UCLA School of Public Health Department of Community Health Sciences CHS 200: Global Health Problems Winter Quarter 2016 Thursday 1:00 3:50 PM, Room 61-235 CHS Jessica D. Gipson, MPH PhD Email: jgipson@ucla.edu Requirements: Graduate students Lecture and Discussion 4 units Course Description: Instructor: Office hours: Mon/Fri 10:30-12 Office: CHS 46-071B This course addresses major health problems facing the world. It aims to provide an introductory overview to global health problems in countries at different levels of economic development. We will pay particular attention to low- and middle-income countries and to health inequities between and within countries. The course will address key global health discoveries and research methods that brought them to light. Topics to be examined include: chronic and infectious diseases, child and maternal health, nutrition, social determinants of health, sexual and reproductive health, approaches to solving global health problems, and working in global health. This course is designed to provide a brief overview of several, key global health issues. After completing this introductory course, you may further benefit from courses that delve deeper in to specific global health topics such as Maternal and Child Nutrition, Infectious Disease Epidemiology, Child and Reproductive Health in Communities, Environmental Health, Medical Anthropology and advanced courses in Program Planning and Evaluation in International Health, Health Policy and Management, among others. See course listings for further information. Course Objectives Upon completion of this course participants should be able to do the following: 1) Know, understand, and appreciate the scope and nature of the major health problems in the world 2) Analyze and critique, both verbally and in writing, issues and problems related to complex interrelationships between health, determinants, and social diversity in developing regions 3) Understand and critically evaluate the distribution of health problems between countries at different levels of socioeconomic development. Format The course will take a lecture and discussion format and requires your active participation in discussion and presentations. Required readings and lecture slides will be posted on the course web site. 1
Assignments 1) Global health news. (Weekly) Joining with 1 or 2 other students, you will find an article in the popular media about global health. You will provide that article to your fellow students in advance for them to read. Your team will also identify a matching article from the peer-reviewed literature or a reputable INGO, NGO or government source. Your team will lead a classroom discussion on the news article and will augment this discussion with insights from the matching article. 2) Short assignments. (Due January 21 and February 25) These two assignments will allow you to explore two key topics in the context of one country of your choice and to allow for some feedback from me. Each short assignment should be no more than 2 pages, not including tables and figures. a. Assignment #1 - Data: You will use data (population pyramid graphs, indicators such as DALYS, life expectancy, fertility and mortality rates) to describe the country s position in the demographic and epidemiologic transition. You should not provide a laundry list of indicators, but rather carefully selected indicators that tell the story and the current situation of your chosen country. b. Assignment #2 - Priorities: Based on the above data and profile of your selected country, assert which problems the country should focus on and why. 3) Two-thirds exam. (February 18) The exam will be based on readings and presentations and will include questions and short case studies with short written answers. 4) Final paper. (March 14 by 9am) The director of a foundation approaches you, a global health expert, to help her develop a global health program. You are asked to prepare a Program Development Report. The director will base her funding decision on your report. a. Choose a global health challenge and describe its biomedical and epidemiological features. Most importantly, address the significance of this challenge. b. List and briefly describe the major stakeholders and funders of work in this area. c. Describe the policies and programs that aim to improve this problem. How strong is the evidence-base supporting these policies and programs? d. Based on the size of the foundation (up to you to decide), what type of program do you suggest this foundation launch? What general and specific advice can you offer to the director? Length: 13-15 pages, double-spaced, not including references; 12-point font References: Choose a style, just be consistent, correct, and complete! Margins: 1 Grading and Evaluation 1) Global health news 10% 2) Short assignment #1 15% 3) Short assignment #2 15% 4) Midterm 25% 5) Final paper 35% 2
Week Week 1 January 7 Topic Introduction to Course and Instructors Introduction to Global Health Merson, et al. Global Health: Introduction (pages xvii xxiv) Bloom DE. 7 Billion and counting. Science 2011; 333:562-569. Koplan et al. Towards a common definition of global health. The Lancet 373(9679) Week 2 January 14 Measuring health and disease in the global context - Epidemiological transition - DALYs, Indicators, measurement, burden of disease assessment *TEAM #1: GLOBAL HEALTH NEWS Selected readings for presentation (Team #1) Merson, et al. Measures of Health and Disease in Populations (Chapter 1; READ pgs 1-13, 19, end of 24-39) Murray CL et al. (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2197-2223. G.B.D. Risk Factors Collaborators. (2015) Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. Dec 5;386(10010):2287-323. Lozano R., et al. (2012) 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 15 Dec 380(9859): 2095-2128. Week 3 January 21 Sexual and reproductive health Social determinants and global health *ASSIGNMENT #1 DUE Merson, Chapter 4 (READ PAGES 115-end of section, page 149) Gipson, J.D., et al. (2011) Perceptions and practices of illegal abortion among urban young adults in the Philippines: A qualitative study. Studies in Family Planning Commission on Social Determinants of Health. (2008) Closing the gap in a generation: Health equity through action on the social determinants of 3
health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization. (PAGES 0-23; Executive Summary) Additional Information and Resources Beyrer, et al. (2012) Global epidemiology of HIV infection in men who have sex with men. Lancet 380(9839):367-377. Barot, S. Sexual and reproductive health and rights are key to global development: The case for ramping up investment. Guttmacher Policy Review 18(1): 1-7. Marmot et al. Building of the global movement for health equity: from Santiago to Rio and beyond. Lancet 2012; 181-88. Week 4 January 28 SPECIAL GUEST SPEAKER: DR. CHEIKH NIANG, University Cheikh Anta Diop, Dakar, Senegal (CLASS IN CHS 61-269) Week 5 February 4 Infectious diseases *TEAM #2: GLOBAL HEALTH NEWS Selected readings for presentation Merson, Black & Mills. Chapter 5 Bygbjerg, I.C. Double Burden of Non-communicable and infectious diseases in developing countries. Science 2012; 337, 1499-501 G.B.D. Risk Factors Collaborators. (2015) Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. Dec 5;386(10010):2287-323. (see Week 2 reading) Child and maternal health Double burden - Obesity and malnutrition *TEAM #3: GLOBAL HEALTH NEWS Selected readings for presentation Merson, Chapter 4 (READ Beginning of section, page 149-162) Christian, P., et al. (2015) Nutrition and maternal, neonatal, and child health. Seminars in Perinatology. 39(5): 361-372. Shrimpton, R, et al. (2012) The double burden of nutrition: A review of global evidence. The International Bank for Reconstruction and Development/The World Bank. (READ Executive Summary ix-xi) Liu, L. et al. (2015) Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. The Lancet 385(Jan 31):430-440. 4
Lawn JE, Cousens S, Zupan J, Lancet Neonatal Survival Steering T. 4 million neonatal deaths: when? Where? Why? Lancet 2005;365(9462):891-900. Swinburn BA et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet 2011; 9793: 804-814 Requieo JE et al. Countdown to 2015 and beyond: fulfilling the health agenda for women and children. Lancet 2014 World Health Organization. (2014) Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Week 6 February 11 Non-communicable diseases Review before exam *TEAM #4: GLOBAL HEALTH NEWS *TEAM #5: GLOBAL HEALTH NEWS Merson et al. Global Health: Chapter 7: 345-360, 365 (end) -67 (end), 376-383 (top); Table 7-18, page 391- end Beltran-Sanchez, H., et al. (2015) Twentieth century surge of excess adult male mortality. PNAS, 112(29)8993-98. Rivera et al. (2014) Trends and Heterogeneity of Cardiovascular Disease and Risk Factors Across Latin American and Caribbean Countries. Progress in Cardiovascular Diseases 57(3): 276-285. Week 7 February 18 Week 8 February 25 *EXAM Environmental health Portier CJ, et al. 2010. A Human Health Perspective On Climate Change: A Report Outlining the Research Needs on the Human Health Effects of Climate Change. Environmental Health Perspectives/National Institute of Environmental Health Sciences. (READ Executive Summary, pages iv-vii) Violence and Injuries Mental Health *ASSIGNMENT #2 DUE Haagsma, J.A., et al. (2015) The global burden of injury: incidence, mortality, 5
disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Cooper, H. They Helped Erase Ebola in Liberia. Now Liberia is Erasing Them. December 9, 2015. The New York Times. Advocates for Youth (2010) Factsheet: Gender inequality and violence against women and girls around the world. Merson, Chapter 9 (READ pages 445-459; Table 9-2; 468-470) Blum, et al. (2009) Childhood drowning in Matlab, Bangladesh: An in-depth exploration of community perceptions and practices. Social Science and Medicine World Health Organization (2013) Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and nonpartner sexual violence. Whiteford, H.A., et al. (2013) Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet Nov 9;382(9904):1575-86. Week 9 March 3 Expert lecturer: Dr. Alina Dorian (1-2:20pm) Expert lecturer: Dr. Paula Tavrow (2:30pm 3:50pm) Program development and evaluation in low resource settings - Case study: Complex disaster response Health systems strengthening and Integrated Management of Childhood Illness (IMCI) Merson et al. Global Health Chapter 16 Mills A. (2014) Health Care Systems in Low- and Middle-Income Countries. New England Journal of Medicine 370: 552-557. Pariyo G.W., et al. (2005) Improving facility-based care for sick children in Uganda: training is not enough. Health Policy and Planning. Dec;20 Suppl 1:i58-i68. Arifeen SE et al. Effect of the Integrated Management of Childhood Illness strategy on childhood mortality and nutrition in a rural area in Bangladesh: a cluster randomised trial IMCI. Lancet 2009 Huda TM. Interim evaluation of a large scale sanitation, hygiene and water improvement programme on childhood diarrhea and respiratory disease in rural Bangladesh. Social Science & Medicine 2011 Gyaltsen G. J., et al. (2014) Reducing high maternal mortality rates in western China: a novel approach. Reproductive Health Matters 22(44):164-73. Week 10 March 10 Working in Global Health 6
Expert lecturer: Dr. Dallas Swendeman (2:30-3:50pm) Community mobilization and empowerment - Case study: Sex workers in India *TEAM #6: GLOBAL HEALTH NEWS Selected readings for presentation Crump JA et al. Ethics and best practice guidelines for training experiences in global health. Am J Trop Infect Dis 2010; 83(6):1178-82 Swendeman D, et al. (2009) Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases. Social Science & Medicine 69:1157-1166. 7
ASPH Competencies Objectives: Upon completion of this course students will be able to: 1) Know, understand and appreciate the scope and nature of the major health problems in the world and its dynamic nature. 2) Analyze and critique, both verbally and in writing, issues and problems related to complex interrelationships between health, determinants, and social diversity in developing regions. 3) Understand and critically evaluate the distribution of health problems between countries at different levels of socioeconomic development. ASPH Competencies: E. 2. Identify the causes of social and behavioral factors that affect health of individuals and populations. E.4. Identify critical stakeholders for the planning, implementation and evaluation of public health programs, policies and interventions. G.3. Explain why cultural competence alone cannot address health disparity. J. 4. Apply the core functions of assessment, policy development, and assurance in the analysis of public health problems and their solutions. K. 1. Describe how social, behavioral, environmental, and biological factors contribute to specific individual and community health outcomes. E.2. Identify the causes of social and behavioral factors that affect health of individuals and populations. E.4. Identify critical stakeholders for the planning, implementation and evaluation of public health programs, policies and interventions. E. 9. Apply ethical principles to public health program planning, implementation and evaluation. G.3. Explain why cultural competence alone cannot address health disparity. J. 4. Apply the core functions of assessment, policy development, and assurance in the analysis of public health problems and their solutions. K.1. Describe how social, behavioral, environmental, and biological factors contribute to specific individual and community health outcomes. E.2. Identify the causes of social and behavioural factors that affect health of individuals and populations. E.6. Describe the role of social and community factors in both the onset and solution of public health problems. E. 9. Apply ethical principles to public health program planning, implementation and evaluation. G.3. Explain why cultural competence alone cannot address health disparity. 8