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Major GH Challenges - Coggle Diagram

- - - - Barriers for integrated intervention
        As part of new pub mngt, politicians, donor agencies, health pros & researchers inclined or forced to focus on 1 particular health pb to get visible results & fulfill contracts
- - - - 5 insights from the Global Burden of Disease Study (Murray et al .2019)
        
        1. High impact of SDI on health progress
        Should double down on policies & strategies that:
        
        stimulate econ growth
        
        expand access to primary & secondary schooling
        
        imrpove the status of women
        
        :tada: Catch-up social & econ dvlpt fuelling more rapid health progress in lower SDI quintiles
        
        :broken_heart: Alarmingly, in some high SDI nations, decreased mortality in CVD have slowed or reversed over past decade
        
        2. MDG health agenda has been working -- might need to down-prioritize CMNN diseases
        Faster progress in reduction of CMNN diseases compared to NCDs & injuries
        
        Despite pop growth, the abslute nb of DALYs for CMNN causes has decreased
        
        VS DALY for NCDs have barely reduced (pop growth & ageing resuluted in increased DALYs)
        
        :tada: Success in reducing GBD from causes of CMNN diseases by global collective action to fund key progs!!
        
        :tada: Using health dvlpt goals more broadly will reinforce the policy value of global comparative assessments in the health sector
        i.e. the ongoing GBD
        
        3. Health systems must be more agile to adapt to rapid shift to NCDs & disabilities
        
        Coverage of CMNN diseases increases almost linearly (esp w/ higher SDI)
        
        Coverage of NCD intervention lags behind (esp in rapid transition countries w/ lower-SDI)
        
        Middle-SDI gap emerges
        --> Despite gap, most policy discussion firmly focused on CMNN disease agenda
        
        => Importance of "Double Burden of dDsease" requires integrated control strategies that begin in the PHC sector
        
        4. PH failing to address the increase in crucial global risk factors
        --> All risks in GBS account for 48% of global DALYs
        
        As global SDI increased = many risks (correlated w/ SDI) have decreased:
        
        air pollution
        
        child growth failure
        
        unsafe WASH
        
        Smoking
        
        Might be approaching turning point in terms of life expectancy gains:
        
        Increased in exposure to key metabolic risks
        
        the slowing / reversals of l-t reductions in CVDs
        
        Inadequate policy attention & funding for PH action & behavioral R seen
        
        through failure to slow / reverse global rise in BMI (facilitate healthier diets or increase phy act)
        
        :broken_heart: Rising exposure to crucial risks
        
        High BMI
        
        High fasting P-glucose
        
        Ambient particulate matter pollution
        +
        Stagnant exposure to many other behavioral risks
        
        diet qual & phy act
        
        Might attenuate past 70 years of sustained improvements in health
        
        :broken_heart: New challenges must be urgently addressed = rising temp & associated increases in poverty
        
        5. Social, fiscal & geopol challenges of inverted pop pyramids
        --> Countries w/ neg natural rates of increase (crude death rate > crude birth rate)
        
        Female educ attainment (reaches 16yo) + Met contra' need (reaches 95%) = global total fertility rate DECREASE to 1.41
        
        Over time, decreased fertility rates lead to inverted age pyramids
        
        From where could the age gap be filled in pops in Europe, asia, Oceania & America? + could Covid have changed the situation?
        
        :broken_heart: Low fertility likely to be a profound socio-econ challenge
- - - - HTN
        
        Nb of people living w/ HTN x2 since 1990 (30y) = from 650M to 1.28B
        -> Half did not know they had it
        
        +700M w/ untreated HTN
        
        1 of top causes of death & diseases
        
        Increases risk of heart, brain & kidney diseases
        
        Easily detected through BP measure
        
        Effectively treated w/ low-cost meds
        
        Burden shift from wealthly nations to LMICs
    - - Multimorbidity
        the co-existence of 2 or more chronic conditions, where 1 is not necessarily more central than the others (often l-t & requiring complex on-going care)
        
        More used by health researchers to describe patients w/ Multiple Chronic Conditions (MCCs)
        
        Ageing pops + increasing l-t confitions = nb of people w/ MCCs will increase
        
        More common in disadvantaged grps (contributing to health ineqs'
        
        At higher risk of safety issues in primary care due to complex patient needs for MCCs
        
        Polpharmacy = may lead to poor medication adherence & adverse drug events
        2.More frequent & complex interactions w/ HC services = greater susceptibility to failures of care delivery & coord
        
        Need for patient-centered care w/ clear comms
        
        Demanding self-mngt regimens & competing priorities
        
        More vulnerability due to:
        
        poor health
        
        advanced age
        
        cognitive impairment
        
        limited health literacy
        
        comorbidity of depression or anxiety
        
        4 (potential) solutions
        
        Systems-based approach - MM associated w. socio-econ deprivation
        
        Primary care coverage - managing MCCs depends on a well-organized PHC system
        
        Promoting generalism - may need specialist care in episodic fashion but overall care needs are best met by generalists ("intepretive medicine" integrating multiple sources of knowledge w/ ind needs ass)
        
        Clinical guidelines - usually focused on single conditions
        
        :green_book: Cape Town socio-econ determinants & inequalities
        No adequate areas to exercise bc of high murder rates & inadequate env
        BUT
        Opening of the Gugulethu Community Health Centre (founded by Desmond Tutu, 2004) where comprehensive services are offered for free
        
        AIDS advice & antiretroviral (ARV) treatment
        
        DM diagnosis & care
        
        CD dispensing unit
        
        MH & palliative care
        TB s-t treatment
        
        Violence survivor support
        
        DM & Obesity / Low birth weight
        --> View HTN & DM2 sheet
        
        Low birth weight may predispose to DM as much as high birth weight
        
        Prevention of DM = avert both LBW & HBW
        
        In India, optimal birth weight to avoid 2.9 kg
        
        In USA, 3.4 kg
        
        In Africa, malaria during pregnancy lowers birth weight by up to 0.25 kg
        
        :alarm_clock: Time to think horizontally regarding double or triple risk exposures rather than through ranks
- - - - "Grown up" society
        
        Accidents (injuries) & violence-related morbidity & mortality increases -- esp among young
        
        Infectious diseases (TB) prevail
        
        Chronic NCDs increase -- esp in urban pops
        
        "Aging" society
        = NCDs predominate
        
        DM2 & CVDs
        
        Cancer & degenerative disorders
        
        => Accidents -> DM (NCDs) -> Coronary Heart Dis -> Cancer
    - - 5 Patterns:
        
        Hunter gatherer = inds live highly active lifestyles, hunting & foraging for food. Diets typically are rich in fibrous plants & high in protein from lean wild animals.
        
        Early Agri = Famine is common, slowing inds growth & decreasing their body fat.
        
        End of famine = Famine recedes as Y rises & nutrition improves.
        
        Overeating = As Y continues to rise, inds have access to an abundance of high-calorie foods, & become less active, leading to increases in obesity & related chronic diseases (ie diabetes & CVD)
        
        Behavior Change = In response to increasing rates of obesity & related chronic diseases, inds change their behavior & communities promote behavior changes
        
        Most LMICs are rapidly moving from Pattern 3 to 4 w/ shift from tradi to Western diets