Working in Global HealthChapter 18Chapter 18 Working i

Working in Global Health
Chapter 18
Chapter 18: Working in Global Health
1
Positions in Global Health
Universities
NGOs
Social entrepreneurships
Bilateral and multilateral aid organizations
Consulting
Global health is a growing field and there are many
opportunities to work in it.
2
When considering a job in Global health
Understand the skills, knowledge, and experience this type of
career would entail and how you might fill gaps you have in
terms of the required background for a position.
May require a good understanding of economic development.
Should appreciate cultures.
Have the ability to write and speak well.
Be willing to live and work in low and middle income countries.
If you are considering a job in global health, you should:
Understand the skills, knowledge, and experience this type of

career would entail and how you might fill gaps you have in
terms of the required background for a position.
May require a good understanding of economic development.
Should appreciate cultures.
Have the ability to write and speak well.
Be willing to live and work in low and middle income countries.
3
Other valuable points
Get your degree in an area related to the one in which you want
to work.
Build on that area through internships, fellowships, and other
opportunities to live and work abroad.
Consider a graduate program to build in your studies and
experiences.
Work with mentors who work directly in the field.
Other things to consider are: Get your degree in an area related
to the one in which you want to work.
Build on that area through internships, fellowships, and other
opportunities to live and work abroad.
Consider a graduate program to build in your studies and
experiences.
Work with mentors who work directly in the field.
4
Resources for careers
DEVEX http://globalhealth.org/
The Global Health Council http://globalhealth.org/
Global Health Hub www.globalhealthhub.org

International Jobs Center http://www.internationaljobs.org/
Idealist www.idealist.org
U.S Government
USAID https://www.usaid.gov/
CDC http://www.cdc.gov/
Here are a few resources to consider when looking for a career
in global health.
5
Personal Quote
“Working in global health has been my dream as long as I can
remember. And just imagine how reality could be better than a
dream- and that’s exactly how I feel working in this field. It’s
the most fulfilling career that I could ever imagine.”
Dr. Tara Rava Zolnikov
Assistant Professor
National University
Water project in Narok, Kenya
HIV/AIDS project in Busia, Kenya
Access to water research in Kitui, Kenya
Science, Technology, and Global Health
Chapter 17
1

Chapter 17: Science, Technology, and Global Health
The Need for New Products
Characteristics of new technologies must reflect the following:
Most important target groups are poor people.
Quality of care and injection safety is often low.
Many low- and middle-income countries have poorly organized
health systems.
Science and technology have the potential to make major
contributions to the development of diagnostics, vaccines,
drugs, and medical devices that can help address the highest
burdens of disease in low- and middle-income countries.
2
Diagnostics : specific, sensitive, inexpensive, easy to use, and
noninvasive
Drugs : safe, effective, inexpensive, and able to be used for
many years without becoming susceptible to resistance
Vaccines : safe, effective, inexpensive, include several antigens,
and require only one dose to confer lifelong immunity
Ideally these products would also be easy to transport, heat
stable, and not require refrigeration
Needed technological advances are unlikely to come about on
their own. Historically, the for-profit sector has been a major
developer of diagnostics, vaccines, and drugs but does not
believe that the market for these products in the developing
world is sufficient to give it an adequate return on its
investment. Only a small number of drugs have been developed

over the last 20 years to address the main burdens of disease
among the poor in low- and middle-income countries.
3
Goals of the Grand Challenges in Global Health
Improve vaccines
Create new vaccines
Control insect vectors
Improve nutrition
Limit drug resistance
Cure infection
Measure health status
The Grand Challenges in Glob;a Health Goals include:
Improve vaccines
Create new vaccines
Control insect vectors
Improve nutrition
Limit drug resistance
Cure infection
Measure health status
4
Gaps in current technology:
Effectiveness of TB vaccine is “limited.”
Drugs for TB, malaria and HIV are susceptible to resistance.
There are no vaccines for HIV, malaria, or any of the NTDs.
HIV drugs can control, but not cure the infection.
Current technology has not yet address the issues of the limited

effectiveness of current TB vaccine. Drugs for TB, malaria, and
HIV have already developed resistance to the medicines used
for these diseases. There is a huge need for vaccines for
malaria, HIV and any of the NTDs.
5
The Potential of Science and Technology
Sequencing the genome of pathogens could help improve the
development of vaccines and drugs and reduce resistance.
Improvements in technology will facilitate the development of
new drugs.
New technologies can assist in the design and manufacture of
new vaccines.
Genetic modification of plants could lead to more nutritious and
disease resistant crops (but is not always welcome).
Scientific progress has led to significant control for so many
diseases. Sequencing the genome of pathogens could help
improve the development of vaccines and drugs and reduce
resistance. So far sequencing has been done for 100 microbial
species. Improvements in technology will facilitate the
development of new drugs; can assist in the design and
manufacture of new vaccines.
6
Constraints to Applying Science and Technology to Global
Health Problems
For-profit sector does not believe it could make a sufficient
profit from products for low- and middle-income countries.
Costs of research and development on new products are very
high.
Number of firms engaged in vaccine production is small .

There are some several constrains to the development of desired
products. First, most of the research and development on new
drugs, vaccines and diagnostics is carried out in the for profit
sector and For-profit sector does not believe it could make a
sufficient profit from products for low- and middle-income
countries. Second, Costs of research and development on new
products are very high. Given these costs, profit making firms
are more willingly to produce “ Blockbuster” drug against
diseases like high cholesterol that could be sold in high income
countries. In addition to all these vaccine markets carry some
particular constrains. The cost is considerably high in addition
to the governmental regulations that further reduce the market.
The number of firms engage in vaccine production worldwide
are also very few and their production capacity is limited.
7
Enhancing New Product Development
Means of reducing the risk of developing new products enough
that the for-profit sector might be interested:
Push Mechanisms : reduce risk and cost of investments
Pull Mechanisms : assure a future return in the event that a
product is produced
Overcoming market failures and encouraging the development
of desired products will probably require a series of measures.
Some of these can be “push mechanisms,” which lower the cost
of research and development for the private sector.
8
Push/Pull Mechanism for Product Development
Adapted from Glass S. N., Batson, A., Levine, R. Issues Paper:
Accelerating New Vaccines. Geneva: Global Alliance for
Vaccines and Immunizations; 2008.

Other efforts can be “pull mechanisms,” which are intended to
help assure a satisfactory return to investors in the event that a
product is produced.
9
Some Ideal Characteristics of Diagnostics, Vaccines, Drugs and
Delivery Devices
Some of the ideal characteristics that are desirable in diagnosis,
vaccines, drugs, and delivery devices are described in this table.
10
Product Development Partnerships
Public-private partnerships created to overcome limitations of
the private sector.
Many of these public-private partnerships are product
development partnerships (PDPs).
Examples of PDPs include Aeras, Malaria Vaccine Initiative,
International Partnership for Microbicides and the International
AIDS Vaccine Initiative.
Considerable hope for new product development is being placed
in public-private product development partnerships, such as the
International AIDS Vaccine Initiative, the Global Alliance for
TB Drug Development, and the Medicines for Malaria Venture
11

Working Together to Improve Global Health
Chapter 16
Chapter 15: Working Together to Improve Global Health
1
Cooperating to Improve Global Health
Cooperation is in everyone’s interest:
Creates consensus around a cause.
Strengthens advocacy efforts.
Allows for sharing knowledge and setting standards.
Many aspects of global health are “global public goods.”
Better surveillance.
More effective financing.
Some global health issues can only be solved through the
cooperation of various actors in global health. This could
include, for example, the development of an AIDS or Ebola
vaccine.
It is important that global standards in some health fields be
established and widely accepted. It is imperative that different
actors work together globally in areas such as disease
surveillance, the global fight for polio eradication, and the
standards for some diseases control programs, such as TB.
2
Key Actors in Global Health

Agencies of the United Nations
WHO - World Health Organization
UNICEF - United Nations Children’s Fund
UNAIDS - Joint United Nations Program on HIV/AIDS
Engaged in advocacy, generating and sharing knowledge,
setting global standards and other key functions
There are many actors in global health and among the most
actively involved are WHO, UNICEF, UNAIDS. These
organizations are engaged in advocacy, generating and sharing
knowledge, setting global standards and other key functions.
3
African Development Bank, the Asian Development Bank, the
Inter-American Development Bank, and the World Bank
Owned by their member countries
Lend or grant money to countries to promote economic and
social development
Multilateral Development Banks
There are a number of banks that lend or grant money to
developing countries and economies in transition. Among them
are African Development Bank, the Asian Development Bank,
the Inter-American Development Bank, and the World Bank.
These banks are owned by their member countries and referred
as multilateral. These institutions differ from real bank in the
way that they do not function to earn money through their
lending opportunities; rather their main focus is to serve as
financial intermediary.

4
USAID, Australian Agency for International Development,
Canadian International Development Agency, and others
Primarily the development assistance agencies of developed
countries.
Work directly with low- and middle-income countries to
advance economic and social development.
Involved in advocacy, knowledge generation, financing.
Bilateral Agencies
Most high-income countries have development assistance
organizations, such as USAID, AUSAID, and DFID, which also
play important roles in the health sector. These organizations
work directly with low- and middle-income countries to advance
economic and social development and are involved in advocacy,
knowledge generation, financing.
5
Foundations
A number of foundations are deeply involved in global health
work, such as the Bill & Melinda gates Foundation and the
Carter Center.
Rockefeller Foundation is a New York based foundations that
seek to reduce avoidable unfair differences in the health status

of the populations. This foundation was instrumental in the
establishing the first schools of public health in the United
States and was also deeply involved in the development of a
vaccine against yellow fever.
The Carter Center which was founded and currently stationed in
Atlanta, Georgia. A nonprofit public policy center founded by
Jimmy and Rosalynn Carter to fight disease, hunger, poverty,
conflict, and oppression around the world, which received the
Nobel Peace Price in 2002. The Carter Center began
spearheading the campaign to eradicate Guinea word disease.
In1986, there were about 3.5 million annual cases of the
disease in 20 countries in Africa and Asia. In 2013, there were
148 reported cases in four countries. Guinea worm disease is
poised to be the first parasitic disease to be eradicated and the
only disease to be eradicated without the use of vaccines or
drugs.
The Gates Foundation is based in the United States with the aim
to help spread known technologies like immunization to
improve health. The main areas of work for this foundation are
nutrition, maternal health and family planning, neonatal and
child health, infectious diseases-HIV, TB, malaria, pneumonia,
neglected diseases, and diarrhea, vaccine preventable diseases,
and tobacco.
6
Research Funders
Focus on doing and funding research.
Gates Foundation, Wellcome Trust, Howard Hughes Medical
Research Institute.
US National Institute of Health, National Health and Medical
Research Council of Australia, and others supported by national
governments.

There are a number of organizations whose primary focus is to
carry out and fund research. Gates Foundation, Wellcome Trust,
Howard Hughes Medical Research Institute ,US National
Institute of Health, National Health and Medical Research
Council of Australia, and others supported by national
governments are examples of some such organizations.
7
Nongovernmental Organizations
BRAC
Currently working in several countries in Asia and Africa.
Works in areas of human rights and social empowerment,
education and health, economic empowerment and enterprise
development, livelihood training, environmental sustainability
and disaster preparedness.
Women and children take priority.
BRAC was founded in Bangladesh in 1972. It is the largest
NGO in the world involved in international development.
Currently working in several countries in Asia and Africa,
BRAC works in areas of human rights and social empowerment,
education and health, economic empowerment and enterprise
development, livelihood training, environmental sustainability
and disaster preparedness. This organization gives women and
children priority through a variety of approaches. They have
created birthing centers for women living in slums and initiated
programs to promote exclusive breastfeeding and timely
introduction of complementary foods.
8
Medicins Sans Frontieres/

Doctors Without Borders
Umbrella organization made up of affiliated groups in 18
countries.
Best known for provision of health services following
humanitarian crises.
Commitment to political independence, medical ethics and
human rights
Video: About Doctors without Borders (9:11)
https://www.youtube.com/watch?v=73zMcdGfXGE
On the next few slides, we will be learning about some specific
organizations that have been working in the area of global
health tirelessly to provide emergency help and short and long
term development programs.
In this video, we will learn about Doctors without Borders.
9
Oxfam
Supports long-term development programs in local communities
with a focus on women.
Emergency relief for natural disasters and conflict with an
emphasis on clean water, sanitation and shelter.
Advocacy work on the international policy front.
Video: A beginner’s guide to land grab (2:23)
http://www.oxfam.org/en/grow/video/2012/beginners-guide-
land-grabs

On this slide, we will learn about Oxfam.
10
Save the Children
Seeks to contribute to individual and community self-
sufficiency.
Particular attention to well-being of newborns and children,
reproductive health, and HIV/AIDS.
Video: Work of Save the Children (3:26)
http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.61463
57/k.2755/What_We_Do.htm
On this slide we will learn about Save the Children.
11
Advocacy Organizations
Carry out research and policy studies studies
Advocacy activities for public at large, funding agencies,
national legislatures, governments
May be aligned with specific issues
Think Tanks and Universities
Often create institutes that bring researchers together to work
on global health issues
Involved in teaching, research, and practice on global health
issues
Technical assistance on the design, monitoring and evaluation
of global health projects

Consulting Firms
For-profit and not-for-profit
Address a range of issues such as management, economics,
financing, and policy
Particular areas of expertise, such as supply chain management,
nutrition, behavior change communications, or social marketing
Specialized Technical Organizations
Best known example is the CDC
Assist with planning and carrying out disease surveillance
Technical assistance for disease control programs
Let us look at some other nongovernmental organizations and
their activities in global health.
12
Partnerships Related to WHO
Most of the resource poor countries cannot tackle these
problems without aid, and no individual development partner
can provide enough assistance to help deal effectively with the
scale of these problems. Therefore a number of organizations
have decided work together like partnerships that work closely
with WHO. Examples of such partnerships are Roll Back
Malaria and Stop TB.
13
STOP TB
Composed of a wide array of partners with the goal of
eliminating TB as a public health problem.

Roll Back Malaria
Partnership including a variety of public and private actors that
promote appropriate prevention and treatment of malaria.
Other Partnerships and Special Programs
GAVI - Main aims are to improve the ability of health systems
to carry out immunization, raise rates of coverage in low- and
middle-income countries, and promote uptake of underused
vaccines.
The Global Fund - Provides financing and engages in advocacy
for HIV, TB, and malaria with a particular interest in scaling up
programs for HIV antiretroviral therapy.
Global partners are considering concerns over a number of
issues that affect poor. One need is to provide vaccination
programs in disadvantage group. To address immunization more
effectively, the Global Alliance for Vaccines and Immunizations
was established. The main aims of this organization are to
improve the ability of health systems to carry out immunization,
raise rates of coverage in low- and middle-income countries,
and promote uptake of underused vaccines. The Global Fund to
fight AIDS, TB, and Malaria was also established provides
financing and to engage in advocacy for HIV, TB, and malaria
with a particular interest in scaling up programs for HIV
antiretroviral therapy.
14
Other Partnerships and Special Programs
Public-Private Partnerships
Aim is often to develop new products.

International AIDS Vaccine Initiative (IAVI)- advocates for
AIDS vaccine, develops policies and programs that would
encourage use of an AIDS vaccine if one were developed,
engages in research and development of candidate AIDS
vaccines.
As interest in global health rose in the mid-1990s, many of the
actors in this field increasingly believe in the mechanism for
developing, manufacturing and distributing new products.
Today there is wide range of public private partnerships for
health, including Aeras, Global Alliance for TB Drug
Development, Human Hookworm Vaccine Institute,
International AIDS Vaccine Initiative, International Partnership
for Microbicides, Malaria Vaccine Initiative, and Medicines for
Malaria Venture.
15
Trends in Global Health Efforts
Shift to focus on building capacity for global public health
efforts, health systems development, and working together to
fight the burden of disease.
Family planning shift from focus on limiting family size to
focus on general reproductive health.
Importance of primary care.
Greater private sector involvement.
Different countries have realized it is essential to address the
health issues collectively. Hence, the shift has focused on
building capacity for global public health efforts, health
systems development, and working together to fight the burden
of disease. Another area of shift has been seen in family
planning. Family planning shift from focus on limiting family
size as it was led by USA to focus on general reproductive
health. The Alam Ata declaration has put emphasis on primary

health care and on the health needs of the poor. The Alam Ata
declaration was linked to the world’s effort to achieve what was
called globally “Health for All by the year 2000”.
16
Setting the Global Health Agenda
World Health Assembly of the World Health Organization.
Groups of development assistance agencies.
Increasing role in agenda setting of the Gates Foundation.
Writings and advocacy efforts of WHO, multilateral or bilateral
agencies, and NGOs.
Popular action led by NGOs, often including, for example, MSF
or Doctors Without Borders.
Each year ministers of health of WHO member countries meet
in Geneva, Switzerland, to consider important global health
matters and resolutions proclaiming their interest in and
commitment to key health issues. Some of the global health
development has been encouraged by writing, advocacy efforts
and program activities of WHO, multilateral or bilateral
agencies and some of the important NGOs involved in health.
The way in which the agenda is set for specific health topics
will depends on the actors who have particular interest in the
topic at hand.
17
Future Challenges
Cooperative surveillance, prevention and treatment of emerging
or re-emerging conditions.
Working together to strengthen weak health systems.
Addressing knowledge gaps that prevent progress in preventing
and treating AIDS, TB, Ebola, malaria.
Creating new public-private partnerships.
Financing important initiatives.
Continuing good leadership in the global health community.

The global health community will likely face a number of key
challenges in the future. These might include, for example:
filling key gaps in knowledge and encouraging public and
private sector organizations to develop the diagnostics,
vaccines, and drugs needed to address the most important global
health issues. Other key challenges include the need for
organizations to work together to strengthen health systems, to
combat individual diseases, and to try to ensure that critical
global health needs have adequate financing.
18
Natural Disaster and Complex Humanitarian Emergencies
Chapter 15
Chapter 15: Natural Disaster and Complex Humanitarian
Emergencies
1
The Importance of Natural Disasters and Complex Emergencies
to Global Health
Lead to increased death, illness, and disability.
Large economic impacts.
Measures taken to reduce costs of disaster and conflict would be
most effective if those involved worked together on the most
important priorities.
VIDEO: The worst natural disasters (3:59)
http://www.bbc.co.uk/science/earth/collections/worst_natural_di
sasters#p00gttdw

Complex Humanitarian Emergencies and natural disasters have
a significant impact on global health as it can lead to increased
death, illness and disability. The economic cost is also likely to
be very large. Measures taken to reduce costs of disaster and
conflict would be most effective if those involved worked
together on the most important priorities.
2
Key Terms
Disaster - Any occurrence that causes damage, ecological
destruction, loss of human lives, or deterioration of health and
health services on a scale sufficient to warrant an extraordinary
response from out the affected community area.
Natural and man-made
Rapid- and slow-onset
Video:
Sandy victims critical to storm relief (2:48)
http://www.cnn.com/video/#/video/bestoftv/2012/11/15/exp-
erin-sandy-victims-relying-on-neighbors-not-the-government-
deb-feyerick.cnn?iref=allsearch
Flood in Nigeria 2012
Let us look at disaster and complex emergency terms in more
details.
A Disaster could be natural or could be man-made. It also could
be rapid onset such as an earthquake, or slow onset like a
famine. Examples of natural disasters are earthquakes,
hurricanes or flood. Man-made disasters include chemical spills,
as it happened in the town of Bhopal, India or radiation or

industrial accidents.
3
Key Terms
Complex emergency - Complex, multi-party, intra-state conflict
resulting in a humanitarian disaster which might constitute
multi-dimensional risks or threats to regional and international
security. Frequently within such conflicts, state institutions
collapse, law and order break down, and banditry and chaos
prevail, and portions of the civilian population migrate.
Complex emergencies are the ones that causes multi-
dimensional risks or international threat. Frequently within such
conflicts, state institutions collapse, law and order break down,
and banditry and chaos prevail, and portions of the civilian
population migrate.
4
Tohoku earthquake
Japan suffered its most devastating tsunami in decades
following an earthquake in Tohoku in March 2011
One of the example for natural disaster in Japan. Japan faced
most devastating tsunami in decades following an earthquake.
5
Key Terms
Refugee – A person who is outside his or her country of
nationality or habitual residence; has a well-founded fear of
persecution because of his or her race, religion, nationality,
membership in a particular social group or political opinion;
and is unable or unwilling to avail him- or herself of the

protection of that country, or return there for fear of persecution
Refugees are accorded certain rights by international law
Video: Rohingya boat people stuck in limbo (2:55)
https://www.youtube.com/watch?v=d6Wdqnv5bgE
Complex emergencies create refugees. Under international law a
refugee is a person who is outside his or her country of
nationality or habitual residence; has a well-founded fear of
persecution because of his or her race, religion, nationality,
membership in a particular social group or political opinion;
and is unable or unwilling to avail him- or herself of the
protection of that country, or return there for fear of
persecution.
The Video: In Thailand, dozens of people from the ethnic
Rohingya group who fled Myanmar remain in limbo in a
Bangkok detention centre a year after they were brought ashore
on the Thai coast. Unwanted in their homeland and are given no
rights, they now fear they will languish indefinitely in Thai
jails.
6
Key Terms
Internationally displaced people - People who are forced to flee
or migrate and leave their homes during a disaster or complex
humanitarian emergency but stay in the country in which they
were living.
Legal status is not as well-defined as that for refugees
Some of the people who are forced to flee or migrate and leave

their homes during a disaster or complex humanitarian
emergency but stay in the country in which they were living and
has not crossed international border are known as internally
displaced person (IDP). The status of refugee and IDP vary
because the label of refugee will only be applicable if he/she
crosses the border.
7
Key Terms
Crude mortality rate - The proportion of people who die from a
population at risk over a specified period of time.
Attack rate - Proportion of an exposed population at risk who
become infected or develop clinical illness during a defined
period of time.
Case fatality rate - Number of deaths from a specific disease in
a given period, per 100 episodes of the disease in that same
period.
Some of the health indicators of the complex humanitarian
emergency are crude mortality rate, attack rate, and case fatality
rate.
8
The Characteristics of Natural Disasters
Include droughts, hurricanes, typhoons, cyclones, heavy rains,
tsunamis, earthquakes, and volcanoes.
Number of natural disasters are increasing, affecting larger
numbers of people, causing more economic losses, but causing
proportionally fewer deaths.
Biggest relative impact is on the poor in low- and middle-
income countries.
Cause damage to health systems and other infrastructure.

There are several types of natural disasters. Some of these
related with weather for instance droughts, hurricanes,
typhoons, cyclones, heavy rains, tsunamis, earthquakes, and
volcanoes. It seems like number of natural disasters are
increasing, affecting larger numbers of people, causing more
economic losses, but causing proportionally fewer deaths.
However, the biggest impacts fall on the poor in low- and
middle-income countries. Natural disaster causes damage to
health systems and other infrastructure. Health clinics,
hospitals, water supply, sewage system all become affected in
natural disaster and lead to a number of consequences.
9
Cyclone Ali, West Bengal, India
Earthquake in China
Drought in Africa
These pictures show the outcome of some natural disasters.
10
The Characteristics of Complex Emergencies
Often go on for long periods of time.
Sometimes groups that are fighting will not allow humanitarian
assistance to be provided.
Combatants often target civilians.
Systematic abuse of human rights.
Food shortages.
Breakdown of publicly supported health system
Unhealthy living circumstances in refugee camps.

CHEs often go on for long periods of time. The strife in Sudan
has gone more than a decade. In civil wars, sometimes groups
that are fighting will not allow humanitarian assistance to be
provided. During war, combatants often target civilians causing
displacement, injury and death. Systematic abuse of human
rights is also very evident in wars in the form of torture, rape,
sexual abuse. The disruption of society leads to food shortages.
Beside food shortage there might be total breakdown of publicly
supported health system. In refugee camp since too many people
live there in unhygienic condition diseases can spread faster
among them.
11
The Health Burden of Natural Disasters
Direct and indirect effects depend on type of disaster.
Some effects are short-term such as death, others are long-
lasting like mental problems.
Very old, very young and very sick are most vulnerable.
The direct and indirect effects depend on the type of disaster.
Earthquake can kill so many people quickly and in short term
period could lead to so many injuries. In the long run
earthquake survivors may suffer disabilities, mental health
problems, and chronic disease conditions. The most common
problems that are seen in most disaster are communicable
diseases, broken water supply and inadequate sanitation, and in
the long run effect on mental health.
12
The Health Effects of Complex Humanitarian Emergencies
Large and underestimated.
About 250 million people affected by climate-related disasters.
In 2011, natural disasters caused a total of 30,773 deaths and

245 million victims globally.
In 2012, 9,655 people were killed and 124.5 million were
displaced.
Malnutrition, lack of safe water, food shortages, and breakdown
of health services can lead to illness, disability and death.
The burden related with CHEs is large and underestimated
because of the fact that it is difficult to obtain such data. About
250 million people are affected by climate-related disasters.
Other illnesses come about as an indirect result of such
emergencies. Malnutrition, lack of safe water, food shortages,
and breakdown of health services are example of such indirect
effects.
13
Adopted from East Africa drought: Cholera outbreak in Kenya
camp, BBC news available at http://www.bbc.co.uk/news/world-
africa-15742664
2011 cholera outbreak in Kenya’s
The map here is showing areas of food shortage in East Africa
as a result of drought.
14
Causes of Death in CHEs
In the early stages, most deaths occur from diarrheal diseases,
respiratory infections, measles, or malaria.
Populations affected are generally poor and may suffer from
protein-energy malnutrition in a camp.

Most of the deaths occur after CHEs are from diarrheal disease,
respiratory infections, malaria and measles. Diarrheal diseases
are the most common cause of death in refugee camp. Major
epidemics of cholera occurred in refugee camps of Malawi,
Nepal, Bangladesh, and Tanzania. Case fatality rates are also
high if the diarrheal diseases turn into dysentery. Measles have
been the killer for displaced person because this population are
malnourished and lack vaccination against measles.
Respiratory infections and malaria incidences are also high
among refugee and internally displaced person. On top of that
people who are affected most by CHEs are poor and suffer from
protein energy malnutrition.
15
Mental Health
Social and psychological shocks due to changes in way of
living, loss of livelihoods, damaged social networks, and
physical and mental harm.
Children and adults suffer from high rates of depression and
PTSD.
Important to help people rebuild their lives and social networks
as quickly as possible.
Post traumatic stress disorders among adults ranged from 4.6%
among Burmese refugee in Thailand to 37.2% among
Cambodian refugee in Thailand. The rate of PTSD is about 1%
in the population of USA. Among children the result of trauma
could be long lasting. One survey of 170 Adolescent Cambodian
indicates that almost 27% of them suffer from PTSD.
16

Addressing the Health Effects of Complex Humanitarian
Emergencies
Assessment and Surveillance
Carry out assessment of displaced population.
System for disease surveillance for diseases that cause
epidemics among displaced persons.
Daily crude mortality rate is used as an indicator of the health
of the affected group and will signify a public health
emergency.
It is very important to assess the health situation immediately
after the disaster has occurred. As the assessment is going on,
it is also necessary to begin care for the victims. In the earliest
stage of disaster some important public health functions like
establishment of continuous diseases surveillance among
affected people needs to be carried out.
17
Addressing the Health Effects of Natural Disasters
Health situation assessed immediately.
Care for trauma cases.
Other injured people who are in need of early treatment.
Establishment of continuous disease surveillance.
Provision of food, water and shelter.
Funds Spent for Haiti Earthquake Response
It is very important that the health situation be assessed
immediately after the disaster. Once the immediate care for
trauma cases are taken care for , relief care workers should pay
attention to other injured people who are in need of early

treatment. In the earliest stage it is also important to establish
continuous disease surveillance among the affected population
and to provide food, water and shelter.
18
Addressing the Health Effects of Natural Disasters
External assistance will have to:
Include all external partners.
Be based on a cooperative relationship.
Have partners working in complementary ways.
Be evidence-based and transparent.
Involve affected communities.
*Disaster preparedness plans are also helpful for reducing
impact.
To be most helpful, external assistance will have to: include all
external partners, be based on a cooperative relationship, have
partners working in complementary ways, be evidence-based
and transparent, and should involve affected communities.
19
Emergencies
A Safe and Healthy Environment
Maintenance of environmental and personal hygiene.
Adequate clean water for drinking, cooking and bathing.
Adequate number of toilets segregated by sex.
Effective and culturally appropriate shelter.
Given the fact that extent and nature of conflict is difficult to

predict, it would be wise for the concerning organizations to
have some plan for the areas where it likely to have conflict.
Plans should include maintenance of environmental and
personal hygiene, supply of adequate clean water for drinking,
cooking and bathing, providing adequate number of toilets
segregated by sex and to have effective and culturally
appropriate shelter.
20
Emergencies
Food
At least 2100 kilocalories of energy per day for adults.
Care taken to make sure that female-headed households and
children get their rations.
Vitamin A given to all children.
Urgent nutrition supplementation to children who need it.
It is suggested that each adult in a camp should get at least
2100 kilocalories of energy sufficient food per day. Care must
be taken to make sure that female-headed households and
children get their rations. Vitamin A should be given to all
children and there should be supply of urgent nutrition
supplementation for children who need it. In Syria, shortages
of fuel and flour have made bread production erratic across the
country.
21
Addressing Health Effects of Complex Humanitarian
Emergencies
Disease Control
Vaccinate all children from 6-15 years for measles.
Ensure children up to 5 years get vitamin A.
Proper management of diarrhea.

Appropriate diagnosis and treatment for malaria.
Health education and hygiene promotion.
In the humanitarian crisis the goal of disease control is to
prevent and reduce excess morbidity and mortality and to
promote a return to normalcy. With this goal in mind one of the
target is to prevent epidemic of measles. All children from 6-15
years should be vaccinated for measles. It is also important to
ensure children up to 5 years get vitamin A. Other priorities
include proper management of diarrhea, appropriate diagnosis
and treatment for malaria and health education and hygiene
promotion.
22
Future Challenges
Reducing negative health impact.
Developing and using standard approaches among all actors.
Responding with the most cost-effective approaches.
Among a number of challenges, one of the challenges for the
future is to reduce negative health impact. Developing and
using standard approaches among all actors is crucial to guide
work in emergencies. Responding with the most cost-effective
approaches for low and middle income countries is one of the
priorities to combat natural and complex humanitarian
emergencies.
23
Unintentional injuries
Chapter 14

Chapter 14: Unintentional Injuries.
1
The Importance of Unintentional Injuries
Among the single leading causes of death and DALYs lost
worldwide.
In 2010, more than 3 million people died of unintentional
injuries worldwide.
Unintentional injuries represent about 7% of all deaths
worldwide and 9% of total DALYs.
Among the single leading causes of death and DALYs lost
worldwide. In 2010, 3 million people died of unintentional
injuries. This about the same number of people who died of
respiratory infections, more than the number of people died of
HV/AIDS, diarrheal diseases. Unintentional injuries often lead
to disability. Thus unintentional injuries represent 7% of deaths
worldwide, 9% of DALYs lost
2
Key Definitions
Injury - “the result of an act that damages, harms, or hurts;
unintentional or intentional damage to the body resulting from

acute exposure to thermal, mechanical, electrical, or chemical
energy or from the absence of such essentials as heat or
oxygen”
Unintentional injuries - “that subset of injuries for which there
is no evidence of predetermined intent”
Let us learn some key words like unintentional injury and
injury.
3
The Burden of Unintentional Injuries
4.2% of total deaths in high-income countries occurred due to
unintentional injuries. Versus 7.9% of total deaths in LAMI
countries.
Percentage of deaths from unintentional injuries was almost
twice as high in low- and middle-income countries as in high-
income countries.
Deaths only represent part of the burden.
Significant differences between rates in males and females.
Variation among different regions.
Percentages of deaths from unintentional injuries was almost
twice as high in low- and middle-income countries as in high-

income countries. Males commonly suffer from unintentional
injuries. About 2/3 of the deaths from unintentional injuries
were among males. We also see variation in injuries by region.
Sub-Saharan Africa shares a relatively low burden from
unintentional injuries than other regions. Latin America and the
Caribbean are relatively higher than in any other region, largely
a reflection of the natural disasters on this region. Road traffic
accidents are the largest cause of unintentional injuries in all
regions.
4
Children deaths by unintentional injuries
2,270 children die every day as a result of an unintentional
injury.
5
Distribution of global child injury deaths by cause
This table demonstrates death rates among children by cause.
6
Road traffic injuries

Road traffic injuries are the leading cause of death among 10 to
19 year olds. More than 260,000 children and teenagers die
from road traffic injuries each year. That is about 718 children
per day. Approximately 10 million more are non-fatally
injured.
7
Risk Factors for Unintentional Injuries
Developmental immaturity relative to dangers present in
environment.
Inability to provide adult supervision and child care.
Exposure to unsafe workplaces.
Poor motor safety practices.
The cost and consequences with unintentional injuries are
considerable. The economic burden include direct costs
including medical care, hospitalization, re -habilitation and
funeral services and indirect cost including lost wages, sick
leave, disability payments, and insurance payouts. Injuries
represent a significant drain on personal and societal resources.
The economic burden is rapidly increasing due to road traffic
injuries in some countries. Costs including health care,
administrative expense and vehicle and property damage are

some additional cost making the burden heavier. Finally, there
are psychosocial consequences such as pain, fatigue, memory
loss, changes in work status; altered family dynamics all of
which are significant impact able consequences of injuries.
8
The Costs and Consequences of Injuries
Direct costs including medical care, hospitalization,
rehabilitation and funeral services.
Indirect costs including lost wages, sick leave, disability
payments, and insurance payouts.
Rapidly increasing economic burden due to road traffic injuries
in some countries.
Psychosocial consequences such as pain, fatigue, memory loss,
changes in work status, altered family dynamics.
Formal surveillance systems are fundamental to provide
information on numbers and patterns of injury. Low income
countries are lacking formal systems as high income countries
but there should be some minimum standard for injury
morbidity and mortality data. Interventions should be designed
for individual communities. The theoretical approach for injury
prevention and control is known as Haddon’s Matrix that
demonstrate interaction of environment, vector, and host in an
injury event. Finally, there should be comprehensive education,
enforcement, and engineering efforts to reduce the high burden
of injury.
9
Addressing Key Injury Issues
Formal surveillance systems to provide information on numbers
and patterns.

Interventions designed for individual communities.
Haddon’s Matrix to demonstrate interaction of environment,
vector, and host.
Education, enforcement, and engineering efforts.
Low income countries should examine investing in low-cost, but
effective ways of improving emergency medical services. This
could be special vehicles for low-income or rural communities,
or could make advance arrangements with owners of available
transport. Community members who frequently come in contact
with RTAs like truck drivers could be trained to provide first
aid and transport to the injured. Countries also should began
investing in training healthcare personnel who work in
emergency situations.
10
Emergency Medical Services
Low-cost, but effective ways of improving EMS:
Special vehicles for low-income or rural communities.
Advance arrangements with owners of available transport.
Training truck drivers to provide first aid and transport.
Training healthcare personnel who work in emergency
situations.
Knowing the fact that there is very little data on injuries on low
income countries, focusing additional attention on unintentional
injuries is vital. Integrating lessons learned in high-income
countries could be a starting point towards morbidity and

mortality reduction form unintentional injuries. As low income
countries become more motorized it will be valuable for them to
engineer safety into newer roads construction. Insufficient
attention has been given in educating public for injury
prevention, so it will be worthy to Increase knowledge of injury
prevention among general population.
11
Future Challenges
Focusing additional attention on unintentional injuries in low-
and middle-income countries.
Integrating lessons learned in high-income countries.
Engineering safety into newer roads.
Increasing knowledge of injury prevention.
Future challenges include:
Focusing additional attention on unintentional injuries in low-
and middle-income countries
Integrating lessons learned in high-income countries
Engineering safety into newer roads and
Increasing knowledge of injury prevention
12

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