Global Health | SkilledProfessors

Arun Chockalingam

Goldman-Cecil Medicine, 5, 19-21.e2  Newer version available   Newer Version Open reading modeHealth is a human right, but more than 2 billion people live with a daily income of less than $2 and have no access to good health care. Health is determined by the context of people’s lives. Individuals are unable to control many of the social determinants of health ( Chapter 4 ), such as income, social status, education, physical environment, social support network, genetics, health services, and gender.In the process of modernization from a less developed to a more developed nation, the epidemiological transition of modern sanitation, medications, and health care has drastically reduced infant and maternal mortality rates and extended average life expectancy. As a result, the world has progressed from the age of pestilence and famine, with a life expectancy between 20 and 40 years, to the age of receding pandemics, with a life expectancy of 30 to 50 years, and now to the current age of degenerative and man-made diseases, with a global life expectancy at birth of 73.5 years in 2019 prior to the severe acute respiratory syndrome coronavirus-2 pandemic ( Chapter 342A ). 1bThese trends, coupled with subsequent declines in fertility rates, have driven a demographic transition in which the major causes of death change from infectious diseases to chronic and degenerative diseases. As many countries around the world have undergone globalization, owing to their internal urbanization, modernization, and economic development, an increased proportion of their burden of morbidity and mortality is now due to chronic noncommunicable diseases, including cardiovascular, 1 , 1c , 1d cerebrovascular, and renovascular diseases 2 as well as cancer, 2b diabetes, hypertension, 2c chronic respiratory diseases, and mental disorders ( Table 5-1 ).TABLE 5-1EPIDEMIOLOGIC TRANSITION IN CARDIOVASCULAR DISEASESModified from Omran AR. The epidemiological transition: a theory of the epidemiology of population change. The Milbank Quarterly. 2005;83:731-757. Reprinted from The Milbank Memorial Fund Quarterly. 1971;49:509-538; and Yusuf S, Reddy S, Ounpuu S, et al. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104:2746-2753.
STAGES OF DEVELOPMENTLIFE EXPECTANCYBURDEN OF CARDIOVASCULAR DISEASE DEATHS, % OF TOTAL DEATHSPREDOMINANT CARDIOVASCULAR DISEASES AND RISK FACTORSMODERN REGIONAL EXAMPLES
1.
Age of pestilence and famine20-40 years5-10Infections, rheumatic heart disease, and nutritional cardiomyopathiesRural India, sub-Saharan Africa, South America
2.
Age of receding pandemics30-50 years10-35As above plus hypertensive heart disease and hemorrhagic strokesChina
3.
Age of degenerative and man-made diseases50->60 years35-65All forms of strokes; ischemic heart disease at young ages; increasing obesity and diabetesAboriginal communities, urbanIndia, former socialist economies
3A.
Age of delayed degenerative diseases>60 years<50Stroke and ischemic heart disease at old ageWestern Europe, North America, Australia, New Zealand
3B.
Age of health regression and social upheaval50-60 years35-55Re-emergence of deaths from rheumatic heart disease, infections, increased alcoholism and violence; increase in ischemic and hypertensive diseases in the youngRussia
View full sizeDuring stages 1 to 3A, life expectancy increases, whereas life expectancy decreases in stage 3B compared with stage 3A and even stage 3. What Is Global Health?The term global health is sometimes confused with public health, international health, tropical medicine, and population health. Global health, which is defined as the health of populations in a global context, transcends the perspectives and concerns of individual nations and crosses national borders. Global health depends on the public health efforts and institutions of all countries, including their strategies for improving health, both population-wide and for individuals. Global health depends on multiple factors, including social, political, environmental, and economic determinants of health. Although global health often focuses on improving the health of people who live in low- and middle-income countries, it also includes the health of any marginalized population in any country.Global health requires using a wide range of institutions that collaborate in addressing all health issues. Global health also depends on the constructive use of evidence-based information to provide health and health equity, in part by strengthening primary health care and the health care delivery system.Millennium Development GoalsIn an attempt to address global inequity, the United Nations advanced eight millennium development goals with the objective of achieving these goals between 2000 and 2015. These eight goals incorporate 21 targets ( E-Table 5-1 ), with a series of measurable health and economic indicators for each target. Although many of the targets have not yet been achieved, substantial progress has been made toward all targets. 3E-TABLE 5-1MILLENNIUM DEVELOPMENT GOALS AND TARGETS (2000-2015)From United Nations Millennium Development Goals. http://www.un.org/millenniumgoals/poverty.shtml . 2008. Accessed May 10, 2019.
GOAL 1: ERADICATE EXTREME POVERTY AND HUNGERTarget 1A: Halve, between 1990 and 2015, the proportion of people living on less than $1.25 a day.Target 1B: Achieve decent employment for women, men, and young people.Target 1C: Halve, between 1990 and 2015, the proportion of people who suffer from hunger.GOAL 2: ACHIEVE UNIVERSAL PRIMARY EDUCATIONTarget 2A: By 2015, all children (girls and boys) can complete a full course of primary schooling.GOAL 3: PROMOTE GENDER EQUALITY AND EMPOWER WOMENTarget 3A: Eliminate gender disparity in primary and secondary education preferably by 2005, and at all levels by 2015.GOAL 4: REDUCE CHILD MORTALITY RATESTarget 4A: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate.GOAL 5: IMPROVE MATERNAL HEALTHTarget 5A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.Target 5B: Achieve, by 2015, universal access to reproductive health.GOAL 6: COMBAT HIV/AIDS, MALARIA, AND OTHER DISEASESTarget 6A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS.Target 6B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it.Target 6C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases.GOAL 7: ENSURE ENVIRONMENTAL SUSTAINABILITYTarget 7A: Integrate the principles of sustainable development into country policies and programs; reverse loss of environmental resources.Target 7B: Reduce biodiversity loss, achieving, by 2010, a significant reduction in the rate of loss.Target 7C: Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation.Target 7D: By 2020, to have achieved a significant improvement in the lives of at least 100 million slum-dwellers.GOAL 8: DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENTTarget 8A: Develop further an open, rule-based, predictable, non-discriminatory trading and financial system.Target 8B: Address the special needs of the least developed countries.Target 8C: Address the special needs of landlocked developing countries and Small Island developing States.Target 8D: Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term.Target 8E: In cooperation with pharmaceutical companies, provide access to affordable, essential drugs in developing countries.Target 8F: In cooperation with the private sector, make available the benefits of new technologies, especially information and communications.
View full sizeThe millennium development goals emphasize that health and development are interconnected. To address global inequity, fundamental issues include reducing poverty, improving education, and empowering people. In addition to specific goals for reducing infant and child mortality, maternal mortality, and mortality owing to infectious diseases such as HIV/AIDS, malaria, and tuberculosis, the millennium development goals strongly encourage environmental sustainability and global partnership. Global Burden of DiseasesThe global burden of disease is measured in terms of total and cause-specific mortality and morbidity, as well as the national economic burden for health care. 3b About 55 million people die from all causes annually, with about 25% of deaths due to communicable, maternal, neonatal, and nutritional disorders, 65% due to noncommunicable diseases, and 10% due to injuries ( Table 5-2 ). 4 Although overall deaths between 1990 and 2010 increased by 13.5%, medical and public health advancements reduced deaths from communicable diseases by 17%, whereas deaths due to noncommunicable disease increased by 30% and deaths due to injury, including war-related deaths, increased by 24%.TABLE 5-2GLOBAL DEATHS IN 1990 AND 2015 FOR ALL AGES AND BOTH SEXES COMBINEDAdapted from Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095-2128; and GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459-1544.
CAUSES OF DEATHALL AGES—DEATHS (THOUSANDS)
19902015% CHANGEALL CAUSES46,51155,793+20Communicable, Maternal, Neonatal, and Nutritional Disorders15,85911,264−29HIV/AIDS and tuberculosis17702,305+30Diarrhea, lower respiratory infection, and other common IDs77724,960−36Neglected tropical diseases and malaria1211843−30Maternal disorders359275−23Neonatal disorders30812163−30Nutritional deficiencies977406−58Other communicable, maternal, neonatal, and nutritional disorders690311−55Noncommunicable Diseases26,56039,804+50Neoplasm57798,765+52Cardiovascular and circulatory diseases11,90317,921+51Chronic respiratory diseases39863,796−5Cirrhosis of the liver7781,292+66Digestive diseases (except cirrhosis)9731,203+24Neurologic disorders5952,259+280Mental and behavioral disorders138325+136Diabetes, urogenital, blood, and endocrine diseases15443,409+121Musculoskeletal disorders7090+29Other noncommunicable diseases794745−6Injuries40924,725+16Transport injuries9581,467+53Unintentional injuries other than transport injuries20301,839−9Self-harm and interpersonal violence10091,238+23Forces of nature, war, and legal intervention95183+93
View full sizeHIV/AIDS = human immunodeficiency virus infection/acquired immunodeficiency syndrome; ID = infectious disease.Adapted from Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095-2128; and GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459-1544.Child mortality under the age of 5 years decreased by 52% between 1990 and 2015. Neonatal deaths and stillbirths also have fallen significantly. 5 Changing Patterns of DiseasesDespite the general trends of declining morbidity and mortality from communicable diseases, parts of Africa, Asia, and Latin America are still facing the challenges of infectious diseases, such as HIV, malaria, and tuberculosis, even as their prevalence of chronic noncommunicable diseases has risen—a so-called double burden. Concerted global health efforts and public awareness, as well as investments by industrialized countries, multilateral agencies, and nongovernmental organizations, have resulted in significant progress against HIV/AIDS ( Chapter 360 ). The worldwide mortality owing to HIV/AIDS and tuberculosis rose by 50% in 2010 compared with 1990 and then declined by 30% in 2015, but drug-resistant tuberculosis ( Chapter 308 ) is an increasing worldwide challenge. 6Although malaria deaths have fallen worldwide over the last decade, malaria is a rising threat in parts of Southeast Asia—especially Cambodia, Myanmar, Thailand, and Vietnam—where drug resistance to antimalaria medications is problematic.The age of the population is increasing all over the world, and so is the number of people living with consequences of diseases and injuries. Epidemiological shifts driven by socioeconomic change also contribute to the worldwide increase in years lived with disability as well as the rate of increase in years lived with disability. 7 Although some countries have recognized the problem of aging and developed programs to deal with its burden on health care resources, many countries are not prepared at all. 8Noncommunicable diseases account for nearly two thirds of the global burden of disease. Nearly 80% of all noncommunicable diseases related to death and disability occur in the low- and middle-income countries, 9 where they account for about 14 million deaths in people under age 60 years. The prevention and control of noncommunicable diseases should involve both upstream and downstream approaches, such as: social determinants; national and international policies regarding trade, agriculture, transportation, and environmental and other policies; health care, including accessibility, availability, and affordability; and settings, such as schools and worksites, where health promotion and disease prevention are targeted, as well as media by which health can be influenced.Although the global burden of disease has been shifting from infectious diseases to degenerative noncommunicable diseases, the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes—officially named coronavirus disease 2019 (COVID-19)—has triggered a worldwide pandemic. As of April, 2021 this pandemic has resulted in over 150 million confirmed cases and more than 3 million confirmed deaths, 9b thereby making it the single most common cause of death and disability in recent years.Population growth and aging also have resulted in an increasing number of people living with atherosclerotic vascular disease worldwide, despite the decrease in the age-adjusted incidence of myocardial infarction and ischemic stroke in high-income regions. Rising levels of obesity ( Chapter 207 ) and diabetes ( Chapter 216 ) have reached epidemic proportions in many countries. Smoking ( Chapter 29 ) rates are increasing in low-income countries, with the increase more than offsetting declines in high-income countries. 10 Hypertension ( Chapter 70 ) has an estimated worldwide prevalence of 35 to 45% of the global population—more than 2 billion people over the age of 25 years. 11 The age-standardized prevalence of hypertension is highest in Africa, where it is about 45% for both sexes, and is lowest in the Americas, where it is about 35% for both sexes. 12 In all regions, men have a slightly higher prevalence of hypertension than do women. Despite significant efforts by global nongovernmental and multilateral organizations, including the World Health Organization, more than 50% of the world’s population with hypertension does not even know their condition, and the percentage treated and controlled varies from less than 5% in Zambia to 66% in Canada. A promising possibility is a multicomponent community-based intervention, which has shown promise in Asia. A1bThe growing epidemic of noncommunicable diseases, including mental disorders, and the unfinished agenda of controlling infectious diseases (HIV/AIDS, malaria, tuberculosis, maternal and child health, and other infectious |and parasitic diseases) poses a huge threat to the global population both in terms of human and fiscal losses. Noncommunicable diseases represent a growing economic threat across the globe and are becoming an acute problem in low- and middle-income countries ( Table 5-3 ) in which they are estimated to account for nearly $500 billion per year.TABLE 5-3WHO ESTIMATES, 2015: PROBABILITY OF DYING FROM ANY OF THE 4 MAJOR NONCOMMUNICABLE DISEASES (CARDIOVASCULAR DISEASES, CANCER, DIABETES OR CHRONIC RESPIRATORY DISEASES) BETWEEN THE AGES OF 30 AND 70Adapted from World Health Statistics 2017: monitoring health for the SDGs. World Health Organization. https://reliefweb.int/sites/reliefweb.int/files/resources/9789241565486-eng.pdf . Accessed May 10, 2019.
LOW PROBABILITY 16% OR LESSHIGH PROBABILITY MORE THAN 25%REGIONCOUNTRY(%)COUNTRY(%)AfricaAlgeriaCabo Verde, Gabon1516Côte d’IvoireSierra Leone2830AmericaCanadaChile, Costa Rica1011Trinidad and TobagoGuyana2628Eastern MediterraneanQatarIran1415SudanAfghanistan, Yemen2631EuropeIcelandItaly, Sweden, Switzerland89Belarus, Kazakhstan, Russian FederationTurkmenistan2935South East AsiaMaldivesThailand1216Democratic People’s Republic of KoreaIndonesia2627Western PacificRepublic of KoreaAustralia, Japan89FijiPapua New Guinea3136
View full sizeWorldwide adoption of best practices could substantially reduce that economic burden. For example, population-based interventions to reduce tobacco and harmful alcohol use, as well as to improve unhealthy diets and increase physical activity, are estimated to cost less than $0.40 per person per year.Although individual countries theoretically take responsibility for the health of their respective citizens, many low- and middle-income countries are unable to meet their domestic population’s basic needs. The sum of public and private health care expenditure by countries based on their gross domestic product varies between 1.6% in South Sudan to 18% in the United States, with many high-income countries spending more than 10%. Thus, the worldwide solution requires a response of all of human society, including strategic domestic and international investments, both within countries and through multilateral agencies. This societal responsibility must be shared by the private sector, nongovernmental organizations, academia, professional societies, and the public themselves. 12bTo meet these global needs, all 192 United Nations member states agreed to address their prevention and control worldwide, particularly in developing countries. The emphasis is on four major noncommunicable diseases (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) and four key risk factors common to all four of these noncommunicable diseases (tobacco use, unhealthy diets, physical inactivity, and harmful use of alcohol). Since 2011, there has been considerable discussion about both mental health and musculoskeletal disorders, which also contribute to the global burden of noncommunicable diseases. 13 The World Health Organization developed a global monitoring framework to enable global tracking of progress in preventing and controlling these four major noncommunicable diseases and their key risk factors, aiming for a 25% reduction by 2025—with a slogan of 25 By 25.The United Nations also adopted a set of goals to end poverty, protect the planet, and ensure prosperity for all as part of a new sustainable development agenda called Sustainable Development Goals (SDG) 2015-2030. 14 The sustainable development goals aim to protect the world from dangers of environmental catastrophe and to protect the planetary life. The aims by 2030 are to reduce premature mortality from noncommunicable diseases by one third through prevention and treatment and to promote both mental health and well-being.As the world has undergone unprecedented hardship because of COVID-19, urgent attention focused on the development of vaccines. By mid-November 2020, 164 candidate vaccines were in preclinical evaluation, 48 vaccines were in clinical evaluation, 14b and at least nine were in phase III clinical trials. Four completed phase III trials (Pfizer/BioNtech’s BNT162b2, A1c NIAID/NIH sponsored Moderna’s mRNA-1273, A1d University of Oxford and AstraZeneca’s AZD1222, A1e and Russian Gamaleya’s Sputnik V vaccine 14c ), and the first three are becoming widely available for human use.Universal health coverage is a key global health transition for the future. Although many high-income countries have some form of universal health coverage and some upper middle-income countries have introduced basic universal health coverage, many lower-middle-income and low-income countries are just beginning to introduce universal health coverage. This transition, if successful, should bring global equity, save people from paying huge health care costs, and lead to better health outcomes. Grade A References
A1b. Jafar TH, Gandhi M, de Silva HA, et. al.: A community-based intervention for managing hypertension in rural South Asia. N Engl J Med 2020; 382: pp. 717-726.
View In Article Cross Ref
A1c. Walsh EE, Frenck RW, Falsey AR, et. al.: Safety and immunogenicity of two RNA-based Covid-19 vaccine candidates. N Engl J Med 2020; 383: pp. 2439-2450.
View In Article Cross Ref
A1d. Jackson LA, Anderson EJ, Rouphael NG, et. al.: An mRNA vaccine against SARS-CoV-2 – preliminary report. N Engl J Med 2020; 383: pp. 1920-1931.
View In Article Cross Ref
A1e. Folegatti PM, Ewer KJ, Aley PK, et. al.: Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial. Lancet 2020; 396: pp. 467-478.
View In Article Cross RefGeneral References
1b. GBD 2019 Demographics Collaborators : Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: pp. 1160-1203.
View In Article Cross Ref
1. Roth GA, Johnson C, Abajobir A, et. al.: Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017; 70: pp. 1-25.
View In Article Cross Ref
1c. Yusuf S, Joseph P, Rangarajan S, et. al.: Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 2020; 395: pp. 795-808.
View In Article Cross Ref
1d. Roth GA, Mensah GA, Johnson CO, et. al.: Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol 2020; 76: pp. 2982-3021.
View In Article Cross Ref
2. Thomas B, Matsushita K, Abate KH, et. al.: Global cardiovascular and renal outcomes of reduced GFR. J Am Soc Nephrol 2017; 28: pp. 2167-2179.
View In Article
2b. Canfell K, Kim JJ, Brisson M, et. al.: Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet 2020; 395: pp. 591-603.
View In Article Cross Ref
2c. Geldsetzer P, Manne-Goehler J, Marcus M-E, et. al.: The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1.1 million adults. Lancet 2019; 394: pp. 652-662.
View In Article Cross Ref
3. Development goals in an era of demographic change: global monitoring report 2015/2016. World Bank Group 2016 http://pubdocs.worldbank.org/en/31141444230135479/GMR-Over-and-Exec-Summary-English.pdf
View In Article
3b. Dagenais GR, Leong DP, Rangarajan S, et. al.: Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study. Lancet 2020; 395: pp. 785-794.
View In Article Cross Ref
4. GBD 2017 Causes of Death Collaborators : Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the global burden of disease study 2017. Lancet 2018; 392: pp. 1736-1788.
View In Article Cross Ref
5. GBD 2015 Child Mortality Collaborators : Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the global burden of disease study 2015. Lancet 2016; 388: pp. 1725-1774.
View In Article
6. Dheda K, Gumbo T, Maartens G, et. al.: The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis. Lancet Respir Med 2017; 5: pp. 291-360.
View In Article Cross Ref
7. GBD 2017 DALYs and HALE Collaborators : Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: pp. 1859-1922.
View In Article Cross Ref
8. Chockalingam A: Next major challenge in global noncommunicable diseases. Int J Non-Commun Dis 2017; 2: pp. 27-29.
View In Article Cross Ref
9. Allen L, Williams J, Townsend N, et. al.: Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review. Lancet Glob Health 2017; 5: pp. e277-e289.
View In Article
9b. WHO Coronavirus (COVID-19) Dashboard. World Health Organization . https://covid19.who.int . Accessed May 2, 2021.
View In Article
10. GBD 2015 Tobacco Collaborators : Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the global burden of disease study 2015. Lancet 2017; 389: pp. 1885-1906.
View In Article
11. Forouzanfar MH, Liu P, Roth GA, et. al.: Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm hg, 1990-2015. JAMA 2017; 317: pp. 165-182.
View In Article Cross Ref
12. Mills KT, Bundy JD, Kelly TN, et. al.: Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation 2016; 134: pp. 441-450.
View In Article
12b. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050. Lancet 2019; 393: pp. 2233-2260.
View In Article Cross Ref
13. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. World Health Organization http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf?ua=1
View In Article
14. Sustainable development goals : Goal 3: good health and well-being. United Nations Development Programme http://www.undp.org/content/undp/en/home/sustainable-development-goals/goal-3-good-health-and-well-being.html
View In Article
14b. Dong Y, Dai T, Wei Y, et. al.: A systematic review of SARS-CoV-2 vaccine candidates. Signal Transduct Target Ther 2020; 5: pp. 237.
View In Article
14c. Cohen J. Russia’s approval of a COVID-19 vaccine is less than meets the press release. Science Mag . https://www.sciencemag.org/news/2020/08/russia-s-approval-covid-19-vaccine-less-meets-press-release . Accessed December 14, 2020.
View In ArticleReview Questions
1.
Hypertension or high blood pressure is the major risk factor for heart disease, stroke, and kidney diseases worldwide. Which of the following statements is incorrect?
A.
The prevalence of hypertension over the age of 25 varies between 35 and 45% globally.
B.
Across all countries, men have a slightly higher prevalence of hypertension than do women.
C.
The global hypertension control rate is about 60%.
D.
Early diagnosis of hypertension leads to prevention of all forms of vascular complications.
E.
According to the World Health Organization, population attributable deaths owing to hypertension are estimated to be about 7.5 million per year.Answer: C The global control rate varies from less than 5% in Zambia to 66% in Canada and is very low overall worldwide. All other statements (Answers A, B, D and E) are correct.
2.
Which of the following statements about global health is correct?
A.
Global health is not the opposite of domestic health.
B.
Global health must integrate both infectious diseases and noncommunicable diseases.
C.
Public, private, and societal partnership is necessary to deliver effective global health.
D.
Academia has a major role in promoting global health.
E.
All of the above.Answer: E Statement A is true since global health includes domestic health as well, particularly on the health of marginalized people in developed countries. Statement B is true, since the current health system must address all diseases, particularly when noncommunicable diseases account for 65% of all global causes of death. New evidence shows that one fifth of all cancers worldwide are caused by chronic infections produced by agents such as HIV, human papillomavirus, and hepatitis B virus. Infections and parasitic diseases also cause other noncommunicable diseases, such as rheumatic heart disease, Chagas disease, cardiomyopathy, and peptic ulcer. As HIV/AIDS survivors live longer, they also are exposed to lifestyle-related risk factors and noncommunicable diseases. Statement C is true. The economic burden of diseases is so large that public-private partnership is essential. Statement D is true. Academia should develop and supply needed knowledge and train the next generation of the global health work force.  Previous Chapter Next Chapter  Goldman-Cecil MedicineTwenty Sixth EditionCopyright © 2020 by Elsevier, Inc. All rights reserved.Get rights and content

Contact Us Resource Center Registered User Agreement Help Terms & Conditions Privacy Policy Accessibility
We use cookies to help provide and enhance our service and tailor content. By continuing you agree to the Cookie settings | Your Privacy Choices.All content on this site: Copyright © 2024 Elsevier Inc., its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies. For all open access content, the Creative Commons licensing terms apply.