What is Global Health? Global Health: An Overview Linda C. Baumann, PhD, RN, FAAN Professor Emerita UW-Madison School of Nursing & School of Medicine and Public Health Health that transcends political and geographic boundaries Newer term: Planetary health www.thelancet.com/infographics/planetary -health Nationalacademies.org/USglobalhealth Report: Global Health and the Future Role of the United States. National Academies of Science Why care about global health? Global health is an investment that acknowledges Interdependency To promote economic growth we need health populations, delay/avoid premature loss from disability/disease Focus more on noncommunicable disease Malaria, TB and HIV/AIDS remain threats Priority areas for action 1. Poverty 1. Achieve global health security - Ability to respond to epidemics, outbreaks 2. Maintain a sustained response to continuing threats of communicable disease 3. Save and improve the lives of women and children 4. Promote cardiovascular health and prevent cancer Nairobi 1
2. Pollution 3.Population growth Anshan Demographic Transition: Joseph A. McFalls, Jr. Population: A Lively Introduction. Third edition. Population Reference Bureau 53(3); 1998: 38 Urban and Rural Population of the World, 1950-2030 Shifting Patterns of Disease Mortality Rates Chronic Infectious Source: World Urbanization Prospects: The 2005 Revision. UN Department of Economic and Social Affairs. New York: 2006. Epidemiologic Transition Top 5 causes of outpatient visits (% of new cases) 60 50 40 30 20 10 eye infection diarrhea skin infection ARI malaria Infant tetanus, Vietnam 0 1997 1998 Mosoriot Health Center, Eldoret Kenya 2
Major global chronic conditions Heart disease #1 cause of death worldwide Cancers: lung, colon, breast, prostate Mental health problems Alcohol/drug abuse Depression Schizophrenia Diabetes (80% is type 2) The Problem Health systems are not designed to manage chronic disease Risks of chronic disease are largely caused by unhealthy lifestyle and an aging population Untreated chronic disease worsens poverty Non-communicable disease (NCDs)Definitions NCD is NOT: a chronic disease and includes disability and injury Chronic conditions have high co-morbidity, many shared risk factors Cause of death does not often address the underlying risk, such as diabetes not MI Approach to NCDs is to reduce disease burden not cure Shared Risk Factors Risk dependent on behaviors and environment smoking inactivity unhealthy diets exposures resources 15 16 Diabetes Prevalence in 2000 vs. 2030 Triple burden of disease-road traffic accidents Over 366 million by 2030! 3
UNIVERSAL DECLARATION OF HUMAN RIGHTS Adopted and proclaimed by United Nations General Assembly resolution 217 A (III) of 10 December 1948 Everyone has the right to a standard of living adequate for the health and well being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. UNIVERSAL DECLARATION OF HUMAN RIGHTS Adopted and proclaimed by United Nations General Assembly resolution 217 A (III) of 10 December 1948 Everyone has the right to education. Education shall be free, at least in the elementary and fundamental stages. Social Determinants of Health Sustainable Development Goals http://www.un.org/sustainabledevelopment /sustainable-development-goals/ In 2015, UN countries adopted a set of goals to end poverty, protect the planet, and ensure prosperity for all development agenda. Each goal has specific targets to be achieved over the next 15 years. Leading causes of disease burden 15 years and older Males HIV/AIDS Ischemic heart disease Cerebrovascular disease Depression Road traffic accidents Tuberculosis Alcohol use Violence Females Depression HIV/AIDS Ischemic heart disease Cerebrovascular disease Cataracts Adult hearing loss COPD Tuberculosis The World Health Report 2003 DALY = days of life years lost 4
Global Burden of Diabetes 189 million people worldwide have diabetes This will double by 2025 80% of new cases will occur in developing countries The economic costs will be staggering as DM occurs at younger ages, requires lifelong care associated with major complications Source: www.who.int/mediacentre/factsheets/fs312/en What contributes to the increase in diabetes? Cultural beliefs Fat=strong, wealthy Thin=weak, poor Globalization Diets with more sugar, fat, and calories Urbanization Less physical activity Changing lifestyles Increased availability of food Paradigm shifts Physician control > Patient control Acute care Episodic Physician Hospital based > Prevention > Continuous care > Physicians & nurses > Community & family based (WHO, 2002) New York Times, December, 2003 Provide Human Resources for Health See http://www.who.int/hrh/en/ Distribution of HC workers 5
Examples of nurse-led efforts Tonga established NCD training for primary care nurses to work in 14 national health centers In Thailand, nurses and midwifes are 70% of the national health workforce Nurses have a major role in screening for risk factors, registering patients into health centers, and diagnosing more 32 conditions earlier. What do you need to be a global citizen for health? Advocate for health in all areas of your life Keep informed about the global situation Be aware of how politics, economics and social values affect health Discourage the use of unsustainable use of the environment Advocate for peace, not war DECLARATION OF ALMA ATA WHO-UNICEF 1978 Health, which is a sustainable state of complete physical, mental and social well-being and not just the absence of disease... is a fundamental human right... Can we provide sustainable health? Why save infants to let them die of starvation as children? To be killed in conflict? 6