Kajian Strategis Kesehatan Masyarakat Global

1. Introduction to Global
Health as an overview
PRESENTED BY:
NI’MAL BAROYA, M. PH.
PUBLIC HEALTH FACULTY, UNIVERSITY OF JEMBER EAST JAVA INDONESIA
ADAPTED FROM: MANY SOURCE
1. PROF. DR.SHARMEEN YASMEEN, CEO, PUBLIC HEALTH FOUNDATION OF BANGLADESH,
HEAD OF THE DEPT. OF COMMUNITY MEDICINE, BANGLADESH MEDICAL COLLEGE,
DHAKA
2. DR YOGA NATHAN, SENIOR LECTURER IN PUBLIC HEALTH, GEMS UL

2. Contents-
 Definition of global health and global health issues
 The differences between global and international health
 Comparison of inequalities in health status
 Global health agenda
 Key concepts in relation to global health
 Recognize the importance of information sharing in the area
of global health

3. Why should we learn global health?
 As of today, global health appears as newer concept
 Health is becoming a global concern with the shifting
paradigm of chronic diseases being a number one killer
around the globe
 Global Health is important for all professionals and young
learners, those in health, engineering, chemistry, etc.
 Professionals and students will be better equipped to face
the challenges of their unique profession
 Can explore better the priority areas for research

4. Definition of Global Health
Health problems, issues, and concerns that
transcend national boundaries, may be
influenced by circumstances or experiences
in other countries, and are best addressed
by cooperative actions and solutions
(Inst. of Medicine-USA: 1997)

5. Global Health Issues
Non communicable diseases
Emerging and remerging infections
Climate change
Urbanisation
Malnutrition – under or over nutrition
Nuclear war and bioterrorism etc

6. From individual to Global Health
Global Health
International
Health
Public Health
• Health problems know no boundary
• Health in the interconnected
context, globalization, extends
beyond problem on and capability
of one country
• Problem and/or concern beyond
frontier
• Focuses on solving health problem in
developing countries
• Health problem within national
boundary
• aims to promote health of the
population through prevention and
health promotion including sanitation
Individual Health << Family Health << Community Health
Source: J P Koplan et al. Towards a common definition of global health Lancet 2009; 373: 1993–95 4

7. Historical Development of Term
 Public Health: Developed as a discipline in the mid 19th century in UK,
Europe and US. Concerned more with national issues.
 Data and evidence to support action, focus on populations, social justice and equity,
emphasis on preventions vs cure.
 International Health: Developed during past decades, came to be more
concerned with
 the diseases (e.g. tropical diseases) and
 conditions (war, natural disasters) of middle and low income countries.
 Tended to denote a one way flow of ‘good ideas’.
 Global Health: More recent in its origin and emphasises a greater scope
of health problems and solutions
 that transcend national boundaries
 requiring greater inter-disciplinary approach

8. It’s the Real Thing

9. Global health issues are closely related to
numerous other fields of policy such as;
Development, security, trade, economics,
human rights, food, agriculture, research,
employment, education, migration, environment
climate protection, humanitarian aid.

10. Global health issues Vs. Global Impact
Health Issue Global Perspective
Cigarette
smoking
Tobacco is ranked as the second
major cause of death in the world
Tobacco is a multinational business with
global marketing strategies. Illicit tobacco
marketing is also important
Obesity
One billion adults worldwide are
overweight; 300 million are clinically
obese
Food retailing and marketing is a
multinational business
STIs
340 million new cases of sexually
transmitted infections occur world
wide each year
Increased travel and migration contribute to
the spread of STIs; global action is required
to coordinate containment efforts

11. Mental health
Health Issues
450 million people worldwide
are affected by mental illness
at any one time
Global Perspective
Conflict and poverty are major contributors;
these generally involve more than a single
country and intervention strategies require
multinational collaboration
Alcohol 76.3 million people worldwide
have alcohol use disorders
Alcohol marketing and distribution is a global
business; lessons can be learned from other
countries
Inequities
Disparities in power and
wealth directly influence
health.
inequities in societies are great, there are much
greater disparities between countries.

12. Gaps in health status worldwide
 Every second of every day, four women
around the world give birth. And every
minute, one of those women dies
 In Sweden, the life-time risk of a woman
dying during pregnancy and childbirth is 1
in 17, 400; in Afghanistan, it is 1 in 8.

13. Gaps in health status worldwide
 Today, there is a 36-year gap in life expectancy between
countries. A child born in Malawi can expect to live for only
47 years while a child born in Japan could live for as long
as 83 years.
 In Chad, every fifth child dies before they reach the age of
5, while in the WHO European Region, the under-five
mortality rate is 13 out of 1000.
 There is no biological or genetic reason for these alarming
differences in health and life opportunity.

14. Gaps in health status within country
 There are significant gaps in health outcomes within
countries, too – rooted in differences in social status, income,
ethnicity, gender, disability or sexual orientation.
 For example in the United States, infants born to African-
American women are 1.5 to 3 times more likely to die than
infants born to women of other races/ethnicities. American
men of all ages and race/ethnicities are approximately four
times more likely to die by suicide than females.

15. Key Facts-Inequality in health service
 Worldwide, about 150 million people a year face
catastrophic health-care costs because of direct payments
such as user fees, while 100 million are driven below the
poverty line.
 Even if they could pay, access to doctors would be a
challenge.
 Low-income countries have ten times fewer physicians than
high-income countries. Nigeria and Myanmar have about 4
physicians per 10 000, while Norway and Switzerland have 40
per 10 000.

16. Cause of death Death in Millions Percent of Death
Coronary heart disease 7.20 12.2
Stroke and other cerebrovascular diseases 5.71 9.7
Lower respiratory infections 4.18 7.1
Chronic obstructive pulmonary disease 3.02 5.1
Diarrheal diseases 2.16 3.7
HIV/AIDS
2.04 3.5
Tuberculosis
1.46 2.5
Trachea, bronchus, lung cancers 1.32 2.3
Road traffic accidents 1.27 2.2
Prematurity and low birth weight 1.18 2.0
10 leading causes of death around the world (WHO)

17. Source: W.H.O. Statistics
Source: WHO statistics 2008

18. Global Governance
The term “global governance” refers to
the interaction of all mechanisms and
forms of international cooperation to
solve global issues in the context of
globalization.

19. Global and National Health Agenda
HFA: 1981 to 2000 AD: 12 global indicators
MDGs: 2000 to 2015: 8 goals, 18 targets and 48
indicators
SDGs: 2016 to 2030 : 17 goals and 169 targets and
UN Statistical Commission will finalize around 300
indicators by March 2016

20. Global Goals – all SDGs

21. Health in post-2015 development goals
17 goals & 169 targets
Target Description
3.1 Reduce global MMR to <70 per 100,000 live births
3.2
End preventable newborn & U5 deaths, with all countries aiming to reduce neonatal mortality to
at least as low as 12 per 1,000 live births & U5 mortality to at least as low as 25 per 1,000 live
births
3.3
End AIDS, tuberculosis, malaria & neglected tropical diseases epidemics
& combat hepatitis, water-borne diseases & other communicable diseases
3.4
Reduce by 1/3rd premature NCD mortality through prevention & treatment
& promote mental health & well-being
3.5
Strengthen prevention & treatment of substance abuse, including narcotic drug abuse &
harmful use of alcohol
3.6 Halve the number of global deaths & injuries from road traffic accidents
3.7
Ensure universal access to sexual & reproductive health-care services, including for FP,
information & education, & the integration of RH health into national strategies & programs
3.8 Achieve UHC, including financial risk protection, access to quality essential health-care
services & access to safe, effective, quality & affordable essential medicines & vaccines for all
3.9
Substantially reduce number of deaths & illnesses from hazardous chemicals & air, water & soil
pollution & contamination
Ensure health lives & promote well-being
for all at all ages

22. Linkage between National and Global movements
Examples
 Framework Convention on Tobacco Control (FCTC)
 Health for All
 Global Fund
 MDGs
 NCDs
 IHR
 Alcohol: Global Strategy, National Strategy,
 SDGs
 UHC etc
6

23. Key Concepts in Relation to Global Health
1. The determinants of health
2. The measurement of health status
3. The importance of culture to health
4. The global burden of disease
5. The key risk factors for various health problems
6. The organisation and function of health
systems

24. 1. Determinants of Health
 Genetic make up
 Age
 Gender
 Lifestyle choices
 Community influences
 Income status
 Geographical location
 Culture
 Environmental factors
 Work conditions
 Education
 Access to health services
Source: Dahlgren G. and
Whitehead M. 1991

25. Determinants of Health
PLUS MORE GENERAL FACTORS SUCH AS:
 POLITICAL STABILITY
 CIVIL RIGHTS
 ENVIRONMENTAL DEGRADATION
 POPULATION GROWTH/PRESSURE
 URBANISATION
 DEVELOPMENT OF COUNTRY OF
RESIDENCE

26. 2. The Measurement of Health Status
 Cause specific death rate
 Life expectancy at birth
 Maternal mortality rate
 Infant mortality rate
 Neonatal mortality rate
 Child mortality rate

27. 3. Culture and Health
 Culture:
 The predominating attitudes and behaviour that characterise the
functioning of a group or organisation
 Beliefs about health
 e.g. epilepsy – a disorder of neuronal depolarisation vs a form of
possession/bad omen sent by the ancestors
 Psychoses – ancestral problems requiring the assistance of
traditional healer/spiritualist
 Diversity, marginalisation and vulnerability due to race, gender and
ethnicity

28. 4. The global burden of disease
 Predicted changes in burden of disease from
communicable to non-communicable between 2004 and
2030
 Reductions in malaria, diarrhoeal diseases, TB and HIV/AIDS
 Increase in cardiovascular deaths, COPD, road traffic accidents
and diabetes mellitus
 Ageing populations in middle and low income countries

29. Trends in Global Deaths 2002-30
Source: World Health Statistics 2007

30. 5. Key Risk Factors for Various Health
Conditions
 Tobacco use –
 related to the top ten causes of mortality world wide
 Poor sanitation and access to clean water-
 related to high levels of diarrhoeal/water borne diseases
 Low condom use –
 HIV/AIDS, sexually transmitted infections
 Malnutrition –
 Under-nutrition (increased susceptibility to infectious diseases)
and over-nutrition responsible for cardiovascular diseases,
cancers, obesity etc.

31. 6. The Organisation and Function
of Health Systems and UHC
 A health system
 comprises all organizations, institutions and resources
devoted to producing actions whose primary intent is to
improve health (WHO)
 Most national health systems consist:
 public, private,
 traditional and informal sectors:

32. Global Health Players - More complex
and not only UN
 UN: UNGA, WHO, UNICEF, UNFPA, UNAIDs, etc
 WB and regional banks, and IMF, WTO
 Bilateral donors: USAID, DFID, AFD, NORAD, SIDA,
CIDA, IDRC, JICA, EC and G8
 Foundations: BMGF, RF, Ford, CMB, etc.
 NGOs: MSF, Oxfam, Clinton foundation, etc
 Global Health Partnerships: GAVI, GF, RBM, Stop TB,
PMNCH, HMN, GHWA, CORDs, etc.
10

33. 4
11

34. Digital divide: gap between haves and have nots
One of the biggest global health challenges is access
to information
Potential Solution:
WWW and
Mobile Global Health

35. The importance of knowledge,
learning, innovation, and IT
“The most fundamental resource in
modern economy is knowledge and,
accordingly, the most important process
is learning”
Lundvall, Bengt-Åke (1992) National Systems of Innovation. Towards a Theory of
Innovation and Interactive Learning. Pinter, London and New York, pp. 342

36. GloCal Health (Global to Local)
Your Patient and
Where you live

37. Global Health References
 Skolnik R. Essentials of Global Health. Jones & Bartlett
Publishers, Sudbury MA 2008. Chapter 1
 Ed. Robert Beaglehole, 2003. Global Public Health: A
new era. Chapter 1
 Megan Landon. 2006. Environment, Health and
Sustainable Development
 Bonder, B. Martin L. Miracle A. Culture in Clinical Care
 Koplan J et al, 2009. Towards a common definition of
global health The Lancet, Volume 373, Issue 9679, Pages
1993-1995