What are the shared health problems of megacities and remote

GLOBAL HEALTH

THIRD EDITION

INTRODUCTION TO

Kathryn H. Jacobsen, MPH, PhD George Mason University

Fairfax, Virginia

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Library of Congress Cataloging-in-Publication Data Names: Jacobsen, Kathryn H., author. Title: Introduction to global health / Kathryn H. Jacobsen. Description: Third edition. | Burlington, MA: Jones & Bartlett Learning, [2019] | Includes bibliographical references and index. Identifiers: LCCN 2017044502 | ISBN 9781284123890 (paperback: alk. paper) Subjects: | MESH: Global Health | Communicable Diseases | Health Promotion | Social Determinants of Health | Health Transition Classification: LCC RA441 | NLM WA 530.1 | DDC 362.1—dc23 LC record available at https://lccn.loc.gov/2017044502

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iii

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3.8 Governance and Politics . . . . . . . . . . . . . . . . . . . . .61

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63

Chapter 4 Environmental Determinants of Health . . . . . . . . . . . . . . . . . . . 65

4.1 Environmental Health and the SDGs . . . . . . . . .65

4.2 Water, Sanitation, and Hygiene . . . . . . . . . . . . . .67

4.3 Energy and Air Quality . . . . . . . . . . . . . . . . . . . . . . .75

4.4 Occupational and Industrial Health . . . . . . . . . .81

4.5 Urbanization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84

4.6 Sustainability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88

4.7 Climate Change and Health . . . . . . . . . . . . . . . . .92

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94

Chapter 5 Health and Humans Rights . . . 98 5.1 Health and Human Rights . . . . . . . . . . . . . . . . . . .98

5.2 Access to Basic Human Needs . . . . . . . . . . . . . 101

5.3 Access to Health Services . . . . . . . . . . . . . . . . . . 103

5.4 Access to Medicines . . . . . . . . . . . . . . . . . . . . . . . 106

5.5 Health and Natural Disasters . . . . . . . . . . . . . . . 108

5.6 Conflict and War . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

5.7 Bioterrorism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

5.8 Health in Prisons . . . . . . . . . . . . . . . . . . . . . . . . . . 118

5.9 People with Disabilities . . . . . . . . . . . . . . . . . . . . 119

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Chapter 6 Global Health Financing . . . . . 126 6.1 Personal and Public Health . . . . . . . . . . . . . . . . 126

6.2 Health Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

6.3 Paying for Personal Health . . . . . . . . . . . . . . . . . 131

6.4 Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . 133

6.5 Paying for Global Health Interventions . . . . . 135

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii

New to This Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x

Chapter 1 Global Health Transitions . . . . . . 1 1.1 Defining Global Health . . . . . . . . . . . . . . . . . . . . . . . 1

1.2 Health Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . 3

1.3 Prevention Science . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1.4 Health Transitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

1.5 World Regions and Featured Countries . . . . . .12

1.6 Global Health Security . . . . . . . . . . . . . . . . . . . . . . .17

1.7 Globalization and Health: Shared Futures . . . .18

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Chapter 2 Global Health Priorities . . . . . . 21 2.1 Global Health Achievements . . . . . . . . . . . . . . . .21

2.2 Prioritization Strategies . . . . . . . . . . . . . . . . . . . . . .23

2.3 Health Metrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

2.4 Millennium Development Goals . . . . . . . . . . . . .34

2.5 Sustainable Development Goals . . . . . . . . . . . . .36

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

Chapter 3 Socioeconomic Determinants of Health . . . . . . . . . . . . . . . . . . . 42

3.1 Health Disparities and the SDGs . . . . . . . . . . . . .42

3.2 Economics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44

3.3 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

3.4 Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54

3.5 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

3.6 Minority Populations . . . . . . . . . . . . . . . . . . . . . . . .57

3.7 Migrant and Refugee Health . . . . . . . . . . . . . . . . .59

Contents

iv Contents

9.4 Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

9.5 Other Respiratory Infections . . . . . . . . . . . . . . . 206

9.6 Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

9.7 Immunization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210

9.8 Vaccine-Preventable Infections . . . . . . . . . . . . 212

9.9 Viral Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

9.10 Meningitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

Chapter 10 Malaria and Neglected Tropical Diseases . . . . . . . . . . 224

10.1 Malaria, NTDs, and Global Health . . . . . . . . . 224

10.2 Parasites: Protozoa and Helminths . . . . . . . . 227

10.3 Malaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228

10.4 Malaria Interventions . . . . . . . . . . . . . . . . . . . . . 229

10.5 Dengue and Other Arboviruses . . . . . . . . . . 233

10.6 Chagas Disease and Trypanosomiasis . . . . . 236

10.7 Leishmaniasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

10.8 Schistosomiasis . . . . . . . . . . . . . . . . . . . . . . . . . . 237

10.9 Lymphatic Filariasis . . . . . . . . . . . . . . . . . . . . . . . 238

10.10 Onchocerciasis . . . . . . . . . . . . . . . . . . . . . . . . . . 239

10.11 Leprosy, Buruli Ulcer, and Trachoma . . . . . 240

10.12 Rabies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

10.13 Soil-Transmitted Helminths . . . . . . . . . . . . . 242

10.14 Other Neglected Tropical Diseases . . . . . . 244

10.15 Eradication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247

10.16 Emerging Infectious Diseases . . . . . . . . . . . 250

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252

Chapter 11 Reproductive Health . . . . . . 257 11.1 Reproductive Health and Global Health . . 257

11.2 The Fertility Transition . . . . . . . . . . . . . . . . . . . . 259

11.3 Population Planning. . . . . . . . . . . . . . . . . . . . . . 263

11.4 Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . 264

11.5 Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268

11.6 Healthy Pregnancy . . . . . . . . . . . . . . . . . . . . . . . 269

11.7 Maternal Mortality and Disability . . . . . . . . . 272

11.8 Neonatal Health . . . . . . . . . . . . . . . . . . . . . . . . . . 275

11.9 Gynecologic Health . . . . . . . . . . . . . . . . . . . . . . 279

6.6 Official Development Assistance . . . . . . . . . . . 136

6.7 Multilateral Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

6.8 Foundations and Corporate Donations . . . . 140

6.9 Personal Donations . . . . . . . . . . . . . . . . . . . . . . . . 142

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146

Chapter 7 Global Health Implementation . . . . . . . . . . . 148

7.1 Global Health Interventions . . . . . . . . . . . . . . . 148

7.2 Local and National Governments . . . . . . . . . . 150

7.3 International Cooperation . . . . . . . . . . . . . . . . . 151

7.4 The World Health Organization and the United Nations . . . . . . . . . . . . . . . . . . . . .153

7.5 International Health Regulations . . . . . . . . . . . 156

7.6 Global Partnerships . . . . . . . . . . . . . . . . . . . . . . . . 158

7.7 The Nonprofit Sector . . . . . . . . . . . . . . . . . . . . . . 159

7.8 The Corporate Sector . . . . . . . . . . . . . . . . . . . . . . 161

7.9 Research and the Academic Sector . . . . . . . . 162

7.10 Measuring Impact . . . . . . . . . . . . . . . . . . . . . . . . 163

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165

Chapter 8 HIV/AIDS and Tuberculosis . . . 167 8.1 HIV/AIDS, TB, and Global Health . . . . . . . . . . . . 167

8.2 Viruses, Bacteria, and Fungi . . . . . . . . . . . . . . . . 168

8.3 HIV and AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

8.4 HIV/AIDS Epidemiology . . . . . . . . . . . . . . . . . . . 173

8.5 HIV Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . 179

8.6 Other Sexually Transmitted Infections . . . . . . 183

8.7 Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184

8.8 TB Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

8.9 Antimicrobial Resistance. . . . . . . . . . . . . . . . . . . 189

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

Chapter 9 Diarrheal, Respiratory, and Other Common Infections . . . . . . . . . . . . . . . . . 195

9.1 Infectious Diseases and Global Health . . . . . 195

9.2 Diarrheal Diseases . . . . . . . . . . . . . . . . . . . . . . . . . 198

9.3 Diarrhea Interventions . . . . . . . . . . . . . . . . . . . . . 200

Contents v

14.4 Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346

14.5 Other Cardiovascular Diseases . . . . . . . . . . . . 348

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349

Chapter 15 Other Noncommunicable Diseases . . . . . . . . . . . . . . . . . 351

15.1 The Epidemiologic Transition and Global Health . . . . . . . . . . . . . . . . . . . . . . . . .351

15.2 NCDs and Behavior Change . . . . . . . . . . . . . . 355

15.3 Chronic Respiratory Diseases . . . . . . . . . . . . . 358

15.4 Tobacco Control . . . . . . . . . . . . . . . . . . . . . . . . . . 360

15.5 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363

15.6 Chronic Kidney Disease . . . . . . . . . . . . . . . . . . 366

15.7 Liver and Digestive Diseases . . . . . . . . . . . . . . 367

15.8 Neurological Disorders . . . . . . . . . . . . . . . . . . . 368

15.9 Genetic Blood Disorders . . . . . . . . . . . . . . . . . . 369

15.10 Musculoskeletal Disorders . . . . . . . . . . . . . . . 371

15.11 Sensory Disorders . . . . . . . . . . . . . . . . . . . . . . . 372

15.12 Skin Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . 374

15.13 Dental and Oral Health . . . . . . . . . . . . . . . . . . 374

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375

Chapter 16 Mental Health . . . . . . . . . . . . 381 16.1 Mental Health and Global Health . . . . . . . . . 381

16.2 Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382

16.3 Bipolar Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . 383

16.4 Depressive Disorders . . . . . . . . . . . . . . . . . . . . . 383

16.5 Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . 385

16.6 Alcohol and Drug Use Disorders . . . . . . . . . . 385

16.7 Other Mental Health Disorders . . . . . . . . . . . 387

16.8 Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388

16.9 Autism and Neurodevelopmental Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .390

16.10 Dementia and Neurocognitive Disorders 391

16.11 Mental Health Care . . . . . . . . . . . . . . . . . . . . . 391

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392

Chapter 17 Injuries . . . . . . . . . . . . . . . . . . 396 17.1 Injuries and Global Health . . . . . . . . . . . . . . . . 396

11.10 Men’s Reproductive Health . . . . . . . . . . . . . . 279

11.11 Sexual Minority Health . . . . . . . . . . . . . . . . . . 280

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281

Chapter 12 Nutrition . . . . . . . . . . . . . . . . 285 12.1 Nutrition and Global Health . . . . . . . . . . . . . . 285

12.2 Macronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . 286

12.3 Protein-Energy Malnutrition . . . . . . . . . . . . . . 288

12.4 Food Security and Food Systems . . . . . . . . . 293

12.5 Micronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

12.6 Iodine Deficiency Disorders . . . . . . . . . . . . . . 297

12.7 Vitamin A Deficiency . . . . . . . . . . . . . . . . . . . . . 297

12.8 Iron Deficiency Anemia . . . . . . . . . . . . . . . . . . 298

12.9 Other Micronutrient Deficiencies . . . . . . . . . 300

12.10 Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . 302

12.11 Overweight and Obesity . . . . . . . . . . . . . . . . 304

12.12 Food Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311

Chapter 13 Cancer . . . . . . . . . . . . . . . . . . . 315 13.1 Cancer and Global Health . . . . . . . . . . . . . . . . 315

13.2 Cancer Biology . . . . . . . . . . . . . . . . . . . . . . . . . . . 316

13.3 Cancer Epidemiology . . . . . . . . . . . . . . . . . . . . 316

13.4 Cancer Risk Factors and Prevention . . . . . . . 320

13.5 Cancer Screening and Diagnosis . . . . . . . . . 324

13.6 Cancer Treatment . . . . . . . . . . . . . . . . . . . . . . . . 326

13.7 Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328

13.8 Breast Cancer and Cervical Cancer . . . . . . . . 328

13.9 Prostate Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . 332

13.10 Liver Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332

13.11 Esophageal, Stomach, and Colorectal Cancers . . . . . . . . . . . . . . . . . . . . . . .333

13.12 Other Cancers . . . . . . . . . . . . . . . . . . . . . . . . . . 334

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335

Chapter 14 Cardiovascular Diseases . . . . 338 14.1 Cardiovascular Disease and Global Health 338

14.2 Ischemic Heart Disease . . . . . . . . . . . . . . . . . . . 342

14.3 Cerebrovascular Disease (Strokes) . . . . . . . . 344

vi Contents

Chapter 19 Promoting Healthy Adulthood and Aging . . . . . . 425

19.1 Aging and Global Health . . . . . . . . . . . . . . . . . 425

19.2 Health Promotion in Early and Middle Adulthood . . . . . . . . . . . . . . . . . . . .428

19.3 Health Promotion for Older Adults . . . . . . . . 430

19.4 Caring for Aging Populations . . . . . . . . . . . . . 431

19.5 Health Promotion Across the Life Span . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .434

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434

Chapter 20 Global Health Careers . . . . . . 436 20.1 Career Pathways in Global Health . . . . . . . . . 436

20.2 Global Health Education . . . . . . . . . . . . . . . . . 437

20.3 Experiential Learning in Global Health . . . . . . . . . . . . . . . . . . . . . . . . . . .439

20.4 Global Health Matters . . . . . . . . . . . . . . . . . . . . 440

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .443

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .468

17.2 Transport Injuries . . . . . . . . . . . . . . . . . . . . . . . . . 400

17.3 Falls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402

17.4 Drowning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403

17.5 Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404

17.6 Other Unintentional Injuries . . . . . . . . . . . . . . 405

17.7 Intentional Injuries . . . . . . . . . . . . . . . . . . . . . . . 405

17.8 Interpersonal Violence . . . . . . . . . . . . . . . . . . . 406

17.9 Gender-Based Violence . . . . . . . . . . . . . . . . . . . 407

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408

Chapter 18 Promoting Neonatal, Infant, Child, and Adolescent Health . . . . . . . . . 410

18.1 Progress in Child Survival . . . . . . . . . . . . . . . . . 410

18.2 Improving Neonatal Survival . . . . . . . . . . . . . 415

18.3 Promoting Infant and Child Health . . . . . . . 417

18.4 Promoting Early Childhood Development 419

18.5 Children with Special Needs . . . . . . . . . . . . . . 419

18.6 Health Promotion for Older Children . . . . . 420

18.7 Health Promotion for Adolescents . . . . . . . . 421

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423

vii

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across the income spectrum. For example, the SDGs include targets for preventing new hep- atitis B virus infections; reducing the number of adults who die from cardiovascular diseases, cancers, and other noncommunicable diseases before their 70th birthdays; reducing the suicide mortality rate; increasing access to treatment for substance use disorders; and reducing deaths from road traffic injuries and violence. These conditions affect people in every country, and all countries have the opportunity under the SDGs to track their progress toward improving health metrics related to these concerns.

This third edition of Introduction to Global Health is a book for the SDG era. The socioeconomic and environmental determi- nants of health are presented in the context of the SDGs. The shifting landscape for financ- ing and implementing global health initiatives is described in expanded chapters on payers and players. Chapters on infectious diseases, reproductive health, and nutrition are comple- mented by new chapters on noncommunica- ble diseases, mental health, and injuries. The similarities and differences in the conditions that cause illness and death in featured coun- tries representing diverse world regions and income levels are illustrated with estimates from the Global Burden of Disease (GBD) project, which now produces annually updated profiles of health status in every country. (Dis- closure: the author is a GBD collaborator.) The global health agenda has expanded to cover all of the world’s people, and this book provides a positive, forward-looking perspective on the numerous actions that are helping promote the health, well-being, and security of people across the lifespan and across the globe.

The first and second editions of Intro- duction to Global Health were written during the Millennium Development

Goals (MDG) era of global health. The MDGs spelled out an ambitious plan for significantly reducing global poverty between 2000 and 2015. They were wildly successful. The num- ber of people living on less than $1 per day dropped substantially during the first 15 years of the 21st century. As a growing number of global health partnerships set agendas for change and financed action plans, significant progress was made toward alleviating hun- ger, preventing maternal and child mortality, and controlling HIV/AIDS and malaria.

The next generation of global goals—the Sustainable Development Goals (SDGs)—were launched at the end of 2015. They spell out 17 goals for enhancing human flourishing by 2030, including targets related to poverty reduction, hunger, health, education, gender equality, clean water and sanitation, affordable and clean energy, decent work, infrastructure and tech- nology development, human rights, sustainable urbanization, responsible production and con- sumption, climate and environment, peace, and governance. The SDGs seek to promote pros- perity while upholding human rights, protect- ing the planet, and fostering peace and security. All of the goals are interdependent, and all are inextricably tied to health. Improvements in any of the 17 areas will yield benefits for popula- tion health, and improvements in public health will enable other SDGs to be achieved.

Most of the MDGs were targeted at improv- ing quality of life among the world’s poorest people. The SDGs retain those aims but add a lengthy list of objectives that apply to countries

Preface

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Chapter 6 is a new chapter that describes the health system models used in various countries and explains the funding mecha- nisms used to pay for global health activities. Chapter 7 features the diversity of entities involved in implementing and evaluating global health interventions, including gov- ernmental and intergovernmental agen- cies, nonprofit organizations, and for-profit corporations.

Chapters 8 through 17 present the health conditions that account for the greatest burden of disease globally. Each chapter begins with a section that explains why the featured topic is considered to be a global health issue, and each chapter emphasizes the interventions that can reduce the impact of adverse health conditions on individuals and populations. Health met- rics from the Global Burden of Disease (GBD) collaboration are used to i

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