1. What are some of the most significant health concerns in your community? Are these concerns that are likely to be shared by other communities in your country and in other parts of the world? Could these problems be considered global health issues?
2. Sketch out a causal web for a relatively common disease in your country, adding at least 10 risk factors to the figure. Based on the arrows on your web, what interventions might prevent the disease from occurring?
3. Create a brief disease profile for one of the many infections, diseases, or disabilities introduced in the textbook. What sources provide trusted background information about the symptoms of the disease and ways to prevent and treat it? What sources provide good statistical information about how many people worldwide are affected by the condition? What can academic publications contribute to your profile?
Chapter 1
Global Health
Transitions
Defining Global Health
1.1
Defining Health
• The Constitution of the World Health
Organization (WHO) defines health as
“a state of complete physical, mental,
and social well-being and not merely
the absence of disease or infirmity.”
• A diversity of medical, behavioral,
social, economic, environmental, and
other interventions can help people
make progress toward long, healthy life
trajectories.
Figure 1-1
Examples of health trajectories.
Defining Global Health
• Global health refers to the
collaborative actions taken to identify
and address transnational concerns
about the exposures and diseases that
adversely affect human populations.
• There are many different lenses that are
used to identify global health issues.
Figure 1-2
PACES: defining global health.
Figure 1-3
PACES: examples of global health priorities.
Health Interventions
1.2
Causes of Disease
• Etiology is the study of the social
and behavioral, environmental,
biological, and other causes of
disease.
• A person’s health status at a given
age is a function of his or her
experiences across the life course.
Medicine and Public Health
• Medicine focuses on preventing, diagnosing, and
treating health problems in individuals and families.
• Public health focuses on promoting health and
preventing illnesses, injuries, and early deaths at the
population level by identifying and mitigating
environmental hazards, promoting healthy
behaviors, ensuring access to essential health
services, and taking other actions to protect the
health, safety, and wellbeing of groups of people.
• The lines between medicine and public health are
blurry.
Figure 1-4
Reproduced from The public health system & the 10 essential public health services. Centers
for Disease Control and Prevention website
https://www.cdc.gov/stltpublichealth/publichealthservices/essentialhealthservices.html.
Updated September 20, 2017.
Essential public health services
Figure 1-5
Comparing medicine and public health.
Interventions
• An intervention is a strategic action
intended to improve individual and
population health status.
• Interventions targeted at any level,
from the individual to the
community, the nation, and the
world, can be effective at improving
personal and public health.
Figure 1-6
Examples of interventions that improve health
trajectories across the life span.
Prevention Science
1.3
Prevention
• “Prevention is better than a cure.”
• Prevention science is the study of
which preventive health interventions
are effective in various populations,
how successful the interventions are,
and how well they can be scaled up for
widespread implementation.
• There are three levels of prevention:
primary, secondary, and tertiary.
Figure 1-7
Maintaining good health status through
preventive interventions is less costly than
paying for rehabilitation after health crises.
Figure 1-8
Three levels of prevention: primary, secondary,
and tertiary.
Health Transitions
1.4
Health Transitions
• A health transition is a shift in the
health status of a population that
usually occurs in conjunction with
socioeconomic development.
• Because some countries have gone
through these health transitions and
other countries have not, there are now
significant differences in health status
in the highest-income and lowestincome countries.
Figure 1-9
Examples of health transitions.
Figure 1-10
There are significant differences in health status and access to the tools
for health in low-income and high-income countries.
World Regions and
Featured Countries
1.5
Featured Countries
• Data from eight large countries will
be used to represent the diversity of
the world’s health profiles.
Figure 1-11
Data from World development indicators 2016. Washington: World Bank;
2016.
The eight featured countries represent nearly
half of the world’s population.
Figure 1-12
Data from World development indicators 2016.
Washington: World Bank; 2016; and Human development
report 2016. New York: UNDP; 2016.
Eight featured countries by income group.
(The countries are listed in order from highest
to lowest human development index.)
Figure 1-13
Data from World development indicators 2016.
Washington: World Bank; 2016.
Most of the world’s people live in a country
classified as middle income by the World Bank.
Figure 1-14
Data from World development indicators 2016. Washington:
World Bank; 2016.
The eight featured countries represent nearly
half of the world’s population.
Figure 1-15
Data from World development indicators 2016. Washington:
World Bank; 2016; and World health statistics 2016: Monitoring
health for the SDGs. Geneva: WHO; 2016.
Eight featured countries by geographic
location.
Figure 1-16
Income level terminology.
Figure 1-17
Data from Human development report 2016. New York: UNDP; 2016.
Examples of socioeconomic and health trends.
Global Health Security
1.6
Security
• Global health security seeks to protect populations
from threats to health and safety by engaging a
diversity of stakeholders, including governmental
and military personnel, in public health
interventions.
• Communities and countries suffering from
widespread health problems are more likely to have
political and economic instability, and poverty and
unrest can further exacerbate public health problems
that might spill over into other parts of the world.
• International and global health initiatives can help
to break this cycle, facilitating peace and
productivity.
Globalization and
Health: Shared Futures
1.7
Globalization
• Globalization is the process of countries
around the world becoming more
integrated and interdependent across
economic, political, cultural, and other
domains.
• Global health offers a proactive way to
prevent outbreaks (and to respond to them
when they happen), to protect economic
and political interests at home and abroad,
to promote goodwill and humanitarian
values, and to achieve shared health goals.
Shared Futures
• The health patterns that exist today are
not the same as the patterns from 100
years ago, and new health transitions
will occur in the coming decades.
• Global health provides an opportunity
to use prevention strategies and other
interventions to shape a healthier, safer
future for the world’s people.