Racial & Ethnic Inequities in Health/ Global Health
Who runs global health?
*UN agencies *Development Banks *Bilateral and foreign aid agencies *Foundations *Research funders *NGOs *Technical agencies *Partnerships *Consulting
companies *Universities *Pharma/industry
What are the 3 principles of the Belmont Report?
Respect for Persons
Beneficence
Justice
What is the main cause of injury-related deaths?
#1. Poisoning... overdose!
How long can you survive without water?
◦ Varies with age, weather conditions, health
conditions
◦ Average of 3 days
What do we mean when we refer to access to health care?
◦Distance to a clinic
◦Services available
◦Appointments are available
◦Road conditions
◦Access to a car or public transportation
What are health disparities?
Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.
What is IRB and what does it do?
International Review Board ensures ethical principles are followed in human subjects research
• Attempt to assure appropriate steps are
taken to protect the rights of humans
participating in research
• Initial, annual, and closure reviews
Explain unintentional vs intentional injury.
Unintentional: Injuries that occur without anyone intending harm to be done
• No longer called “accidents”
Intentional: Injuries that are purposefully inflicted on oneself or others
If death results, these are known as:
• Suicide
• Homicide
Which 6 “Criteria Air
Pollutants” were included in the Clean Air Act
of 1970?
*Particulate matter *Sulfur dioxide *Carbon monoxide *Nitrogen oxides *Ozone *Lead
What are the 10 categories of care required under all insurance plans?
Define ethnicity
Groups that share a common identity-based ancestry, language, or culture.
Often based on religion, beliefs, and customs as well as memories of migration or colonization
What is the Nuremberg Code and its principles?
*A result of the Nuremburg trials
*Outlines the key features of human subject's research
*Blueprint for today’s principles that ensure the rights of subjects
10 Principles:
In the 1990s, 2 key things triggered an increase in use of opioids. What were they?
1. Concern About Inadequate Pain Control
2. Aggressive and False Marketing of Opioid Pain Killers
What does WASH stand for and explain each component?
Water: sufficient quantity of water free of bacteria, parasites and viruses for cooking, drinking, preparing food, and handwashing.
Sanitation: having places to deposit human waste (urine and feces) that are contained and separated from water sources, food supplies and
protected from disease vectors (flies, rodents).
Hygiene: Ability to sanitize hands thoroughly, ideally with soap and water.
Why is being uninsured a problem?
◦Don’t obtain preventive care
◦Postpone getting care when ill
◦Don’t take their medications
◦Receive care in the emergency department
◦Are more likely to be hospitalized for preventable illnesses
◦Are less likely to survive serious illnesses
◦Health care costs are a major cause of personal bankruptcy in the US
What is governance?
A web of formal and informal relationships (governments, NGOs, the private sector, multilateral organizations, philanthropies and various partnerships and funds)--> the way in which the global health system is managed
What can be done to improve trust in the
research process? Explain it.
*Community Based Participatory Research
(CBPR)
-involves all partners in the research process and recognizes the unique strengths that each brings
Explain the difference between occupational injury vs illness.
Occupational injury
◦An injury caused by a single work-related event or exposure
Occupational illness
◦A health condition caused by factors associated with employment
◦Can be caused by contact with toxic substance (e.g., inhale)
◦Can be an caused by repeated exposure (e.g., carpal tunnel)
What are strategies for meeting clean air standards?
1. Focusing on Motor Vehicles
• Tailpipe emissions limits
• Vapor recovery systems on gasoline pumps
• Inspection and maintenance requirements
• Requirements that auto makers develop zero
emission vehicles (movement to e-vehicles)
• Public transportation development
• Encouraging carpooling
OR 2. Focusing on Industrial Sources
• “Scrubbers” on smokestacks
– Essentially smokestack filters that remove
harmful particles, gases, or chemical byproducts
from industrial exhaust
• Less polluting fuels (limits on high-sulfur coal)
• Market approach: buy and sell pollution
allowances
What is the Children's Health Insurance Program?
*Passed by Congress in 1997 to cover children (< 19) whose families earn too much to receive Medicaid but too little to afford insurance
-Jointly run and funded by Federal and state governments
-Services provided through Medicaid and separate CHIP programs
-Eligibility varies by state◦Upper income limit ranges from 170% to 400% of the Federal poverty level
◦Some cover pregnant women
◦States can enroll lawful immigrants but don’t have to
2020 – CHIP covered 9 million children◦Typically, about 1/3 of US children
What is a major challenge in global health? Give an example.
Possible answers:
*Who has the power
*Neo-colonization
Examples will vary.
What is the Tuskegee Syphilis Study and why is it important?
The Tuskegee Study of Untreated Syphilis in the Negro Male was a study conducted between 1932 and 1972 by the United States Public Health Service and the Centers for Disease Control and Prevention on a group of nearly 400 African Americans with syphilis.
Importance: Led to...
*1974- National Research Act
*Created the National Commission
for the Protection of Human Subjects of Biomedical and
Behavioral Research
*Charged with identifying the basic ethical principals for research
*Commission produced the Belmont Report
Who is at highest risk of workplace injuries (gender and age) and why?
*Workers 55+
*Men
Why is Diarrheal Disease Fatal in Much of the
World?
•Diarrhea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms.
•During an episode of diarrhea, water and electrolytes including sodium, chloride, potassium and bicarbonate are lost through liquid stools, vomit, sweat, urine and breathing. Children with diarrhea become severely
dehydrated when these losses are not replaced.
•Diarrhea is a major cause of malnutrition, depressing the immune system and making the person more susceptible to future bouts of diarrhea and
to other diseases.
Explain Medicaid vs. Medicare.
Medicare:
-Passed by Congress in 1965 to provide health insurance for 65 or older; Younger people with disabilities
◦End-Stage Renal Disease (kidney failure requiring dialysis/transplant)
◦US citizens or permanent residents
-Covers about ½ of expenses◦Most get supplemental plans or Medicaid
-Meant to be paid for by 2.9% payroll tax◦Split by employers & employees
Medicaid:
-Passed by Congress in 1965 to provide health insurance for the poor◦Income must be below a certain % above of the Federal Poverty Level (FPL)
◦In 2021, for a household of 4 persons, the poverty level is $26,500
-Jointly run and funded by Federal and state governments
-Federal government requires states to cover low-income people in “mandatory eligibility groups”◦65 or older
◦Disabled
◦Children
◦Pregnant women or an adult caring for a child
-States can expand beyond these groups if they want