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Lecture 1.2 I Introduction to Global Health “Become part of the conversation.”. Lori DiPrete Brown Associate Director, Global Health Institute. Objectives. Provide an overview of teaching resources on: Definition of Global Health and GH Successes Current GH Trends and Challenges

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lecture 1 2 i introduction to global health become part of the conversation

Lecture 1.2IIntroduction to Global Health“Become part of the conversation.”

Lori DiPrete Brown

Associate Director, Global Health Institute


Provide an overview of teaching resources on:

  • Definition of Global Health and GH Successes
  • Current GH Trends and Challenges
  • Global Health Timeline
  • The MDGs and the Post 2015 Agenda
  • How to Find and Use and Communicate GH Information
  • First Do No Harm…
why should we care about global health
Why Should we Care about Global Health?
  • National Security
  • Trade economic productivity
  • Inequalities are unethical and unjust
  • States have humanitarian responsibilities to other states
  • Are we separate countries, or an interconnected world?
  • “Global health, like global climate change, may soon become a matter so important to the world’s future that it demands international attention, and no state can escape the responsibility to act.” -- Gostin
have global health efforts been successful just say yes
Have Global Health Efforts been Successful? Just say YES!
  • Small pox eradication 1979
  • Vitamin A supplementation in Nepal prevents 200,000 child deaths
  • Polio eliminated from western hemisphere 1991
  • Reduction of infant death due to diarrhea by 82% from 1982 to 1987 in Egypt
  • Dramatic reduction in Guinea Worm –reduced by 99% in 20 countries
  • Fertility reduction in Bangladesh from 7 to 3 children per woman
  • Overall improvements in IMR 126 to 56/1000, CMR 197 to 82/1000, from 1960 to 2002.
  • Under 5 child mortality decreased by 60% from 1990 thru 2010
  • Between 1990 and 2010, life expectancy increased by 12-15 years for men and women
  • Burden due to HIV and Malaria is falling
successful programs in action
Successful Programs in Action
  • Bangladesh Rural Advancement Committee (BRAC)
  • http://www.youtube.com/watch?v=5s0yVZlFdMU
  • Meningitis Vaccine for Africa
  • http://www.youtube.com/watch?v=tZMiYTZpQUQ
  • For other success stories see RX for Survival Series http://www.pbs.org/wgbh/rxforsurvival/series/video/index.html
Is Global Health EngagementOptional or a Human Rights Imperative?A Preferential Option for the Poor

“Although PIH is a secular organization not affiliated with, motivated by, or espousing any particular religious ideology, we find the concept of “a preferential option for the poor” to be a powerful moral imperative. The “poor” includes but is not limited to those who are economically deprived. The concept of “a preferential option for the poor” challenges us to be advocates for the voiceless and powerless among us. Those who are in any way and for any reason deprived, marginalized, or vulnerable have a special moral claim on the community. As a matter of both justice and charity, we must put in place structures and systems to address and meet their needs, so that they might participate more fully in the common good and thereby flourish more fully as human persons.” –Partners in Health

….for all of us, when we are vulnerable to harm?

what is global health
What is Global Health?

Image Courtesy of: lidc.org.uk

what is global health1
What is Global Health?
  • Health care, but not “just” health care
  • NOT just the absence of disease
  • NOT limited to sites outside the US
  • Linked to terms international health, global public health, public health, sustainable health
  • Draws on many disciplines
  • Grounded in social justice philosophy
  • Includes HEALTH IN ALL POLICIES multi-sector efforts to improve well-being that use prevention as prime intervention strategy
  • Linked to government, bilateral and multi-lateral cooperation, NGOs, civil society and the private sector.
  • Global Health is Public Health for the World!
global health scope trends and challenges
Global Health Scope, Trends and Challenges

Image Courtesy of: lidc.org.uk

the scope of global health
The Scope of Global Health
  • Communicable Disease
  • Non-Communicable Disease
  • Nutrition and Food Systems
  • Unintentional Injuries and Violence
  • Disability
  • Mental Health
  • Environmental Health
  • National Disasters, War and Complex Emergencies
  • Global Population Dynamics
  • Meeting the health needs of special populations:

Difference is not disease!


Factors that Affect Health

WHO Determinants of Health

current global health trends
Current Global Health Trends
  • Growing population
  • Aging population manifesting in shifts in disease burden to NCDs
  • Urbanization
  • Changing patterns of consumption with economic development
  • Global spread of tobacco
  • Diets high in sugar, fat, salt
  • Physical inactivity
some current global health challenges
Some Current Global Health Challenges
  • In 2011, 6.9 million (down from 11 million in 1990) children under 5 die from preventable diseases
  • 222 million women do not have access to family planning and reproductive health services
  • 13 million people die yearly from preventable infectious disease (half due to HIV/AIDS)
  • 1.2 billion people do not have access to clean water
  • Over 300 million adults are obese raising risk for chronic disease
  • 17 neglected tropical diseases affect 1 billion people worldwide.
  • Nearly 1 billion males and 250 million females smoke
  • 76.3 million struggle with alcohol use disorders, 185 million use other drugs
global health a timeline
Global Health: A Timeline

Ancient Civilizations -- herbal knowledge,

rituals, bone-setting, obstetric practices,

sanitation measures

  • 542--Plague of Justinian extends from Asia to Ireland
  • 1346--Black Death kills 25 million in Europe alone
  • 1348--First “Quarantine” in Venice
  • 500-1500-- Middle Ages: smallpox, diphtheria, measles, influenza, tuberculosis, rabies, scabies, leprosy
  • 1100s--First Hospitals in Europe

1400s--Colonial Era Begins and diseases spread

    • Influenza, measles, typhus, smallpox, Cholera, syphilis, dysentery, malaria, sleeping sickness
  • 1552--Codex Badianus –Compendium of medicinal herbs from Latin America (Aztecs), and interest in other ancient traditions
  • 1600s—Jesuits learn indigenous n=malaria cure

in South America – Cinchona Bark –Quinine

  • 1700--Enlightenment brings urban sanitation

and water systems to European cities.

Paris, then others.


1796 -- Edward Jenner safe vaccine for Small Pox 1803 -- Charles IV commissions the Balmis-Salvany Smallpox Expedition. It is the first public health vaccination campaign in South America

THEN: http://www.paho.org/English/DPI/Number11_article6.htm

  • NOW: http://www.youtube.com/watch?v=tZMiYTZpQUQ

1851 – First International Sanitary Conference (international cooperation regarding quarantine to prevent cholera and other problems)

  • 1905– Yellow Fever and Malaria control: Panama (William Crawford Gorgas)



1880-1910 – medical discoveries, vaccines, health education

  • 1910-1945 – global health infrastructure begins to develop (schools, foundations, agencies)
  • 1960s and 1970s – immunization, disease specific programs
  • 1978 –Alma Ata Declaration – Health for All, 134 countries sign


  • 1980 -- Ken Horne, the first AIDS case in the United States is reported to the Center for Disease Control.
  • 2000 UN Millennium Declaration
  • 2004 – PEPFAR and others launch global HIV/AIDS treatment initiative



2012 – UN High Level Mtg on Non-Communicable Diseases

  • January 2014 – Polio eradication in India.
      • Continued challenges in Nigeria,
      • Pakistan and Afghanistan. Last
      • case may be seen in 2014.
  • http://online.wsj.com/news/articles/SB10001424052702303848104579312453860810752
the mdgs and the post 2015 agenda
The MDGs and the Post 2015 Agenda

Image Courtesy of: lidc.org.uk


Millennium Development Goals 2000By the year 2015, all 191 UN member nations have pledged to meet these goals

  • Eradicate extreme poverty and hunger
  • Achieve universal primary education
  • Promote gender equality and empower women
  • Reduce child mortality
  • Improve maternal health
  • Combat malaria, AIDS and other diseases
  • Ensure environmental sustainability
  • Develop a global partnership for development

Images Courtesy of:pnowb.org (top), cities-localgovernments.org (bottom)

were the mdgs good for health
Were the MDGs Good for Health?
  • Raised profile of GH and mobilized assistance
  • Considerable progress in low and middle income countries
  • MDGs contributed to fragmentation of interventions
  • Further progress will require the reduction of inequality, discrimination and human rights violations.
other post 2015 themes all relate to health
Other Post 2015 Themes:All Relate to Health
  • Population
  • Education
  • Food and Nutrition Security
  • Environmental Sustainability
  • Water
  • Energy
  • Disasters, Conflict and Fragility
  • Economic Growth and Employment
  • Inequalities
  • Governance
useful links
Useful Links
  • BBC News Country Profiles http://news.bbc.co.uk/2/hi/country_profiles/default.stm
  • The World Health Organization (WHO) Country Reports, see http://www.who.int/countries/en/
  • World Bank Country Profileshttp://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/0,,pagePK:180619~theSitePK:136917,00.html
  • CIA World Factbook at https://www.cia.gov/library/publications/the-world-factbook/
  • 2010 GBD Country Summaries http://www.healthmetricsandevaluation.org/gbd/country-profiles
  • Food and Agriculture Organization (FAO), http://www.fao.org/countryprofiles/selectcountry/en/
  • Set up TWITTER or other News Aggregator and follow as a class
the global burden of disease studies
The Global Burden of Disease Studies

Image Courtesy of: lidc.org.uk

gbd 2010 global burden of disease injuries and risk factors
GBD 2010 Global Burden of Disease, Injuries and Risk Factors
  • Published in Lancet, December 2012
  • Builds on World Band and WHO studies for 1990, 1999-2002 and 2004
  • 7 partners: WHO, Inst of Health Metrics, 5 universities
  • 235 causes of death (from 107), 67 (from 10) risk factors, 21 regions, 20 age groups, sex, morbidity and mortality, DALYs
  • Universal access to findings at:
  • http://www.thelancet.com/themed/global-burden-of-disease#
ranked causesof diseases and risk factors interactive visual tools to access gbd data
Ranked Causesof Diseases and Risk Factors:Interactive Visual Tools to Access GBD Data
  • http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-2010-change-leading-causes-and-risks-between-1990-and-2010
patterns and distributionby broad causes interactive visual tools to access gbd data
Patterns and Distributionby Broad Causes:Interactive Visual Tools to Access GBD Data
  • http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-2010-patterns-broad-cause-group
heat map comparisons interactive visual tools to access gbd data
Heat Map Comparisons:Interactive Visual Tools to Access GBD Data
  • http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-2010-leading-causes-and-risks-region-heat-map

Using GPH Information EffectivelyThe River of Mythshttps://www.youtube.com/watch?v=OwII-dwh-bkPopulation Growth and Climate Changehttps://www.youtube.com/watch?v=SxbprYyjyyUWill Saving Poor Children Lead to Overpopulation?https://www.youtube.com/watch?v=BkSO9pOVpRM

mage Courtesy of: lidc.org.uk

disparities within countries
Disparities within Countries

Image Courtesy of: lidc.org.uk

chart 3 4 life expectancy at birth is five years lower for blacks compared with whites
Chart 3-4. Life expectancy at birth is five years lowerfor blacks compared with whites.

Life expectancy in years of life remaining, 2003

Note: Based on 1990 post-censal estimates of the United States resident population.

Source: National Center for Health Statistics. Health, United States, 2006: With Chartbook on Trends in the Health of Americans. 2006.


Chart 3-5. Infant mortality rates are more than two timeshigher for blacks than for whites, despite a slight declinefor all groups in the past eight years.

Deaths per 1,000 live births by maternalrace/ethnicity, 1995 and 2003

AI/AN = American Indian/Alaska Native.

Note: Infant is defined as a child under one year of age.

Source: T. J. Matthews and M. F. MacDorman, “Infant Mortality Statistics from the 2003 PeriodLinked Birth/Infant Death Data Set,” National Vital Statistics Reports, May 3, 2006 54(16):1–29.

Chart 3-12. Minority women have lower rates of breast cancer, but black women are more likelyto die from the disease.



New cases per 100,000 female population, 2003

Deaths per 100,000 female population, 2000–2003

AI/AN = American Indian/Alaska Native.

Note: Data are age adjusted.

Source: National Center for Health Statistics. Health, United States, 2006: With Chartbook on Trends in the Health of Americans. 2006.

Chart 3-14. Black men are 50 percent more likelyto have prostate cancer than whites but are more than twice as likely to die from it.



Deaths per 100,000 male population, 2000–2003

New cases per 100,000 male population, 2003

AI/AN = American Indian/Alaska Native.

Note: Data are age adjusted.

Source: National Center for Health Statistics. Health, United States, 2006: With Chartbook on Trends in the Health of Americans. 2006.

chart 3 19 blacks are three times more likely to die from asthma than whites
Chart 3-19. Blacks are three times more likelyto die from asthma than whites.

Number of asthma deaths per 100,000 people, 2003

AI/AN = American Indian/Alaska Native.

Note: Data are age adjusted to the 2000 United States standard population.

Source: L. Akinbami, Asthma Prevalence, Health Care Use and Mortality: United States, 2003–05. National Center for Health Statistics.


First Do No Harm….http://vimeo.com/22008886Do Students do Too Much Too Soon?http://chronicle.com/article/Overseas-Health-Programs-Let/142777/

Image Courtesy of: lidc.org.uk

selected references
Selected References
  • Birn, Ane-Emanuelle, and Yogan Pillay, and Timothly Holtz. Chater 2, the historical Origins of Modern International Health, in Textbook of international Health: Global Health In a Dynamic World, Oxford University Press, 2009.
  • Beaglehole R and Bonita R, What is global health? Global Health Action, 2010,3, 5142.
  • Fried LP, Bentley ME, Brekens P, Burke DC, Frenk JJ, et.al. Global health is public health. Lancet 2009; 375,536-537.
  • Gostin, L. Why Should Rich Countries Care about the World’s least healthy People? JAMA, July 4, 2007—Vol 298, No. 1
  • Koplan J,  Bond C, Merson M et. Al.  Towards a common definition of global health.  Lancet 2009; 373:1993-1995.
  • Fineberg H, and Hunter, D. A Global View of Heath, NEJM, January, 2013
  • Levine R, Case Studies in Global Health: Millions Saved. Jones and Bartlett 2007.
  • Lindstrand et al. Global Health, Narayana Press, Denmark, 1007.
  • United Nations Millenium Declaration, 2000.  Read primary text posted at learn at UW and explore Millennium Development Goals indicators and progress at www.developmentgoals.org.
  • Alma Ata Declaration, 1978.  http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf
  • GBD 2010, The Lancet, December 2012.
  • Rx for Survival. http://www.pbs.org/wgbh/rxforsurvival/
  • Health in the Post 2015 Agenda. Report of the Global Thematic Consultation on Health. April 2013. Pages 7-15 and 21-50.