Global Health Communicable Diseases and Risk Factors

 Health problems, issues, and concerns that  Infectious diseases are communicable
transcend national boundaries, which may be  But.. so are elements of western lifestyles:
influenced by circumstances or experiences in o Dietary changes
other countries, and which are best addressed by o Lack of physical activity
cooperative actions and solutions (Institute Of o Reliance on automobile transport
Medicine, USA- 1997) o Smoking
o Examples include infectious diseases o Stress
(SARS, TB, avian influenza, malaria,) o Urbanisation
non infectious diseases (diabetes
mellitus, tobacco related diseases) and Key Concepts in Relation to Global Health
other health risks (global warming, 1. The determinants of health
conflict, nuclear power) etc.  Genetic make up
Global Health Issues  Age
 Refers to any health issue that concerns many  Gender
countries or is affected by transnational  Lifestyle choices
determinants such as:  Community influences
o Climate change  Income status
o Urbanisation
 Geographical location
o Malnutrition – under or over nutrition
 Culture
 Or solutions such as:
 Environmental factors
o Polio eradication
 Work conditions
o Containment of avian influenza
o Approaches to tobacco control  Education
 Access to health services
Historical Development of Term  Plus more general factors such as:
 Public Health: Developed as a discipline in the o Political Stability
mid 19th century in UK, Europe and US. o Civil Rights
Concerned more with national issues. o Environmental Degradation
o Data and evidence to support action, o Population Growth/pressure
focus on populations, social justice and o Urbanization
equity, emphasis on preventions vs cure. o Development of Country Residence
 International Health: Developed during past  Multi-sectoral Dimension of the
decades, came to be more concerned with Determinants of Health
o the diseases (e.g. tropical diseases) and o Malnutrition
o conditions (war, natural disasters) of  more susceptible to disease
middle and low income countries. and less likely to recover
o Tended to denote a one way flow of o Cooking with wood and coal
‘good ideas’.  lung diseases
 Global Health: More recent in its origin and o Poor sanitation
emphasises a greater scope of health problems  more intestinal infections
and solutions o Poor life circumstances
o that transcend national boundaries  commercial sex work and
o requiring greater inter-disciplinary STIs, HIV/AIDS
approach o Advertising tobacco and alcohol
 addiction and related
Disciplines involved in Global Health diseases
 Social sciences o Rapid growth in vehicular traffic
often with untrained drivers on
 Behavioural sciences
unsafe roads
 Law  road traffic accidents
 Economics 2. The measurement of health status
 History  Measurement of Health Status I
 Engineering o Cause of death
 Biomedical sciences  Obtained from death
 Environmental sciences certification but limited
 because of incomplete
coverage
o Life expectancy at birth
 The average number of
years a new-borns baby
could expect to live if
current trends in mortality
were to continue for the rest
of the new-born's life
o Maternal mortality rate
 The number of women who
die as a result of childbirth
and pregnancy related
complications per 100,000
live births in a given year
 Measurement of Health Status II
o Infant mortality rate
 The number of deaths in
infants under 1 year per
1,000 live births for a given
year
o Neonatal mortality rate
 The number of deaths
among infants under 28
days in a given year per
1,000 live births in that year
o Child mortality rate
 The probability that a new-
born will die before
reaching the age of five
years, expressed as a
number per 1,000 live births
3. The importance of culture to health
 Culture:
o The predominating attitudes and
behaviour that characterise the
functioning of a group or
organisation
 Traditional health systems
 Beliefs about health
o e.g. epilepsy – a disorder of
neuronal depolarisation vs a form of
possession/bad omen sent by the
ancestors
o Psychoses – ancestral problems
requiring the assistance of
traditional healer/spiritualist
 Influence of culture of health
o Diversity, marginalisation and
vulnerability due to race, gender and
ethnicity
4. The global burden of disease
 Predicted changes in burden of disease from
communicable to non-communicable
between 2004 and 2030
o Reductions in malaria, diarrhoeal
diseases, TB and HIV/AIDS
o Increase in cardiovascular deaths,
COPD, road traffic accidents and
diabetes mellitus
 Ageing populations in middle and low
income countries
 Socioeconomic growth with increased car
ownership
 Based on a ‘business as usual’ assumption
5. The key risk factors for various health problems
 Tobacco use
o related to the top ten causes of
mortality world wide
 Poor sanitation and access to clean water
o related to high levels of
diarrhoeal/water borne diseases
o Diarrhoea contributes to about 1·5
million child deaths and around 88%
of deaths from diarrhoea
 Low condom use
o HIV/AIDS, sexually transmitted
infections
 Malnutrition
o Under-nutrition (increased
susceptibility to infectious diseases)
and over-nutrition responsible for
cardiovascular diseases, cancers,
obesity etc.
6. The organisation and function of health systems
 A health system
o comprises all organizations,
institutions and resources devoted to
producing actions whose primary
intent is to improve health (WHO)
 Most national health systems consist:
o public, private,
o traditional and informal sectors:
Health Patterns
 Genetic Factors
 Environmental Factors
 Lifestyle Factors
 Communicable Diseases vs. Non-communicable
Diseases
Health Patterns in Resource Poor Countries
 INFECTIOUS/COMMUNICABLE DISEASES
PREVALENT:
o VACCINE PREVENTABLE
DISEASES, e.g. measles
o ACUTE RESPIRATORY
INFECTIONS (ARI)
o DIARRHOEAL DISEASES (cholera)
o MALARIA
o TB
 o HEPATITIS
o HIV/AIDS
 Plus:
o MALNUTRITION RELATED
CONDITIONS:
 CALORIE DEFICIENCIES
 MICRO-NUTRIENT
DEFICIENCIES
 TRAUMA/ACCIDENTS
 Many of these diseases are treatable
Health Patterns in Resource Rich Countries
 NON-COMMUNICABLE DISEASES
PREVALENT:
o Causes of death (all ages):
 40% Circulatory diseases, e.g.
heart disease, strokes, etc.
 25% Cancers
 16% Respiratory diseases
 5% Injuries and Poisonings
 0.6% Infectious diseases
 Premature mortality (<65):
o 25% Circulatory diseases
o 33% Cancers
o 16% Injuries (RTAs/Suicides) and
Poisonings
o 1% Infectious diseases
 Many of these deaths are related to lifestyle
factors and are preventable
 Lifestyle factors affecting physical and mental
health:
o Smoking – one third of cancer deaths
related to smoking
o Drinking
o Healthy eating/nutrition
o Physical activity
o Substance abuse
Cholera: the Disease
 Entry: oral
 Colonization: small intestine
 Symptoms: nausea, diarrhea, muscle cramps,
shock
 Infants with cholera
John Snow and the Pump Handle
 John Snow is credited by many with developing
the modern field of epidemiology
 John Snow and cholera in 1854 London
http://www.ph.ucla.edu/epi/snow.html
London in the 1850’s
 Germ theory of disease not widely accepted
 People lived in very crowded conditions with
water and privies in yard (NY 1864: 900 people
in 2 buildings 180’ deep x 5 stories
o – 1 pump a block away, privy in yard)
John Snow’s Observations
 People with cholera developed immediate
digestive problems: cramps, vomiting, diarrhea
 Face, feet, hands shriveled and turned blue; died
in less than a day
 Probably spread by vomiting and diarrhea
 Comparison of pump location with cholera
deaths, first 3 days of epidemic in 1854
Cholera Epidemiology
 Of 83 people, only 10 lived closer to a different
pump than Broad Street
 Of these 10, 5 preferred taste of Broad Street
water and 3 were children who went to nearby
school
 Snow convinced neighborhood council to let
him remove handle from water pump on Broad
Street
 The new cases declined dramatically
 Many on council not convinced by his evidence
Snow Index Case
 Index case is first person to become ill
 40 Broad Street – husband and infant child
became ill
 Wife soaked diapers in pail and emptied pail into
cistern next to pump
The Great Experiment
 Two water companies supplied central London
 Lambeth Company: water intake upstream of
London sewage outfall into Thames
 Southwark & Vauxhall Company: water intake
downstream of sewage outfall
 Customers mixed in same neighborhood
 Snow went door to door asking which water
company served home and compared locations
with cholera data
Cholera in the 1990s
 Epidemic in Peru beginning 1991
 From 1991-1994
o Cases 1,041,422
o Deaths 9,642 (0.9%)
 Originated at coast, spread inland
Why Cholera Re-emerged
 Deteriorating sanitary facilities as larger
population moves into shanty towns
 Trujullo, Peru – fear of cancer from chlorination
so water untreated
 Use of wastewater on crops
 Africa – civil wars and drought caused
migrations into camps
 Simultaneous appearance along whole coast of
Peru
 Traveled in ship ballast?
 Traveled in plankton from Asia?
 Always present in local zooplankton (copepods)
but dormant until triggered by ???
o Copepod Carrying Vibrio cholerae