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Global health

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Global health is the health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...

 of populations in a global context and transcends the perspectives and concerns of individual nations. Health problems that transcend national borders or have a global political and economic impact, are often emphasized. 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
Health For All
Health For All is a programming goal of the World Health Organization , which envisions securing the health and well being of people around the world that has been popularized since the 1970s...

 people worldwide'. Thus, global health is about worldwide improvement of health, reduction of disparities, and protection against global threats that disregard national borders. The application of these principles to the domain of mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...

 is called Global Mental Health
Global Mental Health
The World Health Organization defines mental health as a 'state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community'.The term Global...

.

The major international agency for health is the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 (WHO). Other important agencies with impact on global health activities include UNICEF, World Food Programme
World Food Programme
The World Food Programme is the food aid branch of the United Nations, and the world's largest humanitarian organization addressing hunger worldwide. WFP provides food, on average, to 90 million people per year, 58 million of whom are children...

 (WFP) and the World Bank
World Bank
The World Bank is an international financial institution that provides loans to developing countries for capital programmes.The World Bank's official goal is the reduction of poverty...

. A major initiative for improved global health is the United Nations Millennium Declaration and the globally endorsed Millennium Development Goals
Millennium Development Goals
The Millennium Development Goals are eight international development goals that all 193 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015...

.

History


Many of the key events on the modern global health and development timeline occurred in the 1940s, with the formation of the United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...

, World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 and World Bank Group
World Bank Group
The World Bank Group is a family of five international organizations that makes leveraged loans, generally to poor countries.The Bank came into formal existence on 27 December 1945 following international ratification of the Bretton Woods agreements, which emerged from the United Nations Monetary...

. In 1948, the member states of the newly formed United Nations gathered together to create the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

. A cholera epidemic that took 20,000 lives in Egypt in 1947 and 1948 helped spur the international community to action.

One of the greatest accomplishments of the international health community since then was the eradication of smallpox
Smallpox
Smallpox was an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning "spotted", or varus, meaning "pimple"...

. The last naturally occurring case of the infection was recorded in 1977. But in a strange way, success with smallpox bred overconfidence and subsequent efforts to eradicate malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...

 and other diseases have not been as effective. Indeed, there is now debate within the global health community as to whether eradication campaigns should be abandoned in favor of less costly and perhaps more effective primary health and containment programs.

Disciplinary perspectives


Global health is a research field at the intersection of medical and social science disciplines--including demography
Demography
Demography is the statistical study of human population. It can be a very general science that can be applied to any kind of dynamic human population, that is, one that changes over time or space...

, economics
Economics
Economics is the social science that analyzes the production, distribution, and consumption of goods and services. The term economics comes from the Ancient Greek from + , hence "rules of the house"...

, epidemiology
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...

, political economy
Political economy
Political economy originally was the term for studying production, buying, and selling, and their relations with law, custom, and government, as well as with the distribution of national income and wealth, including through the budget process. Political economy originated in moral philosophy...

 and sociology
Sociology
Sociology is the study of society. It is a social science—a term with which it is sometimes synonymous—which uses various methods of empirical investigation and critical analysis to develop a body of knowledge about human social activity...

. From different disciplinary perspectives, it focuses on determinants and distribution of health in international contexts.

An epidemiological perspective identifies major global health problems. A medical perspective describes the pathology of major disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

s, and promotes prevention, diagnosis, and treatment of these diseases.

An economic
Health economics
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and health care...

 perspective, emphasizes the cost-effectiveness and cost-benefit approaches for both individual and population health allocation. Aggregate analysis, e.g. from the perspective of governments and non-governmental organizations (NGOs), focuses on analysis for the health sector. Cost-effectiveness analysis compares the costs and health effects of an intervention to assess whether health investments are worthwhile from economic perspective. It is necessary to distinguish between independent interventions and mutually exclusive interventions. For independent interventions, average cost-effectiveness ratios suffice. However, when mutually exclusive interventions are compared, it is essential to use incremental cost-effectiveness ratios. The latter comparisons suggest how to achieve maximal health care effects from the available resources.

Individual health analysis from this perspective focuses on the demand and supply of health. The demand for health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...

 is derived from the general demand for health. Health care is demanded as a means for consumers to achieve a larger stock of "health capital." The optimal level of investment in health occurs where the marginal cost of health capital is equal to the marginal benefit resulting from it (MC=MB). With the passing of time, health depreciates at some rate δ. The general interest rate in the economy is denoted by r. Supply of health focuses on provider incentives, market creation, market organization, issues related to information asymmetries
Information asymmetry
In economics and contract theory, information asymmetry deals with the study of decisions in transactions where one party has more or better information than the other. This creates an imbalance of power in transactions which can sometimes cause the transactions to go awry, a kind of market failure...

, the role of NGOs and governments in health provision.

Another, ethical approach, emphasizes distributional considerations. The Rule of Rescue
Rule of Rescue
The Rule of Rescue is a term coined by A.R. Jonsen in 1986 that is currently used in a variety of bioethics contexts:* 'a perceived duty to save endangered life where possible'...

, coined by A.R. Jonsen (1986), is one way to address distributional issues. This rule specifies that it is 'a perceived duty to save endangered life where possible'. John Rawls ideas on impartial justice is a contractual perspective on distribution. These ideas have been applied by Amartya Sen
Amartya Sen
Amartya Sen, CH is an Indian economist who was awarded the 1998 Nobel Prize in Economic Sciences for his contributions to welfare economics and social choice theory, and for his interest in the problems of society's poorest members...

  to address key aspects of health equity. Bioethics research also examines international obligations of justice, in three broadly clustered areas: (1) When are international inequalities in health unjust?; (2) Where do international health inequalities come from?; (3) How do we meet health needs justly if we can't meet them all?

A political approach, emphasizes political economy considerations applied to global health. Political economy originally was the term for studying production, buying and selling, and their relations with law, custom, and government. Originating in moral philosophy (e.g. Adam Smith was Professor of Moral Philosophy at the University of Glasgow), political economy of health is the study of how economies of states — polities, hence political economy - influence aggregate population health
Population health
Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” It is an approach to health that aims to improve the health of an entire population. One major step in achieving this aim is to reduce health...

 outcomes.

Measurement


Analysis of global health hinges on how to measure health burden. Several measures exist: DALY, QALY and mortality measurements
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...

. The choice of measures can be controversial and includes practical and ethical considerations.

Life expectancy


Life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...

 is a statistical measure of the average life span (average length of survival) of a specified population. It most often refers to the expected age to be reached before death for a given human population (by nation, by current age, or by other demographic variables). Life expectancy may also refer to the expected time remaining to live, and that too can be calculated for any age or for any group.

Disability adjusted life years


The disability-adjusted life year (DALY) is a summary measure that combines the impact of illness
Illness
Illness is a state of poor health. Illness is sometimes considered another word for disease. Others maintain that fine distinctions exist...

, disability
Disability
A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...

 and mortality on population health. The DALY combines in one measure 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 and the burden of disease as a measurement of the gap between current health status and an ideal situation where everyone lives into old age free of disease and disability. For example, DALYs for a disease are the sum of the years of life lost due to premature mortality (YLL) in the population and the years lost due to disability (YLD) for incident cases of the health condition. One DALY represents the loss of one year of equivalent full health.

Quality adjusted life years


Quality-adjusted life years, or QALYs, is a way of measuring disease burden
Disease burden
Disease burden is the impact of a health problem in an area measured by financial cost, mortality, morbidity, or other indicators. It is often quantified in terms of quality-adjusted life years or disability-adjusted life years , which combine the burden due to both death and morbidity into one...

, including both the quality and the quantity of life lived, as a means of quantifying in benefit of a medical intervention. The QALY model requires utility independent
Utility
In economics, utility is a measure of customer satisfaction, referring to the total satisfaction received by a consumer from consuming a good or service....

, risk neutral
Risk neutral
In economics and finance, risk neutral behavior is between risk aversion and risk seeking. If offered either €50 or a 50% chance of each of €100 and nothing, a risk neutral person would have no preference between the two options...

, and constant proportional tradeoff behaviour. QALYs attempt to combine expected survival with expected quality of life into a single number: if an additional year of healthy life expectancy is worth a value of one (year), then a year of less healthy life expectancy 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. QALYs are useful for utilitarian analysis, but does not in itself incorporate equity considerations.

Infant and child mortality


Life expectancy and DALYs/QALYs represent the average disease burden well. However, infant mortality
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...

 and under-five child mortality
Child mortality
Child mortality, also known as under-5 mortality, refers to the death of infants and children under the age of five. In 2010, 7.6 million children under five died , down from 8.1 million in 2009, 8.8 million in 2008, and 12.4 million in 1990. About half of child deaths occur in Africa....

 are more specific in representing the health in the poorest sections of a population. Therefore, changes in these classic measures are especially useful when focusing on health equity
Health equity
Health equity refers to the study of differences in the quality of health and health care across different populations....

. These measures are also important for advocates of children's rights
Children's rights
Children's rights are the human rights of children with particular attention to the rights of special protection and care afforded to the young, including their right to association with both biological parents, human identity as well as the basic needs for food, universal state-paid education,...

. Approximately 56 million people died in 2001. Of these, 10.6 million were children under 5 years of age, 99% of these children were living in low-and middle-income countries. That translates to roughly 30,000 children dying every day.

Morbidity


Morbidity
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

 measures include incidence rate, prevalence and cumulative incidence. Incidence rate is the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator.

Health conditions


The main diseases and health conditions prioritized by global health initiatives are sometimes grouped under the terms "diseases of poverty
Diseases of poverty
Diseases of poverty is a term sometimes used to collectively describe diseases and health conditions that are more prevalent among the poor than among wealthier people. In many cases poverty is considered the leading risk factor or determinant for such diseases, and in some cases the diseases...

" versus "diseases of affluence
Diseases of affluence
Diseases of affluence is a term sometimes given to selected diseases and other health conditions which are commonly thought to be a result of increasing wealth in a society...

", although the impacts of globalization are increasingly blurring any such distinction.

Respiratory diseases and measles


Infections of the respiratory tract and middle ear are major causes of infant
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...

 and child mortality
Child mortality
Child mortality, also known as under-5 mortality, refers to the death of infants and children under the age of five. In 2010, 7.6 million children under five died , down from 8.1 million in 2009, 8.8 million in 2008, and 12.4 million in 1990. About half of child deaths occur in Africa....

. In adults, tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

 is highly prevalent and causes significant morbidity and mortality. Mortality in tuberculosis has increased due to the spread of HIV. The spread of respiratory infections is increased in crowded conditions. Current vaccination programmes against pertussis prevent 600 000 deaths each year. Measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...

 is caused by the morbillivirus and spread via the airways. It is highly contagious and characterized by flulike symptoms including fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...

, cough, and rhinitis and after a few days deveopment of a generalized rash. It can effectively be prevented by vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...

. In spite of this, almost 200,000 people, mostly children under 5 years of age, died from measles in 2007.http://www.who.int/mediacentre/factsheets/fs286/en/ Pneumococci and Haemophilus influensae cause approximately 50 % of child deaths in pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...

, and also cause bacterial menigitis and sepsis. Novel vaccines against pneumococci and Haemophilus influensa are clearly cost-effective in low-income countries. Universal use of these two vaccines are estimated to prevent at least 1 000 000 child deaths annually. For maximal long-term effect, vaccination of children should be integrated with primary health care measures.

Diarrhoeal diseases


Diarrhoeal infections
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...

 are responsible for 17 per cent of deaths among children under the age of five worldwide, making them the second most common cause of child deaths globally. Poor sanitation
Sanitation
Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic...

 can lead to increased transmission through water, food, utensils, hands and flies. Rotavirus
Rotavirus
Rotavirus is the most common cause of severe diarrhoea among infants and young children, and is one of several viruses that cause infections often called stomach flu, despite having no relation to influenza. It is a genus of double-stranded RNA virus in the family Reoviridae. By the age of five,...

 is highly contagious and a major cause of severe diarrhoea and death (ca 20%) in children. According to the WHO, hygienic measures alone are insufficient for the prevention of rotavirus diarrhoea. Rotavirus vaccines are highly protective, safe and potentially cost-effective. Dehydration due to diarrhoea can be effectively treated through oral rehydration therapy
Oral rehydration therapy
Oral rehydration therapy is a simple treatment for dehydration associated with diarrhoea, particularly gastroenteritis or gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth...

 (ORT), with dramatic reductions in mortality. By mixing water, sugar and salt or baking soda and administering it to the affected child, dehydration can be effectively treated. Important nutritional measures are promotion of breastfeeding
Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...

 and zinc supplementation.

Maternal health


In many developing countries, complications of pregnancy
Complications of pregnancy
Complications of pregnancy are the symptoms and problems that are associated with pregnancy. There are both routine problems and serious, even potentially fatal problems. The routine problems are normal complications, and pose no significant danger to either the woman or the fetus...

 and childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

 are the leading causes of death among women of reproductive age. A woman dies from complications from childbirth approximately every minute. According to the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

, in its World Health Report 2005
World Health Report
The World Health Report is a series of reports produced regularly by the World Health Organization . First published in 1995, the World Health Report is WHO's leading publication...

, poor maternal conditions account for the fourth leading cause of death for women worldwide, after HIV/AIDS, malaria, and tuberculosis. Most maternal deaths and injuries are caused by biological processes, not from disease, which can be prevented and have been largely eradicated in the developed world - such as postpartum hemorrhaging
Postpartum hemorrhage
Hemorrhage after delivery, or postpartum hemorrhage, is the loss of greater than 500 ml of blood following vaginal delivery, or 1000 ml of blood following cesarean section...

, which causes 34% of maternal deaths in the developing world but only 13% of maternal deaths in developed countries.

HIV/AIDS



Human immunodeficiency virus (HIV) is a retrovirus that first appeared in humans in the early 1980s. HIV progresses to a point where the infected person has AIDS or Acquired Immunodeficiency Syndrome. HIV becomes AIDS because the virus had depleted CD4+ T-cells that are necessary for a healthy immune system. Antiretroviral drugs prolong life and delay the onset of AIDS by minimizing the amount of HIV in the body.

HIV is transmitted through bodily fluids. Unprotected sex, intravenous drug use, blood transfusions, and unclean needles spread HIV through blood and other fluids. Once thought to be a disease that only affected drug users and homosexuals, it can affect anyone. Globally, the primary method of spreading HIV is through heterosexual intercourse. It can also be passed from a pregnant woman to her unborn child during pregnancy, or after pregnancy through breast milk. While it is a global disease that can affect anyone, there are disproportionately high infection rates in certain regions of the world.

In June 2001, the United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...

 held a Special General Assembly to intensify international action to fight the HIV/AIDS epidemic and to mobilize the resources needed towards this aim, labelling the situation a "global crisis".

Malaria


Malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...

 is an infectious disease caused by protozoan Plasmodium parasites. The infection is transmitted via mosquito bites. Early symptoms may include fever, headaches, chills and nausea. Each year approximately 500 million cases of malaria occur worldwide, most commonly among children and pregnant women in underdeveloped countries.
Malaria can hinder economic development of a country. Economic effects of malaria include decreased work productivity, treatment cost, and time spent for getting treatment.

Deaths in malaria can be sharply and cost-effectively reduced by use of insecticide-treated bednets
Mosquito net
A mosquito net offers protection against mosquitos, flies, and other insects, and thus against diseases such as malaria, dengue fever, yellow fever, and various forms of encephalitis, including the West Nile virus, if used properly and especially if treated with an insecticide, which can double...

, prompt artemisin-based combination therapy, and supported by intermittent preventive therapy
Intermittent preventive therapy
Intermittent preventive therapy is a public health intervention aimed at treating and preventing malaria episodes in infants , children , schoolchildren and pregnant women...

 in pregnancy. However, only 23% of children and 27% of pregnant women in Africa were estimated to sleep under insecticide-treated bednets.http://www.who.int/malaria/wmr2008/MAL2008-SumKey-EN.pdf

Nutrition and micronutrient deficiency


Greater than two billion people in the world are at risk of micronutrient
Micronutrient
Micronutrients are nutrients required by humans and other living things throughout life in small quantities to orchestrate a whole range of physiological functions, but which the organism itself cannot produce. For people, they include dietary trace minerals in amounts generally less than 100...

 deficiencies (including lack of vitamin A, iron, iodine and zinc). Among children under the age of five in the developing world, malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....

 contributes to 53% of deaths associated with infectious diseases. Malnutrition impairs the immune system, thereby increasing the frequency, severity, and duration of childhood illnesses (including measles, pneumonia and diarrhoea). Micronutrient deficiencies also compromise intellectual potential, growth, development and adult productivity.

However, infection is also an important cause and contributor to malnutrition. For example, gastrointestinal infections causes diarrhoea, and HIV, tuberculosis, intestinal parasites and chronic infection increase wasting and anemia
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...

.

Fifty million children under the age of five are affected by vitamin A deficiency. Such deficiency has been linked with night blindness. Severe vitamin A deficiency is associated with xerophtalmia and ulceration of the cornea
Cornea
The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Together with the lens, the cornea refracts light, with the cornea accounting for approximately two-thirds of the eye's total optical power. In humans, the refractive power of the cornea is...

, a condition that can lead to total blindness. Vitamin A is also involved in the function of the immune system and in maintaining epithelial surfaces. For this reason, vitamin A deficiency leads to increased susceptibility to infection and disease. In fact, vitamin A supplementation was shown to reduce child mortality rates by 23% in areas with significant levels of vitamin A deficiency.

Iron deficiency affects approximately one-third of the world's women and children. Iron deficiency contributes to anemia
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...

 along with other nutritional deficiencies and infections and is associated with maternal mortality, prenatal mortality and mental retardation globally. In anemic children, iron supplementation combined with other micronutrients improves health and hemoglobin levels. In children, iron deficiency compromises learning capacity, and emotional and cognitive development.

Iodine deficiency is the leading cause of preventable mental retardation
Mental retardation
Mental retardation is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors...

. As many as 50 million infants born annually are at risk of iodine deficiency. Pregnant women whom are iodine deficient should be included in the target population for this particular intervention because pregnant women with iodine defiency increases the chance of miscarriages and also lowers the development potential of the infant. Global efforts for universal salt iodization are helping eliminate this problem.

According to Lasserini and Fischer et al., zinc deficiency may increase the risk of mortality from diarrhea, pneumonia and malaria. Almost 30% of the world's children are estimated to be zinc deficient. Supplements have been shown to reduce the duration of diarrhea episodes.

Interventions to prevent malnutrition include micronutrient
Micronutrient
Micronutrients are nutrients required by humans and other living things throughout life in small quantities to orchestrate a whole range of physiological functions, but which the organism itself cannot produce. For people, they include dietary trace minerals in amounts generally less than 100...

 supplementation, fortification of basic grocery foods, dietary diversification, hygienic measures to reduce spread of infections, and promotion of breastfeeding
Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...

. Dietary diversification aims to increase the consumption of vital micronutrients in the regular diet
Diet (nutrition)
In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management...

. This is done by education and promotion of a diverse diet, and by improving access to micronutrient-rich and locally produced food.

Surgical disease burden


While infectious diseases such as HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

 exact a great health toll in low-income countries, surgical conditions including trauma from road traffic crashes or other injuries, malignancies, soft tissue infections, congenital anomalies
Congenital disorder
A congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life , regardless of causation...

, and complications of childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

 also contribute significantly to the burden of disease and impede economic development. http://www.who.int/entity/healthinfo/global_burden_disease/2004_report_update/en/index.html. It is estimated that surgical diseases comprise 11% of the global burden of disease, and of this 38% are injuries, 19% malignancies, 9% congenital anomalies, 6% complications of pregnancy, 5% cataracts, and 4% perinatal conditions. The majority of surgical DALYs are estimated to be in South-East Asia (48 million), though Africa has the highest per capita surgical DALY
Daly
Daly or DALY may refer to:* Daly * Daly City, California* Daly College, India* Daly detector, atype of mass spectrometry detector* Daly languages, group of Australian aborigine languages...

 rate in the world.

As discussed above, injuries are the largest contributor to the global surgical disease burden with road traffic accidents (RTAs) contributing the largest share. According the WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...

, more 3500 RTA related deaths occur daily with millions injured or disabled for life. Road traffic accidents are projected to rise from the ninth leading cause of death and DALYs lost globally in 2004, to the top five in 2030. This would place injuries ahead of infectious diseases by 2030. http://www.who.int/entity/healthinfo/global_burden_disease/2004_report_update/en/index.html

Chronic disease



The relative importance of chronic non-communicable disease
Non-communicable disease
A non-communicable disease, or NCD, is a medical condition or disease which is non-infectious. NCDs are diseases of long duration and generally slow progression. They include heart disease, stroke, cancer, asthma, diabetes, chronic kidney disease, osteoporosis, Alzheimer's disease, cataracts, and...

 is increasing. For example, the rates of type 2 diabetes
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...

, associated with obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...

, have been on the rise in countries traditionally noted for hunger levels. In low-income countries, the number of individuals with diabetes is expected to increase from 84 million to 228 million by 2030. Obesity is preventable and is associated with numerous chronic diseases including cardiovascular conditions, diabetes, stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...

, cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

s and respiratory diseases. About 16% of the global burden of disease, measured as DALYs, has been accounted for by obesity.

In September 2011, the United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...

 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 important 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.

Health interventions


Many low-cost, evidence-based health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...

 interventions for improved health and survival are known. Priority global targets for improving maternal health
Maternal health
Maternal health refers to the health of women during pregnancy, childbirth, and the postpartum period. It encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to reduce maternal morbidity and mortality.Preconception care can include...

 include increasing coverage of deliveries with a skilled birth attendant
Birth attendant
A birth attendant, also known as “skilled birth attendant” , is a midwife, physician, obstetrician, nurse, or other health care professional who provides basic and emergency health care services to women and their newborns during pregnancy, childbirth and the postpartum period...

. Interventions for improved child health and survival
Child survival
Child survival is a field of public health concerned with reducing child mortality. Child survival interventions are designed to address the most common causes of child deaths that occur, which includes diarrhea, pneumonia, malaria, and neonatal conditions...

 include: promotion of breastfeeding
Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...

, zinc supplementation, vitamin A fortification and supplementation, salt iodization, handwashing and hygiene interventions, vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...

, treatment of severe acute malnutrition. In malaria endemic regions, use of insecticide treated bednets and intermittent pharmacological treatment reduce mortality.
Based on such studies, the Global Health Council
Global Health Council
The Global Health Council is a United States-based non-profit networking organizing linking "several hundred health non-governmental organizations around the world to share knowledge and resources, build partnerships and together become stronger advocates for health"...

 suggests a list of 32 treatment and intervention measures that could potentially save several million lives each year.

Progress in coverage of health interventions, especially relating to child and maternal health (Millennium Development Goals 4 and 5), is tracked in 68 low-income countries by a WHO- and UNICEF-led collaboration called Countdown to 2015. These countries are estimated to account for 97% of maternal and child deaths worldwide.

To be most effective, interventions need to be appropriate in the local context, be timely and equitable, and achieve maximum coverage of the target population. Interventions with only partial coverage may not be cost-effective. For example, immunization programs with partial coverage often fail to reach the ones at greatest risk of disease. Furthermore, coverage estimates may be misleading if not distribution is taken into account. Thus, mean national coverage may appear fairly adequate, but may nevertheless be insufficient when analyzed in detail. This has been termed 'the fallacy of coverage'.

While investments by countries, development agencies and private foundations has increased substantially in recent years with aim for improving health intervention coverage and equitable distribution, including for measuring progress towards the achievement of the Millennium Development Goals, attention is also being increasingly directed to addressing and monitoring the health system
Health system
A health system can be defined as the structured and interrelated set of all actors and institutions contributing to health improvement. The health system boundaries could then be referred to the concept of health action, which is "any set of activities whose primary intent is to improve or...

s and health workforce
Health Human Resources
Health human resources — also known as “human resources for health” or “health workforce” — is defined as “all people engaged in actions whose primary intent is to enhance health”, according to the World Health Organization's World Health Report 2006. Human resources for health are identified as...

 barriers to greater progress. For example, in its World Health Report 2006
World Health Report
The World Health Report is a series of reports produced regularly by the World Health Organization . First published in 1995, the World Health Report is WHO's leading publication...

, the WHO estimated a shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide, especially in sub-Saharan Africa, in order to meet target coverage levels to achieve the Millennium Development Goals 4 and 5.

See also



  • Global Mental Health
    Global Mental Health
    The World Health Organization defines mental health as a 'state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community'.The term Global...

  • Global Pulse Journal
    Global Pulse Journal
    The Global Pulse Journal is an open access online-only journal on global health. It is student-run and peer-reviewed. It was established in 2005 and is published twice yearly. It is an official journal of the American Medical Student Association, but operates with editorial independence...

  • Primary health care
    Primary health care
    Primary health care, often abbreviated as “PHC”, has been defined as "essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost...

  • Public health
    Public health
    Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...

  • Global Health Delivery Project
    Global Health Delivery Project
    The Global Health Delivery Project is a project at Harvard University that aims to improve health among disadvantaged populations worldwide by systematizing the study of global health delivery and rapidly disseminating knowledge to practitioners. GHD was founded in 2007 by Dr. Jim Yong Kim, Dr....

     at Harvard University
  • Family Health International
    Family Health International
    Family Health International is a public health and development organization dedicated to improving living standards of the world's most vulnerable people. Family Health International has 2,500 staff conducting research and implementing programs in fifty-five countries...

     non-profit organization
  • MEDICC
    MEDICC
    MEDICC is a non-profit organization founded in 1997 that works to enhance cooperation among the US, Cuban and global health communities through its programs....

     non-profit organization


Global health strategies and policy frameworks
  • Global Strategy for Women's and Children's Health
    Global Strategy for Women's and Children's Health
    The Global Strategy for Women's and Children's Health is a program of the United Nations directed at improving women's and children's health in the developing world.The program was announced by UN Secretary-General Ban Ki-moon in September 2010...

  • Global Code of Practice on the International Recruitment of Health Personnel
  • International Code of Marketing of Breast-milk Substitutes
    International Code of Marketing of Breast-milk Substitutes
    The International Code of Marketing of Breastmilk Substitutes is an international health policy framework for breastfeeding promotion adopted by the World Health Assembly of the World Health Organization in 1981...

  • Millennium Development Goals
    Millennium Development Goals
    The Millennium Development Goals are eight international development goals that all 193 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015...

  • WHO Framework Convention on Tobacco Control


Further reading

  • Jacobsen KH (2008) Introduction to Global Health. Jones and Bartlett
  • Skolnik R (2008) Essential Public Health: Essentials of Global Health. Jones and Bartlett.
  • Levine R (Ed) (2007) Essential Public Health: Case Studies in Global Health. Jones and Bartlett.
  • Launching Global Health Steven Palmer. Ann Arbor, University of Michigan Press
    University of Michigan Press
    The University of Michigan Press is part of the University of Michigan Library and serves as a primary publishing unit of the University of Michigan, with special responsibility for the creation and promotion of scholarly, educational, and regional books and other materials in digital and print...

    , 2010.

External links