GLOBAL HEALTH AND HEALTH DETERMINANTS Charen Andella Dara Risczka Rosdianty Fadilah Fitri Arsy Farah Alphi Nabila Restu Adya Cahyani Rizqy Fauzia Ahsani GROUP 1

Determinant of Health Skolnik, Richard Global Health nd Ed. United State of America : Jones & Bartlett Learning

Key Determinans of Health General make-up Our genetic makeup has much to do with what diseases we get and how healthy we live. One can inherit, for example, a genetic marker for a particular disease, such as Huntington’s disease, which is a neurological disorder. One can also inherit the genetic component of a disease that has multiple causes, such as breast cancer. Sex Sex also has an important relationship with health. Males and females are physically different, for example, and may get different diseases Age Age is also an important determinant of health. Young children in low- and middle-income countries often die of diarrheal disease, whereas older people are much more likely to die of heart disease, to cite one of many examples of the relationship between health and age.

Key Determinans of Health Socioeconomic status Socioeconomic status, which refers to a person’s economic, social, and work status, is an important health determinant. People with higher educational attainment have higher socioeconomic status and more control over their lives than people of lower status Culture Culture helps to determine how one feels about health and illness, how one uses health services, and the health practices in which one engages. The environment The environment, both indoor and outdoor, is a powerful determinant of health. Related to this is the safety of the environment in which people work

Key Determinans of Health Education Education is a powerful determinant of health for several reasons. First, it brings with it knowledge of good health practices. Second, it provides opportunities for gaining skills, getting better employment, raising one’s income, and enhancing one’s social status, all of which are also related to health. People’s own health practices and behaviors Being able to identify when you or a family member is ill and needs health care can be critical to good health. As noted previously, however, one’s health also depends on how one eats, or if one smokes, drinks too much alcohol, or drives safely. We also know that being active physically and getting exercise regularly is better for one’s health than is being sedentary

Key Determinans of Health The way in which families nourish and care for infants and young children Being born premature or of low birthweight can have important negative consequences on health. There is a strong correlation between the nutritional status of infants and young children and the extent to which they meet their biological potential, enroll in school, or stay in school. In addition, poor nutritional status in infancy and early childhood may be linked with a number of noncommunicable diseases later in life Access to appropriate healthcare services The more likely you are to access services of appropriate quality, the more likely you are to stay healthy

Key Determinans of Health The approach that governments take to different policies and programs in the health sector and in other sectors People living in a country that promotes high educational attainment, for example, will be healthier than people in a country that does not promote widespread education of appropriate quality, because better-educated people engage in healthier behaviors. A country that has universal health insurance is likely to have healthier people than a country that does not insure its entire population because the uninsured may lack needed health services

From 2005 to 2008 the World Health Organization (WHO) constituted a Commission on the Social Determinants of Health. WHO published the commission’s report in Some of the important themes related to the report are: Health status is improving in some places in the world but not in others. There are enormous differences in the health status of individuals within countries as well as across countries. The health differences within countries are closely linked with social disadvantage. Many of these differences should be considered avoidable, and they relate to the way in which people live and work and the health systems that should serve them. In the end, people’s life circumstances, and therefore their health, are profoundly related to political, social, and economic forces. Countries need to ensure that these forces are oriented toward improving the life circumstances of the poor, thereby enabling them to enjoy a healthier life, as well.

The Key Health Status Indicators Infant Mortality RateLife Expectancy At BirthMaternal Mortality RatioNeonatal Mortality Rate Under-5 Mortality Rate (Child Mortality Rate)

Life Expectancy At Birth The average number average number of years a newborn baby could expect to live if current mortality trends were to continue for the rest of the newborn’s life Life Expectancy at Birth, by World Bank Region and for High-Income Countries, 2013

Infant Mortality Rate The number of deaths of infants under age 1 per 1000 live births in a given year Infant Mortality Rates, by World Bank Region and for High-Income Countries,

Neonatal Mortality Rate The number of deaths to infants under 28 days of age in a given year per 1000 live births in that year Neonatal Mortality Rates, by World Bank Region and for High-Income Countries, 2013

Under-5 Mortality Rate (Child Mortality Rate) The probability that a newborn baby will die before reaching age 5, expressed as a number per 1,000 live births Under-5 Mortality Rates, by World Bank Region and for High-Income Countries,

Maternal Mortality Ratio The number of women who die as a result of pregnancy and childbirth complications per 100,000 live births in a given years Maternal Mortality Ratio, by World Bank Regions and for High-Income Countries, 2013

Morbidity, Disability, and Mortality Morbidity Mortality : Disability : Courses : Global Health Sickness or any departure, subjective or objective, from a psychological state of well- being. Which refers of death. A death rate is the number of deaths per 1000 population in a given year Some conditions cause people to get sick or die, they might also cause people suffer the “temporary or long-term reduction in a person capacity to function”

Vital Registration can record births, deaths, and the causes of death. The case in low- and lower-middle-income countries: The rudimentary systems of vital registration The access to vital registration systems is highly inequitable The cultural barrier To overcome, Surveys and Projection models, have been developed

HEALTH-ADJUSTED LIFE EXPECTANCY (HALE)

Health-adjusted Life Expectancy (Hale)  It is “health expectancy measure” The HALE summarize the expected number of years to be lived in what might be termed the equivalent of good health. To calculate HALE, “the years of ill health are weighted according to severity and subtracted from the overall life expectancy.”

Health-adjusted Life Expectancy (Hale) Source : Skolnik, Richard. Global Health 2 nd Edition. Table 2-2, pg. 26 Table 2. Life Expectancy at Birth and Health-Adjusted Life Expectancy, Selected Countries, 2004 CountryLife Expectancy / Life Expectancy (Males) Life Expectancy / Life Expectancy (Females) Afghanistan 42/35.3 Bangladesh 62/55.363/53.3 Brazil 67/57.274/62.4 China 70/63.174/65.2 Denmark 75/68.680/71.1 Ghana 56/49.258/50.3 India 61/53.363/53.6 Indonesia 65/57.468/58.9 US 75/67.280/71.3 Peru 69/59.673/62.4

DALY (DISABILITY-ADJUSTED LIFE YEAR)

Disability-Adjusted Life Year (DALY) Commonly used to measure global burden of disease Health Event : illness Disability Death Health Lost Causing the disapearance of future healthy years of life DALY Measured by

DALY “... a unit for measuring the amount of health lost because of a particular disease or injury. It is calculated as the present value of future years of disability free life that are lost as the result of the premature deaths or causes of disability occuring in a particular year”

FACTS of DALY DALY of society with more premature illness, injuries, death >> DALY of society with healthier and has less illness, injuries, and death. 1 2 DALY  take account of periodes living in ill health/disablities and wasted years of life expectancy 3 Categories : Group 1  communicable, maternal, and perinatal condition Group 2  noncommunicable diseases Group 3  injuries

E.G : Person Tb at age of 45 years old Die at the age of 47 years old Life expectancy when healthy 80 years old Living w/ illness for 2 years Losing 33 years of life (from life expectancy) Become part of DALY calculation

BURDEN OF DISEASES Charen & Dila

Burden of disease a) The Burden of Deaths and Disease Within Countries : Healthy : Rural people << urban people Ethnic minorities << majority population poor people << better-off people uneducated people << educated people Women will suffer a number of conditions that relate to their relatively weak social positions Low socioeconomic status, higher chance of : Communicable diseases Death of maternal causes Malnutrition Large burden of diseases (related to unhealthy life style)

b) Burden disease in the future : Economic development Scientific and technological change Climate change Political stability Emerging and re-emerging infectious diseases

THE LEADING CAUSES OF DEATH IN LOW-, MIDDLE-, AND HIGH- INCOME COUNTRIES

Leading Causes of Death by Economy Income Group in 2015 Low – Income Countries >52% all deaths caused by “Group I” conditions (communicable diseases, maternal causes, conditions arising during pregnancy and childbirth, and nutritional deficiencies), lower respiratory system, 38% NCDs, and highest traffic injuries. Middle – Income Countries Communicable diseases, lower respiratory, NCDs (78% occurred globally in middle and low income countries), and road traffic injuries High – Income Countries <7% deaths caused by communicable diseases, lower respiratory system, 88% NCDs, and road traffic injuries. Source :

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References Skolnik, Richard Global Health nd Ed. United State of America : Jones & Bartlett Learning World Health Organization. The top 10 Causes of Death. February 14 th (Diakses pada 14 Februari 2017) (Diakses pada 14 Februari 2017)