Introduction to Global Health
Chapter 1: Global Health Transitions 2
Chapter 2: Global Health Priorities 6
Chapter 3: Socioeconomic Determinants of Health 12
Chapter 4: Environmental Determinants of Health 15
Chapter 5: Health and Human Rights 18
Chapter 6: Global Health Financing 22
Chapter 7: Global Health Implementation 24
Chapter 8: HIV/AIDS and Tuberculosis 27
Chapter 9: Diarrheal, Respiratory and Other Infections 34
Chapter 10: Malaria and Neglected Tropical Diseases 39
Chapter 11: Reproductive Health 45
Chapter 12: Nutrition 48
Chapter 13: Cardiovascular Diseases 53
Chapter 14: Cancer 57
Chapter 15: Diabetes, Chronic Respiratory Diseases and other
Noncommunicable Diseases 62
Chapter 16: Mental Health Promotion 67
Chapter 17: Injury Prevention 70
Chapter 18: Promoting Neonatal, Infant, Child and Adolescent
Health 72
Chapter 19: Promoting Healthy Adulthood and Aging 76
Chapter 20: Interprofessionalism in Global Health 78
1
,Chapter 1: Global Health Transitions
Global health = field of academic study, research and applied practice that seeks to
improve population health worldwide
● Global means ‘worldwide’ as well as ‘comprehensive’
● Problems in low-income countries, but also transnational problems that could affect
people in every country
Core values (acronym PACES):
● Population = global health prioritizes the exposure and diseases that cause a considerable proportion
of preventable deaths and/or disabilities in multiple world regions
○ What are the health issues that cause the greatest number of deaths, illnesses and disability
worldwide? Which populations have the greatest need?
● Action = global health uses evidence-based, cost-effective, sustainable interventions to prevent illness
and injury, treat existing diseases and alleviate suffering
○ What are the “best buys” among available interventions? How do we allocate resources to do
the greatest good for the greatest amount of people?
● Cooperation = global health uses international, multi sectoral partnerships to solve complex health
concerns
○ Who are the partners and what are their shared goals? What problem is the partnership best
equipped to solve?
● Equity = global health reduces health disparities by prioritizing the needs of low-income countries and
other disadvantaged populations: health equity = everyone has equal opportunity to be as healthy as
possible
○ What actions will do the most to improve the health status of vulnerable populations? How will
intervention improve health equity?
● Security = global health tackles the health issues that are most likely to contribute to political and
economic instability and conflict
○ What are the greatest threats to peace? How will the intervention help to achieve the national
interests of sponsoring governments?
Many diseases, environmental hazards and other population health issues are classified as
global health priorities based on the PACES criteria.
Definitions:
● Health (WHO definition) = a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity
● Population health = health outcomes and determinants of health in groups of
humans at the community, regional, national and/or worldwide level
● Determinants of health = biological, behavioral, social, environmental, political and
other factors that influence the health status of individuals or populations
● Intervention = strategic action to improve individual and population health status
● Systems thinking = process of identifying the underlying causes of complex
problems so that sustainable solutions can be developed and implemented
● Prevention science = process of determining which preventative interventions are
effective at improving health status, how successful those interventions are in various
populations and how readily they can be scaled up for widespread implementation
● Implementation science = scientific study of how to increase uptake of
evidence-based practices and policies after effective interventions have been
identified
Health is a complex function of individual, interpersonal (relationships), institutional,
organizational, community factors and public policy.
2
,Prevention and intervention science:
There are multiple health trajectories possible in life:
A. Ideal = healthy infant growing into adulthood without
experiencing serious infections, illnesses or injuries; ends in
very old age with a gentle death without months of disability
and pain
B. Very low-income community = large proportion of
children are born with low birthweight and struggle with
repeated infectious diseases, and it is not uncommon for
young women to die in childbirth or people to die of those
infectious diseases
C. Healthy child but impairment later in life = a
healthy child can develop permanent physical impairment due to an accident, or other illnesses because
of which they die before retirement age
D. Gradual decline = even people that live until old age usually experience a gradual decline in
function and loss of independence prior to dying
Levels of prevention:
● Primordial prevention = general lifestyle habits and environmental conditions that
prevent risk factors for adverse health events from developing
○ Target population: people without disease
○ E.g. eating a nutritious diet, exercising, avoiding tobacco, getting enough sleep
● Primary prevention = protective actions to prevent adverse health events from ever
occurring
○ Target population: people without disease
○ E.g. vaccinations, seat belt, keeping mosquitos out of houses, sanitation facilities
● Secondary prevention = detection of health problems in asymptomatic individuals at
an early stage
○ Target population: people with early, non symptomatic disease
○ E.g. checking blood pressure routinely, cancer screening tests
● Tertiary prevention = interventions that reduce impairment, minimize pain and
suffering, and restore function in people with symptomatic health problems
○ Target population: people with symptomatic disease
○ E.g. managing chronic diseases with medication, alleviating pain, physical therapy after stroke
or injuries
Risk factors:
Etiology = cause of disease or another adverse condition
● Proximal cause = most immediate cause
○ Intrinsic: genetics, psychological factors
○ Extrinsic: infections, environmental hazards
● Distal cause = social, environmental, or other factors that contributes to causal
pathway
● Multicausality = usually, there are many events that might lead to onset and
progression of disease/disorder
○ Necessary risk factor: must be present for a person to develop a disease
e.g. if someone has a genetic disorder, they have to have the gene to be diagnosed with that
disorder
○ Sufficient risk factor: exposure or characteristic of risk factor by itself can cause disease
e.g. being exposed to high doses of radiation could cause some types of cancer, but the cancer
can also develop without the exposure to radiation
● Exposure = personal characteristic, behavior, environmental encounter or
intervention that might change the likelihood of developing a health condition
3
, ● Risk factor = exposure that increases the likelihood of experiencing a particular
health outcome
○ Risk factors can be biological, environmental, social, economic, behavioral
○ Risk factors can be modifiable or nonmodifiable
Bradford Hill Criteria (for evaluating a causal relationship between exposure and outcome):
1. Strength = is the statistical association between exposure and outcome strong?
2. Consistency = has a potentially causal relationship between exposure and outcome
been observed in other studies and populations?
3. Specificity = are the exposure and outcome both narrowly defined rather than
general concepts?
4. Temporality = did exposure happen before the onset of disease?
5. Biological gradient = do people with higher exposure have a higher risk of said
outcome than people with lower exposure?
6. Plausibility = is there a reasonable biological explanation for why the exposure
might cause the outcome?
7. Coherence = is a causal relationship between exposure and outcome congruent with
other knowledge about variables?
8. Experiment = does removal of exposure reduce the risk of the outcome?
9. Analogy = consideration of alternate explanations; could what seems to be a causal
relationship actually not be causal at all?
Health Transitions:
Health transition = shift in health status of a population that usually occurs in
conjunction with socio-economic development
In high-income nations transitioned to longer life expectancy and lower rates of infection and
chronic hunger. Low-income countries have increased less, causing a gap in health equity
between high- and low-income countries. The changes in population health status were
attributed in part to vaccines, antibiotics, contraceptives and other medical advances, but
also improved sanitation, better nutrition, increased education and economic growth.
Health disparity/inequality = avoidable difference in health status between
populations groups, between or within countries
Risk transition = health transition characterized by a shift from exposures (e.g.
undernutrition, unsafe water) that increase the risk of childhood infections, to exposures (e.g.
obesity, physical inability and tobacco use) that increase the risk of chronic diseases.
Major risk factors:
Low income countries Middle income High income
countries countries
#1 Child and maternal High blood pressure Tobacco
malnutrition
#2 Air pollution Tobacco High BMI
#3 Unsafe water, sanitation Dietary risks High blood sugar
and handwashing
4
Chapter 1: Global Health Transitions 2
Chapter 2: Global Health Priorities 6
Chapter 3: Socioeconomic Determinants of Health 12
Chapter 4: Environmental Determinants of Health 15
Chapter 5: Health and Human Rights 18
Chapter 6: Global Health Financing 22
Chapter 7: Global Health Implementation 24
Chapter 8: HIV/AIDS and Tuberculosis 27
Chapter 9: Diarrheal, Respiratory and Other Infections 34
Chapter 10: Malaria and Neglected Tropical Diseases 39
Chapter 11: Reproductive Health 45
Chapter 12: Nutrition 48
Chapter 13: Cardiovascular Diseases 53
Chapter 14: Cancer 57
Chapter 15: Diabetes, Chronic Respiratory Diseases and other
Noncommunicable Diseases 62
Chapter 16: Mental Health Promotion 67
Chapter 17: Injury Prevention 70
Chapter 18: Promoting Neonatal, Infant, Child and Adolescent
Health 72
Chapter 19: Promoting Healthy Adulthood and Aging 76
Chapter 20: Interprofessionalism in Global Health 78
1
,Chapter 1: Global Health Transitions
Global health = field of academic study, research and applied practice that seeks to
improve population health worldwide
● Global means ‘worldwide’ as well as ‘comprehensive’
● Problems in low-income countries, but also transnational problems that could affect
people in every country
Core values (acronym PACES):
● Population = global health prioritizes the exposure and diseases that cause a considerable proportion
of preventable deaths and/or disabilities in multiple world regions
○ What are the health issues that cause the greatest number of deaths, illnesses and disability
worldwide? Which populations have the greatest need?
● Action = global health uses evidence-based, cost-effective, sustainable interventions to prevent illness
and injury, treat existing diseases and alleviate suffering
○ What are the “best buys” among available interventions? How do we allocate resources to do
the greatest good for the greatest amount of people?
● Cooperation = global health uses international, multi sectoral partnerships to solve complex health
concerns
○ Who are the partners and what are their shared goals? What problem is the partnership best
equipped to solve?
● Equity = global health reduces health disparities by prioritizing the needs of low-income countries and
other disadvantaged populations: health equity = everyone has equal opportunity to be as healthy as
possible
○ What actions will do the most to improve the health status of vulnerable populations? How will
intervention improve health equity?
● Security = global health tackles the health issues that are most likely to contribute to political and
economic instability and conflict
○ What are the greatest threats to peace? How will the intervention help to achieve the national
interests of sponsoring governments?
Many diseases, environmental hazards and other population health issues are classified as
global health priorities based on the PACES criteria.
Definitions:
● Health (WHO definition) = a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity
● Population health = health outcomes and determinants of health in groups of
humans at the community, regional, national and/or worldwide level
● Determinants of health = biological, behavioral, social, environmental, political and
other factors that influence the health status of individuals or populations
● Intervention = strategic action to improve individual and population health status
● Systems thinking = process of identifying the underlying causes of complex
problems so that sustainable solutions can be developed and implemented
● Prevention science = process of determining which preventative interventions are
effective at improving health status, how successful those interventions are in various
populations and how readily they can be scaled up for widespread implementation
● Implementation science = scientific study of how to increase uptake of
evidence-based practices and policies after effective interventions have been
identified
Health is a complex function of individual, interpersonal (relationships), institutional,
organizational, community factors and public policy.
2
,Prevention and intervention science:
There are multiple health trajectories possible in life:
A. Ideal = healthy infant growing into adulthood without
experiencing serious infections, illnesses or injuries; ends in
very old age with a gentle death without months of disability
and pain
B. Very low-income community = large proportion of
children are born with low birthweight and struggle with
repeated infectious diseases, and it is not uncommon for
young women to die in childbirth or people to die of those
infectious diseases
C. Healthy child but impairment later in life = a
healthy child can develop permanent physical impairment due to an accident, or other illnesses because
of which they die before retirement age
D. Gradual decline = even people that live until old age usually experience a gradual decline in
function and loss of independence prior to dying
Levels of prevention:
● Primordial prevention = general lifestyle habits and environmental conditions that
prevent risk factors for adverse health events from developing
○ Target population: people without disease
○ E.g. eating a nutritious diet, exercising, avoiding tobacco, getting enough sleep
● Primary prevention = protective actions to prevent adverse health events from ever
occurring
○ Target population: people without disease
○ E.g. vaccinations, seat belt, keeping mosquitos out of houses, sanitation facilities
● Secondary prevention = detection of health problems in asymptomatic individuals at
an early stage
○ Target population: people with early, non symptomatic disease
○ E.g. checking blood pressure routinely, cancer screening tests
● Tertiary prevention = interventions that reduce impairment, minimize pain and
suffering, and restore function in people with symptomatic health problems
○ Target population: people with symptomatic disease
○ E.g. managing chronic diseases with medication, alleviating pain, physical therapy after stroke
or injuries
Risk factors:
Etiology = cause of disease or another adverse condition
● Proximal cause = most immediate cause
○ Intrinsic: genetics, psychological factors
○ Extrinsic: infections, environmental hazards
● Distal cause = social, environmental, or other factors that contributes to causal
pathway
● Multicausality = usually, there are many events that might lead to onset and
progression of disease/disorder
○ Necessary risk factor: must be present for a person to develop a disease
e.g. if someone has a genetic disorder, they have to have the gene to be diagnosed with that
disorder
○ Sufficient risk factor: exposure or characteristic of risk factor by itself can cause disease
e.g. being exposed to high doses of radiation could cause some types of cancer, but the cancer
can also develop without the exposure to radiation
● Exposure = personal characteristic, behavior, environmental encounter or
intervention that might change the likelihood of developing a health condition
3
, ● Risk factor = exposure that increases the likelihood of experiencing a particular
health outcome
○ Risk factors can be biological, environmental, social, economic, behavioral
○ Risk factors can be modifiable or nonmodifiable
Bradford Hill Criteria (for evaluating a causal relationship between exposure and outcome):
1. Strength = is the statistical association between exposure and outcome strong?
2. Consistency = has a potentially causal relationship between exposure and outcome
been observed in other studies and populations?
3. Specificity = are the exposure and outcome both narrowly defined rather than
general concepts?
4. Temporality = did exposure happen before the onset of disease?
5. Biological gradient = do people with higher exposure have a higher risk of said
outcome than people with lower exposure?
6. Plausibility = is there a reasonable biological explanation for why the exposure
might cause the outcome?
7. Coherence = is a causal relationship between exposure and outcome congruent with
other knowledge about variables?
8. Experiment = does removal of exposure reduce the risk of the outcome?
9. Analogy = consideration of alternate explanations; could what seems to be a causal
relationship actually not be causal at all?
Health Transitions:
Health transition = shift in health status of a population that usually occurs in
conjunction with socio-economic development
In high-income nations transitioned to longer life expectancy and lower rates of infection and
chronic hunger. Low-income countries have increased less, causing a gap in health equity
between high- and low-income countries. The changes in population health status were
attributed in part to vaccines, antibiotics, contraceptives and other medical advances, but
also improved sanitation, better nutrition, increased education and economic growth.
Health disparity/inequality = avoidable difference in health status between
populations groups, between or within countries
Risk transition = health transition characterized by a shift from exposures (e.g.
undernutrition, unsafe water) that increase the risk of childhood infections, to exposures (e.g.
obesity, physical inability and tobacco use) that increase the risk of chronic diseases.
Major risk factors:
Low income countries Middle income High income
countries countries
#1 Child and maternal High blood pressure Tobacco
malnutrition
#2 Air pollution Tobacco High BMI
#3 Unsafe water, sanitation Dietary risks High blood sugar
and handwashing
4
