Global Health and Health Transitions

1 Chapter 1. Global Health and Health Transitions One hundred years ago, most populations around the world had similar disease profiles, with a high burden from infectious diseases. Modern medical technologies like antibiotics and vaccines have enabled many people to live longer, healthier lives. But modern lifestyles put a large number of people at risk for serious chronic diseases, and the disparities in Health between the rich and the poor have increased. Global Health draws on a wide variety of disciplines in order to understand and improve the Health of people around the world. DEFINING Health . 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.

2 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 of the 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.

3 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,1 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. 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 socioeconomic, envi- ronmental, and other factors, medicine by itself is a limited approach to Health .

4 Clinicians, other Health workers, social workers and counselors, spiritual advisors, government officials, trash collectors, farmers, and many other people in many other professions all make important contributions to the social, economic, policy, and physical environments that promote or inhibit the Health of communities and nations and, by extension, the Health of individuals and families. Public Health focuses on the Health of populations, whether small villages or entire world regions. The public Health system, which addresses Health at local, state and provincial, national, and international levels, also works to keep individuals safe and healthy. The goals of public Health include pre- venting illnesses, injuries, and deaths at the population level, identifying and mitigating environmental hazards, promoting healthy behaviors, ensuring access to essential Health services, and providing Health education targeted toward at-risk groups of people (Table 1 1).

5 2 Both public Health and medi- cine make important contributions to Global Health , but public Health plays an especially important role because of its population focus (Figure 1 1). (The line between medicine and public Health is also fairly blurry, with community Health nurses and preventive medicine physicians working in both domains.). Medicine and Public Health 3. Table 1 1 Essential public Health services. 1 Monitor Health status to identify community Health problems. 2 Diagnose and investigate Health problems and Health hazards in the community. 3 Inform, educate, and empower people about Health issues. 4 Mobilize community partnerships to identify and solve Health problems. 5 Develop policies and plans that support individual and community Health efforts. 6 Enforce laws and regulations that protect Health and ensure safety. 7 Link people to needed personal Health services and ensure the provision of Health care when otherwise unavailable.

6 8 Ensure a competent public Health and personal healthcare workforce. 9 Evaluate effectiveness, accessibility, and quality of personal and population-based Health services. 10 Research for new insights and innovative solutions to Health problems. Source: Reproduced from the Centers for Disease Control and Prevention (2010). National Public Health Performance Standards Program (NPHPSP): 10. Essential Public Health Services..html. Last updated December 9, 2010. Accessed August 31, 2012. World World Region Nation Domain of Public Health State/Province Community Household Domain of Individual Medicine Figure 1 1 The domains of medicine and public Health . 4 Chapter 1 Global Health and Health Transitions THE EMERGENCE OF Global Health . Global Health refers to transnational Health , Health concerns that cross national borders. The term Global Health is sometimes used interchangeably with international Health , but international Health is now more often used to describe a focus on the Health issues of people who live in lower-income ,4.

7 Global Health is not new. Infectious diseases have long been spread by migration and trade. By the mid-1800s, European countries had cooperation agreements in place to help control the spread of cholera, plague, yellow fever, and other epidemic diseases, and by the early 1900s international regulations addressed drugs and alcohol sales, occupational Health and safety, and water In recent decades, Global Health as a field of work and study has expanded in scope and recognition as modernization and globalization have occurred. Modern transportation allows infectious diseases to spread across the world at an alarming rate. Advances in medical technology and pharmaceuticals are curing diseases that used to be untreatable, but new technologies have also created superbugs that are resistant to current antibiotic therapies. And the threat of bioterrorism requires coordination of public Health responses from many nations.

8 The increasing attention on Global Health also arises from the continued and growing disparities in Health status between nations and within nations, which raise human rights concerns and may contribute to insecurity. Although the main Health concerns of communities in rural Africa (often HIV/AIDS and malaria) are very different from the key Health concerns of urban Americans (often heart disease and cancer), there are important commonalities across the globe. Emerging infections such as multidrug- resistant tuberculosis (MDR-TB), rising cancer rates, and the high preva- lence of mental Health disorders are concerns for everyone. Global Health helps communities, nations, and the world prepare to respond appropriately to emergent Health concerns. Health Transitions IN THE 20TH CENTURY. One hundred years ago, most populations across the world had similar Health profiles: high birth rates, high death rates, short life expectancies, and a lot of disease and death due to infections and undernutrition.

9 During the 20th century, most high-income nations made a transition to a lower Health Transitions in the 20th Century 5. birth rate, a lower death rate, longer life expectancies, and a higher burden from the chronic diseases often associated with overnutrition. Low-income countries have not experienced such dramatic changes, but the Health profiles of middle-income areas are currently shifting. These demographic, epidemiologic, and nutrition Transitions are summarized in Table 1 2. In the United States, the leading causes of death in 1800 and 1900. were pneumonia (including pneumonia caused by influenza), tuber- culosis, and diarrhea all infectious By 1950 the death rate had dropped significantly, life expectancy had increased, and the most common causes of death had shifted to heart disease, cancer, and stroke, the same noncommunicable diseases that are the most frequent causes of death These changes in population Health status were due to a variety of factors, including new Health technologies (such as new Table 1 2 Health Transitions .)

10 Low-Income Areas (and most of the world Middle-Income Category 100 years ago) Areas High-Income Areas Demographic High fertility rate Intermediate Low fertility rate Transition fertility rate Relatively high child Low child Very low child mortality rate mortality rate mortality rate Relatively high Intermediate Relatively low mortality rate mortality rate mortality rate Relatively low life Intermediate life Relatively high life expectancy expectancy expectancy Children are a large Intermediate Older adults are a proportion of the aging profile sizeable proportion population of the population Epidemiologic High burden from Dual burden of High burden from Transition diseases of poverty infectious and diseases of affluence (infectious diseases) chronic diseases (chronic diseases). Nutrition Underweight is a major Concerns about Overweight and Transition concern underweight in obesity are major some popula- concerns tions and obesity in others 6 Chapter 1 Global Health and Health Transitions vaccines, new antibiotics, and new contraceptives), improved nutrition, increased education, and economic Demographic Transitions The demographic transition describes a shift toward lower birth and death rates that often occurs as populations move from being low-income economies (often referred to as developing countries).