Chapter 2- Determinants in

global health
BY: Getabalew Endazenaw (PhD)

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 Learning Objectives
• At the end of the unit the learners able to:
– Explain common determinants of health

– Develop mechanism to reduce negative impact of

each determinants on health

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 Definition of Health
• Health is a state of complete physical, mental
and social well-being, and not merely the
absence of disease or infirmity (World Health
Organization, 1948).
• Health is an individual right and a social justice
issue. It is also a public good.
• Governments have a responsibility for the health
of their peoples which can be fulfilled only by the
provision of adequate health and social measures.

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Determinants of health and risk factors
• Determinants of health are the interconnected
factors that determine an individual’s health
status.
• Determinants of health include the range of
personal, social, economic, environmental factor
which determine the health status of the
population.

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 Determinants and risk factors…

• Risk factors are things in your life that increase

your chances of developing a condition or
disease. E.g.
– Family history of certain disease

– Genetically related factors

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 Types of determinants of health

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 Determinants of health….

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 Biological Determinants
• The genetic make-up is unique in that it cannot be
altered after conception

• From genetic point of view ,Health may be defined

as “the presence in the genetic constitution of the
genes that correspond to normal characterization
and to presence of normal genes.

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 Behavioral Determinants
• The term "lifestyle” is "the way people live",
reflecting a whole range of Social values, attitudes
and activities.
• It is composed of cultural and Behavioral patterns
and lifelong personal habits that have developed
through processes of socialization.
• Lifestyles are learnt through social interaction with
parents, peer groups , friends and siblings and
through school and mass media.

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 Environment determinants
• It is an established fact that environment has a
direct impact on the those living in it.
• Include housing status, sanitation, work place
conditions, etc

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 Socio-economic determinants
• Societal conditions have a direct impact on
health, accounting for an impact of 30-50% or
more on levels of the populations’ health
Mc Giniss et al (2002) Canadian Institute of
Advanced Research (2012)
Health care (up to Health care
15%) (up to 25%)

Social circumstances Socioeconomic

& environmental (50%)
exposure (45%)
Environmental
Health behaviour (10%)
patterns (40%)
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 Health services as determinants of health

• Accessibility, availability, affordability,

acceptability and the quality of health services
can impact health
• Barriers to accessing health services include:
– Lack of availability
– High cost
– Lack of insurance coverage

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 Health services…..
• Barriers to accessing health services lead to:
– Unmet health needs

– Delays in receiving appropriate care

– Inability to get preventive services

– Hospitalizations that could have been prevented

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 Intervention to increase positive outcomes of
determinants

• Interventions that target multiple determinants

are more likely successful.
– Note: Determinants reach beyond traditional
healthcare and public health sectors ►Education,
housing, transportation, agriculture, and
environmental are sectors important in improving
population health.
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 Intervention….
1. Improve health equity: the “attainment of the
highest level of health for all people”
• In an equitable society, everyone has the
opportunity to:
– Complete the education level desired
– Obtain employment needed to support themselves and
their families
– Find food that sustains health
– Live in safe housing
– Breathe clean air and drink clean water
– Participate in making decisions that affect their well-
being
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 Intervention…..
2. Policies related intervention
• Local, state, national, and international policies
could have significant effects on individual and
population health.
– Increasing taxes on tobacco sales can reduce
individual use of tobacco products
– Increased safety standards in cars including safety
belts which reduced rates of injuries and deaths
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 Intervention….

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 Intervention….

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 Chapter 3 Global health governance
and partnerships
Learning objectives:
• At the end of the chapter the learners able to:
– Describe governance and partnership
– Identify the impact of international polices and
declaration in shaping health policies
– identify and explain International cooperation in
global health

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 Definition of global health governance
• The use of formal and informal institutions, rules
and processes by states, intergovernmental
organizations, and non-state actors to deal with
challenges to health that require cross-border
collective action to address effectively
– Moved beyond state-centric focus
– Wide range of issues- diversity of responses
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 states IGO:s
GHG

Private
NGO:s/CSO:s
actors
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 Drivers of global health governance
• In the mid-nineteenth century there was
recognition that collective supranational action
was needed to control epidemic diseases:
– plague and cholera.

– From 1851 to 1903, at least 11 international sanitary

conferences were convened to address the threats of
cholera, yellow fever, and plague.
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 Drivers of GHG....
• The geo-temporal challenge of global health governance
in the nineteenth century was modest.

• In 1850 (the world population 1.2 billion):

– an individual needed about 1 year to circumnavigate

the globe.

• In 2000 (the world population more than 6 billion):

– A traveler could cover the same distance in less than

48 hours.
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 Drivers of GHG…
• Pathogens can now be carried far and wide with
great rapidity:

– severe acute respiratory syndrome (SARS) in 2003

– H1N1 pandemic in 2009

– COVID 19 in 2020

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 Drivers of GHG....
• Globalization
• Factors ignoring national boundaries
• Multispectral / multidisciplinary approaches to
interventions and responses
• Voice to wide range of actors (affected communities /
local ownership)
• Transparency and accountability
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 GHG structure
• Governance structures build consensus for collectively
managing public health actions due to:
• The world’s inhabitants cannot create societies and
economies that are largely self-contained and
insulated from outside threats.
• The world’s inhabitants share the same air, water,
exposure to infectious diseases, foods,
pharmaceuticals, and health workforce
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 GHG structure….
• Current global health governance structures
include a complex web of:
– UN agencies

– Public/private partnerships

– Donor and recipient governments

– Foundations

– corporations, and civil society organizations.

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 UN Agencies in GH
• The WHO is the lead UN agency for health
• Core functions of WHO:
– Provision of collective health leadership
– Shaping of research as well as the generation and
dissemination of knowledge
– Setting of norms and standards and the promotion and
monitoring of their implementation
– Production of ethical and evidence-based policy
options
– provision of technical support and capacity-building
– Monitoring of health situations and trends
– Responding to health emergencies
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 UN agencies……
• Main agenda Of WHO:
– Promote development
– Foster health security
– Strengthen health systems
– Harness research, information, and evidence
– Enhance partnerships
– Improve performance

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 Public-Private Partnerships in GH
• Global health initiatives is now a much more
horizontal and networked
• There are different public-private partnerships which
work to solve the global health problems:
– Roll Back Malaria: Global Health as Partnership
– The Stop TB Partnership
– the Global Alliance for Vaccines and Immunizations (GAVI)
– Global Fund to Fight AIDS, Tuberculosis, and Malaria
(GFATM), etc….
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 Roll Back Malaria: Global Health as Partnership…

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 Global Alliance for Vaccines and Immunizations (GAVI)
• Innovative partnership that links developing-
world governments and donor governments
– Financial community
– Vaccine manufacturers from developed and
developing countries
– Research and technical institutes
– Civil society organizations
– Intergovernmental entities, like WHO, UNICEF,
and the World Bank.

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 GAVI……
• Immunizations funded by GAVI have prevented
an estimated 3.4 million deaths in developing
countries.
• GAVI also supports innovative financing
mechanisms, such as advanced market
commitments to reduce the costs of
immunizations
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 Global Fund to Fight AIDS, Tuberculosis, and
Malaria (GFATM)
• A partnership between governments, civil society, the private
sector, and affected communities
• focus mobilizing and distributing financial resources in a manner
driven by:
– Technically sound national plans and priorities
– Principles of transparency and accountability
• GFATM is the source of finance for:
– one-quarter of AIDS globally
– two-thirds of that for tuberculosis and
– three-quarters of that for malaria
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 Challenges to GHG
1. Chaotic system with many actors:
– complicates coordination
– erodes authority / leadership
– leads to fragmented responses
2. Prioritization issues between donor’s interests and
recipients needs (imbalances between root-causes and
’urgent’ needs (ownership)
3. Funding shortfalls due to economic crises
4. Lack of single motivating rationale
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 Challenges……
– The need to define leadership and authority in GHG

– The need to generate sufficient resources for global

health cooperation and distribute them
appropriately according to agreed priorities

– The sovereignty of states is also a hurdle to giving

“teeth” to global health initiatives because of the
lack of effective enforcement mechanisms

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 Reading assignment
• Global health initiatives (One health, MDG,
SDG)

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 Chapter 4-Globalization and health
• Globalization is a complex and multifaceted
phenomenon that refers to the increasing
interconnectedness, interdependence, and
integration of economies, societies, cultures,
and governance systems across the world.

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 Globalization……..
• Easier travel & communication
• Mixing of customs & cultures
• Integration of national economies (removal of barriers to
international trade & finance)
• Means cannot view national health, interventions and
policies in isolation from:
– other countries
– other sectors (e.g. travel, finance)
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 Globalization….
• Globalization has become a fundamental change
to human society.
• Accelerated in recent decades.
• Impact is seen in every individual and community.
• Effects on wide range of areas: health, economic,
social, political, cultural, and technological
environmental.
• Immense and complex effects on health.
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 Driving forces for globalization
• Advancements in technology

• Advancement in communication

• Advancement in transportation

• Liberalization of trade and investment.

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 Globalization and public health
Globalization has affected public health in three ways:

First: The shrinking of the world by

technology and economic interdependence
allows diseases to spread globally at rapid
speed due to:
1. The increase in international travel, and
2. The increasingly global nature of food handling,
processing and sales.
– HIV/AIDS, TB, cholera and malaria, COVID 19
represent a few infections that have spread to new
regions through global travel and trade.
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 Globalization & PH……
• Second: the development of global market has
intensified economic competition and increased
pressure on governments to reduce expenditures,
including funding of public health programs,
leaving states increasingly unprepared to deal with
emerging disease problems.
– Industrialized as well as developing countries
confront/face deteriorating public health
infrastructures.
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 Globalization & PH……
– Third: Public health programs have also “gone
global” through WHO and health related non-
governmental organizations.
– Medical advances have spread across the planet,
improving health worldwide.
• The world wide eradication of S.pox in 1977,
control of COVID 19 in 2020 is a famous
example.
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 Impact of globalization on global health
• Impacts of globalization are both positive and
negative.
1. Disease Spread:
Globalization has increased the risk of infectious
diseases spreading rapidly across borders.
Increased international travel and trade facilitate the
movement of pathogens, making it easier for disease
outbreaks to become global pandemics
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 Impact of globalization…..
2. Access to Healthcare:
Globalization has led to both positive and negative effects
on access to healthcare.
On the positive side: (sharing of healthcare knowledge,
advancements in medical technology, and the movement of
healthcare professionals).
On Negative side: (disparities in access to healthcare with
certain populations and regions being left behind,
particularly in low-income countries, Brain drain of skilled
health care workers from developing countries)
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 Impact of globalization…..
3. Non-Communicable Diseases (NCDs):
– Influenced lifestyle and behavioral patterns

– Unhealthy diets

– Sedentary lifestyles

– Exposure to global marketing of unhealthy

products

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 Impact of globalization…..
4. Food Systems:
• Transformed food systems, leading to changes in
dietary patterns and nutritional challenges.
– Global trade in food has increased the availability and
consumption of processed and unhealthy foods

– Globalized food supply chain can increase the risk of

foodborne illnesses and contamination

– Trade in poor-quality food and pharmaceuticals

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 Impact of globalization…..
5. Information technology
– Has given us 24 hours access to news,
entertainment and personal messages,
– But takes most of our time from doing
other things; physical inactivity

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 Impact of globalization…..
6. Fast and affordable transport access
– Made travel easy
– Rise in petrochemicals use and leading to
global warming

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 Further reading assignment
Impacts of Globalization on health and
Impacts of Health on globalization

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