in the Middle East and North Africa region. Some key statistics presented include that in 2010 there were 34 million people globally living with HIV, including 3.4 million children. There were also 2.7 million new HIV infections that year. The document then shows data on HIV prevalence rates in various countries in the region and among key populations like men who have sex with men. It also discusses challenges to addressing HIV in the region like stigma, low testing rates, and limited funding and political leadership for HIV programs.
Human Rights and Counting Everyone - Dr. Beth RivinLauren Johnson
The document discusses how counting and data collection are essential to achieving universal health coverage and the UN Sustainable Development Goals. It outlines how human rights principles support health and access to healthcare. Specifically, it describes the four criteria that define the right to health according to international law: availability, accessibility, acceptability and quality of healthcare. The document argues that respecting human rights in data collection and health programs helps promote early diagnosis, treatment and equitable access to care for all.
This document discusses several strategies for managing health risks like aging populations, depression, obesity, diabetes, malaria, and HIV/AIDS. It examines how differing management approaches have led to varying outcomes. Effective management of these issues requires awareness of why some risks are harder to address, like those indirectly caused by modern lifestyles. Both short-term and long-term strategies across multiple levels are needed to control risks and their impacts on public health.
The UN established UNAIDS in 1994 to coordinate the global response to the HIV/AIDS epidemic. UNAIDS aims to prevent the spread of HIV, provide care and support to those living with HIV, reduce vulnerability to HIV, and alleviate the impact of the epidemic. Through UNAIDS' efforts and partnerships with other organizations, deaths from AIDS-related illnesses have declined significantly from 2.3 million in 2005 to 1.6 million in 2012, treatment access has increased dramatically, and millions of lives have been saved due to reduced prices for antiretroviral drugs.
This document summarizes healthcare challenges in South Africa. It notes that while South Africa has made efforts to provide universal healthcare since 1994, key health indicators have stagnated or declined. South Africa faces a major challenge from HIV/AIDS, with the highest prevalence in the world. Nearly half of TB cases are co-infected with HIV. Other issues include high infant, child, and maternal mortality rates. The document calls for integrated primary healthcare services that address the needs of vulnerable populations and achieving health-related UN Millennium Development Goals.
Gender inequality poses significant barriers to women's ability to prevent and manage HIV infection. Women face higher biological and social vulnerability to HIV due to unequal power dynamics and lack of control over sexual decision making. Violence against women and girls is widespread in many parts of the world, increasing vulnerability. Fear of violence also prevents women from accessing HIV testing, treatment and support services. Addressing gender inequality is critical to effectively respond to the HIV/AIDS epidemic.
The document discusses how HIV/AIDS disproportionately affects women and girls globally. It outlines that nearly half of all HIV cases worldwide are among women, and young women ages 15-24 are most at risk. Factors like gender inequality, lack of education, poverty, and violence against women increase women's vulnerability to infection. Effective prevention requires empowering women through education, access to healthcare and protection methods, and eliminating discrimination.
Attitude of the youth towards voluntary counselling and testing (vct) of hiv ...Alexander Decker
This document summarizes a study on the attitudes of youth in Accra, Ghana toward voluntary counseling and testing (VCT) for HIV/AIDS. The study found that while knowledge of HIV/AIDS was high, awareness and use of VCT services was low. Most respondents were unaware that VCT services existed or where they could access them. Of those aware of VCT, very few had utilized the services themselves. Fear of knowing their HIV status appeared to be a major barrier preventing youth from seeking VCT. The study concluded that efforts must be made to increase awareness and use of VCT, especially among youth, through expanded information and education campaigns.
The document discusses gaps in life expectancy and factors contributing to inequities in health across European countries. It finds that differences in access to healthcare, financial security, living conditions, social capital, and employment explain gaps in health status and life satisfaction between the richest and poorest populations. Closing these gaps could provide economic benefits ranging from 0.3-4.3% of GDP for countries. Reducing inequities is achievable through "equity-proofing" policies and empowering communities to identify local health issues and solutions. The document advocates putting individuals' lived experiences and knowledge at the center of policymaking to promote equitable health and development.
Social Determinants and Economic Burden of Non Communicable Diseases (NCD) on...Ruby Med Plus
India is home to almost one fifth of world’s population living in different states and differ in their ethnic origin, culture and various other ways that influence their health status.
National Health Policy 2017 address the issue of NCDs.
There exist dual burden of NCDs and Infectious and maternal-child disease across different states of India.
This puts challenging situation to Indian Health Care System which must be tackled by larger health investments and a balanced approach in reducing infectious and maternal-child diseases and also blunt the rising tide of NCDs and Injuries.
Since 1990’s, the contribution of most of the major non-communicable disease groups like cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, cancers, musculoskeletal disorders, and chronic kidney disease to the total disease burden has increased all over India.
In 2016, three of the five leading individual causes of disease burden in India were non-communicable diseases, with ischaemic heart disease and chronic obstructive pulmonary disease as the top two causes and stroke as the fifth leading cause.
In 2016, the NCD burden across India was 9-fold for ischaemic heart disease, 4-fold for chronic obstructive pulmonary disease, and 6-fold for stroke, and 4-fold for diabetes.
Risks factors like unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight, which mainly contribute to ischaemic heart disease, stroke, and diabetes.
This document discusses gender dimensions of HIV/AIDS among young girls in the context of achieving the Millennium Development Goals. It provides background on MDG 6, which aims to combat HIV/AIDS, malaria, and other diseases. It notes that young women ages 15-24 are particularly vulnerable to HIV infection due to various biological and socioeconomic factors. Statistics about HIV prevalence, condom use, and access to treatment in Bangladesh are presented. The document also discusses programs and interventions supported by various organizations to prevent HIV and achieve universal access to treatment.
This document provides an overview and analysis of progress towards universal access to reproductive health and family planning based on key indicators. Some key points:
- Globally, contraceptive use has increased to two-thirds of married women, but 12% still have unmet need. The most common methods are female sterilization and IUD.
- Over 80% of married women's family planning needs are satisfied globally, but less than half in Africa.
- 15.3 million adolescent girls give birth each year. Adolescent contraceptive use and access to family planning services lag behind other age groups.
- Disparities exist based on location, education, and wealth. Rural, less educated and poorer
Millennium Development Goal 6 aims to combat HIV/AIDS, malaria, and other diseases. Progress has been made in combating HIV/AIDS, with the number of new infections declining and access to antiretroviral therapy increasing. However, more needs to be done as many people still lack access to treatment. Polio has also been combated successfully and is now epidemic in only four countries, though neglected tropical diseases still affect over 1 billion people annually.
This presentation will give you a brief overview about the history of AIDS in Africa. It inlcudes also the view of the govermental side and the public health. You will see that there exist a huge gap between access to the medicine and the prevention for new infections.
Madridge Journal of AIDS (ISSN: 2638-1958); HIV-related stigma is a global issue. Its perpetuation varies in magnitude across and within countries, and serves as a major barrier to HIV prevention efforts.
Male circumcision should be promoted in developing countries as a major means...Felipe Mejia Medina
Male circumcision should be promoted in developing countries as a major means of HIV prevention according to studies showing it reduces HIV infection risk by 50%. However, male circumcision programs require consideration of social, cultural and religious factors. Neonatal circumcision performed in health facilities by trained professionals seems to be a safer and more cost-effective approach, but resources, willingness, and integration with other prevention strategies must be considered.
Pan American Health Organization (PAHO) Strategic Plan 2014-2019. Learn more about PAHO's core functions, health initiatives, goals and challenges in finding solutions to health problems throughout the Americas.
Barry Adam, "The biomedical and the social in HIV prevention"CBRC
The document discusses different approaches to HIV prevention, including biomedical and social approaches. It notes that biomedical approaches have focused on technologies like vaccines, circumcision, and treatment as prevention, but these have had limited effectiveness. In contrast, social approaches like community mobilization have led to the most impactful prevention strategy of increased condom use. It argues we need prevention strategies that address the social organization and networks driving the epidemic.
The document provides information about HIV/AIDS in India, including modes of transmission, evolution of HIV to AIDS, approaches to prevention, and key aspects of India's National AIDS Control Program Phase III (NACP III). It notes that sexual transmission accounts for most HIV infections in India, and that NACP III aims to expand prevention, care, and treatment efforts to curb the epidemic and achieve international goals.
Std’s of bacterial etiology by Sunita Rajbanshi(AMDA)SSPSunita Rajbanshi
This document provides an outline and summary of sexually transmitted infections (STIs). It begins with an introduction to STIs, their significance, and global and national STI situations. It then discusses how STIs can increase HIV infectivity and impact, as well as the relationship between HIV and STIs. Specific data on common STIs in Nepal such as prevalence rates among different populations is presented. The document concludes with components of Nepal's national STI strategy and information on common bacterial STIs, including their signs, symptoms, and epidemiological determinants.
This document outlines the purpose and context of a research study on the impact of health education on HIV prevention in Canada. [1] The study aims to understand how education impacts various intervention programs and factors that help education be successful. [2] It will also seek to understand perceptions incorporated in education that help HIV education programs. [3] Key issues examined will include whether education targets at-risk groups and whether service providers are flexible in assisting people with HIV.
The HIV/AIDS pandemic has provided opportunities to advance scientific understanding while posing ongoing challenges to global health. Over decades of research, knowledge of HIV and AIDS has grown, yet millions remain affected and more work is needed on prevention and treatment. Priorities include increasing access to testing, treatment, and support worldwide while continuing vaccine research and efforts to eliminate HIV transmission.
The MDG for HIV/AIDS, malaria and other diseases: can rhetoric become reality?cmaverga
This document discusses the Millennium Development Goals (MDGs) related to combating HIV/AIDS, malaria, and other diseases. It provides an overview of the goals and progress made, and challenges that remain in achieving the health-related MDGs by 2015. It also outlines ways that the Cochrane Collaboration can help, such as increasing high-quality reviews of interventions and engaging with policymakers, to provide evidence to improve health outcomes and meet the MDG targets.
13Importance of Preventing Sexually Transmitted AnastaciaShadelb
13
Importance of Preventing Sexually Transmitted Diseases
Daniela Montalvo
Miami Regional University
ENC2201: Report Writing and Research Methods
Dr. Uliana Gancea
April 11, 2022
Abstract
While research shows that no one preventative measure can curb cases of HIV prevalence, high rates of infertility, and pelvic inflammatory diseases, STIs prevention has shown to be an effective way of drastically reducing these cases. This is because most STIs are the leading causes of these conditions. Therefore, reducing the rates of STIs is an essential aspect of reducing these cases worldwide. We shall look into the relationship between STIs and HIV prevalence, high infertility rates, and pelvic inflammatory diseases. Using a systematic review of previous research papers, we shall seek to show the importance of preventing STIs.
Keywords: preventing STIs, curbing HIV prevalence, infertility rates, pelvic inflammatory diseases, reproductive health.
Importance of Preventing Sexually Transmitted Diseases
An astounding 376 million sexually transmitted (STI) curable infections emerge annually across the globe. Sexual transmission accounts for more than 80% of all new HIV diagnoses (WHO, 2019). The immense strain of STI morbidity and death has a significant effect on the quality of life, sexual and reproductive health (SRH), and infant health, and as co-components for the transmission of HIV subsequently (Mayaud & McCormick, 2001). The risk of acquiring or transmitting HIV is significantly increased by sexually transmissible diseases like syphilis, chancroid ulcer, and genital herpes simplex virus ulcer. In some instances, they represent over 40% or more HIV transmissions (WHO, 2019).
In the evolution of sexually transmitted infection (STI) management, as with other infectious diseases, the pendulum moves around vertical disease-specific and broader horizontal interventions, from a focused emphasis on conditions and their care to people's more extensive interests that harbor and spread them. STI prevention efforts have been more and more established with respect to the goals of HIV programs since the introduction of HIV in the 1980s. While HIV itself is an STI, attempts to deter its transmission are primarily controlled by funding, execution, and evaluation programs, regardless of other STI management efforts.
Such a broken model has a harmful effect. Too frequently, the overlooked STI programs - the basis on which attempts were made to avoid HIV - fail when funding is limited. As a result, STI hospitals and programs are under-personalized, overlooked, or entirely lost (Steen et al., 2009). HIV testing may be provided for pregnant mothers, but STIs such as syphilis are no longer being thoroughly checked. Furthermore, STI reporting, a vital indicator for sexually transmitted infection inclinations, has withered away. This paper seeks to evaluate the need for putting more emphasis on the prevention of sexually transmitted diseases.
Back ...
13
Importance of Preventing Sexually Transmitted Diseases
Daniela Montalvo
Miami Regional University
ENC2201: Report Writing and Research Methods
Dr. Uliana Gancea
April 11, 2022
Abstract
While research shows that no one preventative measure can curb cases of HIV prevalence, high rates of infertility, and pelvic inflammatory diseases, STIs prevention has shown to be an effective way of drastically reducing these cases. This is because most STIs are the leading causes of these conditions. Therefore, reducing the rates of STIs is an essential aspect of reducing these cases worldwide. We shall look into the relationship between STIs and HIV prevalence, high infertility rates, and pelvic inflammatory diseases. Using a systematic review of previous research papers, we shall seek to show the importance of preventing STIs.
Keywords: preventing STIs, curbing HIV prevalence, infertility rates, pelvic inflammatory diseases, reproductive health.
Importance of Preventing Sexually Transmitted Diseases
An astounding 376 million sexually transmitted (STI) curable infections emerge annually across the globe. Sexual transmission accounts for more than 80% of all new HIV diagnoses (WHO, 2019). The immense strain of STI morbidity and death has a significant effect on the quality of life, sexual and reproductive health (SRH), and infant health, and as co-components for the transmission of HIV subsequently (Mayaud & McCormick, 2001). The risk of acquiring or transmitting HIV is significantly increased by sexually transmissible diseases like syphilis, chancroid ulcer, and genital herpes simplex virus ulcer. In some instances, they represent over 40% or more HIV transmissions (WHO, 2019).
In the evolution of sexually transmitted infection (STI) management, as with other infectious diseases, the pendulum moves around vertical disease-specific and broader horizontal interventions, from a focused emphasis on conditions and their care to people's more extensive interests that harbor and spread them. STI prevention efforts have been more and more established with respect to the goals of HIV programs since the introduction of HIV in the 1980s. While HIV itself is an STI, attempts to deter its transmission are primarily controlled by funding, execution, and evaluation programs, regardless of other STI management efforts.
Such a broken model has a harmful effect. Too frequently, the overlooked STI programs - the basis on which attempts were made to avoid HIV - fail when funding is limited. As a result, STI hospitals and programs are under-personalized, overlooked, or entirely lost (Steen et al., 2009). HIV testing may be provided for pregnant mothers, but STIs such as syphilis are no longer being thoroughly checked. Furthermore, STI reporting, a vital indicator for sexually transmitted infection inclinations, has withered away. This paper seeks to evaluate the need for putting more emphasis on the prevention of sexually transmitted diseases.
Back ...
The document discusses the potential benefits of introducing at-home HIV testing kits in Indonesia. It notes that Indonesia has a rapidly growing HIV epidemic, with over 500,000 new infections projected in 2014 if prevention programs are not accelerated. Currently, HIV testing is only available at hospitals through voluntary counseling and testing clinics, requiring patients to visit. At-home testing kits could increase access to testing by allowing people to test at home privately. However, there are also concerns about the accuracy of at-home tests and the lack of in-person counseling that occurs with clinic-based testing. Studies have found that telephone counseling provided with at-home kits can be an effective alternative to in-person counseling.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Valerie Delpech, Public Health Engand
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
The document summarizes a seminar presentation on HIV/AIDS. It provides background on HIV/AIDS, including how it attacks the immune system. It discusses the global and national epidemiology of HIV/AIDS, highlighting trends in prevalence. It presents the epidemiological triad of HIV/AIDS, including the agent (HIV virus), reservoir of infection (humans), and factors influencing transmission. It states the objectives of the seminar were to explore the epidemiology, review milestones and current policies/strategies in Nepal, and discuss prevention and control methods.
The document outlines a seminar presentation on HIV/AIDS given by Group B. It includes an introduction, background on HIV/AIDS, the epidemiological triad, risk factors, the current situation in Nepal, objectives, methodology, findings, and recommendations for prevention and control. The group discussed the stages of HIV infection, transmission methods, symptoms, complications, and strategies like education, condom promotion, and treatment.
This document provides background information on HIV/AIDS and disease surveillance services. It discusses how HIV first emerged in the 1980s and has since spread globally. Disease surveillance involves the ongoing systematic collection and analysis of data to monitor disease spread and inform prevention and control efforts. The document then reviews studies on HIV prevalence in various countries and age groups. It also discusses theories relevant to disease surveillance and HIV control, including how education and awareness building can impact prevention efforts.
This document outlines an intervention strategy to address the high prevalence of HIV in young men who have sex with men (MSM) in Alexandria, Virginia. The strategy involves conducting bi-monthly support group sessions over 10 months led by a part-time facilitator. The goals are to increase knowledge of HIV/STD prevention, decrease risky behaviors like unprotected sex and binge drinking, and ultimately lower new HIV cases in the target population by 5% within a year. Participants will be recruited through various community locations and incentives will be provided to encourage attendance. The intervention is evidence-based and aims to move participants through stages of behavior change. Objectives, activities, evaluations and a budget are included in the plan.
This document discusses the potential for social protection approaches to address social determinants of tuberculosis (TB) by drawing on lessons from HIV-sensitive social protection. It summarizes that social protection exists on a spectrum from transformative to protective approaches. Experience from HIV shows that social protection can influence health outcomes through multiple entry points across the prevention and treatment continuum. Specifically, conditional cash transfers have been shown to reduce poverty and inequality, increase uptake of voluntary counseling and testing, and reduce sexually transmitted infections when tied to remaining infection-free. However, directly tying incentives to HIV status has not yet demonstrated impact. Social protection can also facilitate HIV treatment access directly through interventions like transportation assistance and indirectly by reducing stigma.
This document discusses sexually transmitted infections (STIs) in the Eastern Mediterranean Region (EMR). It provides estimates of STI incidence and prevalence in the EMR, showing that 34 million new STI cases were reported in 2016. It also discusses challenges related to awareness, knowledge, beliefs and attitudes towards STIs in the region. Some countries have national STI policies, but implementation is slow due to lack of resources and infrastructure. The document highlights regional best practices like Marsa in Lebanon and opportunities to expand integrated STI services, prevention interventions, and advocacy. Overall, it analyzes the regional situation of STIs and identifies socio-cultural barriers to effective prevention and management in the EMR.
Impact of syndromic management of sexually transmittedAlexander Decker
The document summarizes a study that investigated the impact of syndromic management of sexually transmitted infections (STIs) among out-of-school female youths in Sagamu, Nigeria. An intervention training on syndromic management lasted 4 weeks for 80 female youths. Based on pre- and post-test analysis, syndromic management was found to have a significant impact on treating urethra discharge symptoms and abnormal vaginal discharge symptoms, but no significant impact on genital ulcer disease or lower abdominal pain symptoms. The study concludes that syndromic management can help address STIs and related issues among youths if properly implemented.
Similar to Social Determinants of Health and Development Policy at Yale University (20)
2nd Meeting of the United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases Geneva, 30 January 2014. Dudley Tarlton.
Presentation on the Access and Delivery Partnership by Tenu Avafia, 3 April 2014.
The presentation covered:
-Impact of NTDs, TB and Malaria on development outcomes;
-Dual challenges of Innovation and Access;
-Government of Japan and UNDP Partnership: Addressing innovation & Access
-Access and Delivery Partnership: strengthening capacity across the health system
A presentation prepared for a UNDP webinar on "Addressing the Social Determinants of Noncommunicable Diseases". This presentation highlights the NCD crisis in the Pacific, discusses the determinants of NCDs in the Pacific (with an emphasis on trade), and discusses action and future work
This document summarizes progress made towards MDG 6 of combating HIV/AIDS and looks ahead to opportunities and challenges beyond 2015. It notes generally good global progress in preventing and treating HIV, but uneven progress between areas. Key opportunities to further reduce HIV infections to 2015 include expanding treatment as prevention, microbicides, pre-exposure prophylaxis, and male circumcision. The biggest risks on the horizon are sustainable AIDS financing and key populations suffering disproportionately. Options to address these risks include increasing domestic funding through reallocation, efficiencies, and alternative revenues as well as improving allocative efficiency. Emerging issues for post-2015 include integrating AIDS programs with broader health systems and determining approaches for universal health access.
This document discusses gaps in data, funding, and services for men who have sex with men (MSM) and transgender persons in addressing HIV/AIDS. It notes that while the 2011 Political Declaration specifically named MSM, it left out transgender persons. Many countries lack data on HIV incidence, access to treatment, and funding for MSM and transgender communities. The presentation focuses on 9 Asian countries and finds that most do not disaggregate data to show sexual transmission of HIV to MSM and transgender persons. It calls for improved surveillance, increased funding for prevention and treatment, and support for community-led interventions.
The Philippines has seen a rapid increase in new HIV cases, rising from 1 new case every 3 days in 2000 to 8 new cases per day in 2011. The national AIDS council has weak governance and HIV programs face low funding and coordination challenges. At-risk groups like MSM experience strong stigma. UNDP's country program aimed to strengthen government institutions' HIV responses, engage at-risk communities, inform policymaking, and promote non-discrimination. Key strategies included building local governments' and at-risk groups' capacities, establishing coordinating bodies, and conducting research on issues like MSM behaviors. The program achieved outcomes like mainstreaming HIV in local governance, establishing local AIDS councils and policies, and improving MSM groups' engagement
The document discusses the socioeconomic impact of HIV at the household level across several Asian countries based on surveys from 2004-2010. It finds higher unemployment, medical expenditures, school dropouts among girls, and child labor for girls in HIV-affected households. It then discusses examples of HIV-sensitive social protection policies and schemes in various countries, including widow pension programs, poverty status, legal gender recognition, and universal health coverage in Thailand. It recommends prioritizing the most vulnerable populations in social protection and pursuing policies like affordable medicines to promote health equity, poverty reduction, and financial sustainability.
The document summarizes several key findings and recommendations from a meeting on HIV, the law, and treatment access in Dubai:
1. TRIPS flexibilities have increased generic competition and reduced drug costs, leading to a 22-fold increase in HIV treatment over 7 years. However, many countries still do not have access to newer, patented drugs.
2. There is a risk of impending treatment crisis as most HIV drugs are produced generically in India, but India is granting more drug patents which could restrict access.
3. Countries need to continue using TRIPS flexibilities to access affordable treatment and expand access to newer drugs for HIV as well as other diseases like hepatitis C and cancers.
4.
The document discusses the importance of human rights protections in effectively responding to HIV. It summarizes remarks by the UNDP Administrator noting that successes in responding to HIV can only reach the required scale if underpinned by environments that advance human rights, gender equality, and social justice. The Global Commission on HIV and the Law aims to analyze evidence, develop recommendations, increase awareness, and engage civil society to create a positive legal environment for HIV responses. Examples of good practices protecting sex workers' rights in India and decriminalizing sex work in New Zealand are provided, as well as practices reducing discrimination of men who have sex with men, transgender people, and people who use drugs.
This document discusses HIV policy priorities for key populations and urban areas. It notes that most new HIV infections in sub-Saharan Africa occur through heterosexual sex, though sex work, men who have sex with men, injection drug use, and prison populations also play roles. Countries with non-discrimination laws protecting key populations reach more people with HIV prevention services. The document calls for integrating HIV into local development plans, understanding the urban epidemic through data, advocating for rights-based approaches, and ensuring accountability of city responses.
The document discusses greening initiatives in the health sector in Europe and Central Asia. It outlines the three pillars of sustainable development and how health relates to each pillar. It then provides details on programming context, including the Parma Declaration and health sector impacts. Examples of greening initiatives are also summarized, including carbon footprint analysis of Global Fund grants and establishing sustainable procurement guidelines. Lessons learned focus on leveraging partnerships and commitments to make progress on health sector sustainability goals.
This document discusses building resilience through development projects in Europe and Central Asia. It provides case studies of projects in Bulgaria, Georgia, Kyrgyzstan, Albania, and Croatia that addressed challenges like unemployment, access to justice, HIV prevention, landmine removal, and energy efficiency in public buildings. The projects showed innovation at the local level and then transformed and scaled up through multi-sectoral partnerships and national strategies. Building resilience requires strong community participation, addressing social determinants of health, and transforming systems to prevent future crises rather than just reacting to problems. Links are also discussed between these efforts and the WHO's Health 2020 strategy and sustainable development goals.
This document discusses cancer as a public health challenge in Africa and advocates for a rights-based public health approach. It notes that health is a basic human right according to the UN. A rights-based approach would focus on universal access to prevention, screening, early diagnosis, and treatment for cancer through primary healthcare. Solutions proposed include sustainable financing mechanisms, ensuring affordable medicines, improving healthcare quality and efficiency, and learning from other global health initiatives by empowering communities. The overall message is that cancer can be prevented and treated in Africa through this approach.
This document discusses greening the health sector to reduce greenhouse gas emissions. It notes that the health sector accounts for 7.5% of GDP and 4.2% of greenhouse gas emissions in the Europe and Central Asia region. Short-term measures could reduce emissions by up to 25%, while long-term measures could achieve further reductions. Reducing emissions in the health sector also has direct health benefits by saving lives. The document provides data on individual countries' pledged reductions and current greenhouse gas emissions. It examines opportunities to reduce the carbon footprint of pharmaceutical products and gain efficiencies in the health sector to lower emissions.
The document discusses integrating tobacco control plans into national development plans and UN development assistance frameworks. It finds that while most countries have tobacco control strategies, few mention tobacco or the WHO FCTC in their national development plans or UNDAFs. Case studies found enabling factors include government leadership, civil society advocacy, and WHO/UNDP support. Challenges include lack of priority, resources, and data. It recommends continued advocacy, capacity building, learning from other health issues, focusing on taxation, protecting policy discussions, and monitoring integration efforts.
This document summarizes UNDP's work on HIV and key populations in urban contexts. The objectives are to build the capacity of community-led organizations representing key populations, improve access to HIV/STI services and programming targeted for key populations, and access to justice and human rights programs. Activities are underway in 18 countries focusing on municipalities in Asia, Africa, Latin America and Eastern Europe. The methodology involves community engagement, reviewing policies/programs, a needs assessment, validation meetings, and developing action plans. Progress updates indicate implementation has started in several cities, and highlights include political endorsement in Lagos and establishing the first NGO for male sex workers in Santo Domingo. Lessons learned include engaging partners early and ensuring municipal
More from UNDP HIV, Health and Development Practice (19)
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Social Determinants of Health and Development Policy at Yale University
1. Influencing health outcomes
from outside the health sector:
Social Determinants, Structural
Interventions & Development Policy
Jeffrey O’Malley
Director, HIV Practice, UNDP
With Julia Kim, Brian Lutz and Paul Pronyk
The Unite For Sight
Global Health & Innovation 2010 Conference
2. Outline
Significant but uneven progress in global health
Extensive and longstanding evidence that social context
shapes health outcomes – and that strategic structural
investments can contribute to „break through‟ progress
Opportunity for a new health and development paradigm
as part of renewed MDG efforts
3. Progress has been made on important health outcomes
Source: United Nations Millennium Development Goals Report 2009
12.6
9.0
0
5
10
15
1990
2007
Global under-5 mortality
Millions
2.2 2.0
0
0.5
1
1.5
2
2.5
2005
2007
Global AIDS mortality
Millions
0.75
~0.20
0
0.5
1
1.5
2
2.5
2000
2006
Global measles mortality
Millions
Contributions from outside
health services:
• 1.6 billion people have
gained access to safe water
since 1990
• Cost of ARV therapy
radically decreased - trade &
intellectual property
4. But in other areas, progress has been too slow to meet global targets
320
251
0
100
200
300
400
1990
2008
Global maternal mortality
Maternal deaths per 100,000 live births
Source: “Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress toward Millennium Development Goal 5,” The Lancet 2010
MDG
target:
80 by
2015
•The vast majority of maternal
deaths occur in developing
countries, with 50% in just 6:
India, Nigeria, Pakistan, Afgha
nistan, Ethiopia and the DRC
•Globally, we are off track to
meet MDG 5; only 23 countries
are on track
5. Unfinished business: global „progress‟ masks regional challenges
Sub-Saharan
Africa
22.5 million
Latin America
1.6 million
Caribbean
230,000
N Africa &
Middle East
380,000
Eastern Europe & Central
Asia
1.6 million East Asia
800,000
S & SE Asia
4.0 million
North America
1.3 million
Oceania
75,000
W & C Europe
760,000
•Globally, the HIV/AIDS burden is centered in sub-Saharan Africa
• New HIV infections have yet to fall in some of most heavily affected countries and have recently
increased in some countries & regions. Key challenges of social marginalization.
• 4 million on ARVs but 6 million in need. Rapidly approaching crisis of (lack of) access to second line
therapies. Limits of current intellectual property regimes.
6. Unfinished business: some groups are more vulnerable than others
Gender inequalities and HIV among 15 – 24 year olds, Africa
HIV prevalence among 15–24 year-old men and women,
selected countries in sub-Saharan Africa, 2001–2005
0
5
10
15
20
%HIVprevalence
Women Men
Source: UNAIDS AIDS epidemic update, December 2005
7. Unfinished business: some groups are more vulnerable than others
HIV prevalence among MSM in Asian cities, 2006 - 2008
4.2
5.3
5.6
8.1
8.7
29.3
30.8
4.0
8.5
9.4
4.4
0 5 10 15 20 25 30 35
Manila
Kuala Lumpur
Singapore
Tokyo
Ho Chi Minh
Vientiane
Jakarta
Taipei
Phnom Penh
Hanoi
Yangon
Bangkok
HIV prevalence (%)
MSM
MSM & IDU
MSM & TG
0
Source:Health Sector Response to HIV/AIDS among MSM. Report of the Consultation, 18 – 20 February 2009, Hong Kong SAR
(China), WHO, WPRO, Manila, 2009; van Griensven et al, Current Opinion HIV AIDS, 2009; de Lind van Wijngaarden et al, STD, 2009
8. Key concepts
Significant but uneven progress in global health
Extensive and longstanding evidence that social context
shapes health outcomes – and that strategic structural
investments can contribute to „break through‟ progress
Opportunity for a new health and development paradigm
as part of renewed MDG efforts
9. Gender
equity Economic
Dev‟t and
Equity
Early
Child
Development
Urban &
District
Devt
Human
Rights
Employment
Conditions
Globalization
& Trade
Health
Systems
Health
Technology
Better
Health
Social
Protection
Environment
& Climate
Change
Governance
& Social
Inclusion
EducationGender
equity Economic
Dev‟t and
Equity
Early
Child
Development
Social
Protection
Environment
& Climate
Change
Governance
& Social
Inclusion
Education
10. Health systems & health technology alone will not adequately
address intractable structural determinants of poor health
Structural factors influencing
HIV epidemics Impacts
• Migration
• Supply, demand and legal
context of recreational drug
use
• Income inequality
• Lack of social cohesion and
networks (i.e., social capital)
• Stigma and discrimination
• Gender based violence
• Gender inequality
• Economic insecurity
• Increased HIV vulnerability
for
individuals, families, dependents
• Lower uptake of HIV-
related services
(e.g., ART, treatment for
opportunistic infections)
11. Structural determinants and their health consequences persist even
in countries with more advanced health systems
The Bronx, New York Kibera, township outside Nairobi
12. Many structural determinants impact multiple health conditions at the
same time
Structural
determinant1
contributing to Disease/
condition1
Urbanization,
migration
Malaria, TB, leish
maniasis, plague,
intestinal
helminthiasis
Conflict, displ
acement
Malaria, measles, di
arrhea
Climate
change
Cholera, schistosomia
sis, vector-borne
diseases (e.g., river
blindness, sleeping
sickness)
Income
inequality
Avg life
expectancy, infant
mortality, accidents, s
moking
1Not exhaustive list; examples only
Sources: Pronyk P. at Columbia University,WHO, McMichael T.,Sharma VP; Farmer P., Raviglione MC, Howarth JP, Dick B., Wilkinson RG, and others
Anopheles
mosquito, malaria vector
Woman with river blindness
TB bacillus
13. Gender
Inequality
Unprotected
sex
Male control
over economic
resources
Women‟s
economic
dependence
Inability to
negotiate condom
use: fear of
abandonment
Male Physical
and Social
Dominance
Violence
against
Women
Inability to
negotiate condom
use: fear of violence
“Structural interventions”: Acting outside the health sector to
influence health outcomes
Graphic adapted from: Rao Gupta, 2009
Policy interventions: e.g.
Gender equality legislation
Programme interventions:
e.g. Women‟s Self-Help
Groups to build Social Capital
14. Structural interventions at a policy level were critical in reducing
smoking in the United States
Policy
intervention(s)
•Advertising restrictions
•Public awareness campaigns
•Cigarette taxes
•Anti-smoking legislation
•Smoking levels dropped from 52% to
25% over past 30 years
•8 cent cigarette tax alone caused 2
million adults to stop smoking and
prevented 60,000 teens from starting
Source: McKeown T. et al. 1975, US Centers for Disease Control 2000
15. Death rate
per
million
500
1000
1500
2000
2500
3000
1848-53 1901 192119311941 1951 1961 1971
Introduction of
Streptomycin
Hypotheses for decline in TB mortality
prior to chemotherapy:
•Public health measures (e.g., milk
pasteurization, quarantining infected
individuals)
•Improved housing, sanitation, nutrition
Source: McKeown T. et al. 1975
Structural interventions contributed to a massive decrease in TB
mortality in England and Wales prior to curative interventions
16. Building social capital is increasingly recognized as a key structural
approach to improve health
The literature highlights several health
outcomes, or their determinants, influenced by
social capital
• Overall mortality
• Child health
• Mental health
• Alcohol
abuse, smoking
• Crime and
violence
• STI
rates, includin
g HIV
Historical and recent examples from around the
world highlight the importance of social capital
Disease
•HIV/AIDS
Location (Project name)
• San Francisco
• Uganda
• Ecuador and India
(Frontier‟s
Prevention Project)
• 10 River blindness
• 20 malaria, fever
• Africa (Community
Directed
Interventions)
1
2
3
4
Example of social capital at work: Women
mobilizing against HIV/AIDS
17. Strong social networks within the San Francisco gay community were
leveraged to reduce new HIV infections quickly
1
HIV infections in San Francisco gay community
#
Source: Pronyk P., Wohlfeiler 2002
18. Social capital allowed behavioral and prevention approaches to take
root in Uganda and turn the tide on HIV
2
HIV prevalence in Uganda
%
19. Building social capital improved condom use in MSM in Ecuador . . .3
FPP quantitative results (1)
Ecuador Condom use MSM
77.0% 75.3% 72.4%
84.9%
34.5%
21.7%
35.4%
53.1%
37.0%
54.9%
77.0%
33.6%
0%
20%
40%
60%
80%
100%
Comparision FPP Comparision FPP
Baseline Baseline Follow-up Follow-up
Last partner male Condom last female Condom last male
20. . . . and decreased HIV and syphilis rates3
FPP quantitative results (2)
Ecuador biomarkers MSM
10.5% 8.8%
5.6% 6.4%
10.6%
7.6%
0%
10%
20%
30%
40%
50%
Comparision FPP Comparision FPP
Baseline Baseline Follow-up Follow-up
HIV Syphilis
21. Community Directed Interventions built and leveraged social capital
to empower communities in health service design and delivery
4
Began as a community
directed response to river
blindness
Community members
collectively:
* Plan how, when, where and
by whom ivermectin will be
distributed
* Discuss results and adjust
approach as required
District health staff
* Introduce CDI concept to
the community
* Provide training,
supervision and supplies
22. Community mobilization in designing and delivering health services
created synergies, improving multiple health outcomes . . .
4
31
52
57
0
10
20
30
40
50
60
70
%ofhouseholdshavingatleast1ITN
Comparison
districts
ITN through CDI
for 1 year
ITN through CDI
for 2 years
Households with at least 1 ITN
28.6
54.9
69.4
0
10
20
30
40
50
60
70
80
%childrenwithfeverwhoreceived
appropriatetreatment
Comparison
districts
HMM through CDI
for 1 year
HMM through CDI
for 2 years
Appropriate treatment of children with fever
23. . . . and lowering the costs for delivery4
First Line Health Facility Level
District Level
24. From these examples, we begin to understand the multiple, mutually
reinforcing mechanisms by which social capital influences health
• Social support –
emotional, instrumental, ap
praisal, informational
• Social influence
• Social engagement
• Person-to-person contact
• Access to material
resources
Diffusion of health information
More rapid adoption of
behavioural norms
Communities are better self
advocates
Self-esteem, mutual respect
May influence biological
processes
25. Structural approaches are not easy
• Potentially unclear/indirect causal links
• Don’t easily conform to experimental design and
evaluation frameworks
• May be seen as coercive
• Require expertise outside health sector
• Difficult to standardize; contextual
• Diffuse benefits; take time to accrue
• Generates debates about which sector / ministry should
pay for programmes with multi-sector benefits
• Hard to change structural conditions!
Source: AIDS 2000
26. But there is increasing operational evidence about how strategic
structural interventions can make a difference while saving money…
27. Key concepts
Significant but uneven progress in global health
Extensive and longstanding evidence that social context
shapes health outcomes – and that strategic structural
investments can contribute to „break through‟ progress
Opportunity for a new health and development paradigm
as part of renewed MDG efforts
28. Expanded approaches reinforce health sector investments while also
contributing to other MDGs
Health sector
approaches
Expanded
approaches
Approach Description
•Vertical disease-
focused programs
•Programs focused on a single/ subset of
diseases or conditions
(e.g., HIV, malaria, measles vaccinations)
•Tend to focus on “disease” rather than
“health” and emphasize “treatment” over
“prevention”
•Health systems
strengthening
•Investments to improve capacity of larger
health system/sector to deliver for multiple
health needs
•Examples: human
resources, infrastructure, referral
systems, health information
systems, management, supply chains
•Structural
interventions
Source: Blankenship et al. AIDS 2000; Ford Foundation 2009 (Global Review of interventions addressing poverty, women‟s empowerment and HIV)
•Alters the context
(social, economic, political, environmental) in
which health is produced
•Examples: changing laws and policies that
impede access to health services; decreasing
gender-based violence; building social capital
Focus, details follow
29. Simultaneous action on health and development priorities improves
outcomes in all areas – and positive synergies achieve breakthroughs
Microfinance
Gender/HIV
Community
+
+
Poverty
•Food security
•Expenditures
•Household assets
Empowerment
•Self confidence
•Autonomy
•50% reduction in IPV
HIV Risk
•Communication
•VCT
•Condom use
Multiple MDG Impacts = synergy
Source: Lancet 2006
30. Now is an opportune time to develop and implement integrated health
and development strategies
• We need to recognize the importance of and implement “combination
approaches,” including strategic changes in laws and policies at national
level („top down‟) and focused efforts at building social capital („bottom up‟)
• We need to work across sectors where it makes sense and where
synergies can be maximized
• We need to look at health and development in an integrated fashion and
invest in interventions that accomplish multiple health and development
goals concurrently
• We need to keep asking the right questions of the right people:
donors, governments and technical agencies
31. Thank you
Significant but uneven progress in global health
Extensive and longstanding evidence that social context
shapes health outcomes – and that strategic structural
investments can contribute to „break through‟ progress
Opportunity for a new health and development paradigm
as part of renewed MDG efforts
33. Vertical disease-focused programs have yielded impressive gains,
but their impact on health systems is complex
Negative
systems
impacts
Positive
systems
impacts
Examples
•Overstretched systems resources (e.g., front line health
workers, management and information systems, supply chain, etc)
•Redistribution of limited resources, including human resources for
health, negatively impacting other community health needs
•Increase in overall official development assistance for health, though
some offset by reduction in domestic commitments in some places
•Improved availability and affordability of key commodities
•Improved community and civil society participation
•Spill-over of multisectoral approaches into other health areas
Source: WHO Maximum Positive Synergies Collaborative Group
34. Key global health institutions and partnerships are moving toward
health systems strengthening
Global Fund distributions, Rounds 2-7
%
•Over 1/3 of funds go to health systems
•In the most recent round 16% of funds
were allocated to cross-cutting health
systems proposals
•The Global Fund has created flexibilities
to fund national strategic plans
•Launched in 2007, the International Health Partnership and related
initiatives (IHP+) works to strengthen health systems in line with Paris
and Accra Declarations on aid effectiveness
•IHP+ currently has 46 members, consisting of partner
countries, bilateral and multilateral donors and other development
partners
Source: WHO Maximum Positive Synergies Collaborative Group, Global Fund Round 9 funding decision report, IHP+
20
35
45
Administration
and other
Health systems
Commodities, pr
oducts and
drugs
35. Emphasis on systems is not without challenges and risks
Challenges
Examples
• Building sufficient cooperation
and harmonization among donors
• Ensuring alignment with country
needs
• Ensuring accountability and
transparency in use of pooled
resources
• Availability of technical expertise
and sound policy advice to implement
large-scale sector strategies and
rigorously monitor and evaluate
Risks • Increased medicalization of
disease and poor health, including
but not limited to HIV
• Decreased attention to the
legal, economic and social context for
marginalized groups that are most-
at-risk (MARP)
Source: UNGASS Country Reports – HIV prevention expenditure
HIV Prevention expenditure
%
96
4
Other
MARPS*
* Men who have sex with
men, injecting drug users and sex
workers
Expenditures are likely less, since
data are available for only 38
countries. Non-reporting countries
likely spend less
MARPs already receive only a
small share of prevention funding
Editor's Notes
Good morning. I am going to speak today about innovation and evidence in understanding and addressing social determinants of health – and the opportunity to build new synergies within the broader MDG and human rights agendas.
I’ve structured my remarks in three sections.First, I will recap both the progress we are now making in global health, and the significant unfinished agenda to achieve the health MDGs.Second, I will review both long-standing and emerging evidence about how social contexts influence health outcomes, as well as how different kinds of interventions can influence that social context to dramatically improve results. I will then conclude with some reflections about how we can renew our MDG efforts with a health and development paradigm that pays more attention to social determinants of health, as well as more attention to synergies among efforts addressing different MDGs.
Let me begin by emphasizing that we are doing a lot of things right. Child mortality is falling significantly, thanks to a combination of health technology like vaccines, health service delivery, and social change. The most influential structural changes have included improvements in water and sanitation, in nutrition, and in the socio-economic status of women. AIDS mortality climbed relentlessly over the first twenty years of the epidemic, but it finally began to turn around in 2005. We must of course give credit to the diagnostics, the drugs, and the people who deliver them. But just as important, we would not have falling AIDS mortality rates without a combination of community activism, change in trade legislation, and challenges to intellectual property norms: actions outside the health sector that led to lower prices for life-saving drugs. Some health outcomes can be achieved relatively easily through narrow, technical strategies. But most need a combination of focused approaches, health system strengthening, and attention to determinants and influences beyond the health sector itself.
While we are making real progress, we are also dramatically failing far too often. The health related MDG where we are most off-track is maternal mortality, and that is not a surprise. The technical fixes are complex compared to immunization or tuberculosis treatment. There are some strategies to decrease maternal mortality for home births, but dramatic decreases in maternal mortality need both increases in facility-based births, and improvements in the care available at those health facilities. These are major health system strengthening challenges.And the social factors that shape these outcomes – the status of women, caste-discrimination in India that keeps marginalized people out of clinics, malnutrition during pregnancy – have been largely ignored until relatively recently. Many of you may have read or heard about the Lancet report on maternal mortality that came out earlier this week. These data come from that report, which emphasizes that progress is now being made, albeit still too slowly. Another key message from the report is that much of our progress in recent years is linked to innovation in South Asia – in particular attention to social factors and community participation, at the same time as paying attention to the formal health system.
Even where we are achieving some global success, remaining and emerging challenges are enormous. Effective HIV prevention is still hampered by many factors, not least social marginalization. Our recent relative success at HIV treatment scale-up is only relative – 6 million are still in immediate need of therapy that they aren’t getting. And the problem is getting more complex as more people need second line therapy.
Young women in southern Africa are far more likely to be infected with HIV than young men their own age. Physiology plays a part. But so does power.
In Asia – as in many other parts of the world – we see a similar story where men who have sex with men, and transgender people, are disproportionately affected by HIV. Once again, physiology plays a part. But so does power, or lack thereof. If we are going to make dramatic, break-through progress in HIV prevention, we will need to address these issues of power and inclusion much more directly and systematically than we have done to date. The good news is that human rights protection and promotion for girls and women, for sexual minorities, and for other groups disproportionately affected by AIDS, contributes to multiple goals at once.
I’ve already referred several times to the links between social and environmental factors and health outcomes. Let me now discuss social determinants of health more directly, as well as the evidence that action on social determinants can be a ‘game changer’ that can help us break through current barriers to MDG achievement.
I believe that one of the great contributions of the HIV response to public health more broadly has been in its emphasis on strategic multi-sectoral action. Until the emergence of prophylaxis for opportunistic infections and then combination therapy in the mid-1990s, the health sector struggled to offer much in the response to AIDS. That helped to draw attention to prevention, and to the role of other, non-health sectors in trying to reduce both short-term risk of HIV infection and long-term vulnerability. The central insight that structural factors influence HIV epidemics has remained with us into the age of HIV treatment, and indeed it has been further refined as HIV has become stubbornly entrenched in certain populations.
Structural determinants and their health consequences are not just important for developing countries. The transition of the HIV epidemic in the United States from a predominately white, middle-class population to ethnic minorities and the poor underlines this point.
It will almost never be cost-effective or strategic to address a distal or high-level structural influence for the sake of a single disease outcome. If you are trying to prevent the spread of HIV and have to choose between male circumcision and promotion of girls education, the former may give you more of a result in the short term, per dollar invested, as measured in terms of impact on HIV incidence alone. However the latter may have multiple and longer term health and development benefits, which in addition to reduced HIV risk, might include reductions in adolescent pregnancies, smaller and healthier families, and greater opportunities to contribute to and benefit from economic and social development. So we should not be addressing key structural determinants just because of single disease outcomes. As with promoting girls education, many are important issues in and of themselves, regardless of their contribution to ill health. And many structural determinants impact multiple health conditions at the same time – so structural interventions may lead to multiple positive health outcomes. As I will discuss later, we shouldn’t fall into false dichotomies or choices. Countries can and should select an appropriate mixture of strategies that respond to their own health and development needs and resource constraints.
How do we move from an understanding of structural determinants or structural influences, to structural interventions that can make a difference to health outcomes? First, we need to understand and map the pathways that link a broad social phenomenon like gender inequality to a specific outcome like unprotected sex. Here are two different hypotheses about how these phenomena might be linked.Once we have identified the most likely or influential causal pathways, we then need to ask where we can intervene to make a difference. Often, a policy intervention has the advantage of broad reach at low cost, but the disadvantage that it is quite distal or distant from the actual outcome that you are trying to influence. A programme or community-based intervention often contributes more directly to an outcome, but poses challenges of scale, replicability and prioritization. In this example, a structural policy intervention might be to enshrine gender equality in laws and regulations….While a structural programme approach might be building social capital and empowerment of women through self-help groups…. As I will outline over the next few minutes, both approaches have been shown to be effective. What we need to do is mix and match strategies in response to different causal pathways, and in recognition that most of these approaches can contribute to multiple social benefits at the same time.
One example of the power of this approach comes from tobacco control. Decades of health promotion investment to discourage smoking made relatively little impact on tobacco use in the United States.Once the State started using ‘upstream’ or structural approaches, however, we began to see dramatic results.
Tuberculosis in Europe provides another powerful example. Structural factors first drove the spread of TB, with the transition from agricultural to industrial economies in the late 1700’s and early 1800s. With the population explosion in cities, overcrowding, pollution, and difficult working conditions in new factories, one in four deaths in England was due to “consumption” by 1815.But by the 1850s, TB deaths in the United Kingdom began to decline steadily, as shown in this slide. The introduction of the first effective TB treatment in 1947, and then the BCG vaccine in 1954, helped to sustain the decline, but clearly these technical fixes were not the primary solution.The decline in TB mortality in the UK over the last 150 years, once again, has been broadly attributed to changing social conditions. In this particular case, benefits came by cleaning up the negative consequences of the industrial revolution – better housing policy, workplace health and safety regulations, lower birth rates, less crowding, and better nutrition.
Let me now share some examples of programmatic structural interventions at the community level, or what has increasingly been called the building of social capital. I don’t have the time to explore all the nuances of social capital, including its potential negative as well as its positive impacts. What I want to emphasize is that there is now considerable evidence showing that interventions to build the right kind of social capital leads quite directly to better health outcomes in a number of key areas, including child health, mental health, substance abuse and HIV and STIs.I’ll briefly touch on four examples – three from the world of HIV, and one that came out of a river blindness programme in West Africa.
You are probably all familiar with the story of HIV among gay men in San Francisco in the 1980s. After a dramatic spike in new infections, HIV incidence dropped sharply and quickly. Why was there so much behavior change so quickly in this particular community? There is now a strong consensus that the same social and sexual networks that first facilitated the spread of the virus then allowed a rapid networking of saferbehaviour. Community mobilization largely sprung from the bottom-up and in parallel with AIDS prevention agencies rather than as a result of those agencies’ efforts, and community norms swiftly transformed to establish safer sex as routine. Of course, HIV incidence has begun to increase again among men who have sex with men in San Francisco, although at nowhere near the incidence of the early 1980s. There are multiple hypotheses for these increases, but it is striking that the youngest and oldest men, and the men least integrated into the gay mainstream in the city, remain the most likely to be infected.
Analysts also agree that Uganda’s success against HIV in the early 1990s was not the result of a single intervention.Indeed, incidence began to fall prior to widespread scaling up of condom distribution, VCT services, syndromic management of STIs and other technical and clinical prevention efforts.What happened? A climate of political openness with visible political leadership; a dynamic media and civil society movement that confronted AIDS head on; real efforts to enhance the status of women in leadership roles in the country; a reduction of civil conflict that characterized Uganda in the 1980s.In other words – the strengthening of social capital.
In the two examples of San Francisco and Uganda, all of us in the HIV community have tried to use retrospective analysis to understand and explain what might have happened. But there have subsequently been successful initiatives to test these hypotheses in quasi-experimental settings. One example was a multi-country study that I was personally involved in called the Frontiers Prevention Project or FPP. FPP explicitly compared two different prevention approaches, one including only biomedical and health promotion services, and the other adding a community empowerment and social capital component. FPP worked in a number of countries with several different populations, but let me share the results with MSM in Ecuador here. The quantitative results were striking – with condom use by MSM at their last sexual encounters with males and females increasing in all cases, but increasing dramatically more in the full FPP intervention sites – clearly demonstrating the added value of the community empowerment component of the intervention. Although I am not showing them here, the qualitative evaluation, measuring impact on measurable social capital – was even more impressive.
This reported behavioural data was reinforced with biological data.Although the prevalence of syphilis increased in both arms, the increase in the intervention arm was very modest from 6.4% to 7.6% whereas in the comparison arm syphilis prevalence increased from 5.6% to 10.6%.
The final example I want to share is from TDR’s Community Directed Interventions initiative. This began as a response to river blindness, where community members were used to plan, organize and evaluate ivermectin distribution. District health staff were used to introduce the CDI concept to community members and to provide the necessary link to training, supervision and commodities.The first generation of this work was very successful, so TDR decided to design and implement a multi-country study to determine the degree to which ADDITIONAL health interventions could be added to ivermectin, while maintaining results and cost-effectiveness. This of course addresses a crucial question that is often raised when discussing community participation – how complex and multi-pronged can we get before we lose impact?
TDR designed a quasi-experimental, multi-country study, in which CDI districts with social capital and community participation elements were compared to ‘traditional’ delivery of the same services from health centres. CDI districts performed much better on bed nets, as well as on home management of malaria.
Importantly, the TDR CDI study also had a costing element, which demonstrated that not only did the community participation districts achieve better health outcomes, they did so at lower cost than the ‘classic’ health posts that focus only on service delivery.
There is much more literature available, but even from these brief examples, we can begin to synthesize some lessons about social capital.There are two absolutely key and consistent findings.First, social networks and community structures do make a profound difference in health outcomes, which may be positive or may be negative.Second, well designed interventions can influence community norms and social capital in a way that contributes positively to health outcomes – often while saving money in the process.
I don’t want to over-simplify. Structural approaches have many challenges.Understanding and mapping causal pathways is not always straightforward.These are not approaches that can easily be measured in randomized control trials.At a policy level, there can and will be legitimate debates about the appropriate role of the state in regulating or influencing private behaviour. There will also be policy tensions between health experts in health ministries, and those in other ministries who are responsible for the relevant social or economic sector. At community or programme levels, there are challenges in prioritization, standardization and replication. It is not always clear which budget or combination of budgets should be used to finance structural interventions that generate benefits across traditional Ministry lines. And most of all, structural interventions do not generate instant results – it takes time to change structural conditions, and then time again for those changes to influence health outcomes.
Nevertheless, there is a growing evidence base that these approaches are possible, necessary and affordable. The evidence is particularly strong in the fields of reproductive health, HIV, and maternal and newborn health. There is also growing consensus around the key features of successful structural approaches to health, as reflected in this slide.
Let me conclude with a few thoughts on how the evidence on social determinants and structural interventions might contribute to a new health and development paradigm for achieving the MDGs.
Health sector approaches remain important – with the right combination of both focused programmes and system strengthening. But we need to expand our repertoire to address structural determinants if we are really going to have a game changer. The mechanism is two-fold. In some cases, structural interventions work in synergy with traditional approaches, enabling greater uptake of health services. In other cases, structural interventions themselves are needed to address the most intractable health outcomes and populations that the health system alone cannot address.
The IMAGE project in rural South Africa is a perfect example of such a new paradigm. Image combined microfinance and gender and HIV training for women in rural South Africa in an attempt to address structural drivers of HIV including economic and gender inequalities. The study was rigorously evaluated as a cluster randomized trial. After 2 years, the program found positive impacts on household poverty and women’s empowerment, including a 50% reduction in levels of intimate partner violence. Among young women participating in the program, there was a decrease in HIV risk behaviours, including increased communication with partners, increased VCT and condom use.One might argue that these benefits would have been seen with microfinance by itself – so why invest in adding gender and HIV training? However a subsequent study found that microfinance alone (without the gender and HIV training), did not generate the same health and empowerment impacts.Such approaches can be integrated in practical and sustainable ways. In the case of IMAGE – the gender and HIV investments have sustained strong repayment rates for the microfinance institution, allowing the program to scale up from 500 to over 12,000 women.The key lesson of IMAGE is that simultaneous action on multiple priorities can create synergies across multiple MDGs. Not just the health MDGs – in this case, IMAGE contributed to MDGS 1, 3 and 6 at the same time.
We have five years to go until the 2015 deadline of the MDGs. Are we on track? As I said at the beginning of my remarks, we ARE on track in a number of areas, and we need to continue and scale up the straightforward focused programmes and health sector work that are generating important results.At the same time, we need to acknowledge our uneven progress, both across the MDGs and amongst regions and populations. We need a break-through strategy.Fortunately, we are well positioned for just such an approach. Let’s take advantage of the current debates and revisions within the global health and development assistance architecture to promote attention to such a complementary paradigm – promoting combination approaches that can deliver on multiple results at once.
We’re making progress, but not enough.Social factors shape health outcomes – and with multisectoral approaches, we can in turn influence those social factors in a positive way.Looking forward to 2015, we won’t achieve the MDGs by just doing more of the same. We need to more of the same, but we also need to do it for less money and with more impact. The time is now for a paradigm that emphasizes such synergies.Many thanks for your attention today.
I am going to draw very heavily on the findings of the Maximizing Positive Synergies Collaborative Gropu at WHO, their recent Lancet publication and related presentations.The group conducted 14 studies and reviewed 250 others. Their work is incredibly important, moving us from ideological positioning to evidence. Not surprisingly, they found that context matters, that synergies can improve with time and effort, and that it is difficult to generalize conclusions.Let’s remember why there are so many focused disease programmes – they have been shown again and again to deliver real results on key issues, such as HIV, family planning, reproductive health, immunization and ante-natal care. The WHO initiative confirmed that, and pointed out that even non-targeted services can benefit from focused disease programmes. Negative impactsBadly conceived and managed single-disease programmes can cause problems for the health work force and for health information systems, but the WHO study shows that lessons are being learned and significant synergies are being developed.Positive impactsIt’s no surprise to any of us that focused programmes have led to very large increases in official development assistance financing for health.What about the impact on domestic resources? We’ve heard anecdotes this week about how some governments, such as that of Papua New Guinea, have been reducing domestic investments given the availability of international resources, but the evidence is mixed overall. Not suprisingly, there is some evidence of misalignment between available international resources and domestic needs.The WHO study confirms the huge success of focused programmes at improving availability and affordability of key commodities, but notes that system-wide supply management has not received enough attention. Beyond the WHO study, we all know that the HIV response has changed the landscape and possibilities related to intellectual property and trade.Focused efforts are enhancing community participation, and we know from our own experience that HIV responses have significantly enhanced involvement of non-health-sector actors – other sectoral ministries, CSOs, the private sector, and so on – not just in HIV but even now in TB and malaria. Malaria and TB NGOs would not be on country CCMs and acting as major sub-recipients of GFATM projects if not for HIV.
While there is a trend toward health systems strengthening, there is still a considerable way to go: “a recent assessment of child survival funding priorities, which notes while 97% of grants were allocated for the design and testing of new technologies only 3% support interventions to improve the delivery of essential services. “ REFERENCE: Leroy JL, Habicht JP, Pelto G, Bertozzi SM. Current priorities in health research funding and lack of impact on the number of child deaths per year. American Journal of Public Health. 2007;97(2):219-23.
Another massive challenge for the HIV response, as identified by my colleague MandeepDhaliwal in a study for the Stop AIDS Campaign, is the continued misalignment of HIV prevention funding, with marginalized populations continuing to be under-served. This problem would almost certainly be exacerbated if all funding goes to system-strengthening or health sector wide approaches – pointing to the need for complementary and mutually reinforcing approaches, including multiple funding strategies. We must be especially vigilant on these issues as the Global Fund moves towards national strategy funding.