Global Health Determinants

8/6/2019 Global Health Determinants

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GLOBAL HEALTH AND ITS DETERMINANTS

Roberto De Vogli

Department of Epidemiology and Public Health, University

College London


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Theory and Evidence

Ideas

THEORY

Inductive Deductive

Reasoning Reasoning

EVIDENCE

Reality


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Scientific Evidence?

Data speak by themselves

vs.

If you torture the data long enough, they will

eventually confess everything!


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Lies, Damn Lies and Statistics

There are three kinds

of lies: lies, damned

lies and statistics


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It is easy to lie with statistics,

butit is even easier to lie without them


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The important thing

is not to stop

questioning

A. Einstein


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In Africa they didn't know what 'food' meant.

In Eastern Europe they didn't know what 'honest' meant.

In China they didn't know what 'opinion' meant.

In the Middle East they didn't know what 'solution' meant.

In South America they didn't know what 'please' meant. In Western Europe they didn't know what give' meant.

And in the USA they didn't know what 'the rest of the world' meant.

UN Food Shortage Worldwide Survey.UN Food Shortage Worldwide Survey.

The only question asked was:The only question asked was:

Would you please give your honest opinion about solutions toWould you please give your honest opinion about solutions to

the food shortage in the rest of the world?the food shortage in the rest of the world?

The survey was a huge failure....The survey was a huge failure....


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Outline

A. What are the major categories of globalhealth determinants?

B. What are the most important?

C. What are their relative contributions indetermining global health?

D. Exercise


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Outline




D. Exercise


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Meta-theories of Health Determinants

Nutrition (Mc Keown, 1976)

Public health technology (Preston, 1976)

Economic growth - poverty reduction (Preston, 1976)

Sanitation, hygiene and clean water

Education, autonomy of women and maternal and childservices (Caldwell, 1986)

Income Inequality (Wilkinson, 1992)

Health behaviors (Mc Ginnis, 1993)

Medical treatment (Bunker, 1994)

Gene expression (Venter, 2001)


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Frameworks of Health Determinants (I)

Disease HealthCare

Cure, care

OtherFactors

Clinical Epidemiology

Healthcare Evaluation

Health Services Research, etc.Source: Evans and Stoddart, 1994.


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HEALTH CARE


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OECD, 2005. Health at a glance


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Source: Ontario Cancer Registry 1999


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Frameworks of Health Determinants (II)

DiseaseHealth

Care

Cure, care

Other

Factors

Lifestyle Environment Biology

Source: Evans and Stoddart, 1994.Clinical Epidemiology

Healthcare Evaluation

Health Services Research, etc.


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BEHAVIOURS


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Smoking and Lung Cancer: animal studies


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and human studies


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ENVIRONMENT

(PHYSICAL AND SOCIAL)


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Fig 1 Neighbourhood specific homicide rates (per 100 000 population per year) in relation

to male life expectancy at birth (with effects of homicide mortality removed) for 77 communityareas of Chicago, 1988-93


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BIOLOGY


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STRESS AND ITS BIOLOGICAL TRANSLATION

Stress is posited to get under the skin

via different biological pathways

including the hypothalamic-pituitary-

adrenal (HPA) system

People may differ in terms of

psychological, biological and

behavioural response to stressors


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Frameworks of Health Determinants (III)

Wellbeing Prosperity

Individual

Responses:

Behavior

Biology

Social

Environment

Physical

Environment

Genetic

Endowment

Health

&

FunctionDisease

Health

Care

Source: Evans and Stoddart, 1994.


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Outline




D. Exercise


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Kunst A 1998.

Fig. 1. Probability of men in non-manual and manual classes dying between the ages 45 and 65.


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Figure 3. Under-5 mortality rates by socioeconomic quintile of the household for selectedcountries based on data taken from the World Bank.

Victora et al. Lancet 2003;362:233-41


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Source: Davey-Smith (1996) Age adjusted mortality of 300 685 white American men by median family

income of zip code areas in the United States. AJPH 1996;86:497-504.


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1. The sport of choice for the urban poor is

BASKETBALL.

2. The sport of choice for maintenance level employees

is BOWLING.

3.The sport of choice for front-line workers isFOOTBALL.

4. The sport of choice for supervisors is BASEBALL.

5. The sport of choice for middle management is TENNIS.

6. The sport of choice for corporate officers is GOLF.

Socioeconomic status and sport of choice


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Figure Life expectancy among males and females in India compared with United States, mid-1990

from Sen (2002)


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Inequality and health worlwide

Babones (2007) Social Sciences


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Source: De Vogli R, Mistry R, Gnesotto R and Cornia GA (2005) Has the relation between income

inequality and life expectancy disappeared? J Epidemiology and Community Health

Income inequality and life expectancy among wealthy nations


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Fig. 1. Mortality in working age men by proportion of income belonging to the less well off half of households, US states

(1990) and Canadian provinces (1991). Mortality standardised to Canadian population in 1991.State abbreviations: LA-Louisiana; MS-Mississippi; AL-Alabama; SC-South Carolina; FL-Florida; TX-Texas; CA-California; AR-Arkansas;

NH-New Hampshire; MN-Minnesota. Province abbreviations: QC-Quebec; NS-Nova Scotia; NB-New Brunswick; ND-Newfoundland;

PE-Prince Edward Island; ON-Ontario; AB-Alberta; BC-British Columbia; MB-Manitoba; SK-Saskatchewan


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Outline




D. Exercise


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WHO (2002). GLOBAL RISK FACTORS. High-mortality, developing REGIONS=subregions in D and E mortality strata. Lower-mortality, developing

REGIONS=AMR-B, EMR-B, SEAR-B, and WPR-B subregions. Developed REGIONS=AMR-A, EUR, and WPR-A. The figure shows the estimate d

mortality and disease burden for each risk factor considered individually. These risks act in part through other risks and act jointly with other risks.

Consequently, the burden due to groups of risk factors will usually be less than the sum of individual risks.


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WHO (2002).


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Relative Influence of Health Determinants

Societal/social

characteristics

Total Ecology

Genes & Biology

Health Behaviors

Health Care


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Now I can see the real picture

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Global Health Determinants