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Global Health What is it and why the fuss?. C. ‘ Sola Olopade, MD, MPH Professor, BSD Clinical Director, Global Health Initiative. Presentation Outline. Define Global Health and importance Discuss Global Burden of Disease Discuss poverty and life expectancy - PowerPoint PPT Presentation
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Global HealthWhat is it and why the fuss?
C. ‘Sola Olopade, MD, MPHProfessor, BSDClinical Director, Global Health Initiative
Presentation Outline• Define Global Health and importance• Discuss Global Burden of Disease• Discuss poverty and life expectancy• Describe Obama Global Health Initiative
and why US should invest in GH• Discuss work on energy poverty and
implication on health of women and children in Nigeria
Koplan et al: Lancet 2009: 373; 1993-5
What is Global Health ?
• “Area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide”.
Koplan et al: Lancet 2009: 373; 1993-5
Global Health
• Emphasizes transnational health issues, determinants and solutions
• Involves many disciplines beyond health sciences
• Promotes interdisciplinary collaboration• Calls for actions to influence the
global forces that determine the health of people
Determinants of Global Health• Poverty• Weak governance• Weak infrastructure (education, water and health)• Urbanization• Globalization – int’l travel of people & goods; foods,
tobacco etc.• Cultural/societal norms• Environmental pollution- dumping, indoor pollution• Ecological and climate change
Health Risk Transition from Traditional to Modern Times
Global Health Risks | WHO 2009
Global Burden of DiseaseLeading Causes of Death
Global Burden of Disease 2004 |WHO 2008
Global Burden of DiseaseLeading Causes of Death
Global Burden of Disease 2004. WHO 2008
Distribution of Age of Death and Numbers of Deaths, World
Global Burden of Disease 2004 |WHO 2008
Gender Distribution of Deaths
Global Burden of Disease 2004 | WHO 2008
In Developing Countries, Death takes the Young and in Developed countries, the old
Global Burden of Disease 2004 | WHO 2008
Global Burden of Disease 2004 | WHO 2008
Distribution of Child Deaths for Selected Causes by Region
Leading Causes of Death in Adults
Global Burden of Disease 2004 | WHO 2008
Child Mortality Rate by Disease and Region
Global Health Risks | WHO 2009
Globalization and Health• Improved Global wealth and living standards• Widening gap between the rich and poor
– # of Billionaires owning 4% of world GDP 385– World population living on < $300/year 50%
• Exacerbation of extreme poverty (>25%)
– Condition of life so limited by malnutrition, illiteracy, disease, squalid living conditions, high infant mortality and low life expectancy
– Many in Africa live on $1 a day
Poverty and Life Expectancy
Institute of Medicine
Projected Deaths by Cause for High, Middle and Low Income Countries
Today’s Challenge
UNDP 2009
Global Disparities and Life Expectancy• Sub-Saharan Africa accounts for 25% of
Global burden of disease but has less than 3% of needed workforce
• 95% of global R&D directed at health problems of 5% of global population
• Marked disparity in life expectancy between developed and developing countries
– Canada: 80 years and rising– Sub-Saharan Africa: 49 years and falling– Angola: 38 years, Zimbabwe: 49 years
Brain Drain and Global Disparities in Health and Life
Expectancy
F Mullan: NEJM 2005; 353: 1810-8
Why The US Should Invest in Global Health?
• To protect Americans• Enhance economy• Advance USA international interests
Protection of US Citizens Across the Globe
• Infectious diseases• Biological and chemical terrorism• Unregulated pharmaceuticals• Contaminated foods• Natural disasters• Violence
Why Should We Care?U.S. Air-Travel Related Illnesses in
2009/11• Tuberculosis: 662 reports• Chicken pox and shingles: 518 reports• Measles: 78 reports• Mumps: 56 reports• Whooping cough: 41 reports• Typhoid fever: 19 reports• Lassa fever: 1 report• 15-70% of returning travelers to the USA have
a travel-related illness*
CDC 2009, CDC 2011*
Why The US Should Invest in Global Health?
• To protect Americans• Enhance economy• Advance USA international interests
Enhance U.S. Trade and Economy• Healthier populations abroad constitute
vibrant markets for U.S. goods• Provides employment for U.S. public
health professionals• Market for U.S. technology and industry• Training opportunities in the field for U.S.
health professionals• Benefit to U.S. local economies• Enhances U.S. Diplomacy – “soft power”
Why The US Should Invest in Global Health?
• To protect Americans• Enhance economy• Advance USA international
interests
Advance US Diplomatic, Military and other Interests
• US tradition of humanitarian interests• Integral component of US smart foreign
policy• Enhances US interests
– Global political, military and economic leadership
– Commitment to democratic principles– Foreign policy– Support for human rights– National security efforts
The Global Health Paradox
Targeted resources to disease and population specific programs
“PEPFER”
Inadequate effort made to strengthen health systems
Unintended Consequences
• Weakened health systems• Dysfunctional service delivery• Inequitable financing, especially for the
poor• Quality health care considered a luxury• Millions impoverished by out of pocket
expenses for catastrophic illness
Income Changes With Diagnosis
Antaracian C et al: CUGH 2011
Coping Strategy Utilization
Antaracian C et al: CUGH 2011
The Obama Global Health InitiativeCore Principles
• Health is at the heart of human progress• Focus on women, girls and gender equality• Encourage country ownership and invest in
country-led plans• Build sustainability through health systems
strengthening• Strengthen and leverage multilateral
engagement (Universities, Private sector, NGO)• Promote research and innovation• Engage academic institutions in global health
Gostin and Mok: JAMA2010:304
The Obama Global Health Initiative
• Pledged $63B in global health over 6 years ‘09-’15• Make global health an integral part of government’s
three pillars of foreign policy: Diplomacy, development and defense
• Develop whole-of-government approach• Promote strategic coordination in all departments• Ordered first Diplomacy and Development review by
USAID and Dept of State• Hilary Clinton: State Dept to use GH as “soft power”
Gostin and Mok: JAMA 2010:304
Funmi Olopade, MD Funmi Olopade, MD appointed BSD appointed BSD Associate Associate Dean/Director of GHIDean/Director of GHI
Faculty Steering Faculty Steering CommitteeCommittee
September September 2009 2009
Official Official Launch/GlobaLaunch/Global Health l Health Scholars Scholars TrackTrack
March 2010March 2010
Kenneth Polonsky, Kenneth Polonsky, MD appointed BSD MD appointed BSD Dean, and UC VPDean, and UC VP
September 2010September 2010
Strategic Strategic PlanningPlanning
July 2008July 2008
GHI Evolution at University of Chicago
Leveraging our Strengths
• Environment, Health and Vulnerable Populations
• Health Systems Development and Urban Health
• Genomics and Chronic Non-Communicable Diseases
• Maternal and Child Health• Global Health Ethics as a cross-cutting
theme
Energy PovertyImplications for the Lung Health of Women and Children
Energy Poverty in Developing Countries
UNDP/ WHO November 2009
Lack of Electricity in Developing Countries Lack of Electricity in LDC and SSA
UNDP/WHO November 2009
Distribution of People Relying on Solid Fuels for Cooking in Developing Regions
Commonly Used Traditional Biomass Fuel
Bangladesh 2008: Courtesy Faruque Pravez
Bangladesh 2009
Deaths and DALY’s Attributable to 5 Major Environmental Risks
Global Health Risks | WHO 2009
•Why is exposure to IAP so dangerous to women and young children?
Mother-Child Exposure to Biomass Smoke in Nigeria
Exposure to Biomass Smoke in Bangladesh
Scope of the Problem
• More than 3 billion people cook with biomass fuels– More than 75% of Asia – 50–75% in South America and Africa
• Cooking and heating with biomass fuel is the largest traditional source of indoor air pollution (IAP)
• 3 billion women and young children have the highest burden of exposure to IAP
• IAP accounts for 2.7% of the global burden of disease and is a major contributor to global health disparities
• IAP is major contributor to environmental degradation and climate change
Anderson et al., 2005; McCracken et al., 2007
Health Effects of IAP from Solid Fuels
• Causes 2.2–2.5 million deaths /year– 99% of deaths occur in developing countries– 19 – 21% of Acute respiratory infection (ARI) – 22% of Chronic Obstructive Pulmonary Disease– 1.5% of lung cancers
• Majority of deaths occur from pneumonia in children under five years of age
• Over 30% of IAP-related mortality burden is in Africa and South/Southeast Asia
Zhang and Smith, 2007
Specific Aims• Investigate levels of indoor air pollution
created by burning biomass fuels through monitoring CO and PM2.5
• Determine exposure-related symptoms in mother-child pairs in each household
• Determine effect of exposure on lung function• Investigate impact of distribution of low
emission stoves on indoor air quality, symptoms and lung function
The Rural Communities in Nigeria
Results
Characteristics of Participants
Age, years ±SD
Mothers 41 ±11.7
Children 13 ± 2.5
Education
No formal education 50 (43.7%)
Primary/Middle School 44 (37.3%)
Cooking fuel
Firewood 93 (78.8%)
Charcoal 34 (28.8%)
Kerosene 29 (24.5%)
Frequency of Reported Symptoms in Children exposed to IAP
Frequency of Reported Symptoms in Mothers exposed to IAP
Pre-intervention Indoor PM2.5 Concentration
Pre-intervention Indoor CO Concentration
Pulmonary Function in Mothers and Children Exposed to IAP
Pre-InterventionMother† (N=59)
Normal 35 (59.3%)
Mild Obstruction 5 (8.5%)
Moderate obstruction 18 (30.5%)
Restrictive pattern 1 ( 1.7%)
Child‡ (N=59)
Normal 29 (49.1%)
Mild Obstruction 12 (20.3%)
Moderate obstruction 14 (23.7%)
Restrictive pattern 4 (6.8%)
†ATS guidelines‡ATS/ERS guidelines
Humanitarian Award Chest Foundation
Efficient Stoves Distribution
Pre and Post Intervention PM2.5
Levels
Pre and Post Intervention CO Levels
Frequency of Reported Symptoms in Children 1 year Post Intervention
Frequency of Reported Symptoms in Mothers 1 year Post-Intervention
Conclusions• PM 2.5 and CO are major pollutants from firewood• Women and children are at greatest risk of IAP• IAP is associated with obstructive pulmonary disease• Distribution of efficient stoves is an important stop
gap measure in protecting the health of women and children
• Community engagement and partnership in research is essential for influencing research to policy translation and behavior change
• Preventing IAP related mortality has the potential to improve the likelihood of achievement of MDG 4 and 5 goals
Strategies for the Future
• Commitment to distribute 100 Million stoves to vulnerable populations
• Develop cleaner stoves and fuel• Create entrepreneurship around initiative to
empower women• Halt environmental degradation and
Climate change
Sunrise at Serengeti National Park, Tanzania, November 2009
Exposure To Biomass Fuel and Health Risks
Risks to Women•Chronic obstructive pulmonary disease (COPD)•Lung Cancer•Blindness•Emphysema•Adverse pregnancy outcomes
Risks to Children•Acute upper respiratory infection (ARI)•Asthma•Pneumonia•Early Infant Death
Nigeria 2008: Courtesy Femi Oluwole
Millennium Development Goals 2000
• Bolstering human capital– Nutrition– Healthcare– Education
• Improving infrastructure– Safe drinking water– Energy– Communication and preservation of the environment
• Increase social, economic and social rights– Empowering women– Reducing violence– Increasing security of property rights
Millennium Development Goals2000-2015
• 1. Eradicate extreme poverty and hunger• 2. Achieve universal primary education• 3. Promote gender equality and empower
women• 4. Reduce child mortality• 5. Improve maternal health• 6. Combat HIV/AIDS, Malaria and Tuberculosis• 7. Ensure environmental sustainability• 8. Develop a Global partnership for development
What’s Good about the MDG Goals?
• Unanimous acknowledgment of problem• Setting goals• Expanded donor base• Collaborative approach• Commitment to help developing countries
What Progress has been Made?
• Primary school enrolment has increased • Child health improved and mortality reduced• Access to clean water improved• Malaria control better with use of treated nets• Maternal to child HIV transmission reduced• Hunger and malnutrition rose from 2007-2009• Reduction in extreme poverty eradication mostly
driven by China with no change in SSA• New HIV cases outnumber those on treatment• Slow progress on gender equality, maternal
mortality reduction and reproductive health
United Nations General Assembly Document Sept 17, 2010
What Are the Challenges?
• No sustainability plans beyond 2015• Choice of goals? CNCD not a focus despite 2030
projections• Lack of measurement tools for some of the goals• Dependence on household surveys for outcome
monitoring• Lack of reliable records in countries with most
mortality in HIV/AIDS, Malaria and TB• Fragile or non-existent health care infrastructure• Limited research infrastructure to participate in
clinical trials
Globalization of Health Risks
• Unhealthy Dietary habits–fast foods• Reduced physical activity• Explosive growth of tobacco companies in
developing countries• Increased tobacco consumption• Ease of transcontinental travel• Globalization of food market
What Are the Challenges?
• No sustainability plans beyond 2015• Choice of goals? CNCD not a focus despite 2030
projections• Lack of measurement tools for some of the goals• Dependence on household surveys for outcome
monitoring• Lack of reliable records in countries with most
mortality in HIV/AIDS, Malaria and TB• Fragile or non-existent health care infrastructure• Limited research infrastructure to participate in
clinical trials
The Unavoidable
Haiti Earthquake 2010
http://www.flickr.com/photos/unitednationsdevelopmentprogramme/4275397038/
The Unavoidable
Tent City, Haiti 2010
The Unavoidable
Pakistan Flood 2010 http://stockmarkettoday.in/2010/07/31/pakistan-flood-400-dead-rescue-ops-on/
Beyond PEPFARWhere are the Opportunities?
• USAID strategic change to develop partnership with Universities
• Funding training programs (D43, R25, R01) in partnership with developing countries
• Medical Education Planning Initiative– $130 Million USA/Developing Country Medical School
• Grand challenges – Bill Gates– Canada-$300 Million
Brain Drain and Global Disparities in Health and Life
Expectancy
F Mullan: NEJM 2005; 353: 1810-8
Brain Drain and Global Disparities in Health and Life
Expectancy
F Mullan: NEJM 2005; 353: 1810-8
Global Lack of Access to Electricity 2008
UNDP/ WHO November 2009