Global health

Current Global
Health Issues
11/06/2014 Ashok Pandey 1

Content on Global health
Health Indicators of selected countries (2 with HDI high and 2 with HDI
low and 2 from South East Asian region (One high HDI and one low HDI)
and their critical analysis.
Definition of Health indicators
Human Development Index
Categories very high human development Index countries
Categories very low human development Index countries
Categories South East Asian region countries according to the human
development Index
Socio-demographic situation
Overview of Health System
Organization and Governance
Types of Health Care Services
Facts of country
Health Indicators
Critical analysis of Health Indicators

Comparison of major health
indicators
 Mortality Measures (Neonatal mortality, Infant mortality,
childhood mortality and maternal mortality and life
expectancies)
 Disability
 Disease burden
 Top 10 diseases
 Non communicable disease
 and other Global Disease burden and risk factor
o International Health Regulation (IHR) policy
 Background
 The purpose and scope of IHR
 Importance IHR

Cross border disease like HIV AIDS, Malaria, polio, TB,
Swine flu, Bird flu etc and their impact in health system
Global risks for health
Public health crisis in developing countries
Emerging infections
Cross-Border Health Risks
Cross border delivery of services
Positive impacts of Cross border disease in health system
Negative impacts of Cross border disease in health system
Global Health Issues; Bioterrorism, World Bank, IMF, Trade
Related Intellectual Property Rights and Health
Definition of Global Health Issues
History of Global Health Issues
Trends of Global Health Issues
Recent global health issues
Advantages of Global Health

First, Second & Third Worlds
Industrialized countries where businesses operate independently of
governments North America, Western Europe, Japan and Australia
Communist countries, where governments plan the economies.
Russia, Eastern Europe (e.g., Poland), China
Poor, less developed countries, where businesses operate
independently of governments. capitalist (e.g., Venezuela) and
communist (e.g., North Korea, Saudi Arabia, Mali)11/06/2014 Ashok Pandey 5

Developed and Developing
 Countries like Canada, the USA, Britain and Japan
are regarded as developed because of their
industrialized and diverse economies.
 Countries like Indonesia and Egypt are regarded as
developing or less developed (LDC’s).
 The world’s least developed countries, which often
lack resources – like Chad or Laos – are often
described as least less developed (LLDC’s).

Health Gap (2010)
Indicator Least dev.
countries
Developing
countries
Developed
countries
Life expectancy at birth 59 68 80
IMR 71 44 5
U5MR 110 63 6
MMR 410 53 14
Dr. pop ratio(10,000) 4 24 28
Nurse pop ratio (10,000) 10 40 81
Access to safe water %
population
65 93 100
Access to adequate
sanitation % population
37 73 100

World Ranking of health system

Health Indicator of High HDI
and low HDI countries

Human Development Index
 recognizes a country’s development
level as a function of
 economics (GDP per capita),
 social (literacy rate & level of education),
and
 demographic factors (life expectancy)
 Highest possible rank is 1.0

Very high human development
Rank Country HDI
1 Norway 0.955
2 Australia 0.938
3 United States 0.937
4 Netherlands 0.921
5 Germany 0.920
157 Nepal 0.463
UN, Human Development Report14 March 2013

Low human development
Rank Country HDI
183 Burkina Faso 0.343
184 Chad 0.340
185 Mozambique 0.327
186 Democratic Republic of the Congo 0.304
187 Niger 0.304

The WHO South East Asia Region has 11 Member States
Rank Country HDI
12 South Korea 0.909
92 Sri Lanka 0.715
103 Thailand 0.690
104 Maldives 0.688
121 Indonesia 0.629
134 Timor Leste 0.576
136 India 0.554
140 Bhutan 0.538
146 Bangladesh 0.515
149 Burma 0.498
157 Nepal 0.463

Human Development Index

Literacy Rate

Life Expectancy

Physicians /1,000 persons

Pvt Expenditure as % of Total
Health Expenditure

Infant Mortality Rates

 Crude Birth rate
 Rate at which children are being born into the
population
 LDCs face a rate around 24 per 1000 while
MDCs are around 11 per 1,000

Thank YouThank You

Indicators
1. Socioeconomic Indicators
a. HDI
b. GDP per capita
c. Income per capita
d. Source of drinking water
e. Sanitation

Indicators (Contd…)
2. Demography and Fertility Indicator
a.CDR
b.CBR
c.School participation (primary
education)
d.Median age at first marriage
e.TFR
f.CPR
g.Primary immunization coverage11/06/2014 Ashok Pandey 23

Indicators (Contd…)
3. MCH Indicators
a.IMR
b.MMR
c.U5MR
d.NNMR
e.PNMR
f.Still birth rate
g.3 visit in antenatal care
h.TT coverage in pregnancy (2doses)11/06/2014 Ashok Pandey 24

3. MCH Indicators (Contd…)
I. Institutional delivery
j. Exclusive breast feedings
k. LBW
l. Anemia
M. AIDS awareness
N. Domestic violence ever experienced
by women

4. Disease
a. H5N1
b. SARS
c. Malaria
d. Leprosy
e. TB
f. HIV/AIDS
g. Poliomyelitis

Global public health
Global health is the health of populations in a global
context; it has been defined as "the area of study, research
and practice that places a priority on improving health and
achieving equity in health for all people worldwide".
Problems that transcend national borders or have a global
political and economic impact are often emphasized. Thus,
global health is about worldwide health improvement,
reduction of disparities, and protection against global threats
that disregard national borders.
Global health is not to be confused with international
health, which is defined as the branch of public
health focusing on developing nations and foreign aid efforts
by industrialized countries.

Global Health refers to
those health issues which
transcend national
boundaries and
governments and call for
actions on the global
forces and global flows
that determine the health
of people. (Kickbusch 2006)
 Global health and public
health are
indistinguishable.
(Frenk 2011)
Ashok Pandey
Global Health
11/06/2014 28

29
World Poverty Today
Among 7+ billion human beings, about
868 million are chronically undernourished (FAO 2012),
2000 million lack access to essential medicines
(www.fic.nih.gov/about/plan/exec_summary.htm),
783 million lack safe drinking water (MDG Report 2012, p. 52),
1600 million lack adequate shelter (UN Special Rapporteur 2005),
1600 million lack electricity (UN Habitat, “Urban Energy”),
2500 million lack adequate sanitation (MDG Report 2012, p. 5),
796 million adults are illiterate (www.uis.unesco.org),
218 million children (aged 5 to 17) do wage work outside their household — often
under slavery-like and hazardous conditions: as soldiers, prostitutes or domestic
servants, or in agriculture, construction, textile or carpet production.
ILO: The End of Child Labour, Within Reach, 2006, pp. 9, 11, 17-18.

30
At Least a Third of Human Deaths
— some 18 (out of 57) million per year or 50,000 daily — are due
to poverty-related causes, in thousands:
diarrhea (2163) and malnutrition (487),
perinatal (3180) and maternal conditions (527),
childhood diseases (847 — half measles),
tuberculosis (1464), meningitis (340), hepatitis (159),
malaria (889) and other tropical diseases (152),
respiratory infections (4259 — mainly pneumonia),
HIV/AIDS (2040), sexually transmitted diseases (128).
WHO: World Health Organization, Global Burden of Disease: 2004 Update, Geneva
2008, Table A1, pp. 54-59.
11/06/2014 Ashok Pandey

 Activities within the health sector that address
normative health issues, global disease outbreaks
and pandemics as well as international agreements
and cooperation regarding non-communicable
diseases;
 Commitment to health in the context of
development assistance and poverty reduction;
 Policy initiatives in other sectors – such as foreign
policy and trade
Global public health contd…

Key action areas for a global
public health
 Health as a global public good
 Health as a key component of global
security
 Strengthen global health governance for
interdependence
 Health as a key factor of sound business
 Practice and social responsibility
 Ethical principle of health as global
citizenship.

1st World success of public
health
 Changes of developed societies: health
societies
 a high life expectancy and ageing populations,
 an expansive health and medical care system,
 a rapidly growing private health market,
 health as a dominant theme in social and
political discourse and
 health as a major personal goal in life.
 Post-modern health societies of the developed
world stand in stark contrast to the situation in
the poorest countries.

Situation in the poor
countries
 A falling life expectancy in many African countries;
 A lack of access to even the most basic services;
 An excess of personal expenditures for health of the
poorest;
 Health as a neglected arena of national and development
politics;
 Health as a matter of survival.
 Predominant pattern is still infectious diseases
engendered by the natural environment (malaria,
tuberculosis and infant diarrhoea), as well as AIDS and
high rates of maternal deaths.
 Non communicable diseases are also beginning to plague
these regions

Some of the most important
problems in global health today
There are three broad cause groups of
health problems that, collectively,
constitute the world's total disease
burden.
Group 1: communicable, maternal,
perinatal and nutritional conditions;
Group 2: non communicable diseases;
Group 3: injuries.

15 leading individual GH
problems
1.lower respiratory
infections
6.cerebrovascular
disease;
(11) malaria;
2.diarrhoeal diseases 7.tuberculosis; (12) COPD;
3.conditions during the
perinatal period;
8.measles; (13) falls;
4.unipolar major
depression;
(9) road traffic
accidents;
(14) iron-
deficiency
5.ischemic heart disease (10)congenital
anomalies;
(15) anaemia11/06/2014 Ashok Pandey 36

Other problems
 Non communicable diseases are the most
widespread diseases.
 We need to work together to share our
knowledge about these conditions for
prevention and cure.
 Although many international programs and
initiatives target problems like AIDS, Malaria,
TB, etc, chronic disease becomes a major
threat to human health as the countries move
through the epidemiologic transition.

High HDI countries
Canada
Canada is the second largest country in the
world. It takes almost seven hours of flying
time to cross the 7,000 kilometers from one
side of the country to the other. Canada has
different types of geography, weather,
and people.

Overview of Canadian Health
System
 Canada’s health care system is government sponsored, with
its services provided by private entities. In each province,
each doctor handles the insurance claim against the
provincial insurer.
 An individual who accesses health care does not need to be
involved in billing and reimbursements. Government
regulations do not allow insured patients to be charged for
insured services.
 In Canada, private clinics are available, but subject to the
approval of the province and are not allowed to bill an
insured person for more than the pre-determined fee.

General facts:
 Population: 34,300,083 (2012)
 Capital: Ottawa
 largest city: Toronto
 Area: 9,984,670 sq. km
 Main language: English
 Life expectancy: 78.89 years (male), 84.21 years (female) ( 2012)
 10 Provinces : Alberta, British Columbia, Manitoba, New
Brunswick, Newfoundland and Labrador, Nova
Scotia, Ontario, Prince Edward Island, Quebec, and Saskatchewan.
 3 territories : Northwest Territories, Nunavut and Yukon

Facts of Canada/Nepal
S.
N
Indicators Canada
Number/Percent
Nepal
Number/Percent
1 Total population 34,017,000 26,494,504
2 Life expectancy at birth m/f (years) 80/84 67/69(2012)
3 Probability of dying under five (per 1 000 live
births)
6 42 (2012)
4 Probability of dying between 15 and 60 years
m/f (per 1 000 population)
84/53
197/164(2012)
5 Total expenditure on health per capita (Intl $,
2011)
4,520
80(2012)
6 Total expenditure on health as % of Gross
domestic product
GDP (2011)
11.2 5.5 (2012)

Health indicators
Indicators Date/date range Data type Data
Infant mortality rate 2012 Rate per 1000 4.85
Maternal mortality rate 2010 Rate per 100,000 12
Total fertility rate 2012 Rate per 1000 1.59
Under five mortality rate 2011 Rate per 1000 6
Adult HIV/AIDS prevalence rate 2011 % 0.3%
TB prevalence rate 2011 Rate /100,000 6
DPT immunization coverage rate 2011 % 95%
MCV immunization coverage rate 2011 % 98
POL3 immunization coverage rate 2011 % 9911/06/2014 Ashok Pandey 43

Health Status

Norway

Healthcare system overview
 The system of health care provision in Norway is based on a
decentralized model.
 The state is responsible for policy design, overall capacity and
quality of health care through budgeting and legislation. The state is
also responsible for hospital services through state ownership of
regional health authorities.
 Within the regional health authorities, somatic and psychiatric
hospitals and some hospital pharmacies, are organized as health
trusts. Within the limits of legislation and available economic
resources, regional health authorities and the municipalities are
formally free to plan and run public health services and social
services as they like. However, in practice, their freedom to act
independently is limited by the available resources.
 The municipalities have the responsibility for primary health care.

Key Economic Indicators Norway
Indicators
Total Population (2009) (Source: World Bank) 4,827,038
Real GDP growth rate - percentage change on previous year (2010) (Source: Eurostat) 0.3%
GDP per Capita US$ (2009) (Source: World Bank) 79,089
Health Care Expenditure as % of GDP (2009) (Source: World Bank) 9.7%
Health expenditure per capita (2009) (current US$) (Source: World Bank) 7,662
Life expectancy at birth (years) (Source: WHO) 79
Infant mortality - dying under five (per 1000 live births) (Source: WHO) 4
Unemployment Rate (as % of the labor force - 2010) (Source: Eurostat) 3.5%

Indicators
MMR (2013) (Source: World Bank) 4
TFR 1.78
Under-5 mortality rank 185
Under-5 mortality rate (U5MR), 1990 9
Under-5 mortality rate (U5MR), 2012 3
U5MR by sex 2012, male 3
U5MR by sex 2012, female 3
Infant mortality rate (under 1), 2012 2
Total adult literacy rate (%) 2008-2012* –
Primary school net enrolment ratio (%) 2008-2011* 99.1
http://www.who.int/gho/countries/nor/en/

Use of improved drinking water sources (%) 2011,
total
100
Use of improved sanitation facilities (%) 2011, total 100
Routine EPI vaccines financed by government (%) 2012 100
Immunization coverage (%) 2012, DPT1 99
Immunization coverage (%) 2012, DPT3 95
Immunization coverage (%) 2012, polio3 95
People of all ages living with HIV (thousands) 2012 3.6

Germany

1. INTRODUCTION of GERMANY
 The Federal Republic of Germany covers an area of about 356 978 km2.
The longest distance from north to south is 876 km, from west to east 640
km. The total population is 82 million (40 million males and 42 million
females).
 The largest city is Berlin with 3.5 million inhabitants. Other densely
populated areas are the Rhine-Ruhr region with about 11 million people
and theRhine-Main areasurrounding Frankfurt.
 Germany is a federal republic consisting of 16 states (known in Germany
asLänder).

2. FACTS OF GERMANY
Grossnational incomeper capita($) 40,230
Lifeexpectancy at birth m/f (2011) 78/83
Infant mortality rate(per 1000 live
births)(2011)
3.51
Under fivemortality rate(per 1000
livebirths)(2011)
4
Maternal mortality ratio(2011) 7
Total expenditureon health per
capita($ 2011)
4,371
Total expenditureon health as% of
GDP(2011)
11.1

3. HEALTHCARESYSTEMOFGERMANY
3.1 Introduction
 Earliest German health care system, referred as the Bismarck system, dates
back to 1883, when theBismarck parliament mandated nationwidestatutory
health plans.
 About two decadeslater, theprivatehealth careplansstarted to emerge.
 The system then underwent some developments and stopped growing
during theSecond World War.
 After the War in 1945, due to the economic booming in Germany the
system experienced an enormous expansion: the number of the health plan
providers rose substantially; the specialization of care increased
significantly.

Low HDI country
 The country Niger
 Things about Niger country
 population of people is 17,157
 The capital Niamey
 Area:1,266,700 square miles
 Niger is one of the hottest countries in the
world
 In the year 1922 Niger became a French colony
 Islam-80 %

 landlocked country
 Islam-80 %
 Niger faces serious challenges to development
due to its landlocked position, desert terrain,
poor education and poverty of its people, lack
of infrastructure, poor health care, and
environmental degradation.

Total population (2012) 17,157,000
Gross national income per capita (PPP international $, 2012) 760
Life expectancy at birth m/f (years, 2012) 59/59
Probability of dying under five (per 1 000 live births, 2012) 114
Probability of dying between 15 and 60 years m/f (per 1 000
population, 2012)
257/246
Total expenditure on health per capita (Intl $, 2012) 44
Total expenditure on health as % of GDP (2012) 7.2
Latest data available from the Global Health Observatory
http://www.who.int/countries/ner/en/11/06/2014 Ashok Pandey 59

The Democratic
Republic of the Congo
(
Even though the name says that it’sEven though the name says that it’s
democratic, Congo is actually ademocratic, Congo is actually a
republicrepublic
chief of state: President Josephchief of state: President Joseph
KABILAKABILA
Chief of State: Joseph KabilaChief of State: Joseph Kabila
Ambassador Faida MitifuAmbassador Faida Mitifu

 Located in central Africa, northeast of Angola
 Slightly less than one-fourth the size of the US
 Located in the Congo River Basin
 Mountainous terrain in the east
 Around 905,063 sq. mi
 Capital: Kinshasa
 There are over two-hundred different African ethnic
groups in the Congo
 The official language, like most African countries, is
French
 The population: 68,692,542

Structure of Health System
 National level: Public Health Minister
 Provincial Level: Provincial Health
Inspector
 District Level: 3 divisions: General,
Medicine, & Hygiene
 Zone Level: Local Directors for
~150,000 people, includes 1 hospital
and 15 health clinics (Barumbu)

Gross national income per capita (PPP international $, 2012) 390
Probability of dying between 15 and 60 years m/f (per 1 000
population, 2012)
382/323
http://www.who.int/countries/cog/en/11/06/2014 Ashok Pandey 63

 Major infectious diseases: malaria, plague, and
African trypanosomiasis, bacterial and
protozoan diarrhea, hepatitis A, and typhoid
fever.
 Only 1% of government budget is allocated to
public health
 IMR: 130/1000
 LBW: 15%
 68% of Women have antenatal visits

South East Asia Region

Islands Over 3500
total area- 221 000 km

Government and Political
system
 Capital: Seoul
 Dialing code: 82
 President: Lee Myung-bak
 Currency: South Korean won ₩
 Democratic
 Political system: republic form of
government President as chief of the
state and prime minister as the head of
the government,

1. Nationality: Korean
2. Ethnic group: Homogenous (except
for about 20,000 Chinese)
3. Religion: Christian 26.3%, Buddhist
23.2% (1995 census)
4. Language: Korean, English widely
taught in junior high and high school
5. Literacy: Total Population: 97.9%
Male: 99.2%, Female: 96,6% (2008)

6. Government Type: Republic
7. Date of independence: August 15,
1945 (From Japan)
8. GDP Per capita: $24,600 (2007 est.)
9. Unemployment rate: 3.2% (2007
est.)

10. Natural hazards: Occasional
typhoons bring high winds and floods;
low-level seismic activity common in
south west
11. Environment: current issues: Air
pollution in large cities; acid rain; water
pollution from the discharge of sewage
and industrial effluents; drift net fishing
12. Population: 49,232,844 (July 2008
est.)

13. Age structure:
1-14 yrs: 17.7%
15-64 yrs:72.3%
65 above: 10%
14. Median age:
Total: 34.4 years
Male: 35.3 years
Female: 37.4 years

15. Population growth rate: 0.371% (2008 est.)
16. Birth rate: 9.83 births/1000 population (2008
est.)
17. Death rate: 6.12 deaths/1000 population (2008
est.)
18. Gender ratio: 1.01 males/females (2008 est.)
19. IMR: 5.94 deaths/1000 live births (2008 est.)
20. Life expectancy at birth: 77.42 years

21. Total fertility rate: 1.29 children
born/women (2008 est.)
22. HIV/AIDS adult prevalence rate:
Less than 0.1% (2003 est.)
23. No. of people living with
HIV/AIDS: 83,00 (2003 est.)

Gross national income per capita (PPP international $,
2012)
30,970
Probability of dying between 15 and 60 years m/f (per 1
000 population, 2012)
98/40
Total expenditure on health per capita (Intl $, 2012) 2,321
http://www.who.int/countries/kor/en/

Model of health care system:
National Health Insurance Model
GDP expenditure on Health: 6%
(2005)

Health care in south Korea
All korean citizens must make contributions to
the following insurance schemes
1.National pension
2.National health insurance
3.Industrial accident compensation insurance
4.Unemployment insurance
Provided by a compulsory National Health
Insurance (NHI). Everyone resident in the
country is eligible regardless of nationality or
profession.

Nepal

Where is Nepal?
 One of the poorest countries in the world, Nepal is
landlocked between India and China
 8 out of 10 of the world’s tallest peaks including Mt.
Everest11/06/2014 Ashok Pandey 79

Nepal
11/06/2014Ashok Pandey
80

Nepal
 In Nepal, most health care is provided by the
government but hospitals and clinics run by
private sectors also play an important role
 Health care is variable throughout the country
 Purely private enterprises and public
funded health care institutes are providing
services
 Health insurance system is very negligible11/06/2014 Ashok Pandey 81

 The free health care policy, December 2006, amended January 2008
and New Nepal, Healthy Nepal January 2009 and Urban Health Policy
has made Nepal to provide at least basic health care free of cost to all citizens
and universal free health care to targeted groups like
 Poor
 Senior citizens (>60 yrs)
 Disabled poor
 Helpless citizens
 FCHV
 Cancer patients
 Renal and heart patients are also provided with subsidy to total free of cost
treatment which can be considered as a milestone to universal health care
 Nepal is such a country where even health workers have to pay for their
own treatment

Health Service Coverage Fact Sheet (Annual report
2069/70 (2012/13)
indicator 2069/70
(2012/13)
% of children under one year immunized with BCG 99
% of children under one year immunized with Polio 3 93
% of children aged 9-11 months immunized with Measles/Rubella 88
Incidence of acute respiratory infection (ARI) per 1,000 children under five
years (new visits)
918
Incidence of diarrhea per 1,000 under five years children (new cases) 578
% of pregnant women who received TT2 41
% of pregnant women attending first ANC among estimated number of
pregnancies
89
% of institutional deliveries among estimated number of live births 45
Contraceptive prevalence rate (CPR) (modern method) (unadjusted 45.3
Total number of FCHVs 50,007
TB case finding rate 78
Treatment success rate 90
Estimated HIV cases 48,600
Cumulative HIV reported cases 22,994

Rank Top 10 disease Percentage
1 Gastritis 5.8
2 URTI 5
3 Headache 4.9
4 ARI 4.7
5 Pyrexia 3.6
6 Impetigo/boils 3.2
7 Intestinal worm infestation 3.2
8 Presumed non infectious Diarrhoea 2.8
9 Typhoid 2.5
10 Falls/injuries 2.5
(Annual report 2069/70 (2012/13)

Gross national income per capita (PPP international $, 2012) 1,470
Probability of dying between 15 and 60 years m/f (per 1 000 population,
2012)
197/164
http://www.who.int/countries/npl/en/

Financing Health Care in Nepal
 Government Expenditure as % of total: 23.5 %
(2000)
 Foreign Donor Expenditure as % of total: 62 %
 Main foreign donors include: WHO, UNICEF,
UNDP, UNFPA, World Bank, GTZ, DFID, USAID,
JICA, SDC.
 There is a huge gap between the amount of
funds committed to Nepal healthcare and the
amount of funds that are able to absorbed and
actually end up providing healthcare services.
 i.e. U.K. donated 5 million dollars a year for 5 years to
battle HIV/AIDS

International Health Regulations
(IHR) Policy

 In May 2005, The 58th World Health Assembly adopted
the revised International Health Regulations, “IHR”

Ashok Pandey 90
Brief History of the
International Health
Regulations (IHR)
1851: first International Sanitary Conference, Paris
1951: first International Sanitary Regulations
(ISR) adopted by WHO member states
1969: ISR replaced and renamed the
International Health Regulations (IHR)
1995: call for Revision of IHR
2005: IHR (2005) adopted by the
World Health Assembly
2006: World Health Assembly vote that IHR
(2005) will enter into force in June 2007
11/06/2014

 To prevent, protect against control and provide
a public health response to the international
spread of disease in ways that are
commensurate with and restricted to public
health risks, and which avoid unnecessary
interference with international traffic.
Ashok Pandey 9111/06/2014

Ashok Pandey 92
The purpose and scope of IHR
 To prevent, protect against,
control and provide a public
health response to the
international spread of disease
 To establish a single code of
procedures and practices for
routine public health measures
11/06/2014

International Health Regulations IHR (2005)
 The International Health Regulations
are a formal code of conduct for
public health emergencies of
international concern.
 They're a matter of responsible
citizenship and collective protection.
 They involve all 193 World Health
Organization member countries.

 They are an international agreement that gives
rise to international obligations. They focus on
serious public health threats with potential to
spread beyond a country's border to other
parts of the world.
 Such events are defined as public health
emergencies of international concern, or
PHEIC. The revised International Health
Regulations outline the assessment, the
management and the information sharing for
PHEICs.

 IHRs serve a common interest.
 First of all, they address serious and unusual
disease events that are inevitable in our world
today.
 They serve a common interest by recognizing
that a health threat in one part of the world
can threaten health anywhere, or everywhere.
 And they are a formal code of conduct that
helps contain or prevent serious risks to public
health, while discouraging unnecessary or
excessive traffic or trade restrictions for, quote,
"public health," purposes.11/06/2014 Ashok Pandey 95

Why have IHR?
 Serious and unusual
disease
events are inevitable
 Globalisation - problem in
one
location is everybody’s
headache
 An agreed International
Public Health code of
conduct for a global
approach

H5N1: Avian influenza, a
pandemic threat

1. Health Measures -
Recommendations
 Review travel history and proof of medical examination, lab
analysis, vaccination or other prophylaxis;
 require medical examination, vaccination or other
prophylaxis;
 Public health observation, quarantine, isolation and contact
tracing
 Entry and exit screening
 Refuse entry of suspect and affected persons
 Refuse entry of unaffected persons to affected area.

2. Protections for travellers

3. Health Measures - General
application

4. Affected conveyances and
imported cases

5. Health Measures - additional

What do the IHR call for?
 Strengthened national capacity for
surveillance and control, including in travel
and transport
 Prevention, alert and response to public
health emergencies of international concern
 Rights, obligations and procedures,
and progress monitoring
 Global partnership and international
collaboration

►Requires a commitment of States Parties
Mobilization of national resources: e.g. staff, infrastructure, budget
Development of national action plans, integrated and coordinated with
intermediate and local levels and points of entry (ports, airports, ground
crossings)
► Builds on existing national and regional strategies
► Requires sustained multisectorial approach and international
collaboration
Strengthen national disease
surveillance, prevention, control and
response system

NATIONAL
SURVEILLANCE
AND RESPONSE
WHO GLOBAL
ALERT AND
RESPONSE
SYSTEM
THREAT-
SPECIFIC
CONTROL
PROGRAMMES
INTERNATIONAL
TRAVELS AND
TRANSPORTS
GLOBAL PARTNERSHIP
International
initiatives and
networking
National
Capacity
Strengthening
IHR Strategic Implementation Plan
LEGAL PROCEDURES
AND MONITORING

Ashok Pandey 109
IHR timeframe
 May 2005 World Health Assembly adopted the
revised IHR
 15 June 2007 IHR entered into force and
are binding on 194 States Parties
 2007-2009 Member States assess and
improve their national core capacities for
surveillance and reporting
 2012 the core capacities are in
place and functioning
 For more information visit:
http://www.who.int/csr/ihr/en/
11/06/2014

Ashok Pandey 110
Questions?
Comments?
Organization Personnel Equipment
Purchasing
&
Inventory
Process
Control
Information
Management
Documents
&
Records
Occurrence
Management
Assessment
Process
Improvement
Customer
Service
Facilities
&
Safety
11/06/2014

Thank YouThank You

Cross border disease like
HIV/AIDS Malaria, Polio, TB,
Swine flue, Bird flu and their
impact on health

Public health & Globalisation
Public health
Definition: the organized local and
global efforts to prevent death,
disease and injury, and promote the
health of populations.
Goals: Improve population health;
Reduce health inequalities.

Globalisation and health
Openness Cross border
flows technology
Regional/global rules
and institutions
National Policies
GCP/HSD
June 2000
Health
risks
Health
systems
Level and
distribution
of
household
income
Education
Water
Energy
Transport
Other sectors
Health
Outcomes

Global risks for health
 Exclusion from global markets
 Private ownership of knowledge
 Migration of health professionals
 Cross border transmission of disease
 Environmental degradation
 Conflict

Public health crisis in
developing countries
 Poverty (2.5 billion), debt,
inequalities;
 Population growth (80 million);
 Double burden of disease: HIV/AIDS;
 Weak public health infrastructure;
 Public sector reform.

HEALTH
health
services
risk
factors
household
economy
national economy and
health-related sectors
GlobalizationGlobalization
economic
opening
cross-border
flows
international
rules and
institutions
goods, services,
capital, people,
ideas, information

Cryptosporidiosis
Lyme Borreliosis
Reston virus
Venezuelan
Equine Encephalitis
Dengue
haemhorrhagic
fever
Cholera
E.coli O157
West Nile
Fever
Typhoid
Diphtheria
E.coli O157
EchinococcosisLassa fever
Yellow fever
Ebola
haemorrhagic
fever
O’nyong-
nyong fever
Human
Monkeypox
Cholera 0139
Dengue
haemhorrhagic
fever
Influenza (H5N1)
Cholera
RVF/VHF
nvCJD
Ross River
virus
Equine
morbillivirus
Hendra virus
BSE
Multidrug resistant
Salmonella
E.coli non-O157
West Nile Virus
Malaria
Nipah Virus
Reston Virus
Legionnaire’s Disease
Buruli ulcer
SARS
W135
SARS
E P I D E M I C A L E R T A N D R E S P O N S E
Emerging/re-emerging infectious diseasesEmerging/re-emerging infectious diseases
1996 to 20031996 to 2003

Microbes are unpredictable!
Some WHO-facilitated epidemicSome WHO-facilitated epidemic
response in the field, 1998–2003response in the field, 1998–2003

World Health Organization
Economic impact, selected infectious diseaseEconomic impact, selected infectious disease
outbreaks, 1990–1999outbreaks, 1990–1999
UK—BSEUK—BSE
US$ > 9 billionUS$ > 9 billion
1990-19981990-1998
UR TANZANIA
Cholera
US$ 36 millionUS$ 36 million
19981998
INDIA—PlagueINDIA—Plague
US$ 1.7 billion,US$ 1.7 billion,
19951995
PERU—CholeraPERU—Cholera
SeafoodSeafood
Export BarriersExport Barriers
19911991
MALAYSIA—NipahMALAYSIA—Nipah
Pig destruction, 1999Pig destruction, 1999
HONG KONG SARHONG KONG SAR
Influenza A (H5N1)Influenza A (H5N1)
Poultry destruction, 1997Poultry destruction, 1997
USA—E. coli 0157USA—E. coli 0157
Food recall/Food recall/
destructiondestruction
PeriodicPeriodic

Local Health
International
Health
Global
Health

HISTORY OF EMERGING
INFECTIONS
610 Influenza
644 Leprosy
900 Smallpox
1348 Plague
1495 Syphilis
1510 Scarlet Fever
1546 Typhus
1557 Malaria
1567 Smallpox
YEAR DISEASE

History of Emerging
Infections
1973 Rotavirus
1977 Ebola Virus
1977 Legionnaire’s Disease
1981 Toxic Shock Syndrome
1982 Lyme Disease
1983 HIV-AIDS
1983 Helicobacter Pylori
1991 Multi Drug Resistant
(MDR) TB
1991 Epidemic Cholera
1994 Cryptosporidium
1998 Hong-Kong Bird Flu
1999 West Nile Virus
2001 Anthrax
2003 SARS
2006 Extremely Drug Resistant (XDR) TB)

Cross-Border Health Risks
This term is used to describe risks to human health that
cross national borders. Examples include risks from climate
change and the illegal drugs trade, as well as cross-border
movements of people, which can lead to the spread of
communicable diseases such as HIV/AIDS, malaria, TB and
influenza.
Since 1990, global trade has grown six-fold and the number
of people travelling by air has increased 17-fold. Today,
more than 2 million people cross borders each day and
travel times are shorter than the incubation periods of many
diseases. Increasingly, a country's foreign policy may be
linked to cross-border health risks.

Cross border delivery ofCross border delivery of
servicesservices
 Shipment of laboratory samples, diagnosis
and clinical consultations -mail
 Electronic delivery of health services
 Telehealth- telediagnostic, surveillance and
consultation services (USA hospitals to CA
and EM)
 Telepathology (India to Bangladesh, Nepal)
 E-health - products and services available
over internet

AIDS Pandemic
o AIDS undoubtedly was one of
the most devastating diseases
that emerged during the 20th
century.
o From 1981 to the end of 2004, about 25
million people world-wide have succumbed
to HIV infections.
o The pandemic is expected to progress
well into the 21th century.11/06/2014 Ashok Pandey 126

Influenza
An agent of great concern
globally is influenza virus.
Influenza virus is known to cause
epidemics as early as the 1500’s,
and pandemics have been described
as early as 1889.
The most extensive pandemic ever
known is the pandemic of influenza
of 1918-1919, which killed more 20
million people.

Countries affected with animal cases of avian influenza
H5N1 – from 2003 until 2006

Influenza pandemics 20th
Century
H1N1 H2N2 H3N2
1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”
40-50 million deaths 1-4 million deaths 1-4 million deaths

Ref Business Week, April 14, 200311/06/2014 Ashok Pandey 130

Malaria

TB
TB is an airborne infectious disease
thought to infect almost one-third of the
world's population.
It commonly manifests as an infection
of the lungs, usually with symptoms of
coughing, weight loss and other
constitutional symptoms.
TB spreads easily and quickly and thus
the increased travel generated by
globalization may aid its spread.11/06/2014 Ashok Pandey 132

 Every year, 2 to 3 million people die of TB and
8 million develop active infections. Some 95%
of cases and 98% of TB deaths occur in poor
countries and numbers are rising owing to the
growing HIV/AIDS epidemic.
 Globally, 79% of people with TB do not have
access to directly observed therapy short-
course (DOTS), which is the recommended
treatment. It is estimated that the introduction
of the DOTS strategy could halve a country's
current national economic loss from TB.

Poliomyelitis
EPIDEMIOLOGICAL BASIS
 Man is the only host
 A long term carrier state is not known to occur
 Half life of excreted virus in sewage is about 48hours
 OPV: it is easy to administer and relatively cheap

Global Status 1988
350 000 cases polio-1988
125 polio-endemic countries
http://www.polioeradication.org/

Global Status 2004
1,263 cases in 2004 (99% reduction in cases)
1000 childhood paralysis prevented per day
6 polio-endemic countries, 5 countries re-established transmission
http://www.polioeradication.org

-ve Impact
 These emerging diseases represent a
significant cause of suffering and
death, and impose an enormous
financial burden on society.
 resistant to drug
 update our health threats
legislation
 Public health emergencies
of international concern

+ve impact
 to strengthen preparedness planning
 to improve risk assessment and management of cross-
border health threats
 to establish the necessary arrangements for the
development and implementation of a joint procurement
of medical countermeasures
vaccines and medicines
 to enhance the coordination of response at EU level by
providing a solid legal mandate to the Health Security
Committee
Health Security Committee

THANK YOU

Global Health Issues
 Despite incredible improvements in health since 1950,
there are still a number of challenges, which should have
been easy to solve. Consider the following:
 One billion people lack access to health care systems.
 36 million deaths each year are caused by
noncommunicable diseases, such as cardiovascular
disease, cancer, diabetes and chronic lung diseases. This
is almost two-thirds of the estimated 56 million deaths
each year worldwide. (A quarter of these take place
before the age of 60.)

Global Health Issues contd…
 Cardiovascular diseases (CVDs) are
the number one group of conditions
causing death globally. An
estimated 17.5 million people died
from CVDs in 2005, representing
30% of all global deaths. Over 80%
of CVD deaths occur in low- and
middle-income countries.

 Over 7.5 million children under the age of 5 die from
malnutrition and mostly preventable diseases, each
year.
 In 2008, some 6.7 million people died of infectious
diseases alone, far more than the number killed in the
natural or man-made catastrophes that make headlines.
(These are the latest figures presented by the World
Health Organization.)
 AIDS/HIV has spread rapidly. UNAIDS estimates for
2008 that there are roughly:
 33.4 million living with HIV
 2.7 million new infections of HIV
 2 million deaths from AIDS

 Tuberculosis kills 1.7 million people each year,
with 9.4 million new cases a year.
 1.6 million people still die from pneumococcal
diseases every year, making it the number one
vaccine-preventable cause of death worldwide.
More than half of the victims are children. (The
pneumococcus is a bacterium that causes
serious infections like meningitis, pneumonia
and sepsis. In developing countries, even half
of those children who receive medical
treatment will die. Every second surviving child
will have some kind of disability.)

Contd…
 Malaria causes some 225 million
acute illnesses and over 780,000
deaths, annually.
 164,000 people, mostly children
under 5, died from measles in 2008
even though effective immunization
costs less than 1 US dollars and
has been available for more than
40 years.

BioterrorismBioterrorism

Definitions
• Biological terrorism (BT) – Use of biological agent on
a population to deter, hinder, or otherwise slow the
productivity of a community.
• Biological warfare (BW) - Use of biological agent to
harm or kill an adversary’s military forces, population,
food, and livestock.
• Select agents (SA): designated subset of biological
agents or toxins identified as having the potential to
be used in weapons of mass destruction (WMD’s)

147
Some Bioterrorism Agents
 Bacteria
 Anthrax
 Brucellosis
 Glanders
 Plague
 Tularemia
 Q-fever
 Viruses
 Smallpox
 Venezuelan Equine Encephalitis
 Viral Hemorrhagic Fevers
 Nipah Virus
 Toxins
 Botulinum
 Staphylococcal Enterotoxin B
 Ricin
 T-2 mycotoxins
 E-coli (0157:H7)
Source: http://etl2.library.musc.edu/bioterrorism/resources/ppt_files/5
11/06/2014 Ashok Pandey

HISTORY
• Microbial pathogens were used as potential
weapons of war or terrorism from ancient times:
– the poisoning of water supplies in the sixth century
B.C. with the fungus Calviceps purpurea (rye ergot)
by the Assyrians
– the hurling of the dead bodies of plague victims over
the walls of the city of Kaffa by the Tartar army in
1346
– the spreading of smallpox via contaminated blankets
by the British to the native American population loyal
to the French in 1767.

Anthrax as a Bioweapon
• Anthrax may be the prototypic disease of bioterrorism
although rarely spread from person to person
• U.S. and British government scientists studied anthrax
as a biologic weapon beginning approximately at the
time of World War II (WWII).
• Soviet Union in the late 1980s stored hundreds of tons of
anthrax spores for potential use as a bioweapon
• At present there is suspicion that research on anthrax is
ongoing by several nations and extremist groups
• One example of this is the release of anthrax spores by
the Aum Shrinrikyo cult in Tokyo in 1993. Fortunately,
there were no casualties associated with this episode.

Anthrax as a Bioweapon II
• 1979: the accidental release of spores into the atmosphere from a Soviet
Union bioweapons facility in Sverdlosk:
– at least 77 cases of anthrax were diagnosed with certainty, of which 66 were fatal
– victims have been exposed in an area within 4 km downwind of the facility
– deaths due to anthrax were also noted in livestock up to 50 km away from the
facility
– interval between probable exposure and development of clinical illness ranged from
2 to 43 days (the majority of cases were within the first 2 weeks)
– death typically occurred within 1 to 4 days following the onset of symptoms
– the anthrax spores can lie dormant in the respiratory tract for at least 4 to 6 weeks
• September 2001: anthrax spores delivered through the U.S. Postal System.
– CDC identified 22 confirmed or suspected cases of anthrax (11 patients with
inhalational anthrax, of whom 5 died, and 11 patients with cutaneous anthrax - 7
confirmed - all of whom survived)
– cases occurred in individuals who opened contaminated letters as well as in postal
workers involved in the processing of mail
– one letter contained 2 g of material, equivalent to 100 billion to 1 trillion spores
(inoculum with a theoretical potential of infecting up to 50 million individuals)
– The strain used in this attack was the Ames strain - was susceptible to all
antibiotics

Advantages of BTAdvantages of BT
• Killing efficacy
• Cost effectiveness
• Vehicle
• Relative ease of production
• Interval between dissemination to infection

The World Bank
The World Bank is a United
Nations international financial institution that
provides loans

The World Bank was created at the
1944 Bretton Woods Conference,
along with three other institutions,
including the International Monetary
Fund (IMF).
The World Bank and the IMF are
both based in Washington, D.C., and
work closely with each other.

Five purposes:
• Assist development and reconstruction
• To promote long term balanced international trade
• To lend for project development
• To conduct its operations with due regard to
business conditions
• Promote private investment

• To provide low-interest loans, interest-free credit and
grants to developing countries for education, health,
infrastructure, communications and many other purposes.
• Efforts are coordinated with wide range of partners,
including government agencies, civil society organization
other aid agencies and the private sector.
• The Bank group’s work focuses on the achievement of the
millennium development goals.
• To address issues related to gender, community
development, indigenous people.
Roles and contributions

International Monetary Fund
 The International Monetary
Fund (IMF) is an international
organization that was initiated in 1944
at the Bretton Woods Conference and
formally created in 1945 by 29 member
countries. The IMF's stated goal was to
assist in the reconstruction of the
world's international payment
system post–World War II

 The International Monetary Fund
(IMF) is an organization of 188
countries, working to foster global
monetary cooperation, secure
financial stability, facilitate
international trade, promote high
employment and sustainable
economic growth, and reduce poverty
around the world.

Trade Related Aspects of Intellectual
Property Rights and health
 Intellectual property rights are the rights
given to persons over the creations of their
minds. They usually give the creator an
exclusive right over the use of his/her
creation for a certain period of time

Trade in Health
Goods Medicines; Vaccines and other
health technology
Services Movement of health professionals;
patients; health
related investments and supply of
health care
services across countries
Intellectual
Property
Patents; trade marks; copy rights on
health related
products and services

WHO Work in this area
Commission on Public Health, Innovation
and Intellectual Property
Intergovernmental working group on Public
Health, Innovation and Intellectual
Property
Global Strategy and Plan of Action on
Public Health, Innovation and Intellectual
Property11/06/2014 Ashok Pandey 160

It’s the Real ThingIt’s the Real Thing
11/06/201411/06/2014 Ashok PandeyAshok Pandey 161161

THANK YOUTHANK YOU
11/06/201411/06/2014 Ashok PandeyAshok Pandey 162162

Global health

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (20)

Similaire à Global health

Similaire à Global health (20)

Plus de Ashok Pandey

Plus de Ashok Pandey (20)

Dernier

Dernier (20)

Global health

Notes de l'éditeur