Global Public Health and Disease Control, 1st Ed.

By Omnigraphics

Provides basic consumer information on global public health, infectious diseases that affect global public health, environmental pollutants that affect global public health, and precautions to control these global infections. Includes an index and a directory of organizations for additional help and information.

• Language: English
• Publisher: Omnigraphics
• Release date: Dec 1, 2021
• ISBN: 9780780819658

Book preview

Preface

About This Book

Global health plays an increasingly crucial role in global security. Since the globalization of worldwide economies is on the rise, including extensive international travel and commerce, it is necessary to think about health in a global context. Rarely a week goes by without a headline about the emergence or reemergence of an infectious disease or other health threat somewhere in the world. Globally, the rate of deaths from noncommunicable causes, such as heart disease, stroke, and injuries, is growing. At the same time, the number of deaths from infectious diseases, such as malaria, and vaccine-preventable diseases, is decreasing. Rapid identification and control of emerging infectious diseases help promote health abroad and prevent the international spread of disease. From 2015–2019, the number of cases of drug-resistant tuberculosis worldwide increased, and malaria cases declined just 2 percent, compared to 27 percent in the preceding 15 years. Health experts project that by 2040, noncommunicable diseases could cause 80 percent of deaths in low-income countries, up from 25 percent in 1990. The world community is finding better ways to confront major health threats. All these issues will require enhanced collaboration between all the countries to protect and promote better health for all.

Global Public Health and Disease Control Sourcebook, First Edition gives an overview on what is global health and its threats and challenges of the 21st century, including the impact of population aging; major infectious diseases that affect global health such as pneumonia, influenza, Ebola, Zika, and COVID-19; and the rapid increase in noncommunicable chronic diseases (NCDs). The book also examines the determinants of public health, such as socioeconomic factors and environmental health, and the importance of sustainable development for achieving global health goals. In addition, information about public-health promotion, disease prevention, and emergency preparedness are explained, along with a glossary of related terms and a directory of organizations that provide information about global health.

How to Use This Book

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part 1: Overview of Global Public Health explains the global health challenges in the next decade and social determinants of global health and diseases. It also includes information on global health measurement and Global Health Security (GHS) and its threats, along with emerging issues of disability and aging worldwide.

Part 2: Global Infectious Disease Threats and Public Health begins with details on the globalization of various infectious diseases and goes on to cover the impact of common diseases and infections such as tuberculosis (TB), HIV/AIDS, and malaria. Also explained are major deadly infections worldwide including Ebola, Zika, dengue, influenza, and COVID-19. It also highlights why neglected tropical diseases and diarrheal diseases require more focus.

Part 3: Noncommunicable Chronic Diseases of the 21st Century deals with noncommunicable diseases such as cardiovascular disease (CVD), global cancer facts, chronic respiratory diseases, diabetes, metabolic syndrome, global mental-health crisis, and risk factors of using drugs and alcohol.

Part 4: Environment, Climate Change, and Global Health explains the impacts of human activity on the environment and sustainable development in environmental health, climate change due to global warming, and talks about global safe water and sanitation in improving health systems, bioterrorism, and the global threat of antimicrobial resistance.

Part 5: Public Health Promotion, Disease Prevention, and Emergency Preparedness talks about the developmental goals of global public health, zoonotic disease programs, and One Health approach, and how to strengthen global immunization systems by developing the next generation vaccines, and covers why prioritizing noncommunicable disease prevention and treatment is important. The part also deals with the various research and development needs and future technology in global public health, reduction of the global burden of injuries and violence, along with Global Health Security (GHS) prevention, detection, and response to threats, International Health Regulations (IHR), and health emergencies preparedness.

Part 6: Additional Help and Information provides a glossary of related terms and a directory of organizations that provide information about global public health.

Bibliographic Note

This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Centers for Disease Control and Prevention (CDC); Congress.gov; Digital.gov; Fogarty International Center (FIC); HIV.gov; National Aeronautics and Space Administration (NASA); National Cancer Institute (NCI); National Center for Biotechnology Information (NCBI); National Heart, Lung, and Blood Institute (NHLBI); National Institute of Biomedical Imaging and Bioengineering (NIBIB); National Institute of Environmental Health Sciences (NIEHS); National Institute on Aging (NIA); National Institute on Alcohol Abuse and Alcoholism (NIAAA); National Intelligence Council (NIC); Office of Disease Prevention and Health Promotion (ODPHP); Office of the Assistant Secretary for Preparedness and Response (ASPR); United States Census Bureau; U.S. Department of Agriculture (USDA); U.S. Department of Homeland Security (DHS); U.S. Department of State (DOS); U.S. Environmental Protection Agency (EPA); and U.S. Food and Drug Administration (FDA).

It also contains original material produced by Omnigraphics and reviewed by medical consultants.

The photographs on the front cover are:

© PH888/Shutterstock

© Lightspring/Shutterstock

About the Health Reference Series

The Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. Each volume provides comprehensive coverage on a particular topic. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series. The Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a substitute for the physician–patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate healthcare provider.

A Note about Spelling and Style

Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms and The Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers, and the editor’s primary goal is to present material from each source as accurately as is possible. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).

Medical Review

Omnigraphics contracts with a team of qualified, senior medical professionals who serve as medical consultants for the Health Reference Series. As necessary, medical consultants review reprinted and originally written material for currency and accuracy. Citations including the phrase Reviewed (month, year) indicate material reviewed by this team. Medical consultation services are provided to the Health Reference Series editors by:

Dr. Vijayalakshmi, MBBS, DGO, MD

Dr. Senthil Selvan, MBBS, DCH, MD

Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

Health Reference Series Update Policy

The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to:

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Part 1 | Overview of Global Public Health

Chapter 1 | Major Global Health Challenges for the Next Decade

Global Challenges

First, shared global challenges – including climate change, disease, financial crises, and technology disruptions – are likely to manifest more frequently and intensely in almost every region and country. These challenges – which often lack a direct human agent or perpetrator – will produce widespread strains on states and societies as well as shocks that could be catastrophic. The ongoing COVID-19 pandemic marks the most significant, singular global disruption since World War II, with health, economic, political, and security implications that will ripple for years to come. The effects of climate change and environmental degradation are likely to exacerbate food and water insecurity for poor countries, increase migration, precipitate new health challenges, and contribute to biodiversity losses. Novel technologies will appear and diffuse faster and faster, disrupting jobs, industries, communities, the nature of power, and what it means to be human. Continued pressure for global migration – as of 2020 more than 270 million persons were living in a country to which they have migrated, 100 million more than in 2000 – will strain both origin and destination countries to manage the flow and effects. These challenges will intersect and cascade, including in ways that are difficult to anticipate. National security will require not only defending against armies and arsenals but also withstanding and adapting to these shared global challenges.

Fragmentation

Second, the difficulty of addressing these transnational challenges is compounded in part by increasing fragmentation within communities, states, and the international system. Paradoxically, as the world has grown more connected through communications technology, trade, and the movement of people, that very connectivity has divided and fragmented people and countries. The hyperconnected information environment, greater urbanization, and interdependent economies mean that most aspects of daily life, including finances, health, and housing, will be more connected all the time. The Internet of Things encompassed 10 billion devices in 2018 and is projected to reach 64 billion by 2025 and possibly many trillions by 2040, all monitored in real-time. In turn, this connectivity will help produce new efficiencies, conveniences, and advances in living standards. However, it will also create and exacerbate tensions at all levels, from societies divided over core values and goals to regimes that employ digital repression to control populations. As these connections deepen and spread, they are likely to grow increasingly fragmented along with national, cultural, or political preferences. In addition, people are likely to gravitate to information silos of people who share similar views, reinforcing beliefs and understanding of the truth. Meanwhile, globalization is likely to endure but transform as economic and production networks shift and diversify. Altogether, these forces portend a world that is both inextricably bound by connectivity and fragmenting in different directions.

Disequilibrium

The scale of transnational challenges, and the emerging implications of fragmentation, are exceeding the capacity of existing systems and structures, highlighting the third theme: disequilibrium. There is an increasing mismatch at all levels between challenges and needs with the systems and organizations to deal with them. The international system – including the organizations, alliances, rules, and norms – is poorly set up to address the compounding global challenges facing populations. The COVID-19 pandemic has provided a stark example of the weaknesses in international coordination on health crises and the mismatch between existing institutions, funding levels, and future health challenges. Within states and societies, there is likely to be a persistent and growing gap between what people demand and what governments and corporations can deliver. From Beirut to Bogota to Brussels, people are increasingly taking to the streets to express their dissatisfaction with governments’ ability to meet a wide range of needs, agendas, and expectations. As a result of these disequilibria, old orders – from institutions to norms to types of governance – are strained and in some cases, eroding. And actors at every level are struggling to agree on new models for how to structure civilization.

Contestation

A key consequence of greater imbalance is greater contestation within communities, states, and the international community. This encompasses rising tensions, division, and competition in societies, states, and at the international level. Many societies are increasingly divided among identity affiliations and at risk of greater fracturing. Relationships between societies and governments will be under persistent strain as states struggle to meet rising demands from populations. As a result, politics within states are likely to grow more volatile and contentious, and no region, ideology, or governance system seems immune or to have the answers. At the international level, the geopolitical environment will be more competitive – shaped by China’s challenge to the United States and the Western-led international system. Major powers are jockeying to establish and exploit new rules of the road. This contestation is playing out across domains from information and the media to trade and technological innovations.

Adaptation

Finally, adaptation will be both an imperative and a key source of advantage for all actors in this world. Climate change, for example, will force almost all states and societies to adapt to a warmer planet. Some measures are as inexpensive and simple as restoring mangrove forests or increasing rainwater storage; others are as complex as building massive sea walls and planning for the relocation of large populations. Demographic shifts will also require widespread adaptation. Countries with highly aged populations like China, Japan, and South Korea, as well as Europe, will face constraints on economic growth in the absence of adaptive strategies, such as automation and increased immigration. Technology will be a key avenue for gaining advantages through adaptation. For example, countries that are able to harness productivity boosts from artificial intelligence (AI) will have expanded economic opportunities that could allow governments to deliver more services, reduce the national debt, finance some of the costs of an aging population, and help some emerging countries avoid the middle-income trap. The benefits from technology like AI will be unevenly distributed within and between states, and more broadly, adaptation is likely to reveal and exacerbate inequalities. The most effective states are likely to be those that can build societal consensus and trust toward collective action on adaptation and harness the relative expertise, capabilities, and relationships of nonstate actors to complement state capacity.

Future Global Health Challenges

Advances in basic healthcare during the past few decades, such as wider availability of medicines and vaccines and improvements in medical procedures, have reduced disease, improved overall health outcomes, and extended longevity for large numbers of people globally. During the next two decades, however, several health challenges are likely to persist and expand, in part because of population growth, urbanization, and antimicrobial resistance.

Stalled Progress on Combating Infectious Disease

International progress against tuberculosis and malaria has stalled in recent years. From 2015-19, the number of cases of drug-resistant tuberculosis worldwide increased, and malaria cases declined just 2 percent, compared to 27 percent in the preceding 15 years, in part because of the leveling of international investments. Looking forward, longstanding, emerging, and re-emerging infectious diseases will continue to endanger individuals and communities. The incidence of new pandemics also is likely to grow due to the increased risk of new animal pathogens infecting humans and factors that enable spread, such as human mobility and population density.

Growing Antimicrobial Resistance

Resistance to antibiotic treatment is rising globally, due in part to overuse and misuse of antibiotics in livestock and antimicrobials in human medicine. Drug-resistant infections cause more than half a million deaths annually, and the cumulative economic cost could reach $100 trillion between 2020 and 2050 because of productivity loss and the high cost of extended hospital stays or treatment.

Rising Levels of Noncommunicable Disease

Noncommunicable diseases now cause the majority of deaths worldwide – principally because of diabetes, cardiovascular disease, cancer, and chronic respiratory conditions such as asthma. Health experts project that by 2040, noncommunicable diseases could cause 80 percent of deaths in low-income countries, up from 25 percent in 1990, due in part to longer life expectancies but also to poor nutrition, pollution, and tobacco use. In many countries, health systems are not adequately equipped to respond to this shift, which could increase human suffering. Periods of economic slowdown exacerbate those risks by straining public health systems and putting downward pressure on foreign assistance and private health investments.

Increasing Strains on Mental Health, Especially among Youth

Mental health and substance abuse disorders increased 13 percent during the past decade, principally because of increases in population and life expectancy but also because of the disproportionate prevalence of mental illness among adolescents. Currently, between 10 and 20 percent of children and adolescents globally suffer from mental health disorders, and suicide is the third leading cause of death among people between 15 and 19 years old.

Health experts project that the economic cost of mental illness worldwide could exceed $16 trillion during the next 20 years, with much of the economic burden resulting from lost income and productivity as a result of chronic disability and premature death. Preliminary research suggests that because of the pandemic, people in every region will experience increased rates of mental distress caused by economic losses and social isolation stress disorder.

_____________

This chapter includes text excerpted from Global Trends 2040, National Intelligence Council (NIC), March 2021.

Chapter 2 | Determinants of Health and Disease

Chapter Contents

Section 2.1—The Influence of Social and Cultural Variables on Public Health

Section 2.2—Tackling the Social Dimensions of Health around the World

Section 2.1 | The Influence of Social and Cultural Variables on Public Health

This section contains text excerpted from the following sources: Text in this section begins with excerpts from Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health, Centers for Disease Control and Prevention (CDC), 2008. Reviewed October 2021; Text beginning with the heading Key Domains of Social Determinants of Health is excerpted from About Social Determinants of Health (SDOH), Centers for Disease Control and Prevention (CDC), March 10, 2021.

In its 1988 landmark report, and again in 2003 in an updated report, the Institute of Medicine defined public health as what we as a society do to collectively assure the conditions in which people can be healthy.

Early efforts to describe the relationship between these conditions and health or health outcomes focused on factors such as water and air quality and food safety. More recent public health efforts, particularly in the past decade, have identified a broader array of conditions affecting health, including community design, housing, employment, access to healthcare, access to healthy foods, environmental pollutants, and occupational safety.

The link between social determinants of health, including social, economic, and environmental conditions, and health outcomes is widely recognized in the public health literature. Moreover, it is increasingly understood that the inequitable distribution of these conditions across various populations is a significant contributor to persistent and pervasive health disparities.

Multiple models describing how social determinants influence health outcomes have been proposed. Although differences in the models exist, some fairly consistent elements and pathways have emerged. The model presented here contains many of these elements and pathways and focuses on the distribution of social determinants. As the model shows, social determinants of health broadly include both societal conditions and psychosocial factors, such as opportunities for employment, access to healthcare, hopefulness, and freedom from racism. These determinants can affect individual and community health directly, through an independent influence or an interaction with other determinants, or indirectly, through their influence on health-promoting behaviors by, for example,

Table 2.1. Examples of Health Disparities by Racial/Ethnic Group or by Socioeconomic Status

determining whether a person has access to healthy food or a safe environment in which to exercise.

Policies and other interventions influence the availability and distribution of these social determinants to different social groups, including that defined by socioeconomic status, race/ethnicity, sexual orientation, sex, disability status, and geographic location. Principles of social justice influence these multiple interactions and the resulting health outcomes: inequitable distribution of social determinants contributes to health disparities and health inequity, whereas the equitable distribution of social determinants contributes to health equity. Appreciation of how societal conditions, health behaviors, and access to healthcare affect health outcomes can increase understanding about what is needed to move toward health equity.

The World Health Organization also provides a definition of social determinants of health as the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. The state social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.

Key Domains of Social Determinants of Health

Healthcare Access and Quality

The connection between people’s access to and understanding of health services and their own health. This domain includes key issues such as access to healthcare, access to primary care, health insurance coverage, and health literacy.

Education Access and Quality

The connection of education to health and wellbeing. This domain includes key issues such as graduating from high school, enrollment in higher education, educational attainment in general, language and literacy, and early childhood education and development.

Social and Community Context

The connection between characteristics of the contexts within which people live, learn, work, and play, and their health and wellbeing. This includes topics like cohesion within a community, civic participation, discrimination, conditions in the workplace, and incarceration.

Economic Stability

The connection between the financial resources people have – income, cost of living, and socioeconomic status – and their health. This area includes key issues such as poverty, employment, food security, and housing stability.

Neighborhood and Built Environment

The connection between where a person lives – housing, neighborhood, and the environment – and their health and wellbeing. This includes topics like the quality of housing, access to transportation, availability of healthy foods, air and water quality, and neighborhood crime and violence.

Addressing the Social Determinants of Health

Over 30 years ago, Dr. Margaret Heckler, then Secretary of the U.S. Department of Health and Human Services (HHS), released the seminal Report of the Secretary’s Task Force on Black and Minority Health, also known as the Heckler Report. This report documented health disparities in the United States that impact the health of racial and ethnic minority populations and was one of the first to identify a link between social determinants of health (SDH) and health disparities. In particular, the report identified several priority health problems that contribute to creating an excess burden of disease and account for most of the disparity in mortality among racial and ethnic minorities as compared to whites. Still relevant today, the report highlighted the importance of addressing SDH and noted that clinical interventions alone are insufficient to eliminate health disparities.

Engaging people and patients in the context of their lives maximize the impact of healthcare on health outcomes. On an individual level, this allows for the whole person, patient-centered care which provides the greatest opportunity to fully address the patient’s needs. At a population level, systematic assessment of SDH provides a mechanism for cross-sector partnerships within and outside of the healthcare system. These partnerships can identify opportunities to leverage resources and improve the health and well-being of the community.

In one case, a study found that black and Hispanic children in Boston were hospitalized with complications from asthma more frequently than white children. Boston Children’s Hospital created the Community Asthma Initiative (CAI) to address this racial and ethnic health disparity. CAI nurses make home visits to low-income Boston neighborhoods to provide healthcare for children with asthma. Data indicated that CAI decreased asthma-related hospitalizations by 79 percent, and asthma-related emergency department visits by 56 percent, at 12 months. The CAI model has been applied to other communities and has been used to make a business case to inform lawmakers and health insurers about the positive individual and population health outcomes that result from addressing SDH in a community.

There is an increasing focus on patient behavior change. Lack of adherence by the patient to the treatment regimen can be frustrating for both the patient and the provider. As identified by Maslow in his Hierarchy of Needs, all human beings have basic needs which must be met in order for them to have the opportunity to achieve their full potential. When the most basic of needs (e.g., food and safety) are not met, a person may not be able to significantly change behavior to address higher needs (e.g., health promotion or education). SDH contextualizes the systemic and structural challenges that patients may face in addressing their health goals. For instance, a physician may recommend to the parents of an obese child to increase physical activity and include more fruits and vegetables in the child’s diet, to decrease the risk of diabetes. However, the family may live in a neighborhood that lacks safe areas to walk or with limited access to parks and playgrounds. The school meals program may only offer high-calorie meals and low-cost options like soda, while the family may not have access to nearby supermarkets to purchase healthy foods.

Addressing SDH and developing a plan of action and targeted interventions may not only improve patient satisfaction, but also reduce costs, improve health outcomes, and increase health equity. Numerous studies have demonstrated the benefit of incorporating a systematic approach to identifying SDH that may play a major role in disease prevention, health promotion, and the management of chronic diseases.

Social Determinants of Health Education

Many national and international organizations have called for a redesign of health professional training across the educational continuum. One important aspect of change is adding curricular content to address SDH. The impact of intervening on social factors is broad, ranging from the individual up to community, state, and national levels. A recent survey found that 80 percent of physicians who responded acknowledged the importance of SDH in their patients’ lives, but rarely addressed them. In addition, most physicians believe that unmet social needs of their patients contribute to worsening of health, yet also feel unable to address health concerns caused by these needs.

The biomedical model, focused on identifying and treating disease, is the prevailing framework taught in most medical schools. Little emphasis has been placed on the magnitude that environment, background, and resources ultimately has on health. Addressing SDH begins with educating current and future healthcare professionals on the ways that social factors impact health. SDH should be included in the undergraduate, graduate, and continuing education curricula of health professionals, so that students are taught early in their education and throughout their careers the skills needed to help their patients achieve optimal health and to reduce health inequalities.

SDH should be included in competency requirements and incorporated into didactic and community-based clinical learning experiences that enable students to become aware of and sensitive to the needs of the population they serve. SDH competencies include cultural humility, reflection, advocacy, cultural competency, partnership skills, patient communication, and empathy.

Schools of medicine, dentistry, and other health professions are incorporating courses in cultural competence and cultural humility, including content on race, bias, and disparities, into their curricula. Cultural competence in healthcare refers to providing appropriate services that are respectful of and responsive to the health beliefs, practices, and needs of diverse patients. Cultural humility involves a lifelong commitment to addressing the power imbalance implicit in the provider-patient dynamic, and to developing equal and mutually beneficial partnerships with patients, their families, and local communities. By tailoring services to meet the culture practices and preferences of the individuals and communities they serve, health professionals can facilitate communication, reduce health disparities, and improve health outcomes.

Section 2.2 | Tackling the Social Dimensions of Health around the World

Tackling the Social Dimensions of Health around the World, © 2022 Omnigraphics. Reviewed October 2021.

The factors that contribute to health disparities are complex, diverse, interlinked, and constantly evolving. Where people are in the social hierarchy impacts the environment in which people are born, live, work, and age. Called social determinants of health, these nonmedical factors significantly impact health and wellbeing and access to healthcare. Social determinants in turn are closely linked to a wider set of forces and systems: economics, politics, and social policies. The global context of health is also deeply influenced by how countries and societies develop through their domestic policies and norms and international relations.

Health Inequalities versus Health Inequities

Health Inequality is a generic term for differences in the health of individuals or socially relevant groups. Any measurable aspect of health, which excludes a moral judgment on whether or not the observed difference is just, falls within the scope of health inequality. For example, health inequality can describe differences in infant mortality rate among ethnic groups within a country just the same way it can describe the differences in health status between young adults and the elderly. While the former is an inequality that is preventable, and if allowed to persist, unjust; the latter is not. Health inequities-in contrast to health inequalities- are systematic inequalities that factor in a sound moral judgment in its measurement.

The Social Gradient of Health

Also referred to as the status syndrome, social inequalities are well documented in public health literature and have been demonstrated in many country-wise studies for a number of chronic health conditions and health outcomes. These studies reveal glaring inequalities within and between populations and countries. The famous Whitehall studies, led by Sir Michael Marmot (Professor of Epidemiology and Public Health at University College London) was one of the first of their kind which investigate the link between health and socioeconomic status. Named after the Whitehall area of London, the study examined and established a link between mortality rates of cardiovascular disease among British civil servants of varying grade levels. The study showed that individuals in the lowest grades had significantly higher mortality rates as compared to those occupying higher grades. A number of other studies which succeeded the Whitehall study also reinforced the strong link between socioeconomic status and health outcome by demonstrating a consistent inverse relationship between socioeconomic status and morbidity/mortality rates.

The Right to Health

The acceptance of health as a fundamental human right is one of the compelling reasons for recognizing and addressing health differences within and between populations. Persistent, avoidable health differences raise moral concerns based on notions of equality and justice. While the unequal distribution of myriad resources across populations and countries may not actually be perceived as a violation of basic human rights, health is not one of them. The right to the enjoyment of the highest attainable standard of physical and mental health was first articulated in 1946 by the World Health Organization Constitution, whose preamble defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The UN General Assembly declared health as a human right for all humanity in its Universal Declaration of Human Rights (1948). The Declaration sets forth the right to a standard of living adequate for the health and well-being of an individual and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond the individual’s control. Following this, many countries in the world have committed themselves to uphold the right to health in their constitutions; domestic laws and policies; and at international conferences.

Public Health Importance of Right to Health

The basic premise of public health is the right of all people to enjoy good health. Every person should be provided the opportunity to attain their full health potential regardless of their position in the social hierarchy. Health inequalities are unjust, preventable, remediable differences in health status and healthcare between people or communities at the local, national, or global levels. The human rights-based approach is expected to provide a clear set of policies for defining and evaluating health policies and health-care systems within and across countries.

Research, policy, and public health practice literature have increasingly begun to focus on disparities in health and healthcare access among segments of the population, defined by sex, age, social strata, geographic location, race, and ethnicity, vulnerable groups, among others. Over time, robust body of literature on health disparities has been developed at the national and global levels to address unequal distribution of health resources and improve health outcomes. Understanding the factors and underlying causes of health inequalities are vital to developing effective interventions and bridging the health equity gap, an overarching theme in national and global agendas.

Measuring Inequities in Public Health

Public health focuses on health inequalities that operate across social groups rather than individuals. Group-level health disparity is observed in both low income and high-income countries and the gap is widening making it an important tool for evaluating health inequality. Defining relevant social groups based on stratifiers such as age, gender, religion, education, socioeconomic status, is the first step in examining health inequalities across social groups within and between countries.

What Does International Law Mean for Nations?

Health equity has received a lot of attention in recent times, both nationally and internationally. Major international agencies have assigned explicit value to health and require nations to take affirmative actions in ensuring access to adequate healthcare based on the nation’s economic resources and cultural norms. The WHO has accorded a high priority to health equity and health-related human development. The formation of the Commission on Social Determinants of Health in 2005, which recommends action to reduce health inequities based on social determinants of health, is reflective of this. The right to health and the principle that health, policies, and programs must prioritize those furthest behind toward greater equity has been echoed in the UN’s global agendas including the Millenium Development Goals and the Sustainable development Goals.

Despite all the attention health as a basic right has received on the global stage, translating the law remains a huge challenge to nation-states. This is partly because the right to health is complex and dependent on other human rights, such as the right to education, housing, or employment, and mostly because the political will required to redress the problem of health inequity is lacking. Rightly said by Rudolf Virchow (1821–1902), regarded as the father of social medicine, "Medicine is a Social Science and Politics is nothing but medicine at a larger scale. This statement underscores the importance of social and economic factors as the primary determinants of health and also seeks to address health inequities through social and economic remedies.

The right to health also dictates that the state, regardless of whatever resources they have at their disposal, works toward fulfillment of these rights. The rights-based approach also includes meaningful participation. Participation ensures that all stakeholders – including state,non-state actors (non-governmental organizations) – are meaningfully involved in improving health systems and bridging the health inequality gap by focusing on vulnerable populations which are disproportionately impacted.

Core Components of the Right to Health

Availability

The availability of adequate functioning public health facilities, programs, as well as goods and services for all is crucial for achieving health equity. Gaps in coverage and availability of health-care resources can be measured using stratifiers including age, sex, geographical location (rural areas-globally, most neglected), and socio-economic status.

Accessibility

Health facilities, goods, and services must be accessible to everyone and include three dimensions: physical, economical (affordability), and information accessibility. Nondiscrimination is also a critical component of accessibility and right to health and states must ensure that specific needs of groups that are unequally affected by health challenges, such as higher disease burden, or higher mortality rates are adequately met by redressing anti-discriminatory practice, policy, or the law.

Measuring accessibility by analyzing barriers to healthcare and establishing robust monitoring systems of health-related information are important elements in improving health-care accessibility.

Quality of Healthcare

Health systems need to be based on globally endorsed scientific approaches and should be safe, timely, effective, and people-centered (serve individual needs through culturally appropriate methods). They should integrate a broad range of services across the lifespan and should also be efficient (maximum utilization of the available resources).

Challenges to Health Equity in Developing Countries

Access to health-care services, goods, and technologies remain major hurdles in closing the health equity gap in low and middle-income countries. International agencies estimate that over a third of the global population lacks access to effective health services and there is an urgent need for expanding access to existing interventions for maternal and child health, and infectious and non communicable diseases. Surveys also indicate that unmet needs for pain relief and treatment remain significantly high for terminal conditions such as cancer and AIDS. In most countries, barriers to healthcare access include weak health infrastructure; lack of geographical access; unavailability of skilled human resources; lack of gender- and -culture appropriate healthcare response; and ineffective referral systems. Substandard pharmaceuticals and counterfeit health products are also a huge problem in developing countries as also is inadequate state funding for health-related research and development.

Over half of total health expenditure in these countries involves private spending, and out-of-pocket payments (particularly, catastrophic health expenditure) can expose households to substantial financial risk and further exacerbate impoverishment which in turn is associated with adverse health outcomes and barriers to healthcare access. Many marginalized subgroups in developing countries, including orphans, refugees, people with disabilities, prisoners, indigenous groups, gender minorities, sex workers, and people suffering from diseases like HIV, TB face stigma and discrimination and are denied access to health-care services. Their specific health needs are overlooked by the state which is already burdened with providing basic health-care services to its majority population.

A major challenge in achieving health equity in many developing countries remains the lack of institutional mechanisms that support the realization of the right to health. Despite most countries being signatories to human rights treaties that enshrine the right to health as a fundamental right, the lack of clearly defined legislation and policies makes it difficult or impossible to enforce the state’s obligation meaningfully.

Public health experts believe that Improving socioeconomic status may help translate constitutional provisions and public health laws into policies and programs for mainstreaming human rights in healthcare.

References

Arcaya, Mariana C., Arcaya, Alyssa L., and S. V. Subramanian,. Inequalities in Health: Definitions, Concepts, and Theories, Global Health Action, June 24, 2015.

Human Rights and Health, World Health Organization (WHO), December 29, 2017.

Chapter 3 | Measuring Global Health

Good quality of life requires good health conditions. Our ability to enjoy life is strongly influenced by our ability to prevent disease or injury.

Over the last 25 years, the world has achieved remarkable progress in global health, by lowering the cases of acquired immunodeficiency syndrome (AIDS), infant mortality, hunger, child malnutrition, and expanding access to medications and vaccinations to treat and prevent millions of people.

Officials from global health organizations unveiled new rules for tracking health trends throughout the world. These recommendations set a new bar for public-health transparency and accountability. Above all, they democratize research aimed at assisting people in living longer and better lives.

Global Health

Global health is measured in terms of Global Burden of disease (GBD), which is defined as the effect of a health condition as measured by death, morbidity, and financial cost.

Various diseases impose varying degrees of burden on a population, and this has become the most frequent approach for comparing countries. When comparing GBD statistics from different countries, there is a clear distinction between developing and underdeveloped countries.

Why Global Health Is Measured?

Global health is measured to assess a population’s overall health and generally includes statistics on disability, mortality, and morbidity. According to the National Center for Biotechnology Information (NCBI), health scores can also indicate the subjective quality of life or functional statuses, such as physical functioning and mental well-being.

Understanding the frequency and severity of diseases that cause immense pain for a prolonged period but do not lead to death requires measuring the quality of life by evaluating physical well-being.

As disease outbreaks and major causes of death gets more complex, so does the classification of how global health is assessed. A variety of indicators are used to assess health, such as:

Health-Adjusted Life Year

Health-adjusted life years (HALYs) is a name for a family of metrics that includes disability-adjusted life years (DALYs) and quality-adjusted life-years (QALYs). HALYs are helpful for assessing the burden of disease and comparing the impact of different health problems on populations since they combine morbidity and death rates into a single figure.

Disability-Adjusted Life Year

According to the World Health Organization (WHO), a DALY is a year of healthy life lost. DALY measures can be used to compare different countries’ overall health and life expectancy. The total of DALYs obtained from a population is a measure of the difference between the population’s actual health score and the ideal health score they are aiming for.

DALYs are computed by adding the years of life lost due to early death and the years of life lost due to impairment for persons living with a certain disease or health condition.

Quality-Adjusted Life Year

QALYs are a measure of illness burden that takes into account both the health-related quality of life and the length of life expectancy of an individual.

A QALY score is calculated on a scale of 0 to 1, with 0 equaling death and 1 equaling perfect health.

The QALY score can also be used to track the success of medical interventions in extending a patient’s life expectancy. This widely used conceptual tool has the potential to improve global health decision-making. Assessing which illnesses and health conditions lead to low QALYs, aids in treatment prioritization and healthcare improvement.

Improving Standards to Measure Global Health

The WHO, the World Bank, and the U.S. Agency for