Global Health 101 - Unite For Sight...Global Health 101 Richard Skolnik Objectives • Why is global health important? • What perspectives should one use to consider global health

Global Health 101

Richard Skolnik

Objectives

• Why is global health important?

• What perspectives should one use to consider global health issues?

• What do people get sick, disabled, and die from?

• What are the critical challenges to improving health, especially in LMICs?

• How can these challenges be addressed in cost-effective, doable, sustainable and fair ways?

• The health of anyone, anywhere is the health of everyone, everywhere

• There has been some important progress in improving health

• There remain, however, substantial unfinished and emerging agendas

• Substantial equity issues also remain

• A large share of deaths and DALYS are preventable by addressing a small number of risk factors

• LMICs must now address intersectoral issues and establish effective and efficient UHC as fast as possible

Main Messages

Why is Global Health Important?

• Ethical dimensions

• Impacts on the productivity of individuals and countries

• Links with economic and social development

• Implications for global security and freedom

• Huge expenditures by people and governments

• Lack of respect for boundaries – the health of anyone,

anywhere is the health of everyone, everywhere

Guiding Principles for Considering Global Health

• Think like a Minister of Finance who believes in Human Capital

• If you only have $100, how will you spend it to maximize your people’s health?

• In LICs, how will you bury old people instead of young people, make the transition as fast as possible, and do it at the least cost?

• In HICs, how will you help people live long and healthy lives?

• Always question your fundamental assumptions

• HOW you spend money is more important than HOW MUCH you spend

THE HEALTH OF THE WORLD AN OVERVIEW

Some Good News

INCREASE IN GLOBAL LIFE EXPECTANCY FROM 1960 TO 201342%

FEWER UNDER-5 DEATHS IN 2013 THAN IN 199050%

FEWER NEW HIV CASES EACH YEAR THAN IN THE MID- TO LATE-1990s

1.2 MILLION

FEWER TB DEATHS PER YEAR IN HIV-NEGATIVE INDIVIDUALS FROM 1990 TO 2013

500,000

FEWER MATERNAL DEATHS IN 2015 THAN IN 199044%

DECREASE IN MALARIA MORTALITY RATES AMONG UNDER-5 CHILDREN SINCE 2000

53%

CHILDREN HAVE BEEN IMMUNIZED AGAINST POLIO SINCE 1988, WITH ONLY 100 TOTAL CASES IN 2015

2.5BILLION

REDUCTION OF GUINEA WORM CASES FROM 1986 TO 2015, NEAR ERADICATION

99.9%

Change in Life Expectancy at Birth for World Bank Regions and High-Income Countries, 1960-2014

Source: World Bank. World Development Indicators. Available at: http://data.worldbank.org/indicator

35

40

45

50

55

60

65

70

75

80

85

Life

Exp

ect

ancy

at

Bir

th

Year

High Income

Sub-Saharan Africa

South Asia

East Asia & Pacific

Europe & Central Asia

Middle East & North Africa

Latin America & Caribbean

Declines in Under-Five Child Mortality, by World Bank Region, 1990-2015

Source: World Bank. World Development Indicators. Available at: http://data.worldbank.org/indicator

0

20

40

60

80

100

120

140

160

180

200

1990 2015

De

ath

s p

er

1,0

00

Liv

e B

irth

s

Year

High Income

Sub-Saharan Africa

South Asia

East Asia & Pacific

Europe & Central Asia

Middle East & North Africa

Latin America & Caribbean

Some Less Good News

UNDER-5 CHILD DEATHS IN 20136.3

MILLION

SHARE OF CHILD DEATHS RELATED TO UNDERNUTRITION

45%

AIDS DEATHS IN 20131.5

MILLION

NEW ADULT HIV INFECTIONS IN 20132.1

MILLION

TB DEATHS IN 20131.5

MILLION

MALARIA DEATHS IN 2013584,000

MATERNAL DEATHS IN 2013289,000

PEOPLE INFECTED WITH SOIL-TRANSMITTED HELMINTHS

~ 2BILLION

Snapshot of Global Health Status: Key Health Status Indicators

• Life expectancy

• Maternal mortality ratio

• Neonatal mortality rate

• Infant mortality rate

• Under-five mortality

Life Expectancy at Birth, By World Bank Regions and for High-Income Countries, 2014

Source: World Bank. Data: Life expectancy at birth, total (years). Accessed April 2, 2017. Available at: http://data.worldbank.org/indicator/SP.DYN.LE00.IN/countries/1W-ZG-ZJ-ZQ?display=graph

59

6873 75 75 77

81

0

10

20

30

40

50

60

70

80

90

Sub-SaharanAfrica

South Asia Middle East &North Africa

Latin America &Caribbean

East Asia &Pacific

Europe & CentralAsia

High Income

Life

Exp

ect

ancy

at

Bir

th

Region

Maternal Mortality Ratios for World Bank Regions, High-Income Countries, and Globally, 2014

Source: Data from World Bank. Data: Maternal mortality ratio. Data from the World Bank. http://data.worldbank.org/indicator/SH.STA.MMRT/countries/1W-8S-Z4-ZJ-XD-Z7-ZG?display=graph. Accessed April 2, 2017.

547

182

81 67 59

16 100

100

200

300

400

500

600

Sub-SaharanAfrica



East Asia &Pacific

Europe &Central Asia

High Income

De

ath

s p

er

10

0,0

00

Liv

e B

irth

s

Region

Neonatal Mortality Rates for World Bank Regions,High-Income Countries, and Globally, 2015

Source: Data from the World Bank. World Development Indicators: Mortality. http://data.worldbank.org/indicator/SH.DYN.NMRT/countries/Z4-ZJ-8S-ZG-Z7-ZQ-XD?display=graph. Accessed April 2, 2017.

3029

13

9 9

6

3

0

5

10

15

20

25

30

35

South Asia Sub-SaharanAfrica

Middle East &North Africa

East Asia &Pacific



High Income

De

ath

s p

er

10

00

Liv

e B

irth

s

Region

Infant Mortality Rates for World Bank Regions,High-Income Countries, and Globally, 2015

Source: Data from the World Bank. World Development Indicators: Mortality. http://data.worldbank.org/indicator/SH.DYN.NMRT/countries/Z4-ZJ-8S-ZG-Z7-ZQ-XD?display=graph. Accessed April 2, 2017

56

42

20

15 14

10

5

0

10

20

30

40

50

60

Sub-SaharanAfrica


East Asia &Pacific



High Income

De

ath

s p

er

10

00

Liv

e B

irth

s

Region

Under-Five Child Mortality Rates for World Bank Regions, High-Income Countries, and Globally, 2015

Source: Data from the World Bank. World Development Indicators: Mortality. http://data.worldbank.org/indicator/SH.DYN.NMRT/countries/Z4-ZJ-8S-ZG-Z7-ZQ-XD?display=graph. Accessed April 2, 2017

83

53

2318 17

116

0

10

20

30

40

50

60

70

80

90

Sub-SaharanAfrica



East Asia &Pacific


High Income

De

ath

s p

er

10

00

Liv

e B

irth

s

Region

Neonatal, Infant, and Under-Five Child Mortality Rates, by World Bank Region and for High-Income Countries, 2015

Source: Data from the World Bank. World Development Indicators: Mortality. http://data.worldbank.org/indicator/SH.DYN.MORT/countries/1W-Z4-ZQ-Z7?display=graph. Accessed April 2, 2017.

29 30

139 9

63

56

42

20

14 1510

5

83

53

2318 17

116

0

10

20

30

40

50

60

70

80

90

Sub-SaharanAfrica

South Asia Middle East& North

Africa

Latin America& Caribbean

East Asia &Pacific


High Income

Dea

ths

per

10

00

Liv

e B

irth

s

Region

Neonatal Mortality

Infant Mortality

Under-Five Mortality

BURDEN OF DISEASE

Leading Causes of Death for Low-Income Countries and High-Income Countries, 2015

Rank Low-Income Countries

1 Lower respiratory infections

2 HIV/AIDS

3 Diarrheal diseases

4 Malaria

5 Stroke

6 Ischemic heart disease

7 Tuberculosis

8 Congenital defects

9 Neonatal preterm birth

10 Neonatal encephalopathy

Rank High-Income Countries


2 Stroke

3 Alzheimer’s disease

4 Lung cancer


6 COPD

7 Colorectal cancer

8 Chronic kidney disease

9 Diabetes

10 Breast cancer

Note: High-income defined by World Bank income group while low- and middle-income countries defined as developing countries using the GBD Heatmap. Source: Data from Institute for Health Metrics and Evaluation (IHME). GBD Heatmap. Seattle, WA: IHME, University of Washington, 2015. Available from http://vizhub.healthdata.org/irank/heat.php. Accessed March 18, 2017.

Leading Causes of Death, Globally, 1990 and 2015

1990

Rank Disease


2 Stroke


4 COPD



7 Tuberculosis

8 Road injuries

9 Lung cancer

10 Malaria

2015

Rank Disease


2 Stroke

3 COPD



6 Lung cancer

7 Diabetes

8 Road injuries


10 Chronic kidney disease

Source: IHME. Global Burden of Disease Heatmap. Accessed March 18, 2017. Available at: http://vizhub.healthdata.org/gbd-compare/.

Distribution of the Cause of Death, by Income Group, 2015


Group I52%

Group II39%

Group III9%

Low Income

Group I8%

Group II83%

Group III9%

Upper-Middle IncomeGroup I

6%

Group II88%

Group III6%

High Income

Group I: Communicable, Maternal, Neonatal, and Nutritional Causes

Group II: Non-Communicable Diseases

Group III: Injuries

Group I29%

Group II62%

Group III9%

Lower-Middle Income

Causes of Neonatal Death, Globally, By Percentage, 2013

Injuries; 1%

Diarrheal diseases; 1%

Tetanus; 2%

Acute lower respiratory infection5%

Other communicable, perinatal, and nutritional conditions; 7%

Congenital anomalies; 10%Sepsis and other infections of the

newborn; 15%

Birth asphyxia and birth trauma; 24%

Preterm birth complications; 35%

Notes: Estimates may not add up to 100% due to roundingSource: Adapted from Skolnik, R. L. (2015). Global health 101. Burlington, MA: Jones & Bartlett Learning. P.263;; WHO. Global Health Observatory Data Repository: Mortality and global health estimates. http://apps.who.int/gho/data/view.main.CM300WORLD-CH11?lang=en. Accessed February 28, 2015.

Causes of Post-Neonatal Under-Five Child Death (1-59mos), By Percentage, 2013

Pertussis; 2%

Birth asphyxia and birth trauma; 2%

HIV/AIDS; 3%

Measles; 3%

Prematurity; 4%

Meningitis/encephalitis; 4%

Congenital anomalies; 5%

Other noncommunicablediseases; 7%

Injuries; 9%Other communicable,

perinatal, and nutritional conditions; 10%

Malaria; 13%

Diarrheal diseases; 16%

Lower respiratory infections; 23%

Notes: Estimates may not add up to 100% due to roundingSource: Adapted from Skolnik, R. L. (2015). Global health 101. Burlington, MA: Jones & Bartlett Learning. P.263;; WHO. Global Health Observatory Data Repository: Mortality and global health estimates. http://apps.who.int/gho/data/view.main.CM300WORLD-CH11?lang=en. Accessed February 28, 2015.

Leading Causes of DALYs for Low-Income Countries and High-Income Countries, 2015



2 Malaria

3 HIV/AIDS





8 Neonatal sepsis

9 Protein-energy malnutrition

10 Meningitis



2 Low back & neck pain

3 Sense organ diseases

4 Stroke

5 Lung cancer

6 Diabetes

7 Depressive disorders


9 COPD

10 Skin diseases

Note: High-income defined by World Bank income group while low- and middle-income countries defined as developing countries using the GBD Heatmap. Source: Data from Institute for Health Metrics and Evaluation (IHME). GBD Heatmap. Seattle, WA: IHME, University of Washington, 2013. Available from http://vizhub.healthdata.org/irank/heat.php. Accessed March 18, 2017.

Leading Causes of DALYs Globally, 1990 and 2015

1990

Rank Disease





5 Stroke


7 Malaria

8 Measles


10 COPD

2015

Rank Disease


2 Stroke


4 Low back & neck pain



7 Sense organ diseases


9 Road injuries

10 HIV/AIDS


RISK FACTORS

Leading Risk Factors for Death in Low-Income Countries and High-Income Countries, 2015

Rank Low Income Countries

1 High blood pressure

2 Childhood undernutrition

3 Household air pollution

4 Unsafe sex

5 Unsafe water

6 Ambient particulate matter

7 Unsafe sanitation

8 Handwashing

9 Smoking

10 High fasting plasma glucose



2 Smoking


4 High total cholesterol

5 High body-mass index

6 Impaired kidney function

7 Diet high in sodium


9 Diet low in whole grains

10 Low physical activity

Source: Data from Institute for Health Metrics and Evaluation (IHME). GBD Heatmap. Seattle, WA: IHME, University of Washington, 2015. Available from http://vizhub.healthdata.org/irank/heat.php. Accessed March 18,2017

Leading Risk Factors for Deaths, Globally, 1990 and 2015

1990

Rank Risk Factor


2 Smoking






8 High sodium


10 Unsafe water

2015

Rank Risk Factor


2 Smoking



5Ambient particulate matter




9 Diet low in fruit


Source: IHME. Global Burden of Disease Heatmap. Accessed August 18, 2016. Available at: http://vizhub.healthdata.org/gbd-compare/.

Leading Risk Factors for DALYs in Low-Income Countries and High-Income Countries, 2015



2 Unsafe sex


4 Unsafe water

5 Unsafe sanitation

6 Handwashing



9 Suboptimal breastfeeding

10 Iron deficiency


1 Smoking





6 Alcohol use


8 Impaired kidney function

9 Diet low in fruit

10 Low physical activity

Note: High-income defined by World Bank income group while low- and middle-income countries defined as developing countries using the GBD Heatmap. Source: Data from Institute for Health Metrics and Evaluation (IHME). GBD Heatmap. Seattle, WA: IHME, University of Washington, 2013. Available from http://vizhub.healthdata.org/irank/heat.php. Accessed August 18, 2016.

Leading Risk Factors for DALYs, 1990 and 2015

Rank 1990

Risk Factor


2 Unsafe water



5 Smoking


7 Unsafe sanitation

8 Suboptimal breastfeeding

9 Handwashing


Rank 2015

Risk Factor


2 Smoking







9 Alcohol use



HEALTH EQUITY

Equity, Inequality, and Health Disparities

• Includes fairness concerns about achievement of health and the capability to achieve good health, not just the distribution of health care

Equity

• Differences in health status or in the distribution of health determinants between different population groups

Inequality

• Differences in health that are closely linked with social or economic disadvantage

Health Disparities

Sources: Equity from Whitehead, M. (1992). The concepts and principles of equity and health. International Journal of Health Services, 22, 429–445; Inequality from World Health Organization. (n.d.). Health impact assessment. Glos- sary of terms used. Retrieved December 4, 2014, from http://www.who.int /hia/about/glos/en/index1.html; Health Disparity from Centers for Disease Control and Prevention. Social determinants of health. Definitions. Retrieved December 4, 2014, from http://www.cdc.gov /socialdeterminants/Definitions.html.

Key Factors Associated with Health Disparities

Health status and whether or not the person is disabled

Social and economic status

Ethnicity

Gender

Location

Religion

Occupation

Social capital

Percentage of Births Attended by Skilled Personnel, by Income Quintile, 2003-2009, for Selected Regions

17

2828

39

43

51

60

66

83 84

0

10

20

30

40

50

60

70

80

90

South Asia Sub-Saharan Africa

Pe

rcen

tag e

(%

)

Region

Poorest 20%

Second 20%

Middle 20%

Fourth 20%

Richest 20%

Source: UNICEF. Progress for Children: Achieving the MDGs with Equity. Available at: http://www.unicef.org/media/files/Progress_for_Children-No.9_EN_081710.pdf. Accessed September 17, 2010. ; Adapted from Skolnik, R. L. (2015). Global health 101. Burlington, MA: Jones & Bartlett Learning. p.64.

Coverage of Measles Immunization by Income Quintile, for Selected Regions, 2008


36

44 43

52 50

64 61

74 76

84

0

10

20

30

40

50

60

70

80

90

West and Central Africa South Asia

Perc

enta

ge

(%

)

Region

Poorest 20%

Second 20%

Middle 20%

Fourth 20%

Richest 20%

Percentage of Underweight Children, 0-5 Years of Age, by Income Quintile, Selected Regions, 2003-2009

56

29

20

13

0

10

20

30

40

50

60


Perc

enta

ge (

%)

Region

Poorest 20%

Richest 20%


Percentage of Stunted Children, 0-5 years, by Location, for Selected Regions, 2003-2009

50

46

24

39

32

10

0

10

20

30

40

50

60

South Asia Sub-Saharan Africa Latin America & the Caribbean

Perc

enta

ge

(%

)

Region

Rural

Urban


Percentage of Women 15-49, Married or in Union, Who Are Using Contraception, by Location, for World Bank Regions, 2003-2009

79

70

56

50

18

78 78

66

61

31

0

10

20

30

40

50

60

70

80

90

East Asia & the Pacific Latin America & the

Caribbean

Middle East & North

Africa


Perc

enta

ge (

%)

Region

Rural

Urban


HEALTH SYSTEMS OVERVIEW

WHO Health System Framework

The WHO Health System Framework

System Building Blocks

Service delivery

Health workforce

Information

Medical products, vaccines, & technologies

Financing

Leadership/governance

Access

Coverage

Quality Safety

Improved health (level & equity)

Responsiveness

Social & financial risk protection

Improved efficiency

Overall Goals/Outcomes

Adapted from: World Health Organization. Everybody’s business: Strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva: World Health Organization; 2007.

The WHO Universal Health Coverage Framework

f

Three dimensions to consider when moving towards universal coverage

Extend to non-covered

Reduce cost sharing and fees

Include other services

Services: which services are covered?

Direct costs: proportion of the costs covered

Population: who is covered?

Current pooled funds

Adapted from: World Health Organization. Everybody’s business: Strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva: World Health Organization; 2007.

Many Countries Pursuing Reforms at Various Stages

Source: Presentation by Gina Langamarsino. “Universal Health Coverage – What’s all the “buzz” about?” R4D. February 12, 2012.

Kenya Ethiopia Uganda Zambia Sierra Leone

Liberia Mali Nepal Senegal

China

India

Nigeria

Tanzania

Cambodia Yemen Lao PDR

Ghana Indonesia South Africa Bolivia Morocco

Namibia Turkey

Vietnam Egypt Jordan

The Philippines Mexico Costa Rica Rwanda Peru

Colombia Chile Estonia Kyrgyz Republic Thailand

Brazil Argentina Korea Taiwan Tunisia

<30

%30

-60

%>

60

%

Per

cen

tag

e o

f p

op

ula

tio

n c

ove

red

Early Middle Advanced

Phase of implementation*

* All countries have made a political commitment to pursuing reforms through passing legislation, etc.

ADDRESSING CRITICAL CHALLENGES

Critical Challenges

• Key intersectoral issues

• Weak health systems and the lack of universal health coverage

• Health disparities

• The unfinished agenda

• Noncommunicable diseases

• Risks

• Other public goods

Key Intersectoral Issues

• Water, sanitation, and hygiene

• Tobacco

• Overnutrition/obesity

• Girls’ Education

Addressing Key Intersectoral Issues

• Promote handwashing and increase access to clean water

• MPower package on tobacco and related package on alcohol

• Tax food and beverages high in sugar

• Cash transfers for girls’ education

Key Health Systems Issues

• Enhance basic functions

• Strengthen workforce

• Improve effectiveness and efficiency

• Move toward universal coverage

Addressing Key Health Systems Issues

• Task-shifting

• Contracting in & contracting out

• Results based financing (RBF)

• Cash transfers (CCTs)

• Phase implementation

Key Challenges in Inequality and Inequity

• Health status

• Access to health services

• Coverage of health services

• Protection from financial risks because of health costs

• The extent to which the approach to financing health is fair

• The distribution of health benefits

Addressing Inequality and Inequity

• Measure

• Focus on marginalized groups

• Evaluate from an equity perspective

The Unfinished Agenda: Key Maternal Health Challenges

• Gender inequalities

• Child marriage

• Delaying age of first birth

• Access to contraception

• Complications during childbirth, such as maternal deathand morbidity

Addressing Maternal Health

• Improve nutrition of adolescent girls

• Community-based interventions aimed at delaying age at marriage and first birth

• Improve access to culturally appropriate modern contraceptives & education on three-year birth intervals

• Promote skilled attendants at delivery

• Increase access and adherence to prenatal care: including micronutrient supplementation, monitoring of hypertension & diabetes, & tetanus vaccination

• Ensure emergency obstetric care available

• Improve follow-up of post-partum care & counseling

The Unfinished Agenda: Key Neonatal Health Challenges

• Nutritional status of mother

• Low birthweight

• Prematurity

• Child caring practices

• Deliveries attended by skilled birthing attendants

Addressing Neonatal Health

• Ensure healthy mothers, who are immunized against tetanus

• Ensure attended delivery with emergency care available

• Promote keeping the baby warm

• Increase awareness of the benefits of kangaroo mother care

• Monitor vaccination

• Promote immediate and exclusive breastfeeding on a local and societal level

• Implement community-based diagnosis & treatment of pneumonia

• Train community health workers on referral for emergency care if needed for sepsis, etc.

The Unfinished Agenda: Key Child Health Challenges

• Maternal health & neonatal health interventions

• Exclusive breastfeeding for six months and hygienic introduction of a diverse complementary diet

• Mother to child transmission of HIV

• Malaria

• Vaccine preventable diseases

• Hygienic introduction of a diverse complementary diet

• Diarrheal diseases

• Micronutrient deficiencies

Addressing Child Health Challenges

• Support maternal health & neonatal health interventions

• Promote exclusive breastfeeding for six months

• Prevention of maternal to child transmission of HIV

• Ensure early confirmed diagnosis & treatment for malaria

• Bednet uptake

• Universal immunization

• Promote hygienic introduction of a diverse complementary diet

• Train mothers on oral rehydration therapy with zinc

• Provide Vitamin A supplementation

• Community-based management of pneumonia

The Unfinished Agenda: Key Challenges in Communicable Diseases

• HIV

• TB

• Malaria

• NTDS

Addressing Communicable Diseases

• Mass drug administration for neglected tropical diseases

• Diagnosis & DOTS (Directly Observed Therapy) for TB

• Voluntary counseling & testing for HIV

• Focused HIV prevention

• Anti-retroviral therapy for HIV

• Bednets & early, confirmed diagnosis with Artemisinin-Combination Therapy (ACT) for malaria

Key Challenges in Noncommunicable Diseases

• Tobacco

• Alcohol

• Eating Behaviors

• Physical Activity

• Cancer Vaccines

Addressing Noncommunicable Diseases

• The mPower package on tobacco

• Analogous measures on alcohol

• Enable healthier foods & more exercise

• Treat to reduce cholesterol

• Cancer Vaccines-Hep B and HPV

• Reduce salt consumption

• Aspirin for myocardial infarctions

• Treat hypertension

• Community-based approaches to diagnosis, psychosocial support, & treatment of mental disorders

Key Challenges in Preventing Epidemics and Antimicrobial Resistance

• Disease surveillance

• Surveillance of anti-microbial resistance

• Strengthened laboratory capacity

• Ability to respond nationally to emerging and re-emerging infections and anti-microbial resistance

• Rational use of pharmaceuticals

Preventing Epidemics and the Spread of Antimicrobial Resistance

• Have procedures in place beforehand

• Have mechanisms in place to mobilize quickly

• Engage local communities

• Raise awareness of the public of potential threats

Key Challenges in Public Goods

• The need for new diagnostics, drugs, & vaccines

• Gaps in cross-cutting surveillance

• The need for rapid response to disease outbreaks

• Financial gaps for countries with limited fiscal space

Addressing Public Goods

• Global collaboration

• Implementing push and pull interventions for product development

• Public-private partnerships

• Innovative financing mechanisms

Putting it All Together

• Achieve UHC

• Align Platforms for Service Delivery

• Implement Intersectoral and Fiscal Measures

Main Messages

• The health of anyone, anywhere is the health of everyone, everywhere

• There has been some important progress

• There remains, however, a substantial unfinished agenda and an emerging agenda

• Substantial equity issues also remain

• A large share of deaths and DALYS are preventable by addressing a small number of risk factors

• The issue now is to address intersectoral issues and move as fast as possible to addressing key issues through effective and efficient UHC

Thanks

• Lindsey Hiebert

• Rachel Wilkinson

• Rachel Skolnik Light

• Sarah Walker

• Rachel Strodel

Also, special thanks to Coursera for allowing the repurposing of many slides from my new course, Global

Health 101

Documents

Global Health 101 - Unite For Sight...Global Health 101 Richard Skolnik Objectives • Why is global health important? • What perspectives should one use to consider global health