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• *What is "jugaad" and what is its significance in the context of global health?

  Two messages in this video on frugal innovation/jugaad: related to "more for more" and the benefits of frugal innovation for the Global North and South

  jugaad= a solution created without resources, closing gap between global south and north, cheap creative health problems to help developing countries

  frugal innovation= going into the western market

  global north; running out of resources, and people can no longer afford
• *What are the ideal characteristics of a new health product for global health? Be able to apply this to an example.

  Affordable (in terms of low-income countries)

  Easy to use & convenient (e.g., few doses)

  Safe (low risks)

  Non-invasive (in a layperson's sense) (in body)

  Requires little skill or training to use

  Quick results/interpretation

  Easy to transport, storage

  Heat stable (don't need refrigeration)

  Effective

  example of innovation: using diluted vinegar to swab cervix of uterus for early detection of cancer cells
• What are barriers to development of new technologies for global health?

  "for-profit" entities the major developers of new technologies

  Major profits derived from drugs sold in high income countries

  Only 10% of expenditures for research/development related to diseases of developing world
• What are the four types of technology that can answer global health needs?

  1. Biomedical technologies, e.g., HAART for HIV

  2. Education & motivation, e.g., motivational interviewing

  3. Food & agricultural technologies, e.g.,Plumpy Nut

  4 Public health innovations, e.g., "talking" drones with health messages in China
• What are some of the factors that explain the differences in health of people in Kerala relative to the rest of India?

  High emphasis on education for all

  Primary healthcare services for all

  Focus on nutrition, family planning, immunizations

  Elevated status of women
• *What are key approaches/actions used that led to the eradication of Guinea worm (dracunculiasis) in West Africa?

  filtering and treating water to get rid of copepods, started drilling well to reach un contaminated water, health education (why copepods are there), led by jimmy carter and his foundation
• *Health system factors that can affect if an available technology reaches people.

  functional health care system

  trained workers

  Cost

  Equipment maintenance
• *What is cost effectiveness and how can it be applied in deciding on health expenditures?

  Cost Effectiveness is cost relative to amount of health purchased with that investment

  (1) compare different treatments for a disease, (cheap and less effective malaria drug vs more expensive and effective one)

  (2) compare different goals- treat diabetes vs reduce malaria

  Top 4 "Cost Effective Options" for Global Health in the recent Copenhagen Consensus were:

  1. Micronutrient interventions to fight hunger and improve education

  2. Malaria combination treatment

  3. Childhood immunization

  4. Deworming school kids
• *What do GDP and GINI measure? How do you interpret the GINI?


  Gross Domestic Product (GDP) = Total amount of goods and services produced within a country by its own and foreign corporations during a specified period of time, includes consumer spending, investment, govt spending, exports

  GINI = An index of income inequality.

  0.0 represents perfect equality of income within a country, and 1.0 represents perfect inequality.
• What groups are most likely to face inequities in access to care or in health status?


  *Less educated (underutilize health care)

  *Women (discrimination)

  *Minorities, and indigenous people, eg. (poorer quality, disregard for cultural aspects)

  *Rural: lack of transport to urban areas

  *Sexual minorities; disability groups

  *poor people (cost of service too high)

  *Vulnerable groups along the age spectrum (income and health)?, young (low income= low health) and old (commiting more crime in Japan

  
  

  Scandinavian countries have low inequities and good health;

  Some countries have wide variations in health:

  -Low & middle income: Why? wide variation in income across populations

  -High income countries: Why? ethnic minorities or indigenous populations (dont benefit equally)

  -corruption of countries plays a part in health inequalities
• What are some of the reasons that some countries are poor yet have good health, and others are wealthier and yet have poor health?

  Examples of high income countries that spend relatively lots on health with high life expectancy: Germany, and Iceland

  Examples of low income a countries spending relatively little on health but with relatively higher life expectancy: Thailand, Bangladesh
• *Four Steps in a Technology Improving Health:

  Technology development

  Tech Passes Safety, Effectiveness Tests

  Reaching people: Systems for Delivery

  People's choices to Accept or Reject
• *What are public, private, and out-of-pocket expenditures for health, and how they relate to affect equity?

  1. Public expenditures = expenditure by any level of government or government agency

  2. Private expenditures = expenditure by other entity than from government, insurance, charitable orgs, (NGOs)

  3. Out-of-Pocket expenditure = by people not reimbursed by an insurance program or public sources
• *What do equity and health disparities mean?

  Disparity means: "differences among populations in measures of health and healthcare"

  fact-based differences in health

  Equity means fairness in distribution of a resource;

  Inequity means unfair differences in resources that increase disease burden
• What are examples of how education, income and health affect each other?

  What are examples of how wealth promotes health:

  1. Better nutrition

  2. better housing, eg., AC vs. open windows (malaria and other mosquito borne diseases)

  3. Access to a healthier environment

  4. Reduces financial barriers to health care

  What are some ways health affects income?

  1. Illness with high healthcare costs that may lead to poverty

  2. Illness can lead to inability to work, eg., due to malaria.

  3. Poor health of workers, decreases lifetime earnings & productivity,

  eg., anemia in rubber workers due to hookworm.

  Examples of education and wealth links:

  1. Poorer parents may be unable to afford extra costs.

  2. Poorer children may have to work instead of go to school.

  Examples of relationships between education and health:

  1. Health & education of parents (eg. HIV) affect children's health and development

  2. Children's learning & school attendance depends on health.
• What were important signs of progress made globally in education and poverty shown in the Gates Foundation quiz?

  poverty is decreasing

  more kids are in school

  18 is the median age in Africa
• Chapters 4 & 18: Health, Education Poverty, and the Economy, & Technology

  *How is extreme poverty defined in SDG 1?

  SDG#1: End poverty in all its forms (extreme poverty> $1.25)
• *What are the key concepts in the health belief model, diffusion of innovation theory, and positive deviant approach and how may these be applied into solutions to health problems in an area?

  Four important beliefs/concepts of the Health Belief Model include:

  Perceived susceptibility,

  Perceived seriousness,

  Perceived benefits,

  and Perceived Barriers

  Diffusion of innovations Theory:

  "Success" in using this theory depends on:

  use "opinion leaders"

  use of people seen as like them, "homophily", and

  promote changes that are easy, and fits with culture,

  The Positive Deviant Approach emphases local solutions:

  Find who has good health even with limited means (the positive deviant);

  Study what they do to achieve these good outcomes

  Organize local meetings to mobilize interest in solving the problem

  Work to implement local solutions of positive deviants
• *How did culture facilitate the spread of Ebola in West Africa (e.g., (Brief at the end of Chapter 7)?

  video: mistrust of authority and unwillingness to quarantine

  burial practices are most notable factor related to ebola (culture calls for family member to wash and prepare the body for burial, exposing person to high viral load)

  performing religious rites during burials that directly require touching of the body, or when distributing personal belongings of the deceased that might have ebola on it

  men- go out hunting and encounter animals that could spread the virus to human, infected early on in outbreak

  woman- are more likely to take care of sick relatives and perform burial rituals, woman cases greatly exceeds the number of male cases

  stigma and fear of disease result in harsh travel restrictions that limit exchange of physical and human resources that disease afflicted areas need.
• *What are key principles of culturally appropriate solutions to health problems? Be able to identify examples of these principles

  1. Community involvement & empowerment - eg. local advisory committee; teach skills

  2. Socioculturally-tailored techniques- eg. shape solutions to local culture, society

  3. Community evaluation and feedback in real-time- eg. keep local community engaged by sharing information on progress toward goals

  4. Utilization of local communication techniques- eg. Have "cultural brokers" who know preferred local communication methods

  5. Use both the spoken word and the local tongue- eg. Use local meaningful words and symbols

  6. Aim for sustainability & community-health autonomy- eg. Plan how change can last after you are gone.
• *What are ethnocentrism, cultural relativism, and cultural humility, and how do they affect how a person views another's culture? What is cultural trauma?


  Ethnocentrism: evaluate another culture from one's own cultural perspective; in the UK they drive on the wrong side

  Cultural relativism - evaluate another culture by that culture's standards, even if aspects are harmful

  Cultural humility is: awareness that knowing another's culture is a long, evolving process... outsider a learner

  Cultural trauma: impact on people of historical devaluation of a culture & its transmission (e.g., indigenous Australians)
• What are the 3 broad categories of health care providers in global health?

  a. Indigenous: Midwives, shamans

  b. Western biomedical: Pharmacists, Nurses,

  c. Other health system, eg., Chinese traditional medicine, Ayurvedic practitioners (India)
• *What is medical pluralism and give examples?

  What is Medical pluralism? 2 or more medical "science" systems that can co-existence

  What are 3 theories/methods of a traditional and Western medical "science" systems:

  1. Etiology (disease cause),

  2. Method of diagnosis,

  3. Methods of treatment
• *What were key ideas in the video in which the nurse discussed illness in a rural and remote context in Australia?

  Torres Strait Islanders; had to lean on cultural based medicine, using a medicine man to help cure a black hex that had caused emotional distress; to the indigenous worker it was a "cultural thing"
• How do the concepts of disease and culture-based illness differ?


  Disease in Western biomedical view: Malfunction of biological and psychophysiological processes in the body,

  Culture-based illness: Physical state/condition perceived as an illness, but may lack a biomedical cause; it often will have:

  a culturally recognized name for symptoms (i.e., evil eye)

  a spiritual or social cause

  a focus of traditional health care
• What were beliefs in rural Mauritania that supported forced feeding of girls?

  Gender roles & women's place in culture- being fat= marriageable and profitable

  Customs (birth, death, marriage, traditions)- making girls fatter at a young age so they can be married faster (child marriages), fat=beauty
• Why is culture important in global health and health care??

  Health beliefs about disease causes & seriousness

  Names of illnesses/diseases & suitable treatment

  Culture-based health behaviors & practices

  Utilization of health services

  Note: Health workers' cultural awareness of these affects their effectiveness
• Why is being aware of one's cultural identity important when thinking about how to improve the health of others?


  Cultural self-identity is: one's belief, values, and norms for behavior based on the society/group with which one identifies or participates in

  it influences the health care needed in order to adequately care for a patient

  Health beliefs about disease causes & seriousness

  Names of illnesses/diseases & suitable treatment

  Culture-based health behaviors & practices

  Utilization of health services

  Note: Health workers' cultural awareness of these affects their effectiveness
• Chapter 7. Cultural Influences on Health

  How is culture defined and what are its characteristics?

  Culture can be thought of as an inherited lens that affects how the individual perceives and understands the world

  Socially learned (not genetically transmitted)

  Shared meanings and values

  Patterns of behavior based on meanings & values

  Often exist at an unconscious level

  5. May change over time and with experiences
• *What are key strategies that can be taken to prevent infection by the malaria parasite?

  distribution of mosquito nets, draining swamps, spraying bug spray, resources were done with unicef (unicef was doing a lot of the work), government was doing anything bc of lack of resources
• *How does the malaria parasite and blood cells interact, and what are key symptoms of malaria as the body tries to destroy it?

  white blood cells in the blood attack the malaria parasite trying to destroy it

  First, the malaria parasite burrows into a liver cell to replicate before infecting the red blood cells. The malaria parasites then burrow in red blood cells. Then the malaria parasite replicates in red blood cell, causing the red blood cells to explode

  fever, pain, chills, (symptoms)
• What are the 3 broad groups of causes of death used by WHO?


  WHO Disease Groups:

  Group I: Communicable, maternal, perinatal, nutritional

  Group II: Non-communicable (usually chronic) diseases (NCD)

  Group III: injuries
• What are the key differences in causes of mortality in low- and high-income countries?


  low income (diarrheal diseases, malaria, HIV/AIDS, TB tuberculosis, stroke)

  high income (stroke, lung and tracheal cancers, chronic obstructive lung disease, alzheimer's disease)

  high income= lower mortality in group 1 and 3

  lower income= lower mortality in group 2

  WHO Disease Groups:

  Group I: Communicable, maternal, perinatal, nutritional

  Group II: Non-communicable (usually chronic) diseases (NCD)

  Group III: injuries
• *What are the leading causes of death shared in low- and high-income countries?

  lower respiratory infections, ischemic heart disease

  High blood pressure, high fasting glucose ( top common risk factor)
• *What are the demographic and the epidemiologic transitions, and what changes do they represent?

  Demographic transition (describes population over time): age shifts in populations

  Epidemiologic transition (describes changing population patterns in terms of fertility, life expectancy, mortality, and leading causes of death): shifts from communicable to non-communicable diseases
• What are key factors that can affect the shape of a country's population pyramid?

  Population pyramid: % of each age group making up the population

  econ variations, political changes, conflicts, public health and natural events
• What are DALYs and what "losses in health" are considered in DALYs versus mortality rates?


  Disability Adjusted Life Years (DALY): health lost due to particular illnesses & disabilities; measure of total burden of disease, 1 DALY= 1 yr lost to disability

  mortality rate: losses in health= death?
• *How are incidence and prevalence calculated and how are they different?

  Prevalence rate:all cases

  = Number of all ill people

  Average population or total in group

  (during a time period)

  
  

  Incidence rate: new cases

  = Number of new cases

  (Total population at risk)-(minus "old" cases)
• *Define mortality, morbidity, incidence, life expectancy, and prevalence and what each measures. Which focuses on the overall population?

  Mortality focuses on deaths

  morbidity focuses on sicknesses/diseases

  Life expectancy at birth: average number of years a newborn baby could expect to live can expect to live if current trends persist.

  prevalence refers to how widespread a disease is, total number of cases in a population at a given time
• What are the components of the epidemiological triangle related to disease?

  Host ( dependent of person disease resistance, if they get sick, still host ), environment ( includes vectors ), agent ( bacteria, virus, causes disease )