Chapter 04 Perspectives in Global Health Care

1Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 04

Perspectives in Global Health Care


Objectives

1. Identify the major aims and goals for global health that have been presented by the Millennium Global Developmental Goals (2009) addressing global health concerns.

2. Identify the health priorities of Health for All in the 21st Century (HFA21).

3. Analyze the role of nursing in global health.4. Explain the role and focus of a population-

based approach for global health.5. Discuss the many causes of global health

problems.


Objectives, Cont’d

6. Identify some solutions for at least one of these global health problems.

7. Describe how global health is related to economic, industrial, environmental, and technological development.

8. Compare and contrast the health care system in a developed country with one in a lesser-developed country.

9. Define burden of disease.


Objectives, Cont’d

10. Explain how countries can prepare for natural and man-made disasters and the role of nurses in these efforts.

11. Describe at least five organizations that are involved in global health.


Historical Perspective

Health for All in the 21st Century (HFA21) World Health Assembly stated that all citizens of

the world should enjoy a level of health that would permit them to lead a socially and economically productive life

Healthy People 2020 Millennium Development Goals (MDGs) –

United Nations The Millennium Report (2009)

Many of the world’s health problems directly affect the health of individuals in the United States.


Definitions

Developed country Lesser-developed country


Role of Population Health

Population health Focuses on the broad range of factors and

conditions that have a strong influence on the health of populations

Determinants Example: Canada


Primary Health Care

WHO/UNICEF believe that a unified approach to creating primary care services globally is important.

Global primary health care services Example: Mexico


Nursing and Global Health

Nurses play leadership role in health care throughout the world

Role of the nurse is defined poorly in lesser-developed countries Care often depends on physicians

Leaders during and recovery from natural disasters

Role of nursing changing in China High physician-to-population ratio in some

countries


Major Global Health Organizations

Multilateral organizations WHO, UNICEF, PAHA, World Bank

Bilateral organization USAID

Non-governmental organizations (NGOs) or private voluntary organizations (PVOs) Oxfam, Project Hope, International Red Cross,

Catholic Relief Services (CRS), church-sponsored health care missionaries


Global Health and Global Development

Global health diplomacy Example: the Uganda project

Improvement in overall health status of a population contributes to the economic growth of a country in several ways.


Health Care Systems

The NetherlandsJapan

CanadaMexico

The United KingdomChina


The Netherlands

Residents are required to purchase health insurance. Insurance provided by private health care insurers Insurers required to accept every resident in their

coverage area Tax credits given to low income patients People under age 18 insured at no cost

Exceptional Medical Expenses Act


Japan

All citizens required to have health insurance Either through employer-based health insurance

program or through the national health care program

Public assistance available for those who cannot afford the premiums

Insurers are not-for-profit Japanese Ministry of Health, Labour, and

Welfare and fixes health service prices patients have access to all health institutions

and choose their provider


Canada

Publicly funded and administered universal health care system delivers care primarily through private providers Private insurance exists to cover any gaps in

services• Gaps example: long waiting times on specialty coverage

Patients pay no co-pays or deductibles Patients can choose their doctor


Mexico

Fractionalized system with variety of public programs

No universal coverage, but social security administered system covers the unemployed Private insurance mostly used by wealthy Seguro Popular program – set up to cover more of

the uninsured Out-of-pocket payments account for more

than half of financing for the health care system


The United Kingdom

Tax-supported health system that is owned and operated by the government

Services available to all citizens for free or a small fee

Physicians paid by number of patients they serve rather than by individual visits


China

Chinese collective system emphasized the common good for all people, not individuals or special groups Financed through cooperative insurance plans Owned and controlled by the state Used barefoot doctors

Health care managed by Ministry of Public Health Set national health policy Recent economic reforms led to decline in health

care, especially in rural areas


Major Global Health Problems and the Burden of Disease

Communicable DiseasesDiarrheal Disease

Maternal and Women’s HealthNutrition and World Health

Natural and Man-Made Disasters


Communicable Diseases

Immunization Prevention through immunization and improving

environmental conditions Eradication of smallpox throughout the world

Tuberculosis (TB) Largest cause of death from a single infectious

agent AIDS

Increasing incidence in adolescents, young adults, and heterosexuals

Malaria Affects more than 50% of the world’s population


Diarrheal Disease

One of the leading causes of illness and death in children less than 5 years of age throughout the world Each year there are 1.6 million diarrheal deaths

related to unsafe water, sanitation, and hygiene Rampant among the impoverished Many countries have developed diarrhea

control programs that improve childhood nutrition.


Maternal and Women’s Health

A woman’s ability to survive pregnancy and childbirth is indicative of the society in which she lives.

Maternal health has widespread effects on children and families.

Most deaths to women around the world are related to pregnancy and childbirth.

Safe motherhood initiatives are still needed.


Nutrition and World Health

Poor nutrition by itself or that associated with infectious disease accounts for a large portion of the world’s disease burden.

Many children around the world are underweight and have multiple micronutrient deficiencies.

Improved nutrition is related to stronger immune systems, decreased illness, better maternal and child health, longer life spans, and improved learning outcomes for children.


Natural and Man-Made Disasters

Natural disasters Earthquakes, tsunamis, floods, hurricanes,

cyclones, droughts Typically the poor are the worst hit due to their

lack of resources to cope and rebuild. Man-Made disasters

Bioterrorism attack Chemical emergency Radiation poisoning Genocide


Surveillance Systems

Used to track potential risks for intentional harm to the people of the world

Four primary tasks: Systematic disease intelligence and detection Outbreak verification Immediate alert Rapid response

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Chapter 04 Perspectives in Global Health Care