GLOBAL HEALTH

GLOBAL HEALTH

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Dr-Srikant-Sharma

DR. SRIKANT SHARMA,

MBBS, MD

A sound mind and sound soul needs a healthy body.

Aim is to improve the health of all people and achieving health equity worldwide with an emphasis on addressing transnational problems.

History

One of the first organisation to tackle cross border health issues was the pan American sanitary bureau, formed in 1902 by 11 countries in America. The primary goal was to control infectious diseases. In 1948 United Nations formed the first truly Global Health institution the World Health Organisation (WHO). Health for all by year 2000 was proposed, to achieve providing Universal access to Primary Health Care worldwide. Thereafter four inexpensive interventions proposed, collectively known as GOBI : growth monitoring, oral rehydration, breastfeeding, and immunization for diphtheria, whooping cough, tetanus, polio, TB, and measles. GOBI later was expended to GOBI-FFF, which included female education, food and family planning. HIV/AIDS first described in 1981, and emerged as a global disease, and which also strained malaria and TB Control Programme, continued to take as many lives as ever. At the dawn of the 21st century, these three diseases alone killed nearly 6 million people per year. Hence new research, new policies and new funding mechanism were called for, like Global fund to fight AIDS, Tuberculosis and malaria , U.S. presidents emergency plan for AIDS relief (PEPFAR), Bill and Melinda Gates Foundation.

At a United Nations Summit in 2000, member nations declared eight Millennium Development Goals (MDGs),for human development globally, by 2015. Building on the MDGs, a new Sustainable Development Agenda with 17 Sustainable Development Goals (SDGs) has been established for the years 2016-2030. The first goal being pledge to end poverty. This 2030 Development Agenda was titled Transforming our world.

Dr. Srikant Sharma, MBBS, MD (Medicine), Senior Consultant medicine, MCKR Hospital, New Delhi, published many national and international papers and chapters in books.

Dr. Sharma, an eminent medicine specialist with decades of experience in health care management with a holistic perspective having researched on sub systems of health care presents his article on Dengue Awareness – Key to Dengue Prevention.

MORTALITY AND THE GLOBAL BURDEN OF THE DISEASE

Of the 56.9 million death worldwide in 2016, fifty four percent were because of 10 top leading causes of death. Ischemic heart disease and stroke constitute 15.2million (M) being the top diseases of death. Chronic pulmonary obstructive pulmonary disease (3M deaths per year) rank the 3rd. Lower respiratory tract infection (3M deaths per year)being the fourth and most deadly communicable diseases. Dementia and Alzheimers disease being the fifth killer.Lung, bronchial and tracheal cancer being 6th killer (1.7 M deaths per year). Diabetes(7th) killed 1.6 M per year. Road injuries(8th) killed 1.4M peoples in 2016. Diarrhoeal disease(9th) still kills 1.4M peoples. Tuberculosis is the 10th cause of death, killing 1.3M peoples.

Tuberculosis remains a high-burden disease. Globally, TB incidence declined from 173 new and relapse cases per 100 000 population in 2000 to 140 per 100 000 population in 2016 – a 19% decline over the 16-year period. The TB mortality rate among HIV-negative people fell by 39% during the same period. In 2016, an estimated 10.4 million people fell ill with TB.

The global burden of death due to hiv/aids and malaria was on upward slope until 2004, significant improvement has been documented thereafter. Global deaths from hiv infection in 2016 was one million. Globally, HIV incidence has declined from 0.40 per 1000 uninfected population in 2005 to 0.26 per 1000 uninfected population in 2016.The global scale-up of antiretroviral therapy (ART) has been the main driver of the 48% decline in HIV-related deaths.

Globally, an estimated 216 million cases of malaria occurred in 2016, compared with 237 million cases in 2010.Malaria claimed the lives of approximately 445 000 people in 2016.

The worlds population is living longer; global life expectancy has increased to 71.8 years in 2015. This demographic change accompanied by the fact that the prevalence of NCD increases with age, which have surpassed communicable, maternal, nutritional and neonatal diseases. In 2016, an estimated 41 million deaths occurred due to NCD, accounting for 71% of the overall total of 57 million deaths. The majority of such deaths were caused by the four main NCDs, namely: cardiovascular disease (44% of all NCD deaths); cancer (22%); chronic respiratory obstructive disease (9%); and diabetes (4%). Reducing premature NCD mortality by one third by 2030 will require the acceleration of progress, including action to reduce key risk factors such as tobacco use, air pollution, unhealthy diet, physical inactivity and harmful use of alcohol.

Global risk factors for disease burden, as per 2015 in decreasing order are : Hypertension, smoking, high fasting blood sugar, high BMI, childhood underweight, particulate matter pollution, high cholesterol, household air-pollution, alcohol, high sodium intake, low whole grain intake, unsafe sex, low fruit intake, unsafe water and low Glomerular filtration rate.

WHO estimated that roughly one quarter of total global diseases can be prevented by modifiable environmental factors. Ninety four percent of diarrhoeal diseases link to unsafe drinking water and poor sanitation.

Indoor air pollution due to use of solids fuels and tobacco smoke, and outdoor air pollution accounts for 20% of lower respiratory tract infection in developed countries ; and 42% of infection in developing countries.

Every minute a woman dies from complications from childbirth. An estimated 303 000 women worldwide died due to maternal causes in 2015. Maternal mortality crucially depends upon ensuring that women have access to quality care before, during and after childbirth. More than 90% of all births benefited from the presence of a trained professional.

Human immunodeficiency virus (HIV) is transmitted through unprotected sex, unclean needles, blood transfusions, and from mother to child during birth or lactation. Globally, HIV is primarily spread through sexual intercourse.

Malaria is a mosquito-borne infectious disease. The use of insecticide-treated bednets during night sleep, is a cost-effective way to reduce deaths from malaria. Spraying insecticide indoor controls malaria only if most (80%)of the structure targeted community are treated.

Undernutrition impairs the immune system, increasing the frequency, severity, and duration of infections (including measles, pneumonia, and diarrhea). Deficiencies of micronutrient, such as vitamin A, iron, iodine, and zinc, are common worldwide. This may compromise intellectual potential, growth, development. Prevention is done by adding micronutrient supplementation/fortification.

Tobacco use is a major risk factor for cardiovascular disease (CVD), cancers and chronic respiratory disease. In 2016, globally more than 1.1 billion people aged 15 years or older smoked tobacco (34% of all males and 6% of all females). More than one billion people will die of tobacco, in the 21st century.

Almost 800000 deaths by suicide occurred in 2016(Men are 75%). An estimated 477 000 murders occurred globally in 2016, with four fifths of all homicide victims being male.

Latest estimates indicate that in 2016, one in 10 children worldwide did not receive even the first dose of diphtheria-tetanus-pertussis vaccine. Measles vaccine (MCV2) increased from 39% to 64% but this is still insufficient to prevent measles outbreaks and avoid preventable deaths. Global coverage levels of rotavirus vaccine and pneumococcal-conjugate vaccine (PCV) are still under 50%.

More than one billion people were treated for at least one neglected tropical disease in 2015. They are variously caused by bacteria (Trachoma, Leprosy), viruses (Dengue, Rabies), protozoa(Human African trypanosomiasis, Chagas), and helminths (Schistosomiasis, Onchocerciasis, Soil transmitted helminths).

Obesity, a preventable condition, is associated with numerous chronic diseases, including cardiovascular conditions, stroke, certain cancers, and respiratory diseases.

Global interventions for improving child health and survival, include the promotion of breastfeeding, zinc supplementation, vitamin A fortification, salt iodization, hygiene interventions such as hand-washing, vaccinations, and treatments of malnutrition. Nonetheless, every day in 2016,15000 children died before reaching their fifth birthday. Children face the highest risk of dying in their first month of life, with 2.6 million newborns died in 2016. Among these children, acute respiratory infections, diarrhoea and malaria were the leading causes of death.

Over 3 billion people still cooking with polluting stove and fuel combinations. The resulting household air pollution is estimated to have caused 3.8 million deaths In 2016, 91% of the worlds population did not breathe clean air, and more than half of urban population were exposed to outdoor air pollution levels at least 2.5 times above the safety standard set by WHO.

Unsafe drinking water, unsafe sanitation and lack of hygiene also remain important causes of death, with an estimated 870 000 associated deaths occurring in 2016.

In 2017, the Global Task Force on Cholera Control released a global strategy, Ending Cholera a global roadmap to 2030, that aims to reduce cholera deaths by 90%, and to eliminate cholera in up to 20 countries.

A combination of habitat destruction and increased production of carbon dioxide and SLCPs(Short Lived Climate Pollutants) causes global warming. The temperature of the globe is rising, and if current trends continue, warming by 4C is predicted by 2050. The climate is being affected putting millions of people at risk of rising sea levels, flooding, droughts and failed crops.

WHO estimates that 80 percent of all cases of cardiovascular disease and type 2 diabetes as well as 40 percent of all cancer cases can be prevented through healthy diet, increased physical activity and avoidance of tobacco.

Global health diseases can be avoided with, controlling blood pressure,blood sugar, cholesterol, BMI, sodium intake; avoiding pollution, smoking, alcohol ; taking balanced diet, adequate whole grain/ fruits ; maintaining clean surrounding/sanitation, safe water, safe sex, daily exercise, timely vaccination, professional assisted delivery, last but not least positive thinking.

About the author

CSR VISION
CSR VISION is India’s ( probably world’s ) first monthly magazine in print devoted to CSR and Sustainable Development for bringing together all stakeholders of SUSTAINABLE DEVELOPMENT at a global and local levels and act as a platform for promoting strategic CSR and sustainable development practices through dissemination of information and knowledge.