Fundamentals of Global Health (GHP 557)

Session 1: Introduction – Course overview and

a brief look at global health
August 30, 2021
Professor Rifat Atun MBBS MBA DIC FRCGP FFPH FRCP
Professor of Global Health Systems
Harvard University © Prof. Rifat Atun, Harvard University, 2015
 GHP 557: Fundamentals of Global Health

• Required course for all incoming MPH Global Health students

• Fall 1 & 2: Monday, Wednesday and Friday (9:45-11:15 am)

• In depth coverage – key evidence, trends, issues, perspectives,

and policies for global health

© Prof. Rifat Atun, Harvard University, 2021 2

 Course structure (1)

Global, social and economic determinants of

1
global health: analyzing the evolving context

Policy design, development, implementation and

2
evaluation: applying critical policy tools

Domains of response: developing strategic

3
responses to global health challenges

4 Achieving scale for impact: examining lessons

from the field

© Prof. Rifat Atun, Harvard University, 2021 3

 Course structure (2)

Global, social and economic determinants of

1
global health: analyzing evolving context

Policy design, development, implementation and

2
evaluation: applying critical policy tools

Domains of response: developing strategic

Health e

disease control
Communicable

Control of non-
communicable
3

Maternal and
childehealth
responses to global health ual challenges

Water and
sanitation
diseases
e

e
systems

Achieving scale for impact: examining

4
lessons from the field
© Prof. Rifat Atun, Harvard University, 2021 4
 GHP 557 learning journey

Achieving scale for impact:

examining lessons from the field
Learning Emphasis

Domains of response: developing

strategic responses to global health challenges

Policy design, development, implementation and

evaluation: applying critical policy tools

Global, social and economic determinants of global

health: analyzing evolving context

Knowledge Comprehension Application Analysis Synthesis Evaluation

© Prof. Rifat Atun, Harvard University, 2021 5

Block 1. Global, social and economic determinants
of global health: analyzing evolving context
Explores changes in broad context, both past and present, which
influence global health, including patterns and trends in:
(i) Demographics, in particular mortality, fertility and factors influencing
population dynamics
(ii) Epidemiology, in particular morbidity, risk behaviours, burden of disease
and disability
(iii) Political environment
(iv) Legal environment, e.g. international treaties that influence global health
(v) Economic environment
(vi) Socio-cultural milieu
(vii) Ecological environment, such as climate change, and
(viii) Technological advancements

© Prof. Rifat Atun, Harvard University, 2021 6

Block 2. Policy design, development, implementation
and evaluation: applying critical policy tools

• Explores theory, methods and evidence on approaches

used to design, develop, implement and evaluate
policies in global health

• Discusses rights-based and equity perspectives on

priority setting

© Prof. Rifat Atun, Harvard University, 2021 7

 3. Domains of response: developing strategic
responses to global health challenges
Analyses:
• Domains of responses to global health and population
challenges through health systems and strategies for
managing health risks, communicable diseases and
non-communicable diseases
• Universal health coverage as a critical platform for
developing equitable responses to global health
challenges

© Prof. Rifat Atun, Harvard University, 2021 8

4. Strategic responses at scale: lessons from the field

Examines, using case integrating studies:

• To analyse examples of global health challenges experienced

in different contexts and countries, and strategic responses
developed at scale to address them

• To critically assess challenges experienced in varied contexts

in designing, implementing and sustaining large scale
programs for communicable diseases and non-communicable
diseases and injuries

• Application of holistic thinking to link course blocks in order to

bring together theory, empirical evidence, policy and practice
© Prof. Rifat Atun, Harvard University, 2019 9
 Assessment (1): Assignments and Participation
Evaluation component Type Breakdown of Marks % of Final
Mark
Class contribution Individual Class Participation (40); quiz 10%
completion (20); Canvas discussion
(40)
Group Lab Presentation: Group Class Presentation (60%); slide deck 10%
Appraisal of literature (40%)

Assignment I: Analytic essay on Individual Essay (100%) 20%

Global Determinants of Health

Assignment III: Kenya Case Group Slide deck (20%); Report (80%) 20%
Study on priority setting

Assignment IV: Health Systems Group Report (60%); Presentation (30%); 40%
and Policy Analysis Slide deck (10%);

© Prof. Rifat Atun, Harvard University, 2021

10
 Assessment (2): Dates

Type Release date Due date

Assignment I Individual September 10 October 8, 11:59pm EST

Assignment II Group October 8 November 5, 11:59pm EST

Assignment III Group November 5 Presentation: December 8 and 10

during class
Report December 16, 1:59pm EST

© Prof. Rifat Atun, Harvard University, 2021

Lab and Teaching Fellow review sessions

• Required core element of the course – contributes to

participation grade and final mark

• Led by the course Lead Teaching Fellow Dr Che Len Reddy

• Fridays 9:45-11:15am

© Prof. Rifat Atun, Harvard University, 2021 12

 Office hours

Dr. Atun

• Mondays at 1:00-2:40 pm

• Scheduling via Canvas

Dr Reddy

• Wednesdays at 11:30am-1:00 pm

• Scheduling via Canvas

© Prof. Rifat Atun, Harvard University, 2021 13

 Operational Matters
• Familiarize yourself with Canvas, Zoom, online library resources
• Review the full syllabus and clarify anything unclear this week
• Complete profiles on Canvas
• Harvard Key email address
• Relevant background
• Reasons for pursuing studies in global health
• Career plans following completion of your MPH
• Plan how you will manage time for this class (readings, assignments,
group meetings)
Classroom ethos: classroom learning is a
critical component of GHP557
• Enables sharing of rich experiences, views and perspectives

• Collective spirit

• Respect for different views

• Rational, deliberative discourse

• No question is not worthwhile

• Preparation essential for participation

• Individual responsibility for your learning

 Zoom etiquette for guest speaker
sessions
We have very senior guest speakers contributing virtually – 3
former ministers and a current member of parliament. Please
observe the following:

• Punctuality

• Mute when not speaking

• Raise hand to speak – may wish to react during presentation

• Camera on preferably especially when speaking

Questions?

© Prof. Rifat Atun, Harvard University, 2021

 Global health: a brief review

No agreed definition with differing schools of thought and

proponents

• “An area for study, research, and practice that places a

priority on improving health and achieving equity in health for
all people worldwide” (Koplan et al.)

• Differs from public health (a particular community or

population) and international health (that has focused on low-
income and middle-income countries)

• Others disagree, arguing that global health is public health

(Fried LP et al.)
© Prof. Rifat Atun, Harvard University, 2021
 Global health viewed as public health:
key points
• Better health for all

• Commitment to health as a human right

• Global perspective on scientific inquiry and on the translation

of knowledge into practice

• A scientific approach to health promotion and disease

prevention that examines broad determinants of health

• Commitment to inter- and cross-disciplinary approaches to

solve global concerns

• Multilevel systems-based interventions

© Prof. Rifat Atun, Harvard University, 2021
 So why global?
• Globalization

• Interdependence

• Shared risk factors and exposures

• Transnational and trans-country health threats

• Epidemiological convergence

• Collective solutions and global public goods

1 © Prof. Rifat Atun, Harvard University, 2021

Global Health Evolution since 2000: Millennium
Development Goals (MDGs): Disease centric

Millennium Declaration
• 8 Goals and 21 targets
• 3 health-related MDGs
• 8/21 health related targets (7*)
• Goal 4, reduce child mortality
• Goal 5, improve maternal health
• Goal 6, combat HIV–AIDS, malaria and other diseases
• 2000 to 2015
• DAH rose from $11.6 billion in 2000 to a peak of ~$33 billion 2012-2015

© Prof. Rifat Atun, Harvard University, 2021

 MDGs: achievement of health-related
targets: a mixed picture
AFRO status of the health-related MDGs
120

100

80

60

40

20

0
Target 1C, Target 4A, Target 4A, Target 5A, Target 5A, Target 5B, Target 5B, Target 6A, Target 6C, Target 6C,
Indicator 1 Indicator 1 Indicator 2 Indicator 1 Indicator 2 Indicator 1 Indicator 2 Indicator 1 Indicator 1 Indicator 2

AFR Target

© Prof. Rifat Atun, Harvard University, 2021

 Health – a critical core of sustainability
Sustainable Development Goals (SDGs)

UN Resolution in 2015 on SDGs: The 2030 Agenda

• The SDGs are categorized under the 5 Ps — people, planet, prosperity,
peace, and partnership with 17 Goals and 169 targets
Place of Health in the SDGs
• 23/169 health related targets (13*)
• Dedicated SDG – SDG3: Ensure healthy lives and promote well-being for
all at all ages
• 13 targets; 3.8 – achieve UHC
• SDGs 1-6 directly address health disparities by targeting social
determinants of health: Poverty (1), Hunger (2), Education (4), Gender
Equality (5); Clean Water and Sanitation (6)

© Prof. Rifat Atun, Harvard University, 2021

Targets for SDG 3

© Prof. Rifat Atun, Harvard University, 2021

 Class discussion: looking ahead

• How will COVID-19 change global health?

© Prof. Rifat Atun, Harvard University, 2021

 Class poll: The greatest impact of Covid-19 on
global health will be from?

1. Direct effect of new COVID-19 cases and deaths

2. Effect of pandemic on delayed or postponed access to

healthcare leading to excess deaths

3. Economic crisis leading to unemployment and social

disruption

4. Migration

5. Increased nationalism and reduced international cooperation

6. Reduced overseas development assistance for health

© Prof. Rifat Atun, Harvard University, 2021