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1 MIEH Final exam

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14. Non-communicable diseases A disease that is not infectious and instead is a condition that is developed. They have a long duration and slow progression. Chronic 70% of all deaths globally o TOP KILLERS  Cardiovascular – 17.3 million  Heart attacks (coronary heart disease), cerebrovascular disease (strokes), hypertension, peripheral artery disease, congenital heart disease, and heart failure  caused by the top risk factors  Prevent by focusing on risk factors, screening, affordable treatment  Treatment: beta blockers, aspirin  Cancers  Respiratory disease  Diabetes  7th leading cause of death worldwide  9% of the world population. An increase from the 4.7% in 1980.  Increase caused by the increase of overweight, obesity, and physical inactivity.  Type 1: lack of insulin produced  Type 2: inability to effectively use insulin o 90% of all cases  Complications o Blindness, Stroke, Amputation, Kidney failure, Erectile dysfunction, and Gum disease  Prevention: Maintain healthy body weight, be active, screen regularly  Treatment: Lower blood sugar  Control o Type 1: give insulin o Type 2: Maybe use insulin, oral medication o Top risk factors that are modifiable  Unhealthy diet  Physical inactivity  Harmful use of alcohol  Tobacco use  International response to reduce smoking: warnings on every package that are large and clear, rotating, and in the forms of pictures  Obesity  More common in males in developed countries  More common in females in undeveloped countries  Has more than doubled since 1980  65% of the world's population live in countries where overweight and obesity kills more people than underweight.

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15. Neglected Tropical diseases The diseases o Lymphatic Filariasis  Brazil, DR, Haiti, and Guyana are still transmitting  Mainly in Haiti  All for have disability management programs in place  Causes enlarged areas. Sometimes partially reversible  Transmitted by mosquitos – very similar to malaria o Schistosomiasis  Brazil and Venezuela have people still being treated  Treatment: chemotherapy, mostly in brazil o Genhelminthiasis o Trachoma  Blinding by causing inflammation in the eyelid and cause eye lashes to curl inward into the eye  Active in Brazil, Colombia, Guatemala, and Mexico  Brazil: is reviewing and adjusting epi data  Columbia: carrying out mapping in areas of known focus  Guatemala: is planning impact evaluation o Onchocerciasis  Eliminated from several south American countries  Brazil and Venezuela still have active transmission  Those needing treatment has dropped o Helminthiasis  Transmitted through soil o Leprosy  Mainly in Brazil Country capacity strengthened to tackle NTD in the Americas in the framework of the grant between USAID and WHO o Development and implementation of integrated plans of action, projects, programs 2016  6 countries implementing national integrating plans of action for NTDs  7 are implementing project, programs or strategies to tackle their own epidemic  5 are integrated STH deworming in the immunizations programs during the vaccination week of the Americas o Monitoring and evaluation of progress toward NTD elimination 2016 o 12 countries are using WHO joint Application Package for reporting on use of preventive chemotherapy medicines and for planning and requesting the donation for medicines o 10 countries benefit from medicines donated through WHO PLAN OF ACTION o Objectives  Interrupt transmission and eliminate 8 NTD  Prevent, control, and reduce the burden of disease from 5 NTD  Document and evaluate the regional epidemiological situation of other NTDs  Reduce the risk of recrudesces or re-introduction of any NTD o 6 lines of action:

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Strengthen innovative and intensified disease surveillance, diagnosis and clinical case management for NTDs (NIDs)  Strengthen preventive chemotherapy and increase access to basic health care for NTDS  Strengthen integrated management of vectors  Strengthen the prevention of select neglected zoonoses through a Veterinary Public Health/One Health approach  Adopt intersect oral approaches to reduce risk of NTD transmission through improved access to safe water, basic sanitation and hygiene  Incorporate innovative approaches supported by operational/implementation research to eliminate disease transmission and address post-elimination actions and new priorities among the NID Comparisonz

16. Disaster and injuries In developed counties o Reduction in motor vesical accidents  Introduction of seatbelts and health companies to get people to use them  Technology to make cars safer  Regulations and laws added  Decrease in drunk driving In the developing world o Problems

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A lack of regulation. Resulting the less safe cars being sold there, way under the regulation standards of the US  Poor road conditions and narrow roads  Increase of population density  Combination of motor vehicles and animal pulled vehicles o How to fix without putting a burden on them? War and conflict o Cause a severe increase in injury and deaths  Syria with its Civil War is causing a great increase in death by warfare, including bombs and chemical weapons  Causing a sharp increase in refugees and internally displaces people  Targets healthcare workers and infrastructure in killings and bombing Disasters o Specific injuries  Drowning  Increase in vector borne and waterborne diseases from standing water  Pollution of ground water and supplies  Mold  Burns  Increased particulate matter can irritate cardiopulmonary conditions  CO poisoning – with hurricanes and typhoons. When people don’t have electricity, they may use camp stoves indoors without ventilation  Crashes  Suffocation  Cancers due to exposure during disaster, decades later o Impacts  Internally and externally displaced from home  Death  Recovery of businesses, economy, healthcare systems  In Haiti: Cholera epidemic from unscreened UN workers  Healthcare system damage that is unable to respond to increases of need  In Sandy: Hospitals and fire stations were flooded. Roads were too flooded for emergency vehicles to get through  Caused direct (ex. Drowned) and indirect death (ex. Heart attack from post storm cleaning)  In NY: Low income housing have no electricity or running water o In high-rises those with disabilities or elderly were unable to leave due to no elevators. Medication couldn’t be refrigerated. Toilets wouldn’t rush  Information on the storm wasn’t always communicated to linguistically isolated communities. Messages went out in English, Spanish, French, Mandarin… but some places only speak Russian  Some clinics were not rebuilt, hospitals were just reopened  Mental health trauma  In consistent health standards due to jobs not providing safety equipment to all employees

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Anthropogenic Disasters  “accidents” caused by humans: usually because someone didn’t do their job  Someone stored two chemicals that weren’t supposed to be next to each other and caused a massive explosion in China o Terrorism  CBRNE  Chemical, biological, radiological, nuclear, and explosives o Accidents  Chinese chemical factory explosion (mentioned ^)  Deepwater horizon oil spill  Chernobyl disaster o Natural and Anthropogenic Disasters  Japanese earthquake, tsunami, and subsequent radiation release caused by an earthquake that caused a tsunami that broke a nuclear reactor Public Health Challenged in disasters  Cut off from needed medical health services  Surges in healthcare facilities  Unable to accommodate everyone efficiently  Still have standard health conditions like birth...  People who are well coming in thinking they’re sick and waste resources  Provide safe homes is displaced  Trying to accommodate different religions  Making Muslims eat pork unless absolutely necessary  Dealing with mixed populations  Registered sex offender setting up next to a family with children  Reduce further trauma  Mental health  Any disaster can cause mental trauma o PTSD, survivors guilt, responder burnout and compassion fatigue, pediatrics  Public health emergency of international concern  Put in place by WHO. Only 4 declared. Brings global attention for travel bans, screening, etc. o Swine Flu, Polio, Ebola, and Zika

17. Food security and health Over 7 billion people with poverty, even in the developed world Food Supply = total yield of world’s croplands, pasturelands, and fisheries Factors influencing food demand o Population growth --> food supply problems are most acute in Asia, Africa, and Latin America o Rising personal incomes --> translates into increased demand for high-quality foods such as meat and dairy products

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A rapid increase in income promotes more meat-based diet which has become a status symbol of modern lifestyle

Food security o “Food security exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food which meets their dietary needs and food preferences for an active and healthy life” o 3 pillars of food security  Food availability  Food access --> sufficient resources  Food use --> appropriate use based on knowledge of nutrition and care o Food security  High food security: no reported indications of food-access problems or limitations  Marginal food security: one or two reported indications typically of anxiety over having enough food in the house with little to no changes in diet o Food insecurity  Low: reports of reduced quality, variety, or desirability of diet. Little to no indication of reduces food intake  Very low: reports multiple indications of disrupted eating patterns and reduced food intake. Food insecurity vs. hunger o Insecurity = household level limited access to food o Hunger= personal physiological condition that may result from food insecurity Food insecurity exist everywhere… even the US *gasp* o Duration and severity of food security  A duration of inadequate food consumption may be chronic (long time) or transitory (short episode)  Chronic - low income + no access  Transitory - natural disasters, lost job, external factors, famine o It's starting to increase around the world  UN millennium goal is to eradicate extreme poverty  Future food demand is determined by  Pop growth  Increased income  Diversifying diets  Biofuels  Climate change disasters  Fight this by  Eating lower on the food chain  Eat local 18. Poverty and food security and health Hunger o Under-nourishment = status of people whose food intake does not include enough calories to meet minimum physiological needs for an active life.

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Malnutrition = badly nourished characterized by inadequate intake of protein, energy, and micronutrients and by frequent infections and diseases  Measured by physical measurements of the body compared to body's potential Wasting is an indicator of acute malnutrition that results in significant weight loss leaving the individual too thin for their height  Stunting is when a child it too short for their age due to wasting. Can be reversed if caught early enough. But can't overcome damage from developmental years later in life.  Most common in South Asia, Sub-Saharan Africa, Middle east….  Generally decreasing, increasing in Oceania region (not New Zealand or Australia)  If children don’t receive the right nutrition in the developmental years, the damage cannot be fixed in later life  Barker Hypothesis - fetal basis of adult diseases  Cannot be altered  Marasmus is the most common form of malnutrition  There is no fat and very little muscle tissue left on the body. Internal organs are severally weakened and immune system in compromised so the cause of death of infection  Kwashiorkor is when the body is swollen due to retaining water.  Most death is caused by infection. Since the body can't control body temp they are more likely to die at night, hypoglycemia.  Edema - swelling which hides the loss of fat and muscle. May loss hair color, have fragile skin prone to infection. Acutely sick. Gender bias  Girls make up more than 70% of the world's hungry  The make 55% of the world's food, make less money, fewer promotions, but are still expected to have the same household traditions.  Boys are prioritized over girls  A malnourished mother give birth to a weak infant with low birth weight Major challenges to overcoming it  Conflict – Hard to access food if displaced  Climate change – killing crops  Population growth – not enough food  Poverty – can’t afford it Key messages  Malnutrition can be:  Low birth weights, wasting, stunting,  micronutrients deficiencies  Overweight and obesity  Malnutrition is not decreasing and is affecting the majority of the world population  The changing burden of disease should influence the way we think of global development  There are important differences in the world distribution of different form of malnutrition but similar global tends

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19. Maternal and child health I Global Scenario o Half a million women die from maternal causes annually. Mostly in Africa o For every death there are 20 other who suffer pregnancy related illness of other outcomes such as fistulas o 10 million suffer from complications o ~1500 die a day o 80% can be prevented by access to essential maternity and health services o Average lifetime risk of maternal death in least developed countries is +300 times than in industrialized countries o In developed nations, nearly all births are attended by skilled attendants  Barely half in lest developed regions MDG 5: Improve Maternal Health o Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio o 5.1 Maternal mortality ratio o 5.2 Proportion of births attended by skilled health personnel o Target 5.B: Achieve, by 2015, universal access to reproductive health  5.3 Contraceptive prevalence rate  5.4 Adolescent birth rate  5.5 Antenatal care coverage (at least one visit and at least four visits)  5.6 Unmet need for family planning o Most in West and Central Africa India o Huge gap in India between north and south  Cause of death are disorders, Hemorrhage, sepsis, etc.  Most deaths occur the first day after pregnancy Addressing the issue o Promoting a healthy behavior o Securing a quality education  A more educated mother will delay marriage  Know more about nutritional needs of their children and get them immunized  Better at spacing out pregnancy o Preventing child marriage o Ante natal care coverage  Improve quality of reproductive health services  Improve water and sanitation  Access to clean water and better hygiene practices o Skilled delivery care coverage o Enhance Nutrition, maternal care, skilled assistance during pregnancy and childbirth, initiate breastfeeding within 1 hour of birth, expand post-natal care for mother and newborns o Create a more supportive environment for the mother and child  Protect from abuse and violence  Equal participation in home, community, and political life

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Women empowerment Decent standard of living

20. Maternal and child health II Child mortality has been decreasing o 40% of under 5 deaths happen within the first 28 days  a child in a least developed country is 14x more likely to die within the first 28 days than a child in a industrialized country o 55% of all deaths are neonatal caused, infections o about half of deliveries are at home and only 46% are with skilled birth attendants Things that effect infant mortality o Geography o Years before previous birth o Birth order o Mothers age at birth o Countries income o Poverty Where do African Newborns die? o At home. Unnamed and uncounted which effects data o +1/4 of deaths in Africa are newborns When do African newborns die? o Before the age of 5 o 75% of neonatal deaths are in the first week o up to 50% are in the first 24 hours How we gonna fix this o Early postnatal visits reduce newborn deaths. o A first visit within 2 days of birth may reduce deaths by 67% 21. Human trafficking Happening everywhere in the world in the US and beyond More people are enslaved today than ever before o Previously… slavery o Agreements first protected white women and children o Then women and children o Polaris Project  Founded by 2 Brown University students. Leading non=profit with programs set up to advocate and track human trafficking

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Forms o o o o o o o o Scope o o

 Has a hotline Obama made national human trafficking day

Forced Labor Sexual exploitation Child soldiers Forced begging Forced marriage Celling children Removal of organs

Men vs. women, young vs, old, Race/ethnicity/ religion bases According to the United Nations Office on Drugs and Crime (UNODC), human trafficking is the act of gathering, moving, receiving, or keeping human beings by threat, force, coercion, or deception, for exploitative purposes. This includes “the exploitation of prostitution of other or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal of organs.” o Most are women – 51% o Men – 21% o 20% young girls o 8% young boys o Very under-reported since there’s not hot line etc. in developing nations o While female rates are being decreases. The trend in men trafficking is increasing o Mostly sexual exploitation then forced labor Current issues o Traffickers are using status to coercion victims o Act + Means + Purpose = Trafficking o Act can be recruitment, transportation, harboring. Physical act o Mean can be threat or force, abduction, coercion, fraud, abuse of power. o Purpose can be whatever they need the people for. o Look here for places PH can break the cycle o Conflicts  Extreme poverty may force a family to sell a child or lead individuals to sell their body for sex  Refugees are easy targets o Armed groups  Stealing children to be child soldiers or forcing men to fight. Raping and take women of enemies How to prevent o ACT: break here by education bystanders to call tip lines, education at risk groups to recognize suspicions behaviors o MEANS and PURPOSE: educational outreach, protection and enforcement of task forces and international checks to recognize victims Trickle Down complications

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Social Economic – poverty may cause people to go work in other countries which can lead to people being trafficked through “offered jobs” and being taken somewhere else Developmental

Making progress o Identifying victims o Putting in policies to hold those accountable and helping victims o UN initiative to high human trafficking to share national efforts that are cost effective with other countries o Programs in Maryland, DC, and at UMD for empowering and helping

22. Conflicts and refugee health Definitions o Refugees: people who have fled their countries due to a fear of persecution, having crosses and international border o UNHCR (United nations high commission for refugees) is the guardian of the 1951 convention that defined the term refugee and outlines the rights of the displaces as well as the legal obligations of the States to protect them o Internally displaced people: have not crossed a border to find safety. They are still under the protection of their government even if the government is why they flee. They are the more vulnerable. UNHCR still protects them o Immigrant: chooses to move in order to improve the future outlook for them and their family o Refugee camp: temp. place built to take in refugees and people in similar situations. Tre...