World Tuberculosis Day, observed on 24 March each year, is designed to build public awareness about the global epidemic of tuberculosis
(TB) and efforts to eliminate the disease. In 2012, 8.6 million people
fell ill with TB, and 1.3 million died from the disease, mostly in low
and middle-income countries.
24 March commemorates the day in 1882 when Dr Robert Koch
astounded the scientific community by announcing to a small group of
scientists at the University of Berlin's Institute of Hygiene that he
had discovered the cause of tuberculosis, the TB bacillus. According to Koch's colleague, Paul Ehrlich,
"At this memorable session, Koch appeared before the public with an
announcement which marked a turning-point in the story of a virulent
human infectious disease. In clear, simple words Koch explained the
aetiology of tuberculosis with convincing force, presenting many of his
microscope slides and other pieces of evidence." At the time of Koch's announcement in Berlin, TB was raging through Europe and the Americas, causing the death of one out of every seven people. Koch's discovery opened the way toward diagnosing and curing tuberculosis.
In the fall of 1995, WHO and the Royal Netherlands Tuberculosis
Foundation (KNCV) hosted the first World TB Day advocacy planning
meeting in Den Haag, Netherlands; an event they would continue co-sponsor over the next few years. In 1996, WHO, KNCV, the IUATLD and other concerned organizations joined to conduct a wide range of World TB Day activities.
For World TB Day 1997, WHO held a news conference in Berlin during which WHO Director-General Hiroshi Nakajima declared that "DOTS is the biggest health breakthrough of this decade, according to lives we will be able to save." WHO's Global TB Programme Director, Dr. Arata Kochi,
promised that, "Today the situation of the global TB epidemic is about
to change, because we have made a breakthrough. It is the breakthrough
of health management systems that makes it possible to control TB not
only in wealthy countries, but in all parts of the developing world,
where 95 percent of all TB cases now exist."
By 1998, nearly 200 organizations conducted public outreach activities on World TB Day.
During its World TB Day 1998 news conference in London, WHO for the
first time identified the top twenty-two countries with the world's
highest TB burden.
The next year, over 60 key TB advocates from 18 countries attended the
three-day WHO/KNCV planning meeting for World TB Day 1999.
U.S. President Bill Clinton marked World TB Day 2000 by administering the WHO-recommended Directly Observed Therapy, Short-Course (DOTS) treatment to patients at the Mahavir Hospital in Hyderabad, India.
According to Clinton, "These are human tragedies, economic calamities,
and far more than crises for you, they are crises for the world. The
spread of disease is the one global problem for which . . . no nation is
immune."
In Canada, the National Collaborating Centre for Determinants of
Health noted on World TB Day 2014 that 64% of TB cases reported
nationally were among foreign-born individuals and 23% among Aboriginal people, highlighting TB as a key area of concern about health equity.
Today the Stop TB Partnership,
a network of organizations and countries fighting TB (the IUATLD is a
member and WHO houses the Stop TB Partnership secretariat in Geneva), organizes the Day to highlight the scope of the disease and how to prevent and cure it.
Themes by year
Each World TB Day addresses a different theme. The following is a list of annual themes:
2005: Frontline TB care providers: Heroes in the fight against TB
2006: Actions for life – Towards a world free of TB
2007: TB anywhere is TB everywhere
2008–2009: I am stopping TB
2010: Innovate to accelerate action
2011: Transforming the fight towards elimination
2012: Call for a world free of TB
2013: Stop TB in my lifetime
2014: Reach the three million: A TB test, treatment and cure for all
2015: Gear up to end TB
2016: Unite to End TB
2017: Unite to End TB
2018: Wanted: Leaders for a TB-free world
2019: It's time
2020: It's time to end TB!
2008–2009: I am stopping TB
The
two-year World TB Day campaign "I am stopping TB", launched in 2008,
highlighted the message that the campaign belonged to people everywhere
doing their part to Stop TB.
2010: Innovate to accelerate action
The
World TB Day 2010 recognized people and partners who had introduced a
variety of innovations in a variety of settings to stop TB.
On the occasion of World TB Day 2010, the International Committee of the Red Cross
(ICRC) declared that attempts to stem the spread of tuberculosis across
the globe are likely to fall well short of what is needed unless
authorities in affected countries significantly increase their efforts
to stop the deadly disease from breeding inside prisons.
As a result of overcrowding and poor nutrition, TB rates in many
prisons are 10 to 40 times higher than in the general public. The ICRC
had been fighting TB in prisons in the Caucasus region, Central Asia,
Latin America, Asia Pacific and Africa for more than a decade, either
directly or by supporting local programmes.
2011: Transforming the fight
For the World TB Day 2011 campaign, the goal was to inspire innovation in TB research and care.
2012: Tell the world what you want to see in your lifetime
For World TB Day 2012, individuals were called upon to join the global fight to stop TB in their lifetime.
2013: Stop TB in my lifetime
The
World TB Day 2013 campaign provided an opportunity to mark progress
towards global targets for reductions in TB cases and deaths: TB
mortality fell over 40% worldwide since 1990, and incidence was
declining.
Further progress would depend on addressing critical funding gaps: an
estimated 1.6 billion US dollars needed to implement existing TB
interventions.
2014: Reach the three million
Of the 9 million people a year who get sick with TB, 3 million of them are "missed" by health systems.
The focus of World TB Day 2014 was for countries and partners to take
forward innovative approaches to reach the 3 million and ensure that
everyone suffering from TB has access to TB diagnosis, treatment and cure.
2015: Gear up to end TB
World
TB Day 2015 was seen as an opportunity to raise awareness about the
burden of TB worldwide and the status of TB prevention and control
efforts, highlighting WHO's vision of a world free of TB with zero
deaths and suffering.
2017: Unite to end TB
World TB 2017 focused on joining efforts to raise awareness and eliminate Tuberculosis.
2018: Wanted: Leaders for a TB-free world
World
TB 2018 focused on building commitment to end TB, not only at the
political level with Heads of State and Ministers of Health, but at all
levels from Mayors, Governors, parliamentarians and community leaders,
to people affected with TB, civil society advocates, health workers,
doctors or nurses, NGOs and other partners.
2019: It's time
The
theme for World TB day 2019 is "It's time". The emphasis for this
year's event is to pressure world leaders to "act on [their]
commitments".
2020: It's time to End TB
The theme for World TB day 2020 is "It's time to End TB!"
National Security Study Memorandum 200: Implications of Worldwide Population Growth for U.S. Security and Overseas Interests (NSSM200) was completed on December 10, 1974 by the United States National Security Council under the direction of Henry Kissinger.
It was adopted as official US policy by US PresidentGerald Ford in November 1975. It was classified for a while but was obtained by researchers in the early 1990s.
Findings
The basic thesis of the memorandum was that population growth in the least developed countries (LDCs) is a concern to US national security, because it would tend to risk civil unrest
and political instability in countries that had a high potential for
economic development. The policy gives "paramount importance" to
population control measures and the promotion of contraception among 13
populous countries to control rapid population growth which the US deems
inimical to the socio-political and economic growth of these countries
and to the national interests of the United States since the "U.S.
economy will require large and increasing amounts of minerals from
abroad" and the countries can produce destabilizing opposition forces
against the US.
It recommends for US leadership to "influence national leaders"
and that "improved world-wide support for population-related efforts
should be sought through increased emphasis on mass media and other
population education and motivation programs by the UN, USIA, and
USAID."
It also raises the question of whether the US should consider
preferential allocation of surplus food supplies to states deemed
constructive in use of population control measures.
General oversight
The paper takes a look at worldwide demographic population trends as projected in 1974.
It is divided into two major sections: an analytical section and policy recommendations.
The analytical section discusses projected world demographic
trends and their influence on world food supply, minerals, and fuel. It
looks at the relation between economic development in the least
developed nations and investigates the implications of world population
pressures on US national security.
The policy recommendations is divided into two sections. A US
population strategy and action to create conditions for fertility
decline. A major concern reiterated in the paper concerns the effect of
population on starvation and famine.
"Growing populations will have a serious impact on the need for
food especially in the poorest, fastest growing LDCs.[least developed
countries] While under normal weather conditions and assuming food
production growth in line with recent trends, total world agricultural
production could expand faster than population, there will nevertheless
be serious problems in food distribution and financing, making
shortages, even at today's poor nutrition levels, probable in many of
the larger more populous LDC regions. Even today 10 to 20 million people
die each year due, directly or indirectly, to malnutrition. Even more
serious is the consequence of major crop failures which are likely to
occur from time to time.
"The most serious consequence for the short and middle term is
the possibility of massive famines in certain parts of the world,
especially the poorest regions. World needs for food rise by 2.5 percent
or more per year (making a modest allowance for improved diets and
nutrition) at a time when readily available fertilizer and well-watered
land is already largely being utilized. Therefore, additions to food
production must come mainly from higher yields.
"Countries with large population growth cannot afford constantly
growing imports, but for them to raise food output steadily by 2 to 4
percent over the next generation or two is a formidable challenge."
Key insights
"The
U.S. economy will require large and increasing amounts of minerals from
abroad, especially from less developed countries [see National
Commission on Materials Policy, Towards a National Materials Policy:
Basic Data and Issues, April 1972]. That fact gives the U.S. enhanced
interest in the political, economic, and social stability of the
supplying countries. Wherever a lessening of population pressures
through reduced birth rates can increase the prospects for such
stability, population policy becomes relevant to resource supplies and
to the economic interests of the United States.... The location of known
reserves of higher grade ores of most minerals favors increasing
dependence of all industrialized regions on imports from less developed
countries. The real problems of mineral supplies lie, not in basic
physical sufficiency, but in the politico-economic issues of access,
terms for exploration and exploitation, and division of the benefits
among producers, consumers, and host country governments" [Chapter III,
"Minerals and Fuel"].
"Whether through government action, labor conflicts, sabotage, or
civil disturbance, the smooth flow of needed materials will be
jeopardized. Although population pressure is obviously not the only
factor involved, these types of frustrations are much less likely under
conditions of slow or zero population growth" [Chapter III, "Minerals
and Fuel"].
"Populations with a high proportion of growth. The young people, who
are in much higher proportions in many LDCs, are likely to be more
volatile, unstable, prone to extremes, alienation and violence than an
older population. These young people can more readily be persuaded to
attack the legal institutions of the government or real property of the
'establishment,' 'imperialists,' multinational corporations, or other --
often foreign -- influences blamed for their troubles" [Chapter V,
"Implications of Population Pressures for National Security"].
"We must take care that our activities should not give the
appearance to the LDCs of an industrialized country policy directed
against the LDCs. Caution must be taken that in any approaches in this
field we support in the LDCs are ones we can support within this
country. "Third World" leaders should be in the forefront and obtain the
credit for successful programs. In this context it is important to
demonstrate to LDC leaders that such family planning programs have
worked and can work within a reasonable period of time." [Chapter I,
"World Demographic Trends"]
"In these sensitive relations, however, it is important in style as well as substance to avoid the appearance of coercion."
Abortion as a geopolitical strategy is mentioned several dozen times
in the report with suggestive implications: "No country has reduced its
population growth without resorting to abortion.... under developing
country conditions foresight methods not only are frequently unavailable
but often fail because of ignorance, lack of preparation, misuse and
non-use. Because of these latter conditions, increasing numbers of women
in the developing world have been resorting to abortion....
Demography (from prefix demo- from Ancient Greek δῆμος dēmos meaning "the people", and -graphy from γράφω graphō, ies "writing, description or measurement") is the statistical study of populations, especially human beings.
Demography encompasses the study of the size, structure, and
distribution of these populations, and spatial or temporal changes in
them in response to birth, migration, aging, and death.
As a very general science, it can analyze any kind of dynamic living
population, i.e., one that changes over time or space. Demographics are quantifiable characteristics of a given population.
Demographic analysis can cover whole societies or groups defined by criteria such as education, nationality, religion, and ethnicity. Educational institutions usually treat demography as a field of sociology, though there are a number of independent demography departments.
Based on the demographic research of the earth, earth's population up
to the year 2050 and 2100 can be estimated by demographers.
Formal demography limits its object of study to the measurement of population processes, while the broader field of social demography
or population studies also analyses the relationships between economic,
social, cultural, and biological processes influencing a population.
History
Demographic thoughts traced back to antiquity, and were present in many civilisations and cultures, like Ancient Greece, Ancient Rome, China and India. Demography is made up of two word Demos and Graphy . The term Demography refers to the overall study of population.
One of the earliest demographic studies in the modern period was Natural and Political Observations Made upon the Bills of Mortality (1662) by John Graunt, which contains a primitive form of life table.
Among the study's findings were that one third of the children in
London died before their sixteenth birthday. Mathematicians, such as Edmond Halley, developed the life table as the basis for life insurance mathematics. Richard Price was credited with the first textbook on life contingencies published in 1771, followed later by Augustus de Morgan, ‘On the Application of Probabilities to Life Contingencies’ (1838).
In 1855, a Belgian scholar Achille Guillard defined demography as
the natural and social history of human species or the mathematical
knowledge of populations, of their general changes, and of their
physical, civil, intellectual and moral condition.
The period 1860-1910 can be characterised as a period of
transition wherein demography emerged from statistics as a separate
field of interest. This period included a panoply of international
‘great demographers’ like Adolphe Quételet (1796–1874), William Farr (1807–1883), Louis-Adolphe Bertillon (1821–1883) and his son Jacques (1851–1922), Joseph Körösi (1844–1906), Anders Nicolas Kaier (1838–1919), Richard Böckh (1824–1907), Émile Durkheim (1858-1917), Wilhelm Lexis (1837–1914), and Luigi Bodio (1840–1920) contributed to the development of demography and to the toolkit of methods and techniques of demographic analysis.
Methods
There are two types of data collection—direct and indirect—with several different methods of each type.
Direct methods
Direct
data comes from vital statistics registries that track all births and
deaths as well as certain changes in legal status such as marriage,
divorce, and migration (registration of place of residence). In
developed countries with good registration systems (such as the United
States and much of Europe), registry statistics are the best method for
estimating the number of births and deaths.
A census
is the other common direct method of collecting demographic data. A
census is usually conducted by a national government and attempts to
enumerate every person in a country. In contrast to vital statistics
data, which are typically collected continuously and summarized on an
annual basis, censuses typically occur only every 10 years or so, and
thus are not usually the best source of data on births and deaths.
Analyses are conducted after a census to estimate how much over or
undercounting took place. These compare the sex ratios from the census data to those estimated from natural values and mortality data.
Censuses do more than just count people. They typically collect
information about families or households in addition to individual
characteristics such as age, sex, marital status, literacy/education,
employment status, and occupation, and geographical location. They may
also collect data on migration (or place of birth or of previous
residence), language, religion, nationality (or ethnicity or race), and
citizenship. In countries in which the vital registration system may be
incomplete, the censuses are also used as a direct source of
information about fertility and mortality; for example the censuses of
the People's Republic of China gather information on births and deaths that occurred in the 18 months immediately preceding the census.
Rate of human population growth showing projections for later this century
Indirect methods
Indirect
methods of collecting data are required in countries and periods where
full data are not available, such as is the case in much of the
developing world, and most of historical demography.
One of these techniques in contemporary demography is the sister
method, where survey researchers ask women how many of their sisters
have died or had children and at what age. With these surveys,
researchers can then indirectly estimate birth or death rates for the
entire population. Other indirect methods in contemporary demography
include asking people about siblings, parents, and children. Other
indirect methods are necessary in historical demography.
The United Kingdom has a series of four national birth cohort
studies, the first three spaced apart by 12 years: the 1946 National
Survey of Health and Development, the 1958 National Child Development Study, the 1970 British Cohort Study, and the Millennium Cohort Study,
begun much more recently in 2000. These have followed the lives of
samples of people (typically beginning with around 17,000 in each study)
for many years, and are still continuing. As the samples have been
drawn in a nationally representative way, inferences can be drawn from
these studies about the differences between four distinct generations of
British people in terms of their health, education, attitudes,
childbearing and employment patterns.
Common rates and ratios
The crude birth rate, the annual number of live births per 1,000 people.
The general fertility rate,
the annual number of live births per 1,000 women of childbearing age
(often taken to be from 15 to 49 years old, but sometimes from 15 to
44).
The age-specific fertility rates, the annual number of live births per 1,000 women in particular age groups (usually age 15–19, 20-24 etc.)
The crude death rate, the annual number of deaths per 1,000 people.
The infant mortality rate, the annual number of deaths of children less than 1 year old per 1,000 live births.
The expectation of life (or life expectancy), the number of years that an individual at a given age could expect to live at present mortality levels.
The total fertility rate,
the number of live births per woman completing her reproductive life,
if her childbearing at each age reflected current age-specific fertility
rates.
The replacement level fertility, the average number of
children women must have in order to replace the population for the next
generation. For example, the replacement level fertility in the US is
2.11.
The gross reproduction rate, the number of daughters who would be born to a woman completing her reproductive life at current age-specific fertility rates.
The net reproduction ratio is the expected number of
daughters, per newborn prospective mother, who may or may not survive to
and through the ages of childbearing.
A stable population, one that has had constant crude birth
and death rates for such a long period of time that the percentage of
people in every age class remains constant, or equivalently, the
population pyramid has an unchanging structure.
A stationary population, one that is both stable and unchanging in size (the difference between crude birth rate and crude death rate is zero).
A stable population does not necessarily remain fixed in size. It can be expanding or shrinking.
Note that the crude death rate as defined above and applied to a
whole population can give a misleading impression. For example, the
number of deaths per 1,000 people can be higher for developed nations
than in less-developed countries, despite standards of health being
better in developed countries. This is because developed countries have
proportionally more older people, who are more likely to die in a given
year, so that the overall mortality rate can be higher even if the
mortality rate at any given age is lower. A more complete picture of
mortality is given by a life table, which summarizes mortality separately at each age. A life table is necessary to give a good estimate of life expectancy.
Basic equation
Suppose that a country (or other entity) contains Populationt persons at time t.
What is the size of the population at time t + 1 ?
Natural increase from time t to t + 1:
Net migration from time t to t + 1:
This basic equation can also be applied to subpopulations. For
example, the population size of ethnic groups or nationalities within a
given society or country is subject to the same sources of change. When
dealing with ethnic groups, however, "net migration" might have to be
subdivided into physical migration and ethnic reidentification (assimilation).
Individuals who change their ethnic self-labels or whose ethnic
classification in government statistics changes over time may be thought
of as migrating or moving from one population subcategory to another.
More generally, while the basic demographic equation holds true
by definition, in practice the recording and counting of events (births,
deaths, immigration, emigration) and the enumeration of the total
population size are subject to error. So allowance needs to be made for
error in the underlying statistics when any accounting of population
size or change is made.
The figure in this section shows the latest (2004) UN projections
of world population out to the year 2150 (red = high, orange = medium,
green = low). The UN "medium" projection shows world population reaching
an approximate equilibrium at 9 billion by 2075. Working independently,
demographers at the International Institute for Applied Systems Analysis in Austria expect world population to peak at 9 billion by 2070. Throughout the 21st century, the average age of the population is likely to continue to rise.
Science of population
Populations
can change through three processes: fertility, mortality, and
migration. Fertility involves the number of children that women have
and is to be contrasted with fecundity (a woman's childbearing
potential).
Mortality is the study of the causes, consequences, and measurement of
processes affecting death to members of the population. Demographers
most commonly study mortality using the Life Table,
a statistical device that provides information about the mortality
conditions (most notably the life expectancy) in the population.
Migration refers to the movement of persons from a locality of
origin to a destination place across some predefined, political
boundary. Migration researchers do not designate movements 'migrations'
unless they are somewhat permanent. Thus demographers do not consider
tourists and travellers to be migrating. While demographers who study
migration typically do so through census data on place of residence,
indirect sources of data including tax forms and labour force surveys
are also important.
Demography is today w(?) Great Depression many universities across
the world, attracting students with initial training in social sciences,
statistics or health studies. Being at the crossroads of several
disciplines such as sociology, economics, epidemiology, geography, anthropology and history,
demography offers tools to approach a large range of population issues
by combining a more technical quantitative approach that represents the
core of the discipline with many other methods borrowed from social or
other sciences. Demographic research is conducted in universities, in
research institutes as well as in statistical departments and in several
international agencies. Population institutions are part of the Cicred
(International Committee for Coordination of Demographic Research)
network while most individual scientists engaged in demographic research
are members of the International Union for the Scientific Study of Population, or a national association such as the Population Association of America in the United States, or affiliates of the Federation of Canadian Demographers in Canada.
Global health is the health of populations in the 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 (including
mental health), 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 can be measured as a function of various global diseases
and their prevalence in the world and threat to decrease life in the
present day.
The predominant agency associated with global health (and international health) is the World Health Organization (WHO). Other important agencies impacting global health include UNICEF and World Food Programme.
The United Nations system has also played a part with cross-sectoral
actions to address global health and its underlying socioeconomic
determinants with the declaration of the Millennium Development Goals and the more recent Sustainable Development Goals.
Definition
Global health employs several perspectives that focus on the determinants and distribution of health in international contexts:
Medicine describes the pathology of diseases and promotes prevention, diagnosis, and treatment.
Both individuals and organizations working in the domain of global health often face many questions regarding ethical and human rights.
Critical examination of the various causes and justifications of health
inequities is necessary for the success of proposed solutions. Such
issues are discussed at the bi-annual Global Summits of National Ethics/Bioethics Councils, next in March 2016 in Berlin, with experts from WHO and UNESCO, by invitation of the German Ethics Council.
History
Life expectancy by world region, from 1770 to 2018
The 19th century held major discoveries in medicine and public health. The Broad Street cholera outbreak of 1854 was central to the development of modern epidemiology. The microorganisms responsible for malaria and tuberculosis
were identified in 1880 and 1882, respectively. The 20th century saw
the development of preventive and curative treatments for many diseases,
including the BCG vaccine (for tuberculosis) and penicillin in the 1920s. The eradication of smallpox, with the last naturally occurring case recorded in 1977, raised hope that other diseases could be eradicated as well.
At a United Nations Summit in 2000, member nations declared eight Millennium Development Goals (MDGs), which reflected the major challenges facing human development globally, to be achieved by 2015.
The declaration was matched by unprecedented global investment by donor
and recipient countries. According to the UN, these MDGs provided an
important framework for development and significant progress has been
made in a number of areas.
However, progress has been uneven and some of the MDGs were not fully
realized including maternal, newborn and child health and reproductive
health. Building on the MDGs, a new Sustainable Development Agenda with 17 Sustainable Development Goals (SDGs) has been established for the years 2016–2030. The first goal being an ambitious and historic pledge to end poverty. On 25 September 2015, the 193 countries of the UN General Assembly adopted the 2030 Development Agenda titled Transforming our world: the 2030 Agenda for Sustainable Development.
In 2015 a book titled "To Save Humanity" was published, with nearly 100 essays regarding today's most pressing global health issues. The essays were authored by global figures in politics, science, and advocacy ranging from Bill Clinton to Peter Piot, and addressed a wide range of issues including vaccinations, antimicrobial resistance, health coverage, tobacco use, research methodology, climate change, equity, access to medicine, and media coverage of health research.
In 2015, the Lancet Commission on Global Surgery was released
describing the large burden of surgical disease impacting low- and
middle-income countries (LMICs).
The shortfall in access to surgical care worldwide is estimated to
affect approximately 5 billion people who do not have timely access to
life-saving surgical care.
The Commission outlines the need to improve infrastructure to
make the bellwether procedures – laparotomy, caesarean section, open
fracture care – more widely available in LMICs in order to prevent a
$12.3 trillion loss in economic productivity by 2030 as result of
surgically-related morbidity and mortality.
Disability-adjusted life years per 100,000 people in 2004.
No data
Less than 9,250
9,250–16,000
16,000–22,750
22,750–29,500
29,500–36,250
36,250–43,000
43,000–49,750
49,750–56,500
56,500–63,250
63,250–70,000
70,000–80,000
Over 80000
The DALY is a summary measure that combines the impact of illness, disability,
and mortality by measuring the time lived with disability and the time
lost due to premature mortality. One DALY can be thought of as one lost
year of "healthy" life. The DALY for a disease is the sum of the years
of life lost due to premature mortality and the years lost due to
disability for incident cases of the health condition.
Quality-adjusted life years
QALYs combine expected survival with expected quality of life into a
single number: if an additional year of healthy life is worth a value of
one (year), then a year of less healthy life is worth less than one
(year). QALY calculations are based on measurements of the value that
individuals place on expected years of survival. Measurements can be
made in several ways: by techniques that simulate gambles about
preferences for alternative states of health, with surveys or analyses
that infer willingness to pay for alternative states of health, or
through instruments that are based on trading off some or all likely
survival time that a medical intervention might provide in order to gain
less survival time of higher quality.
Infant and child mortality
Infant mortality and child mortality for children under age 5 are
more specific than DALYs or QALYs in representing the health in the
poorest sections of a population, and are thus especially useful when
focusing on health equity.
Morbidity
Morbidity measures include incidence rate, prevalence, and cumulative incidence,
with incidence rate referring to the risk of developing a new health
condition within a specified period of time. Although sometimes loosely
expressed simply as the number of new cases during a time period,
morbidity is better expressed as a proportion or a rate.
Health conditions
The diseases and health conditions targeted by global health initiatives are sometimes grouped under "diseases of poverty" versus "diseases of affluence", although the impact of globalization is increasingly blurring the lines between the two.
Respiratory infections
Infections of the respiratory tract and middle ear are major causes of morbidity and mortality worldwide. Some respiratory infections of global significance include tuberculosis, measles, influenza, and pneumonias caused by pneumococci and Haemophilus influenzae.
The spread of respiratory infections is exacerbated by crowded
conditions, and poverty is associated with more than a 20-fold increase
in the relative burden of lung infections.
Diarrheal diseases
Diarrhea is the second most common cause of child mortality worldwide, responsible for 17% of deaths of children under age 5. Poor sanitation
can increase transmission of bacteria and viruses through water, food,
utensils, hands, and flies. Dehydration due to diarrhea can be
effectively treated through oral rehydration therapy with dramatic reductions in mortality. Important nutritional measures include the promotion of breastfeeding and zinc supplementation. While hygienic measures alone may be insufficient for the prevention of rotavirus diarrhea, it can be prevented by a safe and potentially cost-effective vaccine.
Maternal health
Maternal health clinic in Afghanistan (source: Merlin)
Complications of pregnancy and childbirth are the leading causes of death among women of reproductive age in many developing countries: a woman dies from complications from childbirth approximately every minute. According to the World Health Organization's 2005 World Health Report, poor maternal conditions are the fourth leading cause of death for women worldwide, after HIV/AIDS, malaria, and tuberculosis. Most maternal deaths and injuries can be prevented, and such deaths have been largely eradicated in the developed world. Targets for improving maternal health include increasing the number of deliveries accompanied by skilled birth attendants.
68 low-income countries tracked by the WHO- and UNICEF-led collaboration Countdown to 2015 are estimated to hold for 97% of worldwide maternal and child deaths.
HIV/AIDS
The HIV/AIDS epidemic has highlighted the global nature of human
health and welfare and globalisation has given rise to a trend toward
finding common solutions to global health challenges. Numerous
international funds have been set up in recent times to address global
health challenges such as HIV. Since
the beginning of the epidemic, more than 70 million people have been
infected with the HIV virus and about 35 million people have died of
HIV. Globally, 36.9 million [31.1–43.9 million] people were living with
HIV at the end of 2017. An estimated 0.8% [0.6–0.9%] of adults aged
15–49 years worldwide are living with HIV, although the burden of the
epidemic continues to vary considerably between countries and regions.
The WHO African region remains most severely affected, with nearly 1 in
every 25 adults (4.1%) living with HIV and accounting for nearly
two-thirds of the people living with HIV worldwide.
Human immunodeficiency virus (HIV) is transmitted through unprotected
sex, unclean needles, blood transfusions, and from mother to child
during birth or lactation. Globally, HIV is primarily spread through
sexual intercourse. The risk-per-exposure with vaginal sex in low-income
countries from female to male is 0.38% and male to female is 0.3%.The infection damages the immune system, leading to acquired immunodeficiency syndrome (AIDS) and eventually, death. Antiretroviral drugs prolong life and delay the onset of AIDS by minimizing the amount of HIV in the body.
Malaria
Malaria is a mosquito-borne infectious disease caused by the parasites of the genus Plasmodium.
Symptoms may include fever, headaches, chills, and nausea. Each year,
there are approximately 500 million cases of malaria worldwide, most
commonly among children and pregnant women in developing countries.
The WHO African Region carries a disproportionately high share of the
global malaria burden. In 2016, the region was home to 90% of malaria
cases and 91% of malaria deaths. The use of insecticide-treated bednets is a cost-effective way to reduce deaths from malaria, as is prompt artemisinin-based combination therapy, supported by intermittent preventive therapy in pregnancy. International travellers to endemic zones are advised chemoprophylaxis with antimalarial drugs like Atovaquone-proguanil, doxycycline, or mefloquine
Nutrition
In
2010, about 104 million children were underweight, and undernutrition
contributes to about one third of child deaths around the world. (Undernutrition is not to be confused with malnutrition, which refers to poor proportion of food intake and can thus refer to obesity.) Undernutrition impairs the immune system, increasing the frequency, severity, and duration of infections (including measles, pneumonia, and diarrhea). Infection can further contribute to malnutrition. Deficiencies of micronutrient, such as vitamin A, iron, iodine, and zinc, are common worldwide and can compromise intellectual potential, growth, development, and adult productivity.
Interventions to prevent malnutrition include micronutrient
supplementation, fortification of basic grocery foods, dietary
diversification, hygienic measures to reduce spread of infections, and
the promotion of breastfeeding.
Violence against women
Violence against women
has been defined as: "physical, sexual and psychological violence
occurring in the family and in the general community, including
battering, sexual abuse of children, dowry-related violence, rape, female genital mutilation
and other traditional practices harmful to women, non-spousal violence
and violence related to exploitation, sexual harassment and intimidation
at work, in educational institutions and elsewhere, trafficking in
women, forced prostitution and violence perpetrated or condoned by the
state."
In addition to causing injury, violence may increase "women’s long-term
risk of a number of other health problems, including chronic pain,
physical disability, drug and alcohol abuse, and depression".
The WHO Report on global and regional estimates on violence against
women found that partner abuse causes women to have 16% more chances of
suffering miscarriages,41% more occurrences of pre-term birth babies and
twice the likeliness of having abortions and acquiring HIV or other
STD’s.
Although statistics can be difficult to obtain as many cases go
unreported, it is estimated that one in every five women faces some form
of violence during her lifetime, in some cases leading to serious
injury or even death.
Risk factors for being a perpetrator include low education, past
exposure to child maltreatment or witnessing violence between parents,
harmful use of alcohol, attitudes accepting of violence and gender
inequality. Equality of women has been addressed in the Millennium development goals.
Preventing the violence against women needs to form an essential part
of the public health reforms in the form of advocation and evidence
gathering. Primary prevention in the form of raising women economic
empowerment facilities, microfinance and skills training social projects
related to gender equality should be conducted. Activities promoting
relationship and communication skills among couples, reducing alcohol
access and altering societal ideologies should be organized. Childhood
interventions, community and school- based education, raising
media-oriented awareness and other approaches should be carried out to
challenge social norms and stereotypical thought processes to promote
behavioral alterations among men and raise gender equality. Trained
health care providers would play a vital role in secondary and tertiary
prevention of abuse, by performing early identification of women
suffering from violence and contributing to the addressal of their
health and psychological needs. They could be highly important in
prevention of the recurrence of violence and the mitigation of its
effects on the health of the abused women and their children.
The Member States of the World Health Assembly endorsed a plan in 2016
for reinforcing the health system’s role in addressing the global
phenomenon of violence against women and girls and working towards their
health and protection.
Chronic disease
Approximately 80% of deaths linked to non-communicable diseases occur in developing countries. For
instance, urbanization and aging have led to increasing poor health
conditions related to non-communicable diseases in India. The
fastest-growing causes of disease burden over the last 26 years were
diabetes (rate increased by 80%) and ischemic heart disease (up 34%).
More than 60% of deaths, about 6.1 million, in 2016 were due to NCDs, up
from about 38% in 1990. Increases in refugee urbanization, has led to a growing number of people diagnosed with chronic noncommunicable diseases.
In September 2011, the United Nations is hosting its first
General Assembly Special Summit on the issue of non-communicable
diseases.
Noting that non-communicable diseases are the cause of some 35 million
deaths each year, the international community is being increasingly
called to take measures for the prevention and control of chronic
diseases and mitigate their impacts on the world population, especially
on women, who are usually the primary caregivers.
For example, the rate of type 2 diabetes, associated with obesity,
has been on the rise in countries previously plagued by hunger. In
low-income countries, the number of individuals with diabetes is
expected to increase from 84 million to 228 million by 2030. Obesity, a preventable condition, is associated with numerous chronic diseases, including cardiovascular conditions, stroke, certain cancers, and respiratory disease. About 16% of the global burden of disease, measured as DALYs, has been accounted for by obesity.
Neglected tropical diseases
More than one billion people were treated for at least one neglected tropical disease in 2015.
Neglected tropical diseases are a diverse group of infectious diseases
that are endemic in tropical and subtropical regions of 149 countries,
primarily effecting low and middle income populations in Africa, Asia,
and Latin America. They are variously caused by bacteria (Trachoma, Leprosy), viruses (Dengue, Rabies), protozoa (Human African trypanosomiasis, Chagas), and helminths (Schistosomiasis, Onchocerciasis, Soil transmitted helminths).
The Global Burden of Disease Study concluded that neglected tropical
diseases comprehensively contributed to approximately 26.06 million disability-adjusted life years in 2010, as well as significant deleterious economic effects.
In 2011, the World Health Organization launched a 2020 Roadmap for
neglected tropical diseases, aiming for the control or elimination of 10
common diseases. The 2012 London Declaration
builds on this initiative, and called on endemic countries and the
international community to improve access to clean water and basic
sanitation, improved living conditions, vector control, and health
education, to reach the 2020 goals. In 2017, a WHO report cited 'unprecedented progress' against neglected tropical diseases since 2007, especially due to mass drug administration of drugs donated by pharmaceutical companies.
Surgical Disease
Surgery remains grossly neglected in global health, famously described by Halfdan T. Mahler
as the 'neglected stepchild of global health'. This particularly
affects low-resource settings with weak surgical health systems. 'Global
surgery' is the term now adopted to describe the rapidly developing
field seeking to address this, and has been defined as 'the
multidisciplinary enterprise of providing improved and equitable
surgical care to the world's population, with its core tenets as the
issues of need, access and quality'.
Surgical diseases make up at least 11% of the global burden of
disease, with a mix of injuries, malignancies, congenital anomalies, and
complications of pregnancy.
Globally, 4.2 million people are estimated to die within 30 days of
surgery each year, with half of these occurring in low- and
middle-income countries.
There is significant variation in outcomes associated with the
development level of the country where surgery is taking place. A
prospective study of 10,745 adults undergoing emergency abdominal
surgery from 357 centres across 58 countries found that mortality is
three times higher in low- compared with high-human development index
(HDI) countries even when adjusted for prognostic factors.
The right to health care is a key component of the Universal
Declaration of Human Rights and has lacked the appropriate attention in
low-income countries in recent history.
Surgical diseases can result in considerable morbidity and mortality
for individuals whom are unable to access appropriate care, yet in
low-income countries, this category of disease has been deemed too
expensive to invest in.
In recent years, however, it has been recognized that surgical diseases
are a neglected health problem of great proportion and requires urgent
prioritization.
Surgical conditions such as appendicitis, complications of abdominal
hernias, and obstructed labour can be fatal if not treated by a surgical
team, and on a global scale, the financial consequences of citizens
dying from potentially treatable surgical conditions translates into
upwards of $12.3 trillion of lost economic productivity to LMICs between
2015–2030 if no action is taken to improve access to surgical care.
Health interventions
Global interventions for improved child health and survival include the promotion of breastfeeding, zinc supplementation, vitamin A fortification, salt iodization, hygiene interventions such as hand-washing, vaccinations, and treatments of severe acute malnutrition. The Global Health Council suggests a list of 32 treatments and health interventions that could potentially save several million lives each year.
Many populations face an "outcome gap", which refers to the gap
between members of a population who have access to medical treatment
versus those who do not. Countries facing outcome gaps lack sustainable
infrastructure. In Guatemala, a subset of the public sector, the Programa de Accessibilidad a los Medicamentos
("Program for Access to Medicines"), had the lowest average
availability (25%) compared to the private sector (35%). In the private
sector, highest- and lowest-priced medicines were 22.7 and 10.7 times
more expensive than international reference prices respectively.
Treatments were generally unaffordable, costing as much as 15 days wages
for a course of the antibiotic ceftriaxone. The public sector in Pakistan,
while having access to medicines at a lower price than international
reference prices, has a chronic shortage of and lack of access to basic
medicines.
Journalist Laurie Garrett
argues that the field of global health is not plagued by a lack of
funds, but that more funds do not always translate into positive
outcomes. The problem lies in the way these funds are allocated, as they
are often disproportionately allocated to alleviating a single disease.
In its 2006 World Health Report, the WHO estimated a shortage of almost 4.3 million doctors, midwives, nurses, and support workers worldwide, especially in sub-Saharan Africa.
Surgical Care
Data
from WHO and the World Bank indicate that scaling up infrastructure to
enable access to surgical care in regions which it is currently limited
or non-existent is, in fact, a low-cost measure relative to the
significant morbidity and mortality caused by lack of surgical treatment. For example, it is estimated that 90% of maternal deaths could be prevented with basic surgical care.
From a cost perspective, studies at district hospitals have
demonstrated that provision of basic surgical care can be on par with
vaccination programs, which counters a common perception of surgical
care as a financially prohibitive endeavor in LMICs.
Furthermore, the Lancet Commission on Global Surgery estimates $12.3
trillion in economic productivity will be lost in developing countries
by 2030 if access to surgical care is not improved.
.
Bellwether procedures are considered a minimum level of care that
first-level hospitals should be able to provide in order to capture the
most basic emergency surgical care. These include 3 main surgical
procedures; laparotomy (for abdominal emergencies), caesarean section,
and treatment of an open fracture.
This would require anaesthetists, obstetricians, surgeons, nurses, and
facilities with operating theatres and pre- and post-surgical care
capabilities.
Global Health Security Agenda
The
Global Health Security Agenda (GHSA) is "a multilateral, multi-sector
effort that includes 60 participating countries and numerous private and
public international organizations focused on building up worldwide
health security capabilities toward meeting such threats" as the spread
of infectious disease. On March 26–28, 2018, the GHSA held a high-level
meeting in Tbilisi, Georgia, on biosurveillance of infectious disease
threats, "which include such modern-day examples as HIV/AIDS, severe
acute respiratory syndrome (SARS), H1N1 influenza, multi-drug resistant
tuberculosis — any emerging or reemerging disease that threatens human
health and global economic stability."
This event brought together GHSA partner countries, contributing
countries of Real-Time Surveillance Action Package, and international
partner organizations supporting the strengthening of capacities to
detect infectious disease threats within the Real-Time Surveillance
Action Package and other cross-cutting packages. Georgia is the lead
country for the Real-Time Surveillance Action Package.
GHSA works through four main mechanisms of member action, action
packages, task forces and international cooperation. In 2015, the
Steering Group of the GHSA agreed upon the implementation of their
commitments through 11 Action Packages. Action Packages are a commitment
by member countries and their partners to work collaboratively towards
development and implementation of International Health Regulations
(IHR).
Action packages are based on GHSA’s aim to strengthen national and
international capacity to prevent, detect, and respond to infectious
disease threats. Each action package consists of five-year targets,
measures of progress, desired impacts, country commitments, and list of
baseline assessments.
The Joint External Evaluation (JEE) process, derived as part of the IHR
Monitoring and Evaluation Framework is an assessment of a country’s
capacity for responding to public health threats.
So far, G7 partners and EU have made a collective commitment to assist
76 countries whereas the US committed to helping 32 countries to achieve
GHSA targets for IHR implementation. In September 2014, a pilot tool
was developed to measure progress of the Action Packages and applied in
countries (Georgia, Peru, Uganda, Portugal, the United Kingdom, and
Ukraine) that volunteered to participate in an external assessment.
