Health Determinants
Objectives
Through participatory discussions and public presentations of personal work, develop understanding, explanatory and implementation skills and competencies related to: Discussing, using examples, the social, economic, corporate and environmental determinants of 21st century health in various parts of the world as well as links to the economic model, climate change and ecological transition. Assessing health needs and develop response options in various historical, social, economic, cultural, environmental, structural, commercial, legal contexts. At the end of the curricular unit Students should be able to: 1. Understand and explain the difference between high-risk approach and population approach in public health. 2. Explain the theory of the root causes of social inequalities and use several recent examples. 3. Explain the links between globalization, health inequalities in and between countries, and the prevailing economic model. 4. Outline the concept of planetary health. Outline the interactions between socio-economic-corporate determinants of obesity, malnutrition, and climate change and the major determinants of noncommunicable diseases. 5. Outline the concept of syndemic and provide examples. 6. Analyze global issues of potential ethical concern and identify which actors are almost absent from current global health. Understand the time horizons needed for social change. 7. Outline determinants of infectious diseases such as Ebola Virus Disease. Discuss criteria to trigger a Public Health Emergency of International Concern. Using examples, explain how preventive action based on multi-sectoral approaches could be strengthened. 8. Understand the evolution of the determinants of people's health and the implications of this evolution for health strategies. 9. Propose a multisectoral plan in a specific country to address the largest public health problem. 10. Recognize the importance of the events and determinants that contributed to the progressive “creation” of Global Health and the elements and criteria that can contribute to the description of the present state of Global Health. 11. Realize the importance of trade treaties as well as the role of diplomacy in rights negotiations, for example at the WTO. To be able to develop the main lines of an action and negotiation plan with all the actors, including the forgotten actors of Global Health to modify the great challenges for health in the 21st century. 12. Critically and contextually interpret publications on the socio-economic, commercial and environmental determinants of health. Use examples to illustrate the need for diplomacy, for interdisciplinary actions with broad citizen participation. 13. Understand the concepts of infectious disease, epidemic, endemicity, strength of infection, emerging diseases and diseases with pandemic potential, trends, distribution and factors that determine the global weight of infectious diseases. Recognize new and emerging diseases, their causes, evolution over time and space and “hotspots” and be familiar with factors that are used to prioritize emerging diseases and understand the different risk management phases and actions.
General characterization
Code
5788019
Credits
4
Responsible teacher
Thierry Mertens
Hours
Weekly - 12,5
Total - 32
Teaching language
Portuguese
Prerequisites
Attendance of 2/3 of classes is mandatory
Bibliography
• Global Commission on the social determinants of health: Final report, 2008. http://www.who.int/social_determinants/thecommission/finalreport/en/ • Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence and policy implications. Journal of Health and Social Behavior 2010. 51 (S): S28-S4. • Rose G. Sick individuals and sick populations. Int J Epidemiol. 1985;14(1):32-8. • Stringhini S, Carmeli C, Jokela M et al. Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Lancet, 2017. Vol 389, 1229-1237. • Swinburn, B. A., Kraak, V. I., Allender, S., Atkins, V. J., Baker, P. I., Bogard, J. R., ... and Ezzati, M. (2019). The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. The Lancet, 393(10173), 791-846. • Kuate Defo B. Demographic, epidemiological, and health transitions: are they relevant to population health patterns in Africa? Global Health Action [Internet]. 2014 May 15 [cited 2016 Oct 18];7(0). Available from: http://www.globalhealthaction.net/index.php/gha/article/view/22443 • Thompson, R., and Garry, S. (2019). The political economy of NCDs, and the limits of global health. Lancet 2019. • McCloskey B, Dar O, Zumla A, Heymann DL. Emerging infectious diseases and pandemic potential: status quo and reducing risk of global spread. Lancet Infect Dis. 2014 Oct;14(10):1001-10. doi: 10.1016/S1473-3099(14)70846-1. Review. PubMed PMID: 25189351. • Gebreyes WA, Dupouy-Camet J, Newport MJ, Oliveira CJ, Schlesinger LS, Saif YM, Kariuki S, Saif LJ, Saville W, Wittum T, Hoet A, Quessy S, Kazwala R, -Tekola B, Shryock T, Bisesi M, Patchanee P, Boonmar S, King LJ. The global one health paradigm: challenges and opportunities for tackling infectious diseases at the human, animal, and environment interface in low-resource settings. PLoS Negl Trop Dis. 2014 Nov 13;8(11):e3257. doi: 10.1371/journal.pntd.0003257. Review. PubMed PMID: 25393303; PubMed Central PMCID: PMC4230840. • Biesma, Regien G., Ruairí Brugha, Andrew Harmer, Aisling Walsh, Neil Spicer, and Gill Walt. “The Effects of Global Health Initiatives on Country Health Systems: A Review of the Evidence from HIV/AIDS Control.” Health Policy and Planning 2009; 24: 239–52. doi:10.1093/heapol/czp025. • Smith RD, Correa C, Oh C. Trade, TRIPS, and pharmaceuticals. Lancet, 2009; 373: 684–91. DOI:10.1016/S0140-6736(08)61779-1. • Kickbusch. I - The commercial determinants of health. Lancet 2016 (4): 895-6. • United Nations Development Programme. What does it mean to leave no one behind? Aug 9, 2018. http://www.undp.org/content/undp/en/home/librarypage/poverty-reduction/what-does-it-mean-to-leave-no-one-behind-.html (accessed April 4, 2019).
Teaching method
Seminars, theoretical-practical classes, group work and tutorial guidance.
Evaluation method
The final evaluation of the student will have 2 components: 1. Presentation of a scientific article or scenario such as describing an intersectoral initiative - Specifically, the capacity for understanding, research, synthesis, communication and critical reflection will be assessed. It will represent 45% of the final grade. 2. Elaboration of a final paper or presentation on one of the themes presented during the seminars and classes, which will represent 55% of the final grade.
Subject matter
I. Historical perspective of the concepts of health and disease determinants: genetics, age…, education; determinants and socio-economic, socio-cultural, legal, commercial interests and planetary resources. Corporate determinants of health and commodification of health. Inequalities in Health in and between countries- Consequences and challenges of responses Population health (collective) and individual health (T); II. High risk approach and population approach (TP-OT - G. Rose) - Causal independence of the Socioeconomic Statute in ill health (Stringhini et al). Principles of fundamental causes (Phelan et al.). Ethical issues for global public health. Time horizon for social change. (T); III. Determinants linked to health systems (T); IV. Persistence of infectious diseases in the world: burden of infectious diseases, evolutionary trends, distribution and main determinants, with a particular emphasis on diseases with pandemic potential (TP and OT); V. Determinants of non-communicable diseases with an emphasis on the consequences of air pollution and malnutrition (obesity and malnutrition) as well as links with corporate determinants and climate change - potential measures to reverse syndemia (TP).