Fluent Essays

Instructions: Write a 2-3 page on environmental health, the environmental factors that impact health, and your role with improving/ eliminating environmental barriers to health. Use the following organization: Title page: Environmental Health and Health Effects on Environmental Change Introduction: One paragraph (minimum of 4 to 5 sentences). Synopsis: (include all pertinent information obtained in this lesson (Lesson 2). Sub-Titles: Environmental Factors that Impact Health My role in Improving/ Eliminating Environmental Barriers to Health (give specific examples of how you can make a difference). Summary and Conclusion: (minimum of one paragraph of 4 to 5 sentences).  References: Must use a minimum of 3 reference besides the textbook that is 5 years or newer (2013-2018).  You should: be typed in a WORD document. be 2-3 or more pages (excluding the title page and reference page).  In other words, the body  should be 2 to 3 pages long. include a Title page and a Reference page. Must use a minimum of 3 reference besides the textbook that is 5 years or newer (2013-2018).  Use APA style: Running head, title page, citations, reference page  Follow APA format according to the APA Style Guide use factual information from the textbook and/or appropriate articles and websites. be original work, and will be checked for plagiarism. World Headquarters Jones &: Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 [email protected] www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount infonnation, contact the special sales department at Jones & Bartlett Learning via the above contact infonnation or send an email to [email protected] Copyright © 2014 by Jones & Bartlett Learning, LLC, an Ascend Learning Company All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any fonn, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. Introduction to Global Health, Second Edition is an independent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product. This publication is designed to provide accurate and authoritative information in regard to the Subject Matter covered. It is sold with .the understanding that the publisher is not engaged in rendering legal, accounting, or other profes- sional service . .If legal advice or other expert assistance is required, the service of a competent professional person should be sought. Productiou Credits Publisher: Michael Brown Managing Editor: Maro Gartside Editorial Assistant: Chloe Falivene Production Assistant: Alyssa Lawrence Senior Marketing Manager: Sophie Fleck Teague Manufacturing and fuventory Control Supervisor: Amy Bacus Composition: Lapiz Cover Design: Michael O'Donnell Cover Image: © Marie Docher/age fotostock Printing and Binding: Edwards Brothers Malloy Cover Printing: Edwards Brothers Malloy To order this product, nse ISBN: 978-1-4496-8834-9 Library of Congress Cataloging-in-Publication Data Jacobsen, Kathryn H. Introduction to global health / Kathryn H. Jacobsen. -- 2nd ed. p. ;cm. fucludes bibliographical references and index. ISBN 978-1'4496-4825-1 (pbk.) -- ISBNI-4496-4825-8 (pbk.) I. Title. [DNLM: I. World Health. 2. Communicable Disease Control. 3. Health Transition. 4. Internationality. WA 530.1] 362.1--dc23 6048 Printed in the United States of America 17 16 15 14 13 10 9 8 7 6 5 4 3 2012039129 s 1.1 Defining Health .................................. 1 1.2 Medicine and Public Health ........................ 2 1.3 The Emergence of Global Health ................... .4 1.4 Health Transitions in the 20th Century ................ 4 1.4.A Demographic Transitions ..................... 6 l.4.B Epidemiologic Transitions .................... 7 L4.C Nutrition Transitions ......................... 9 1.5 Risk Factors ................................... 10 1.6 Prevention ..................................... 13 1.7 Careers in Global Health .......................... 15 1.8 Discussion Questions ............................ 16 References ......................................... 17 2.1 The Importance of Health Metrics .................. 19 2.2 Measuring Health and Disease ..................... 21 2.2.A Vital Statistics and Demography .............. 21 2.2.B Measuring Mortality ........................ 21 iii iv CONTENTS 2.2.C Measuring Morbidity ....................... 24 2.2.D Measuring Disability ....................... 25 2.2.E Quantifying Risk Factors .................... 26 2.2.F Health Systems Performance ................. 28 2.3 Classifying Disease .............................. 29 2.3.A Infectious and Parasitic Diseases .............. 30 2.3.B Noncommunicable Diseases ................. 31 2.3.C Neuropsychiatric Disorders .................. 33 2.3.D Injuries .................................. 34 2.4 Sources of Health Information ..................... 37 2.5 Discussion Questions ............................ 39 References ......................................... 39 Chapter 3-Research and Global Health ........... ......... . 41 3.1 The Importance of Global Health Research ........... 41 3.2 The Research Process ............................ 42 3.3 Observational Study Designs ..................... .43 3.3.A Prevalence Surveys ........................ 43 3.3.B Case Series ............................... 44 3.3.C Case-Control Studies ...................... .44 3.3.D Cohort Studies ........................... .47 3.4 Experimental Studies ............................ 50 3.5 Research Ethics ................................. 52 3.6 Synthesis Studies ............................... 54 3.6.A Correlational Studies ....................... 54 3.6.B Systematic Reviews and Meta-Analyses ........ 55 3.6.C Forecasting and Modeling ................... 56 3.7 Interpreting Statistics ............................ 56 3.8 Critical Reading ................................ 59 3.9 Evidence-Based Global Health ..................... 61 3.10 Discussion Questions ............................ 62 References ......................................... 63 Chapter 4-Socioeconomic Determinants of Health .. ......... . 65 4.1 Social Determinants of Health ..................... 65 4.1.A Income, Wealth, and Health .................. 67 4.1.B Employment and Occupational Status .......... 69 4.1.C Literacy and Educational Level ............... 70 Contents v 4.2 Socioeconomic Indicators .................. 0 •••••• 72 4.3 Health of Vulnerable Populations ................... 77 4.3.A Race, Ethnicity, and Health .................. 77 4.3.B Immigrants ....................... 0 ••••••• 79 4.3.C Prisoners ................................. 80 4.4 Culture and Health .............................. 82 4.5 Discussion Questions , ........................... 83 References ......................................... 83 5.1 Inequalities in Child Death ........................ 87 5.2 Neonatal Mortality ............ 0 ••••••••••••••••• 88 5.3 Diarrhea ....................................... 90 5.4 Pneumonia ..................................... 94 5.5 Malaria ....................................... 96 5.6 Vaccine-Preventable Diseases ..................... 97 5.7 Undernutrition and Breastfeeding ................... 97 5.8 Global Child Health Initiatives .................... 101 5.9 The Rights of Children .......................... 104 5.10 Discussion Questions ........................... 106 References ........................................ 107 6.1 Health in Early Adulthood ....................... 109 6.2 Mental Health ................................. 109 6.3 Injuries ..................................... 0 113 6.4 Sex, Gender, and Health ......................... 115 6.5 Reproductive Health and Maternal Mortality ......... 117 6.6 Family Planning ............................... 122 6.7 Fertility ...................................... 124 6.8 Population Growth ............................. 128 6.9 Population Planning Policies ..................... 130 6.10 Discussion Questions ........................... 133 References ........................................ 134 o •• , ••••• , .137 7.1 Global Aging .................................. 137 7.2 Cardiovascular Diseases ......................... 140 vi CONTENTS 7.3 Cancer ....................................... 142 7.4 Chronic Lung Disease ........................... 147 7.5 Diabetes ...................................... 148 7.6 Sensory Impairment ............................ 148 7.7 Disability ..................................... 149 7.8 Dementia ..................................... 153 7.9 Screening and Early Detection .................... 154 7.10 Planning for Aging Populations ................... 156 7.11 Discussion Questions ........................... 159 References ........................................ 160 Chapter 8-The Environmental Context of Health ............ 163 8.1 Environmental and Occupational Health ............ 163 8.2 The Home Environment ......................... 166 8.3 Drinking Water ................................ 167 8.4 Sanitation .................................... 172 8.5 Fuel and Indoor Air QUality ...................... 176 8.6 The Work Environment ......................... 179 8.7 Toxicology ................................... 180 8.8 Communities and Environmental Health ............ 182 8.9 Discussion Questions ........................... 184 References ........................................ 185 Chapter 9-Control of Infectious Diseases .........•........• 187 9.1 Global Infectious Diseases ....................... 187 9.2 Agents of Infection ............................. 188 9.2.A Bacteria ................................ 188 9.2.B Viruses ................................. 189 9.2.C Parasites ................................ 190 9.2.D Fungi ................................... 191 9.2.E Prions .................................. 191 9.3 Exposure, Infection, and Disease .................. 192 9.4 Infectious Disease Transmission ................... 194 9.5 Diarrheal and Foodborne Diseases ................. 196 9.6 Respiratory Diseases ............................ 198 9.7 Vectorborne Diseases ........................... 200 9.8 Sexually Transmitted Infections (STIs) ............. 204 9.9 Neglected Tropical Diseases (NTDs) ............... 205 Contents Vll 9.10 OtherInfectious Diseases ....................... 210 9.11 Infection Control and Prevention ................. 210 9.11.A Behavior Change ......... " ............ 210 9.11.B Environmental Control. .................. 213 9.11.C Vaccination ............................ 214 9.11.D Drug Therapy .......................... 215 9.11.E Surveillance ........................... 216 9.11.F Elimination and Eradication ............... 217 9.12 Discussion Questions .......................... 218 References ........................................ 219 10.1 Comparison of HI V, TB, and Malaria .............. 221 10.2 HIV/AIDS .................................... 221 10.3 Tuberculosis (TB) .............................. 231 10.4 Malaria ...................................... 236 10.5 Influenza ..................................... 242 10.6 Other Global Infectious Disease Initiatives .......... 244 10.7 Discussion Questions ........................... 244 References ......................................... 245 11.1 Essential Nutrients ............................. 249 11.2 Macronutrients ................................ 249 11.3 Micronutrients ................................. 254 11.4 Measuring Nutritional Status ..................... 257 11.5 Undernutrition ................................. 258 11.6 Hunger and Food Security ....................... 260 11.7 Micronutrient Deficiencies ....................... 263 11.7.A Vitamin A Deficiency (VAD) .............. 264 11. 7.B Iodine Deficiency Disorders (IDD) .......... 265 11.7.C Iron Deficiency Anemia (IDA) .............. 265 Il.7.D Zinc Deficiency ......................... 267 11.7.E Preventing Micronutrient Deficiencies ....... 267 1l.8 Overweight and Obesity ......................... 268 11.9 Discussion Questions ........................... 272 References ......................................... 273 viii CONTENTS Chapter 12-Global Health Payers and Players ............... 277 12.1 Health Systems ................................ 277 12.2 Personal Healthcare Costs ....................... 280 12.3 Paying for Global Public Health ................... 283 12.3.A Local and National Government Funds ....... 284 . 12.3.B Bilateral Aid ............................ 285 12.3.C The World Bank and IMF ................. 286 12.3.D Private Foundations ...................... 289 12.3.E Businesses .............................. 290 12.3.F Personal Donations ....................... 290 12.4 Types of Global Health Programs ................. 294 12.5 Implementing Health Programs ................... 295 12.5.A National and Local Governments ............ 296 12.5.B United Nations Agencies .................. 298 12.5.C International Cooperation .................. 299 12.5.D Global Health Partnerships ................. 301 12.5.E Nongovernmental Organizations (NGOs) ..... 302 12.5.F International Committee of the Red Cross ..... 304 12.5.G International Businesses ................... 305 12.6 Discussion Questions ........................... 305 References ......................................... 306 Chapter 13-Globalization and Health ...................... 309 13.1 Globalization and Global Health ................. 309 13.2 Urbanization and Health ........................ 310 13.3 Emerging Infectious Diseases .................... 316 13.4 Nutrition and Food Safety ....................... 319 13.5 Bioterrorism and Security ....................... 322 13.6 Global Environmental Change and Health .......... 325 13.7 Discussion Questions .......................... 330 References ........................................ 331 Chapter 14-Health, Human Rights, and Humanitarian Aid .... 335 14.1 Health and Human Rights ....................... 335 14.2 Access to Health .............................. 338 14.2.A Access to Health Care ................... 340 14.2.B Access to Medication .................... 340 Contents IX 14.2.C Access to Health Technology .............. 344 14.2.D Access to Water ........................ 346 14.3 Disasters and Health ........................... 347 14.3.A Civil Conflict and War ................... 349 14.3.B Refugees and Internally Displaced People .... 350 14.3.C Postconflict Areas ....................... 352 14.3.D Natural Disasters ....................... 352 14.4 Emergency Preparedness and Response ............ 356 14.5 Discussion Questions .......................... 357 References ........................................ 357 15.1 Global Health Successes ........................ 361 15.2 Millennium Development Goals .................. 362 15.3 Current Priorities .............................. 366 15.4 The Price of Global Health ...................... 370 lS.4.A Cost-Effectiveness ...................... 371 15.4.B Sustainability .......................... 373 15.4.C Costs ofInaction ........................ 374 15.5 Beyond Cost-Effectiveness ...................... 374 15.6 Discussion Questions .......................... 376 References ........................................ 376 On June 16, 2006, Bm Gates, founder of Microsoft and the richest man in the world, made headlines when he announced his intention to scale back his work at Microsoft to devote more time to the charitable foundation he had co-founded with his Melinda.! Ten later, even bigger head- lines were made when Warren Buffett, the second wealthiest man in the world, made a surprising announcement-he was handing over most of his fortune to Bill Gates. 2 More precisely, the bulk of his accumulated wealth was going to the Bill & Melinda Gates Foundation, which focuses primarily on improving global health. As a result, the Bill & Melinda Gates Foundation, the largest philanthropic foundation in the world even prior to Buffett's generous donation, doubled in value to more than $60 billion. What would inspire the wealthiest men in the world to develop such a passion for one cause? They had become aware of an awful reality: Every year, several million children die of diseases that are completely prevent- able. In an address to the World Health Assembly, the governing body of the World Health Organization, Bill Gates described the awakening of his philanthropic impulse: I first learned about these tragic health inequities some years ago when I was reading an article about diseases in the developing world. It showed that more than half a million children die every year from "rotavirus." I thought, "'Rotavirus?' -I've never even heard of it. How could I never have heard of something that kills half a million children every yearl?" I read further and learned that millions of children were dying from diseases that had essentially been eliminated in the United States. Melinda and I had assumed that if there were vaccines and Xl xii PREFACE treatments that could save lives, governments would be doing everything they could to get them to the people who needed them. But they weren't. We couldn't escape the brutal conclusion that-in our world today-some lives are seen as worth saving and others are not. We said to ourselves: "This can't be true. But if it is true, it deserves to be the priority of our giving.,,3 Gates ended his speech with a call to action: I am optimistic that in the next decade, people's thinking will evolve on the question of health inequity. People will finally accept that the death of a child in the developing world is just as tragic as the death of a child in the developed world. And the expanding capacities of science will give us the power to act on that conviction. When we do, we have a chance to make sure that all people, no matter what country they live in, will have the preventive care, vaccines, and treatments they need to live a healthy life. I believe we can do this-and if we do, it will be the best thing humanity has ever done. Since global health has become the object of attention for Bill Gates, Warren Buffet, and other influential world leaders, it has, not surpris- ingly, also developed rapidly as an academic and professional field. The Consortium of Universities for Global Health (CUGH), founded in 2009, reports that the number of undergraduate and graduate students at large universities majoring in global health studies doubled in just the 3 years from 2006 to 2009.4 By 2009, all of the top 50 liberal arts colleges ranked by U.S. News & World Report were offering at least one course in global health or public health, and nearly half offer a major, concentration, or other program of study in global or public health. 5 The American Association of Medical Colleges reports that nearly one-third of medical students graduat- ing in 2011 completed a global health experience during medical school,6 up from only about 15% of medical students in the 1990s and less than 10% in the 1980s.7 The trend toward higher enrollment in global health courses, programs, and experiences is expected to continue in the coming years. Global health is not just about health in low-income countries; it is about common health problems faced by the human population as a whole. In today's interconnected world, our own experiences of health and well-being are literally inseparable from everyone else's. We cannot prevent the birds and insects that carry influenza, West Nile virus, and other infectious agents Preface xiii from flying over national borders, just as we cannot inspect every imported banana or bean sprout for possible contaminants. The complexities of infec- tious disease, mental health, injuries, reproductive health, aging, nutrition, and other health-related issues require us to think beyond our households and immediate communities to regional, national, and global levels. Global health is relevant in the workplace too. No matter what the occupation- business, public service, education, medicine, religion, engineering, social work, community development, agriculture, manufacturing, or anything else-workers are involved in activities that intentionally or unintention- ally impact human and environmental health close to home and around the world. The study of global health helps us to make a positive difference in the world. It helps us to understand the causes and consequences of health concerns; to make connections between economics, politics, biology, medi- cine, sociology, psychology, and a host of other fields; to learn from others about effective and ineffective responses to critical problems; and, more generally, to make sense of the complexities of 21st-century life. A solid foundation in global health allows global citizens to assess their own vul- nerabilities and health risks, to make informed choices about their career paths, and to make wise decisions about how to use their time and resources. Studying global health is an opportunity to explore important questions about how the world works, to develop intellectual and practical skills, and to engage with real-world challenges close to home and across the planet. This second edition of Introduction to Global Health provides a starting point for achieving those educational and personal goals, 1. Markoff J, Lohr S. Gates to cede software reins. New York Times. 2006 Jun 16. 2. O'Brien TL, Saul S. Buffett to give bulk of his fortune to Gates charity. New York Times. 2006 Jun 26. 3. Gates B. Address to the 2005 World Health Assembly. Geneva; 2005 May 16. 4. Saving lives: Universities transforming global health. CUGH; 2009. 5. Hill DR, Ainsworth RM, Partap U. Teaching global public health in the undergraduate liberal arts: a survey of 50 colleges. Am J Trap Med Hyg. 2012;87:11-15. 6. Medical school graduation questionnaire: 2011 all schools summary report. Washington, DC: AAMC; 2011. 7, Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P. Global health in medical education: a call for more training and opportunities. Acad Med. 2007;82: 226-230. Global health as a field of study has matured a great deal since the first edition of this textbook was published, and the second edition of Introduction to Global Health has been updated to reflect the current state of the field (including, of course, all new statistics). The first unit of the book focuses on the foundations of global health as an academic and professional discipline. e Chapter 1 has a new emphasis on health transitions, which are the demographic, epidemiologic, and nutritional changes that occur in populations undergoing socioeconomic development. s Chapter 2 is a new overview of global health metrics, the numbers that form the basis for evidence-based policy and practice. Chapter 2 also introduces the eight countries that are highlighted throughout the book as examples of the health profiles in different world regions and income strata: the United States, South Korea (the Republic of Korea), Poland, Brazil, China, India, Kenya, and Sierra Leone. s Chapter 3 provides a brief overview of global health research methods. This chapter gives readers the tools to find, read, understand, and apply health research articles and reports, including the more than 550 sources cited in the textbook. Research skills allow readers to peruse the most up-to-date primary source material, an essential skill for a field as dynamic as global health. @ Chapter 4 is about the social determinants of health-the social, cultural, economic, political, and related factors that influence health status. xv xvi NEW TO THIS EDITION The second unit is about global health across the lifespan. • Chapter 5 is an expanded chapter on infant and child health that emphasizes ways to prevent the most common causes of neonatal and pediatric death worldwide. • Chapter 6 is a new chapter on the health of young adults that discusses mental health, injuries, maternal mortality, family planning, and other important global issues. • Chapter 7 is a new chapter on chronic noncommunicable diseases (NCDs) and aging that highlights the diseases that are the most common causes of death and disability among older adults in every region of the world. These include cardiovascular diseases, cancer, chrQnic lung disease, diabetes, and sensory impairments. The third unit is about global health biology and the environmental context of health. • Chapter 8 focuses on drinking water, sanitation, energy, occupational health, and other aspects of environmental health. • Chapter 9 has a new focus on infectious disease prevention and control. Behavior change, environmental control, vaccination, drug therapy, and other methods for preventing and treating diarrheal, respiratory, vectorborne, and other infections are described. • Chapter 10 provides an in-depth look at HIV/AIDS, tuberculosis, malaria, and influenza, with new coverage of the major initiatives working to address these global concerns. • Chapter 11 covers the complex issues of global nutrition. The fourth unit is about global health policy and practice. • Chapter 12 describes the various entities that pay for and imple- ment public health programs, highlighting the many different career paths and volunteer opportunities for those with interests in global health. • Chapter 13 is an expanded chapter that highlights several of the key emerging issues of globalization and global health, such as urbaniza- tion, emerging infectious diseases, nutrition and food safety, bioter- rorism, and global environmental change. New to This Edition xvii ® Chapter 14 is a new chapter focusing on health and human rights, access to health, health during disasters and humanitarian emergencies, and emergency preparedness and response. ® Chapter 15 summarizes the successes in global health to date and examines priority areas for global health in the 21st century. A transition guide showing how the first and second editions of Introduction to Global Health relate is available from the publisher, Kathryn H. Jacobsen is an associate professor of epidemiology at George Mason University. She earned an MPH in International Health and a PhD in Epidemiology from the University of Michigan. Her research portfolio includes analyses of the global burden of disease and field projects in Africa, Asia, and the Americas. Dr. Jacobsen's work has been published by the World Health Organization and in dozens of international peer- reviewed journals. She is also the author of Introduction to Health Research Methods: A Practical Guide, published by Jones & Bartlett Learning. xix One hundred years ago, most populations around the world had similar disease profiles, with a high burden from infectious diseases. Modem medical technologies like antibiotics and vaccines have enabled many people to live longer, healthier lives. But modem lifestyles put a large number of people at risk for serious chronic diseases, and the disparities in health between the rich and the p()or have increased. Global health draws on a wide variety of disciplines in order to understand and improve the health of people around the world. H?ti:AL'I'H Health is often defined as the absence of disease (or the absence of illness, injury, infection, pain, tumors, or other physical disorders), but this is an incomplete explanation because it focuses on what health is not rather than on what health is. Some definitions of health try to capture its essence by emphasizing health as the ability to conduct normal daily activities. But that kind of statement is also limited, because the definition of "normal" varies from person to person. For example, some people assume that it is normal for an older person to have limited mobility and forgetfulness, but this is not true. Many older people are very active and mentally sharp, and many of those who have joint pain or memory loss could be helped by therapy and medication. Similarly, in many parts of the world parents think it is normal for their children to have intestinal worms. This is also not true, and untreated worm infections significantly reduce the health, growth, and school performance of millions of children around the world. A more comprehensive definition of health addresses both physical and mental health as well as the presence of a social system that facilitates health. The Constitution ofthe World Health Organization (WHO), written 1 2 CHAPTER 1 GLOBAL HEALTH AND HEALTH TRANSITIONS in 1948, defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." This defini- tion recognizes that health is not just a function of biology. Health stems from biology, psychology, sociology, and a host of other factors. Although there is almost no one in the world today who would be clas- sified as having "complete" health according to the WHO statement, l this definition provides a target for medical and public health systems to aim for as they work together to promote the improved health status of individuals and communities. 1.2 MEDICINE AND PUBLIC HEALTH Medicine is concerned with the health of individuals, and clinical health practitioners like physicians, surgeons, dentists, nurses, and physi- cal therapists are instrumental in helping individuals and families reach and maintain health by providing preventive, diagnostic, and therapeutic health services. But because individual health is often the result of …