Lecture 3 Slides: Global Health Overview

GlobalHealth Lab class 3 GlobalHealth OverviewSpring 2013 q shgi ( a gkas

Readings assigned for todayBerwick, Donald M. 2002. “A User’s Manual for the IOM’s ‘Quality Chasm’Report.” Health Affairs, 21(3): 80-90.The IWG Taskforce on Sustainable Business Models. Circa 2012. “FosteringHealthy Businesses: Delivering Innovations in Maternal and Child Health.”Innovation Working Group report. (41 pages.)OptionalWalraven, Gijs, Semira Manaseki-Holland, Abid Hussain, and John B. Tomaro.2009. “Improving Maternal and Child Health In Difficult Environments: TheCase for ‘Cross-Border’ Health Care.” PloS Medicine 6 (1), January: 17-21.[web]International Initiative for Impact Evaluation. 2010. “Access to health: How toreduce child and maternal mortality?” Enduring Questions Brief 14, June. (3pages.)Nieburg, Phillip. 2012. “Improving Maternal Mortality and Other Aspects ofWomen’s Health.” Report of the Center for Strategic and International StudiesGlobal Health Policy Center. October. (21 pages.) [web]2

Plan for today Quick notes- Meet Elli Suzuki- Deborah Hsieh Global health overview- Core facts- Maternal health challenges Coming up:-Draft workplan FridayMentor Meetings: intro/kickoff this week; workplans nextWedUp tomorrowTomorrow lunch sessionVisa, shots, destination: all clear?Ticket purchase instructions to come- Our first case on Thursday- No class next Tuesday

what is global health?

Global health takes on health problems that cross national boundaries.Traditionally the focus has been on those health issues that impose thegreatest burden in resource-limited settings. This has shifted. To addressthe challenges, the field now encompasses a broad range of disciplines.Proponents have argued that it should account for “cultural identities,political organizations, transnational corporations, civil societymovements and academic institutions” (Frenk 2010), along withpopulations.Recent reframings of global health place interdependence at the center. Ifthe origins and effects of many of today’s biggest health problems crossnational borders, then global health should be less concerned withgeographical location or stage of development, and more concerned withthe ways in which health issues are interconnected. This new definition ofglobal health thus aligns with calls for multilateral collaboration andlearning that flow both ways across state, sector, and socioeconomicboundaries, and for recognizing “the many contributions of bothresource-rich and resource-scarce nations” (Fried et al, 10). In fact, someargue that global health is (or should be) “collaborative trans-nationalresearch and action for promoting health for all” (Beaglehole & Bonita,10). Others note that acknowledging interrelationships requires equity tofactor into solutions (Frenk, 10; Piot & Garnett, 10).Source: Sastry 201122-Oct-135

Themes that we may discuss; return/set aside forlater, too—these are big things!- Human rights: is health a right? How then todeliver?- Democracy, governance, accountability—are thesedeeper-level challenges to address- Self-interest angle: XDR TB can move anywhere,fast- “smart diplomacy”- Mention Alma-Aty declaration22-Oct-136

L ()al qa ltq ikq i ikq What are the leading causes of death in the developed world? In thedeveloping world?What is the life expectancy at birth for someone born in the US? Japan?Mali? South Africa? India?What diseases or health conditions impose the biggest burden in thedeveloped world? In low-income countries?What are the biggest health risks for people in each setting?What is your chance of dying in childbirth in Boston? In Burundi? In Austria?How much money flows per year to developing countries as direct assistancefor health?How many doctors per 1000 people are there in Massachusetts? In Malawi?How does Malawi’s gross national income per capita compare with US healthspending per capita?How much does McKinsey take in forits global health consulting?7

Map removed due to copyright restrictions.Source: World Health Statistics 2001World Health Organization (WHO).8

IMPLEMENTATION GAP

The persistence of huge healthand other disparities gave rise tothe millenium developmentgoals 0

Goals from the UN Millennium DeclarationGoal 1: Eradicate extreme hunger and povertyGoal 2: Achieve universal primary educationGoal 3: Promote gender equality and empower womenGoal 4: Reduce child mortalityGoal 5: Improve maternal healthGoal 6: Combat HIV/AIDS, malaria, and other diseasesGoal 7: Ensure environmental sustainabilityGoal 8: Develop a global partnership for developmentSee http://www.un.org/millenniumgoals/pdf/(2011 E)%20MDG%20Report%202011 Book%20LR.pdf11

WHY HAS MATERNAL HEALTHIMPROVEMENT PROVENDIFFICULT? 2

Offslide discussion on maternalhealth

Actually many of those sameissues plague other aspects ofhealth delivery globally, not justMNCH

L () l qaaltq a qyagi f q kgas InterventionImplementationARVs for PMTCTReduce HIVtransmission by 40%9% coverage of womenoverall and 50% ofwomen who testpositive in a clinic aregiven ARVs for PMTCTITNs for MalariaPreventionOnly 24% of children inendemic areas sleepunder netsReduce infant mortalityby 23% 5Source: GHD Project, Harvard University

2008 data, courtesy of the Bill & Melinda Gates Foundation. Used with permission.Source: Venkayya, Rajiv (Gates Foundation) 2009 Ensuring health technologies reach those who need them most,Presentation http://csis.org/files/attachments/090330 venkayya.pdfFor audio and video: h-delivery-systems16

V q aevgaya h ) a Oa hqs Copyright Sasi Group (University of Sheffield) and Mark Newman(University of Michigan). Available under a Creative Commons NC license. 7w(g m ppago(gg

BURDEN OF DISEASE 8

Years of Life Lost Due to Premature Mortality by Broad Causeand Country-income Group (2004)23410310%22%21%69%15%558%28%77%50%Middle incomeHigh incomeLow incomeYears of life (YLL) per 1000 populationCommunicable diseases, maternal andperinatal conditions and nutritionaldeficienciesNoncommunicable conditionsInjuriesImage by MIT OpenCourseWare.Source data: World Health Organization. "World Health Statistics 2010." WHO Press, 2011, pg. .html19

Age distribution of burden ofdisease by country income group,2004 5%4%13%31%35%48%56%High-income Countries8%Low-and Middle-income Countries60 years and over5-14 years15-59 years0-4 yearsImage by MIT OpenCourseWare.Source data: World Health Organization. "The Global Burden of Disease, 2004 Update." WHO Press, 2004, pg. 42.http://www.who.int/healthinfo/global burden disease/2004 report update/en/index.html20

Births attended by skilled healthpersonnelLow incomeMiddle incomeMeasles immunization coverageamong 1-year oldsLow incomeMiddle tage g) egkg qffaga as, 2000e2008 anRuralUrbanUrban-rural differences in the coverage of skilled attendant at birth andmeasles immunization in low-income and middle-income countries2000-2008.WHO, 2010WORLD HEALTH ST ATISTICS Image by MIT OpenCourseWare.Source data: World Health Organization. "World Health Statistics 2010." WHO Press, 2011, pg. 142.2

Quantifying the Burden of Disease frommortality and morbidity Text explaining calculation of Disability-Adjusted Life Year (DALY), Years of Life Lost(YLL), and Years Lost due to Disability (YLD) removed due to copyright restrictions.Source: World Health Organization."Metrics: Disability-Adjusted Life Year (DALY)."22

Re DALYs:Global Burden of Disease, Injuries and RiskFactors 2010 SurveyThe Global burden of disease, injuries and riskfactors study 2010 is revising the disabilityweights used for DALY calculations and iscollecting information through communitysurveys and an internet survey. Click on the linkabove to participate in the internet survey.2

Leading Causes of Mortality and Burdenof Disease (world, 200 ) MortalityDALYs1Ischaemic heart disease12.2Lower respiratory infections6.22Cerebrovascular disease9.7Diarrhoeal diseases4.83Lower respiratory infections7.1Depression4.34COPD5.1Ischaemic heart disease4.15Diarrhoeal diseases3.7HIV/AIDS3.86HIV/AIDS3.5Cerebrovascular disease3.17Tuberculosis2.5Prematurity, low birth weight2.98Trachea, bronchus, lung cancers2.3Birth asphyxia, birth trauma2.79Road traffic accidents2.2Road traffic accidents2.710Prematurity, low birth weight2.0Neonatal infections and l burde n dise ase/GBD2004ReportFigures.ppt 2

vag aphq( s yagsks h Courtesy of Karen R. Siegel et al. Used with permission.Global Health Action 2011, 4: 6339 - DOI: 10.3402/gha.v4i0.6339. Creative Commons BY-NC.Misalignment between perceptions and actual global burden of disease: evidence from the USpopulation, Siegel et al, Global Health Action 2011, 4: 633925

HEALTHCARE IS MISSING NEEDEDINPUTS26

O( h(gs pag pags( In Massachusetts? 4.69 (nonfederal) per 1,000 In Malawi? 0.02http://www.census.gov/compen dia/statab/20 11/ra nks/rank18.html 27Part II. Global health indicator tables and footnotes

Infographic removed due to copyright restrictions.Source: EuroRSCG Amsterdam, Netherlands."Doctors of the World, Netherlands: Perspective."28

IS IT ABOUT ECONOMIC INPUTS?2

Public Health Spendingwww.worldmapper.org Copyright Sasi Group (University of Sheffield) and Mark Newman(University of Michigan). Available under a Creative Commons NC license.

Health Expenditure Per Capita(PPP; International ), 2008 World map depicting health expenditure per capita removed due to copyright restrictions.Source: Kaiser Family Foundation. "Health Expenditure Per Capita (PPP; International )."

Total Health Expenditure per CapitaHealth Spending Per CapitaTotal Health Expenditure Per Capita and GDP Per Capita,US and Selected Countries, 2008 8,000 7,500 7,000 6,500 6,000 5,500 5,000 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 0 ain 30,000NorwaySwitzerlandBelgium CanadaNetherlandsU.K.Sweden 35,000 40,000 45,000 50,000 55,000 60,000 65,000GDP Per CapitaImage by MIT OpenCourseWare.Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECDHealth Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011).Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands,Norway and Switzerland, are OECD estimates. 2

Table 1: Health Status of the United States and Rank among the 29 Other OECD Member Countriesremoved due to copyright restrictions.Source: Schroeder, Steven A. "We Can Do Better — Improving the Health of the American People."New England Journal of Medicine (Sept. 20, 2007). http://www.nejm.org/doi/full/10. 1056/NEJMsa073350

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Comparative health ries.htmlOctober 22, 2012 Jason Kane PBS NewshourHealth Costs: How the U.S. Compares With Other 6/06/business/metricshealth-care-outlier.htmlJune 5, 2010 New York TimesMetrics: Health Spending vs. Resultshttp://www.cbsnews.com/8301-505103 162-57522437/issue-briefhealth-care/October 1, 2012 Jake Miller CBS News/Issue brief: Health care 5

Now go watch this!Reducing child mortality – a moraland environmental[15 minutes run time] September 27, 2010Many countries are making goodprogress towards MDG4 and it’s timeto stop talking about Sub-SaharanAfrica as one place.So, it’s not all bad news—andRosling makes statsand data g-child-mortality-a-moral-an d-environme ntal-imperative/ 6

FUNDING FLOWS: A LOOK AT IHMEDATA ON DEVELOPMENTASSISTANCE FOR HEALTH (DAH) 7

Institute for Health Metrics and Evaluation (IHME). Financing Global Health 2011: Continuedgrowth as MDG deadline approaches. Seattle, WA: IHME, University of Washington, 2012.Available at h-2011-continued-growth-mdg-deadline-appro/. Used with permission.

DAH bychannel ofassistance,1990 to2011 8 Institute for Health Metrics and Evaluation (IHME). Financing Global Health 2011: Continuedgrowth as MDG deadline approaches. Seattle, WA: IHME, University of Washington, 2012.Available at h-2011-continued-growth-mdg-deadline-appro/. Used with permission. 8