Public Health Policies

Chapter 2 Global Health

Priorities

Global Health Achievements

2.1

Global Health Achievements

• Innovations in health technology over the past century have created an incredible set of tools for global health work.

• The uneven distribution of access to them has generated a massive intensification of health disparities.

• Advocates for various health problems and solutions must compete for attention and support.

Figure 2-1

The U.S. CDC’s top 10 public health achievements of the 20th century (1900–1999).

Reproduced from Ten great public health achievem

ents: U nited States,

1990–1999. M M

W R M

orb M ort W

kly Rev 1999;48:241–3.

Figure 2-2

The U.S. CDC’s top 10 global health achievements in the first decade of the 21st century (2001–2010).

D ata from

CD C, Ten great public health achievem

ents: W orldw

ide, 2001– 2010. M

M W

R M orb M

ort W kly Rev 2011; 60:814-8.

Prioritization Strategies 2.2

Prioritization Strategies

• The priorities identified by groups viewing global health with different lenses provide insight into the common health challenges of populations around the world and point toward solutions for shared concerns.

Figure 2-3

PACES: strategies for prioritizing global health issues.

Disease Burden

• The term burden of disease (BOD) refers to the adverse impact of a particular health condition (or group of conditions) on a population.

• Disease burden can be measured with health metrics and economic indicators.

Best Buys

• Low-cost primary prevention activities are usually the most cost- effective interventions.

Figure 2-4

Ten “best buys” in global health from the Disease Control Priorities Project.

Reproduced from Pathw

ays to global health research: strategic plan 2008–2012. Bethesda M

D : The John E. Fogarty International Center, N

ational Institutes of H

ealth (N IH

); 2008, p. 22.

Expertise

• When funding and implementation agencies have particular areas of expertise, they can maximize their impact by applying their existing knowledge and experience toward new projects that build on past successes.

Figure 2-5

Grand Challenges in Global Health.

D ata from

V arm

us H , Klausner R, Zerhouni E, A

charya T, D aar A

S, Singer PA .

G rand challenges in global health. Science 2003; 302:398-9.

Other Prioritization Strategies

• Groups focused on equity prioritize projects that will address perceived injustices and reduce health disparities.

• Groups focused on global health security prioritize direct threats to peace and stability as well as other national interest of sponsoring governments.

Figure 2-6

The U.S. CDC’s top public health challenges for the early 21st century.

D ata from

Koplan JP, Flem ing D

W . Current and future public

health challenges. JA M

A 2000; 284:1696-8.

Health Metrics 2.3

Health Metrics

• Health metrics provide an evidence base for making policy and funding decisions.

Vital Statistics

• Vital statistics are population-level metrics about births, deaths, and other life events.

• The birth rate is the annual number of births per 1000 people in the total population.

• The death rate, also called the mortality rate, is the annual number of deaths per 1000 people (or other units, such as per 100,000 people).

Figure 2-7

Birth rate per 1000 people in 2015 in featured countries.

D ata from

W orld developm

ent indicators 2016. W

ashington: W orld Bank; 2016.

Figure 2-8

Crude and age-standardized all-cause mortality rates per 100,000 people in 2015 in

featured countries.

D ata from

G BD

M ortality and Causes of D

eath Collaborators. G lobal,

regional, and national life expectancy, all-cause m ortality, and cause-

specific m ortality for 249 causes of death, 1980–2015: a system

atic analysis for the G

lobal Burden of D isease Study 2015. Lancet 2016; 388:1459-544.

Life Expectancy

• Life expectancy at birth is the median expected age at death of all babies born alive.

• Healthy life expectancy (HALE) is the number of years the average individual born into the population can expect to live without disability.

Figure 2-9

Life expectancy at birth (2015).

D ata from

W orld developm

ent indicators 2016. W ashington:

W orld Bank; 2016.

Figure 2-10

Life expectancy has increased over time.

D ata from

U nited N

ations D epartm

ent of Econom ic and

Social A ffairs. W

orld population prospects: the 2017 revision. N

ew York: U

N ; 2017.

Figure 2-11

Life expectancy and healthy life expectancy (HALE) at birth.

D ata from

G BD

2015 D A

LYs and H A

LE Collaborators. G lobal, regional, and national

disability-adjusted life years (D A

LYs) for 315 diseases and injuries and healthy life expectancy (H

A LE), 1990–2015: A

system atic analysis for the G

lobal Burden of D

isease Study 2015. Lancet 2016; 388:1603-58.

Morbidity

• Morbidity = the presence of illness or disease, whether that disease is relatively mild, like the common cold, or quite severe.

• Mortality = death.

Morbidity (cont’d)

• Incidence is the number of new cases of the disease occurring in a time period divided by the total number of people at risk for that disease in that time period.

• Prevalence is the number of total existing cases, whether newly-diagnosed or long- established, divided by the total number of people in the population at the time the prevalence is measured.

Figure 2-12

An example of incidence and prevalence

YLLs + YLDs = DALYs

• Years of life lost (YLLs) = the burden from premature mortality in a population.

• Years lived with disability (YLDs) = the burden to a population from nonfatal health conditions that cause significant short- or long-term reduction in health status.

• Disability-adjusted life year (DALY) = the total burden of disease in a population from both premature deaths and disability.

Figure 2-13

Examples of years lived with disability (YLDs) and years of life lost (YLLs) to premature

mortality for different health trajectories.

Figure 2-14

The global distribution of YLLs, YLDs, and DALYs in 2015.

D ata from

G BD

2015 D isease and Injury Incidence and Prevalence Collaborators. G

lobal, regional, and national incidence, prevalence, and years lived w

ith disability for 310 diseases and injuries, 1990–2015: A

system atic analysis for the G

lobal Burden of D isease

Study 2015. Lancet 2016; 388:1545-602.

The Millennium Development Goals

(MDGs) 2.4

MDGs • The Millennium Development Goals

(MDGs) spelled out eight major goals for significantly reducing global poverty by 2015.

• While the MDGs were about general socioeconomic development, the MDGs facilitated remarkable improvements in health status.

• The success of the MDGs successes were the impetus to create a follow-up set of goals called the Sustainable Development Goals (SDGs).

Figure 2-15

Millennium Development Goals (MDGs) (2000–2015).

Reproduced from U

nited N ations. U

nited N ations m

illennium

developm ent goals. http://w

w w

.un.org/m illennium

goals/. Reproduced w

ith perm ission from

U N

D P Brazil.

Figure 2-16

Transitioning from the MDGs to the SDGs.

The Sustainable Development Goals

(SDGs) 2.5

SDGs

• The Sustainable Development Goals (SDGs) are 17 goals established by the member countries of the United Nations at the end of 2015 that aim by 2030 to end poverty, protect the planet, and promote prosperity and peace.

• 17 SDGs are operationalized through 169 targets and 230 indicators.

Figure 2-17

The Sustainable Development Goals (SDGs) (2016–2030).

Reproduced from U

nited N ations. Transform

ing our w orld: The 2030

agenda for sustainable developm ent. N

ew York: U

N ; 2015, p. 14.

SDGs (cont’d) • Like the MDGs, the SDGs consider health to be

both a necessary prerequisite to and an outcome of economic growth.

• Unlike the MDGs, the SDGs are not singularly focused on the world’s poorest billion people; instead, the SDGs mix goals for poverty reduction with a lengthy list of other targets that apply to countries across the economic spectrum.

• Although there is only one SDG focused specifically on health, SDG 3 includes a much greater diversity of targets and indicators than were encompassed by the three health MDGs.

Figure 2-18

Examples of Sustainable Development Goals targets related to health.

D ata from

W orld health statistics 2016: m

onitoring health for the SD G

s. G eneva:

W H

O ; 2016.