Global Issues in Medicine¶
Chapter 485 | Part 17: Global Medicine · Parts 17-18 – Global Medicine & Aging · Chapter 485
Key Clinical Points¶
- Global health is defined as the field of study and practice concerned with improving the health of all people and achieving health equity worldwide, with an emphasis on addressing transnational problems.
- The WHO eradication of smallpox in 1979 remains the greatest success in international health despite Cold War tensions.
- The Alma-Ata (1978) commitment to 'Health for All by Year 2000' led to the GOBI-FFF strategy: growth monitoring, oral rehydration, breast-feeding, immunizations, family planning, female education, and food.
- In 2019, 56.5 million deaths occurred worldwide; 17% (9.6 million) were from communicable diseases, maternal/neonatal conditions, and nutritional deficiencies (predominantly in Sub-Saharan Africa and southern Asia).
- Leading causes of death globally in 2019: ischemic heart disease (16%), stroke (11.7%), and COPD (5.8%).
- By 2019, noncommunicable diseases (NCDs) accounted for 74% of total deaths and 63% of all DALYs.
- The three leading risk factors for global disease burden in 2019 are high systolic blood pressure, smoking, and high fasting plasma glucose.
- As of 2022, approximately 39 million people lived with HIV (67% in Sub-Saharan Africa), with 630,000 deaths from HIV in 2022.
- In 2022, 1.3 million people died from tuberculosis (TB); 890,000 new TB cases occurred among people living with HIV.
- Development assistance for health (DAH) grew from 5.6 billion in 1990 to 38.9 billion in 2018, reaching $64.7 billion in 2021.
1. DEFINITION & OVERVIEW¶
• Definition: The field of study and practice concerned with improving the health of all people and achieving health equity worldwide, with an emphasis on addressing transnational problems.
• Historical Milestones: ◦ Smallpox Eradication (1979): Recognized as the greatest success in international health despite Cold War tensions. ◦ Alma-Ata (1978): Commitment to 'Health for All by Year 2000' → established the GOBI-FFF strategy. ◦ GOBI-FFF Components: Growth monitoring, oral rehydration, breast-feeding, immunizations, family planning, female education, and food.
• Core Objectives & Scope: ◦ Identify barriers to care for populations lacking access to modern medicine. ◦ Analyze population-based data on common health problems in poverty. ◦ Address specific global threats: HIV/AIDS, tuberculosis, malaria, Ebola, COVID-19, and noncommunicable chronic diseases (NCDs). ◦ Promote global health equity through the lens of social justice.
2. EPIDEMIOLOGY & GLOBAL BURDEN¶
• Global Trends in Disease Burden: ◦ Shift in DALYs: Significant transition from communicable/nutritional diseases (1990) to noncommunicable diseases (2019). ◦ Noncommunicable Diseases (NCDs): Account for 74% of total deaths and 63% of all DALYs. ◦ Primary Risk Factors: High systolic blood pressure, smoking, and high fasting plasma glucose.
• Regional Burden Analysis (Table 485-1 & Table 485-2): ◦ World (Overall): ◦ Top DALY burdens: Neonatal disorders (7.3%), Ischemic heart disease (7.2%), and Stroke (5.7%). ◦ Top Death causes: Ischemic heart disease (16.1%), Stroke (11.7%), and COPD (5.8%). ◦ Low-Income Countries: ◦ High burden from Neonatal disorders, Lower respiratory infections, and Malaria. ◦ Significant mortality from Diarrheal diseases and HIV/AIDS. ◦ High-Income Countries: ◦ Primary burdens: Ischemic heart disease (16.4%), Stroke (8.4%), and Lung cancer (6.3%). ◦ Notable DALY contributors: Low back pain, Stroke, and Diabetes. ◦ Sub-Saharan Africa: ◦ High burden from Neonatal disorders, Malaria, Diarrheal diseases, and HIV/AIDS.
Specific Disease Statistics¶
• HIV/AIDS: ◦ 39 million people living with HIV (2022). ◦ 67% of those living with HIV reside in Sub-Saharan Africa. ◦ 630,000 deaths from HIV recorded in 2022.
• Tuberculosis (TB): ◦ 1.3 million global deaths in 2022. ◦ 890,000 new cases occurred among people living with HIV.
3. ECONOMICS & POVERTY¶
• Economics of Global Health: ◦ The Debate: Discussion exists on whether economic development must precede health improvement or if addressing ill health is the necessary starting point for development. ◦ Consensus: Investment in healthcare delivery and control of communicable diseases leads to increased productivity (the 'virtuous cycle').
• Development Assistance for Health (DAH): ◦ Growth Trend: 5.6 billion (1990) → 38.9 billion (2018) → $64.7 billion (2021). ◦ COVID-19 Impact: Triggered the largest yearly increases in DAH ever recorded, with an 86% growth between 2020 and 2021.
• Poverty as a Driver of Health: ◦ Direct Link: Poverty is one of the most significant root causes of poor health worldwide. ◦ Extreme Poverty Statistics: ◦ Defined as living on less than $2.15 per day. ◦ 9% (700 million) of the global population live in extreme poverty. ◦ 50% of those in extreme poverty reside in Sub-Saharan Africa. ◦ Vulnerable Populations: ◦ Children comprise 31% of the world population but account for 50% of those living in poverty. ◦ Economic Impact of COVID-19: The poorest individuals lost twice as much income as the richest between 2020 and 2022.
Reference Tables¶
TABLE 485-1 Leading Causes of Burden of Disease (DALYs), 2019¶
Harrison's 22e, p.3846
| DISEASE OR INJURY | DALYS (MILLIONS) |
PERCENTAGE OF TOTAL DALYs |
|---|---|---|
| World | 2540.0 | 100 |
| 1. Neonatal disorders | 185.9 | 7.3 |
| 2. Ischemic heart disease | 182.0 | 7.2 |
| 3. Stroke | 143.2 | 5.7 |
| 4. Lower respiratory infection | 97.2 | 3.8 |
| 5. Diarrheal diseases | 80.9 | 3.2 |
| 6. COPD | 74.4 | 2.9 |
| 7. Road injuries | 72.9 | 2.9 |
| 8. Diabetes | 70.9 | 2.8 |
| 9. Low back pain | 63.7 | 2.5 |
| 10. Congenital defects | 52.8 | 2.1 |
| Low-Income Countriesa |
TABLE 485-2 Leading Causes of Death Worldwide, 2019
| DISEASE OR INJURY | DEATHS (MILLIONS) |
PERCENTAGE OF TOTAL DEATHS |
|---|---|---|
| World | 56.5 | 100 |
| 1. Ischemic heart disease | 9.1 | 16.1 |
| 2. Stroke | 6.6 | 11.7 |
| 3. COPD | 3.3 | 5.8 |
| 4. Lower respiratory infection | 2.5 | 4.4 |
| 5. Lung cancer | 2.0 | 3.6 |
| 6. Neonatal disorders | 1.9 | 3.3 |
| 7. Alzheimer’s disease | 1.6 | 2.9 |
| 8. Diabetes | 1.6 | 2.7 |
| 9. Diarrheal diseases | 1.5 | 2.7 |
| 10. Cirrhosis | 1.5 | 2.6 |
| Low-Income Countriesa | ||
| 44.4 | ||
| 24.5 | ||
| 23.3 | ||
| 23.2 | ||
| 14.5 | ||
| 12.8 | ||
| 12.2 | ||
| 8.6 | ||
| 6.2 | ||
| 7.4 | ||
| 0.5 | ||
| 0.4 | ||
| 0.3 | ||
| 0.3 | ||
| 0.3 | ||
| 0.3 | ||
| 0.3 | ||
| 0.2 | ||
| 0.1 | ||
| 0.1 | ||
| High-Income Countriesa | ||
| 1. Ischemic heart disease | 26.8 | 7.6 |
| 2. Low back pain | 17.7 | 4.9 |
| 3. Stroke | 15.8 | 4.4 |
| 4. Lung cancer | 13.7 | 3.9 |
| 5. Diabetes | 13.3 | 3.7 |
| 6. COPD | 12.0 | 3.4 |
| 7. Falls | 9.7 | 2.7 |
| 8. Alzheimer’s disease | 9.2 | 2.6 |
| 9. Other musculoskeletal | 9.1 | 2.6 |
| 10. Depressive disorders | 8.6 | 2.4 |
| Sub-Saharan Africa | ||
| 70.5 | ||
| 43.2 | ||
| 42.0 | ||
| 41.1 | ||
| 35.6 | ||
| 18.1 | ||
| 17.6 | ||
| 11.1 | ||
| 10.8 | ||
| 10.4 | ||
| High-Income Countriesa | ||
| 1. Ischemic heart disease | 1.8 | 16.4 |
| 2. Stroke | 0.9 | 8.4 |
| 3. Lung cancer | 0.7 | 6.4 |
| 4. Alzheimer’s disease | 0.7 | 6.3 |
| 5. COPD | 0.5 | 4.9 |
| 6. Lower respiratory infection | 0.4 | 4.1 |
| 7. Colorectal cancer | 0.4 | 3.8 |
| 8. Chronic kidney disease | 0.3 | 3.0 |
| 9. Diabetes | 0.3 | 2.3 |
| 10. Pancreatic cancer | 0.2 | 2.1 |
| Sub-Saharan Africa | ||
| 0.7 | ||
| 0.7 | ||
| 0.6 | ||
| 0.6 | ||
| 0.6 | ||
| 0.4 | ||
| 0.4 | ||
| 0.4 | ||
| 0.2 | ||
| 0.2 |