International Health

1. International Health • We are not alone in the world • We have much better health than most but only rank 37th in total health • We have slipped every year for the last 40 years • Why?

2. International health • Perspectives • Health access • What health care to give • Equity • Disasters and epidemics

3. Access • Alma Atta accords 1983 • Basic health care costs less than public health • Is it effective without PH? • What is Public Health? • Plural health systems

4. Access • In traditional societies, the decision to seek healthcare is a rational choice of a household • Not individual choice • Therefore there are inequities that exist • Gender • Age • Contribution based

5. Access • Married more than never married • Education matters • Income may matter • Household size • Cost • Distance to care • Need, ADLs • Available health systems

6. Access and Health Status • Less care, poorer health • More acute morbidity and chronic morbidity • Higher mortality • Males better than females—patriarchy and empowerment

7. What health care • Developed country costs much more than basic care • Health care budgets • Epidemics and plagues

8. Equity • Different from equality • Gender • Race • Education and income • Need and dependency • At risk populations

9. Disasters and epidemics • McNeill—Plagues and Peoples • Diamond • Guns, Germs and Steel • Farmer—Infections and Inequalities

10. Epidemics • Can shape the economic and social destiny of cultures • Western culture and dominance was shaped by the Black death • AIDS • Bird Flu • Katrina