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Global Health What is it and why the fuss?

Global Health What is it and why the fuss?. C. ‘ Sola Olopade, MD, MPH Professor, BSD Clinical Director, Global Health Initiative. Presentation Outline. Define Global Health and importance Discuss Global Burden of Disease Discuss poverty and life expectancy

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Global Health What is it and why the fuss?

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  1. Global HealthWhat is it and why the fuss? C. ‘Sola Olopade, MD, MPH Professor, BSD Clinical Director, Global Health Initiative

  2. Presentation Outline Define Global Health and importance Discuss Global Burden of Disease Discuss poverty and life expectancy Describe Obama Global Health Initiative and why US should invest in GH Discuss work on energy poverty and implication on health of women and children in Nigeria Koplan et al: Lancet 2009: 373; 1993-5

  3. What is Global Health ? “Area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide”. Koplan et al: Lancet 2009: 373; 1993-5

  4. Global Health Emphasizes transnational health issues, determinants and solutions Involves many disciplines beyond health sciences Promotes interdisciplinary collaboration Calls for actions to influence the global forces that determine the health of people

  5. Determinants of Global Health Poverty Weak governance Weak infrastructure (education, water and health) Urbanization Globalization – int’l travel of people & goods; foods, tobacco etc. Cultural/societal norms Environmental pollution- dumping, indoor pollution Ecological and climate change

  6. Health Risk Transition from Traditional to Modern Times Global Health Risks | WHO 2009

  7. Global Burden of Disease Leading Causes of Death Global Burden of Disease 2004 |WHO 2008

  8. Global Burden of Disease Leading Causes of Death Global Burden of Disease 2004. WHO 2008

  9. Distribution of Age of Death and Numbers of Deaths, World Global Burden of Disease 2004 |WHO 2008

  10. Gender Distribution of Deaths Global Burden of Disease 2004 | WHO 2008

  11. In Developing Countries, Death takes the Young and in Developed countries, the old Global Burden of Disease 2004 | WHO 2008

  12. Distribution of Child Deaths for Selected Causes by Region Global Burden of Disease 2004 | WHO 2008

  13. Leading Causes of Death in Adults Global Burden of Disease 2004 | WHO 2008

  14. Child Mortality Rate by Disease and Region Global Health Risks | WHO 2009

  15. Globalization and Health Improved Global wealth and living standards Widening gap between the rich and poor # of Billionaires owning 4% of world GDP 385 World population living on < $300/year50% Exacerbation of extreme poverty(>25%) Condition of life so limited by malnutrition, illiteracy, disease, squalid living conditions, high infant mortality and low life expectancy Many in Africa live on $1 a day

  16. Poverty and Life Expectancy Institute of Medicine

  17. Projected Deaths by Cause for High, Middle and Low Income Countries

  18. Today’s Challenge UNDP 2009

  19. Global Disparities and Life Expectancy Sub-Saharan Africa accounts for 25% of Global burden of disease but has less than 3% of needed workforce 95% of global R&D directed at health problems of 5% of global population Marked disparity in life expectancy between developed and developing countries Canada: 80 years and rising Sub-Saharan Africa: 49 years and falling Angola: 38 years, Zimbabwe: 49 years

  20. Brain Drain and Global Disparities in Health and Life Expectancy F Mullan: NEJM 2005; 353: 1810-8

  21. Why The US Should Invest in Global Health? To protect Americans Enhance economy Advance USA international interests

  22. Protection of US Citizens Across the Globe Infectious diseases Biological and chemical terrorism Unregulated pharmaceuticals Contaminated foods Natural disasters Violence

  23. Why Should We Care?U.S. Air-Travel Related Illnesses in 2009/11 Tuberculosis: 662 reports Chicken pox and shingles: 518 reports Measles: 78 reports Mumps: 56 reports Whooping cough: 41 reports Typhoid fever: 19 reports Lassa fever: 1 report 15-70% of returning travelers to the USA have a travel-related illness* CDC 2009, CDC 2011*

  24. Why The US Should Invest in Global Health? To protect Americans Enhance economy Advance USA international interests

  25. Enhance U.S. Trade and Economy Healthier populations abroad constitute vibrant markets for U.S. goods Provides employment for U.S. public health professionals Market for U.S. technology and industry Training opportunities in the field for U.S. health professionals Benefit to U.S. local economies Enhances U.S. Diplomacy – “soft power”

  26. Why The US Should Invest in Global Health? To protect Americans Enhance economy Advance USA international interests

  27. Advance US Diplomatic, Military and other Interests US tradition of humanitarian interests Integral component of US smart foreign policy Enhances US interests Global political, military and economic leadership Commitment to democratic principles Foreign policy Support for human rights National security efforts

  28. The Global Health Paradox Targeted resources to disease and population specific programs “PEPFER” Inadequate effort made to strengthen health systems

  29. Unintended Consequences • Weakened health systems • Dysfunctional service delivery • Inequitable financing, especially for the poor • Quality health care considered a luxury • Millions impoverished by out of pocket expenses for catastrophic illness

  30. Income Changes With Diagnosis Antaracian C et al: CUGH 2011

  31. Coping Strategy Utilization Antaracian C et al: CUGH 2011

  32. The Obama Global Health InitiativeCore Principles Health is at the heart of human progress Focus on women, girls and gender equality Encourage country ownership and invest in country-led plans Build sustainability through health systems strengthening Strengthen and leverage multilateral engagement (Universities, Private sector, NGO) Promote research and innovation Engage academic institutions in global health Gostin and Mok: JAMA2010:304

  33. The Obama Global Health Initiative Pledged $63B in global health over 6 years ‘09-’15 Make global health an integral part of government’s three pillars of foreign policy: Diplomacy, development and defense Develop whole-of-government approach Promote strategic coordination in all departments Ordered first Diplomacy and Development review by USAID and Dept of State Hilary Clinton: State Dept to use GH as “soft power” Gostin and Mok: JAMA 2010:304

  34. GHI Evolution at University of Chicago September 2010 March 2010 September 2009 July 2008 Funmi Olopade, MD appointed BSD Associate Dean/Director of GHI Faculty Steering Committee Official Launch/Global Health Scholars Track Strategic Planning Kenneth Polonsky, MD appointed BSD Dean, and UC VP

  35. Leveraging our Strengths • Environment, Health and Vulnerable Populations • Health Systems Development and Urban Health • Genomics and Chronic Non-Communicable Diseases • Maternal and Child Health • Global Health Ethics as a cross-cutting theme

  36. Energy PovertyImplications for the Lung Health of Women and Children

  37. Energy Poverty in Developing Countries Lack of Electricity in Developing Countries Lack of Electricity in LDC and SSA UNDP/ WHO November 2009

  38. Distribution of People Relying on Solid Fuels for Cooking in Developing Regions UNDP/WHO November 2009

  39. Commonly Used Traditional Biomass Fuel Bangladesh 2008: Courtesy Faruque Pravez Bangladesh 2009

  40. Deaths and DALY’s Attributable to 5 Major Environmental Risks Global Health Risks | WHO 2009

  41. Why is exposure to IAP so dangerous to women and young children?

  42. Mother-Child Exposure to Biomass Smoke in Nigeria

  43. Exposure to Biomass Smoke in Bangladesh

  44. Scope of the Problem • More than 3 billion people cook with biomass fuels • More than 75% of Asia • 50–75% in South America and Africa • Cooking and heating with biomass fuel is the largest traditional source of indoor air pollution (IAP) • 3 billion women and young children have the highest burden of exposure to IAP • IAP accounts for 2.7% of the global burden of disease and is a major contributor to global health disparities • IAP is major contributor to environmental degradation and climate change Anderson et al., 2005; McCracken et al., 2007

  45. Health Effects of IAP from Solid Fuels • Causes 2.2–2.5 million deaths /year • 99% of deaths occur in developing countries • 19 – 21% of Acute respiratory infection (ARI) • 22% of Chronic Obstructive Pulmonary Disease • 1.5% of lung cancers • Majority of deaths occur from pneumonia in children under five years of age • Over 30% of IAP-related mortality burden is in Africa and South/Southeast Asia Zhang and Smith, 2007

  46. Specific Aims Investigate levels of indoor air pollution created by burning biomass fuels through monitoring CO and PM2.5 Determine exposure-related symptoms in mother-child pairs in each household Determine effect of exposure on lung function Investigate impact of distribution of low emission stoves on indoor air quality, symptoms and lung function

  47. The Rural Communities in Nigeria

  48. Results

  49. Characteristics of Participants

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