N309 Exam 3 Questions

• Global deaths are related to over or under consuming which type of foods?

  Over or under consuming specific foods like sodium, lack of whole grains, and fruit.
• What are the four risk behaviors for NCDs, and which accounts for the most DALYs?

  Risk factors include all dietary risks (high in sodium), tobacco smoking, alcohol use, low physical activity. All of these account for the most DALYs.
• Is inactivity more prevalent in higher or lower income countries?

  More prevalent in higher-income countries.
• Is there an agreement about what constitutes healthy/safe drinking across countries?


  It varies by countries

  UK: men and women should stick to no more than 14 units of alcohol per week (equivalent of 5 to 6 pints of beer or 6 to 7 of wine per week)

  Australia: healthy men and women should not drink more than 2 standard drinks on any day; a standard drink contains 10 g of pure alcohol

  US: moderate alcohol consumption is defined of having 1 drink per day for women, 2 drink per day for men
• *What is the top cause of tobacco-related deaths?

  Top cause of tobacco-related deaths is lung cancer (70%)

  Other: 42% are respiratory, 10% are from CVD
• *What is/are key prevention strategies shared by the following: tobacco use, abuse of alcohol

  Prevention strategies shared are tax increases on products and banning advertising/promotion
• *How does smoking tobacco on devices (hookah, shisha, etc) compare to smoking cigarettes?

  Smoking tobacco on a hookah and shisha are perceived as less harmful compared to smoking, but it is actually substantially more harmful to health.
• Hookah vs. Cigarettes


  Smoking hookah is perceived less harmful but is substantially more harmful than cigarettes.
• *What positive impacts did the tobacco intervention in Poland have on various key health indicators?

  → 10,000 fewer deaths each year

  Samantha said: a reduction in deaths from lung cancer among men aged 20-44, a reduction in deaths from cardiovascular disease, and a reduction in low body/birth weight
• What are the key concepts in the health promotion theories, and how these be used in influencing behavior change?

  KEY IDEA: communication promotes social change; success depends on the use of opinion leaders which makes it easier to fit with culture
• *What are emergency nutrition relief, desertification, hidden hunger, and food insecurity and their contributing factors?

  Emergency nutrition relief: Providing food in nutritional global crises

  Desertification: Turning fertile land into a desert

  Hidden hunger: Subclinical nutrient deficiencies such as iron, folic acid and vitamin A but does not have overt clinical signs of undernutrition

  Food insecurity: People do not have adequate physical, social, or economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life

  Contributing factors: political (war and conflict), environment (droughts and fragile land along with natural disasters), economic (poverty), family (feeding and care practices)
• *What are the following: low birth weight, underweight, stunting and wasting and what types of undernutrition (acute, chronic) are associated with the latter?

  Low birth weight: birth weight being less than 2500 grams or 5 lbs, 8 oz

  Underweight: low weight for their age → z-score -2

  Stunting (chronic): height for age z-score -2

  Wasting (acute): weight for age z score -2
• *What percentages of children are underweight, stunted, or died of causes related to poor nutrition?

  14% of children <5 are underweight

  22% are stunted (chronic undernutrition)

  45% of deaths of young children related to poor nutrition

  Poor nutrition deals with child wasting, child underweight, vitamin A deficiency, child stunting, non-exclusive breastfeeding
• *What 3 ways to prevent early nutritional risk?

  Through breastfeeding, appropriate complementary foods, and micronutrient-rich foods (such as vitamin A)
• *What are effects of deficiencies in the following on the health of mothers and children: vitamin A, vitamin D, iodine, and iron? How does Vit A affect the immune system?

  Vit A: effect on the immune system (innate: compromise in skin and mucosa barrier, reduction in numbers and killing activity of white blood cells) (adaptive: reduction in growth and differentiation of B cells that depend on Vit A metabolites so less antibody production, reduction of T cells)

  Vit D: skeletal disorders (rickets), emerging functions in many diseases

  Iodine: mental impairment (children and infants), hypothyroidism and goiters, stillbirth, birth disorder and defect

  Iron: causes anemia
• What is a common measure weight status in adults and how are overweight and obesity defined? In what area of the world are there differing recommended definitions of obesity?

  BMI: body mass index; measures weight in kg divided by height in meters square (kg/m2)

  Overweight = BMI >/ 25.0

  Obese = BMI >/ 30.0

  Middle East and North Africa, Central America, Island Nations in Pacific and Caribbean
• *What was a key nutritional deficiency in China? What was the intervention? (Consider the material in Chapter 9, 243-244).

  The key nutritional deficiency in China was iodine deficiency. The intervention was the launch of the National Iodine Deficiency Disorders Elimination Program which helped the population be aware of the risk of iodine deficiency. Packaging was designed to help consumers easily recognize iodized salt along with the ban on non-iodized salt
• *Which are the key UN agencies that focus on health or health-related problems and what is their focus?

  WHO (World Health Organization): "providing leadership on global health matters"

  UNICEF (UN Children's Fund): "overcome poverty, violence, disease... in a child's path"

  WFP (World Food Programme): "world's largest humanitarian agency fighting hunger worldwide"

  Programs on HIV/AIDS UNAIDS: global surveillance/advocate concerning HIV/AIDS
• *What are aspects of NGOs to look at to evaluate and understand their work?

  What is their mission and values?

  What services do they provide?

  How are they financed?

  Use funds shared (annual report)?

  Do they work in partnership with those in need?

  Who their workers are?

  Criticism?
• What were concerns about the role and effectiveness of NGOs in Haiti one year after the Earthquake?


  -Very weak government that is unable to deliver appropriate services to the population

  -Did not work effectively with the government because NGOs had money but were arrogant and tried to do whatever they wanted because of the weakness of the state

  -NGOs exercise more political clout than the government
• *What were features of the program to prevent river blindness shown in the video?

  River blindness is caused by a tiny black fly.

  Free medication called ivermectin

  Individual communities distribute by themselves

  People would use dance and music for cultural reasons (used to ward of demons)
• *What are complex humanitarian emergencies (CHEs)?


  A situation affecting large civilian populations which usually involves... war or civil strife, food shortages, and population displacements, resulting in significant excess mortality.
• *Be able to determine the difference between a refugee, an internally displaced person and an asylee, and implications for health.


  Refugee:Person outside of own country of nationality; fear of persecution based on race, religion, nationality, membership in a certain social group, political opinionInternally displaced person:Someone forced to flee their home because of religious or political persecution or war, but they have not crossed an international border and remain in their own countryAsylee:A person who meets the definition of refugee but traveled on their own without immigration statusHealth implications:malnutrition from food shortages, communicable diseases (diarrheal infections; measles, esp in malnourished children), violence in camps and intimate partners, destruction of health facilities, lack of shelter and clean water for migrating people
• *Which group has the greatest risk of mortality in CHEs: refugees or internally displaced people?

  Refugees
• *Which has the greater effect on health:natural disasters or CHE's?

  Complex Humanitarian Emergencies (CHEs)
• *Identify key agencies responding to CHEs and who they serve.

  UNHCR (UN High Commissioner for Refugees) and other UN agencies

  International Federation of Red Cross/Red Crescent (neutral care of civilians)

  Doctors without Borders (natural care of those injured or in need)

  International Rescue Committee (helps people in humanitarian crises)
• *What does a "Health in All Policies" approach mean?

  Require all departments/ministries to review the health impacts of any new policies: "health impact assessments"
• How percentage of global disease burden is related to household air pollution, ambient air pollution, and unsafe water/sanitation?


  22% of deaths globally are related to environmental exposures.

  Indoor air pollution (e.g. biomass fuels)-4.3% (6% in low/middle income countries)

  Ambient air pollution (usually urban)-4.2%

  Unimproved water and sanitation-0.9%
• What % of the world's population has improved sanitation and what % has improved water? What are diseases that related to poor sanitation?

  Only 68% of people in the world have access to (basic) improved sanitation and 91% of the world's population has access to improved water
• · *What are key features of how cholera it makes you sick and how it is treated?

  Cholera is a waterborne infection (pathogen is in water) and it causes large fluid loss from a bacterial diarrhea; it is treated via vaccine which gives short term immunity; could also prevent if you avoid contact with unclean water (no swimming), also filtering/boiling water (since it is a water based pathogen)
• *Compare improving sanitation only or water only: which has the greatest impact in reducing morbidity due to diarrhea?

  The lowest reductions in diarrhea morbidity comes from investments in water sanitation only, while the largest reductions in diarrhea morbidity comes from investments in sanitation only
• · *What types of fuels and stoves increase indoor air pollution; What types of fuels and stoves that can decrease indoor air pollution?

  Fuels and stoves that increase air pollution: Solid fuels (fossil/coal and biomass fuels such as dung, wood, and crop/logging waste) for cooking and heating (almost ½ of people globally do this), pollution from incomplete combustion of fossil and biomass fuels (breathe in "particulate matter"). Poorly vented stoves (poorer people tend to use open, unvented stoves (unvented to the outside))

  Fuels and stoves that decrease air pollution: Using less polluting but more costly fuels such as kerosene-a liquid fuel or gas, Using vented stoves (especially kerosene and gas stoves;efficient biomass stoves), could also use wood as fuel
• · *What populations and what areas are most vulnerable to outdoor (ambient) air pollution, and where in the world is outdoor air pollution the greatest?

  Those with conditions such as asthma and younger and older people are most vulnerable to outdoor (ambient) air pollution, also south asia (also has the greatest air pollution in the world I think) and east asia are most vulnerable.

  2/3 of global burden of disease from outdoor air pollution comes from Asian countries but Eastern Europe also has air pollution problems
• *What are the two types of disasters caused by humans, and what was one the largest disasters caused (by neglect, etc.) by humans?

  The two types of disasters caused by humans are intentional disasters, such as terrorism, and unintentional (caused by neglect/error). One of the largest disasters caused by neglect/error from humans is the incident that occurred in Bhopal, India in 1984 where methyl isocyanate gas was exposed to the environment after an accident at a union carbide plant. This would lead to 500,000 people being exposed and 2,500 people dying.
• What are health statistics related to disasters and how are these calculated?

  Some health statistics related to disasters are Case Fatality Rate, which describes the number of deaths from a specific disease, like cholera, over a certain period of time (reported as deaths per 100 episodes of the disease)

  Also Attack Rate (like prevalence) which is calculated by the proportion of a population who become infected during a certain period of time times 100

  Ex: In a camp with 3000 people, 1000 got cholera in one week and 30 died. How is the attack rate calculated?? —> 1000/3000 x 100=33.33
• Be able to determine the

  bestcost-effective approaches/solutions for disasters.With cost effective approaches think about the price associated with the good, one example is whether search and rescue teams should be sent in from out of the country. Probably not, likely because there are many issues to deal with before the rescue team is sent in (legal stuff and costs) and by then it would be too late to help people.

  Another example is field hospitals vs durable buildings for care or tents vs building materials for home, and for each the most cost effective answer is the one that will last you longer and is more stable; the durable buildings for care and building materials for home.
• *Be able to identify selected ethical principles for responses to disasters.


  Three of 10 IFRC Ethical Principles: We shall respect culture and custom, ways shall be found to involve beneficiaries in the management of relief aid, in...publicity...we shall recognize disaster victims as dignified humans, not helpless objects
• *Differentiate among: accidents, intentional, and unintentional injuries. Be able to apply to examples.

  -Accidentsuggests nothing can be done to prevent injuries that are unintended (“just bad luck”)-Injury: unintentional or intentional damage to the body from acute exposure to thermal, mechanical, electrical, or chemical energy or absence of sich essentials as heat or oxygen-Unintentional:injuries for which there is no evidence of predetermined intent-Intentional: purposely inflicted physical trauma
• *What are 3 tools to prevent unintentional injuries (including the 3 E's)

  Surveillance systemsfor information on injury numbers and patterns (where, when, who, how)Interventionsdesigned for individual communitiesHaddon's matrixof environment, agent and host3 E’s:Engineering, Education, Enforcement (fit into Haddon Matrix)
• *What is a type of injury that is not included in death certificates?

  Medical errors causing deaths