The Global Burden of Surgical Disease: An Analysis of Inaccessible Surgical Care in Low and Middle Income Countries

Authors: Chau Huynh, Minh NQ Huynh

Abstract

Worldwide, 4.8 billion people do not have access to safe, adequate surgical care and anaesthetic management. Surgical care has been deemed “the neglected child of global health,” a startling reminder of the disparities in health services. The provision of surgical interventions can avert 11% of the global burden of disease and 1.5 million deaths each year. Many obstacles exist for low- and middle-income countries (LMIC) to progress towards accessible surgical care. The first challenge is delivering cost-effective surgical care despite financial constraints and political turmoil. Foreign aid was established to alleviate the financial burden and its contributions have been pivotal. However, based on the political climate in certain countries, funds are siphoned to government sectors other than health care. Moreover, the lack of infrastructure, equipment, and personnel in LMIC compound the issue. The other challenge is determining if surgery is as feasible and effective as non-surgical health interventions. Surgical care is crucial and this paper aims to assess the challenges that limit its stature in global health discussions. The paper will address the influence of financing, infrastructure, workforce, service delivery, and information management on surgical care, and the current resolutions, such as humanitarian aid missions.

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Mortality prediction with a single question

“On a scale from 1 to 5, how would you rate your own health?”

Self-reported or self-rated health status (SRH) is a commonly used indicator in both clinical epidemiology and population health. It is a subjective measure of health that is thought to reflect an individual’s integrated perception of the domains of health, including biological, psychological, and social dimensions. The World Health Organization considers SRH to be a reflection of population health and healthy life expectancy within countries1. It is assessed either by a questionnaire or by a single question which asks subjects to rate their own health, usually on a four or five-point scale from poor to excellent. SRH has been used as a health indicator in epidemiological studies since the 1950s, and has been found to predict future health outcomes independent of physical, socio-demographic, and psychosocial indicators2-5. It is widely considered to be a valid indicator of health status.

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An overview of scientific-based knowledge on sedentary behaviour among the pediatric population – A conceptual model development

Author: Salomé Aubert

Abstract

Sedentary behaviour has been identified as a specifically deleterious personal practice on multiple levels of health of individuals at all ages, including the pediatric population (i.e., 0 to 18 years of age). The aims of this paper are to (I) summarize the literature concerning the definition, the characteristics, the context, the determinants and the consequences of sedentary behaviour among children and youth; (II) propose a conceptual model that summarizes these findings; and finally (III) highlight research gaps in the literature. Sedentary behaviours are common and complex behaviours that can potentially affect the health of children and youth on the physiological and psychological levels. Those deleterious effects on health can vary depending on how they are accumulated throughout the day, for example with or without interruption, or in which context. While childhood engagement in sedentary behaviours is too high in the majority of countries where it has been assessed, developing research and policies that target the reduction of sedentary behaviours among children and youth must be ranked as a top priority for all public health organizations worldwide. Although further research is needed concerning the identification of the specific determinants and consequences of different types and patterns of sedentary behaviours in various contexts, the Conceptual Model for the Study and Understanding of Children and Youth’s Sedentary Behaviour, which I have proposed in this paper, gives an overview of the topic and supports the development of policy and further research.

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An Interdisciplinary Population Health Approach to the Radon Health Risk Management in Canada

Authors: Selim M. Khan, James Gomes

Abstract

Radon is a known carcinogen found in indoor air that exists at higher than the federal reference level (200 Bq/m3) in about 10% of Canadian homes. Every year, over 3,000 people die from radon-induced lung cancer, which accounts for 16% of annual lung cancer deaths in Canada. Radon is the leading cause of lung cancer deaths among non-smokers and is second among smokers. Children, women, and smokers from lower income groups are disproportionately affected. Although the Federal Government has reset the guideline (from the previous 600 Bq/m3 down to 200 Bq/m3) and provincial governments revised the building codes to limit exposure, there remain controversies with the latest scientific development in adopting strategies of radon management in Canada.

This review applies an Integrated Population Health Framework to look at the relationships and interactions between population health determinants such as biology and genetics, environment and occupation, and social and economic factors, that influence the health risk of radon. The evidence gathered supports policy analysis with the application of ethical and risk management principles that lead to the identification of efficient and affordable broad-based and population-level preventive strategies. The final inferences enhance the framework by adding critical intervention modalities to Health Canada’s National Radon Program.

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Sexual and Reproductive Heath and Rights: A Global Obligation

Authors: Kassandra Messier, Ayah Nayfeh

Universal access to sexual and reproductive health care is at the forefront of human rights issues of the 21st century. Every year in developing countries, there are 74 million unintended pregnancies leading to approximately 36 million abortions. Of these abortions, 21 million are unsafe which makes up nearly 13% of all maternal deaths globally [1]. The global advancement of sexual and reproductive health and rights are susceptible to change in 2017, as new international aid agendas are set.

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Addressing the Social Determinants of Health: Actions from the City

Social determinants of health are the social, economic, and environmental factors that influence health and well-being. Social determinants influence health as they define the extent of resources and opportunities that can be made available to individuals, given their social location (Marmot & Wilkinson, 2005; Raphael, 2009). They explain the health disparities observed among individuals and represent an important and continuing public health concern within the health promotion and health services spheres of research.

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Healthcare in Cuba: Defining Features and Future Trends

In 2016, Cuba made headlines for the status of its economic embargo with the US, its increasing foreign investments through tourism, and the death of Fidel Castro. Besides these recent events, in a sense foreshadowing Cuba’s future political and economic paths, throughout the 20th century, Cuba’s healthcare system has been acclaimed as one of the best healthcare systems in the world with very good health outcomes for the Cuban people. For example, infant mortality is lower than in the US and the life expectancy is 77.5 years of age (WHO, 2016). What are the Cuban healthcare system’s defining features? Will recent events alter some of its key aspects?

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Conflict and disease: A complex relationship

Author: Robert A. Frank 

Societies will always be subjected to situations that test their tolerance thresholds. When a stressor exceeds a society’s capacity to cope, “failure” of the system is often manifested as social unrest, falling along a spectrum of intensity ranging from civil wars and revolutions to riots, strikes, and protests (Braha, 2012). The conflict leading to social unrest is most often initiated by groups on the disadvantaged end of systemic inequalities, as a desperate effort at effecting change (Haas, 1986). Although social unrest is sometimes a necessary vehicle for cultural revolution, the resultant disruption of society invariably creates a volatile environment that is vulnerable to adverse health outcomes (Jovanović, Renn, & Schröter, 2012).

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Finding Potential in Another Mother’s Breastmilk

In Canada, the primary cause of mortality in infancy and long-term disability in children is being born at very low birth weight (<1500g or <3.3lbs; Saigal & Doyle, 2008). If these infants are fed their mother’s milk in the neonatal intensive care unit (NICU) they experience fewer severe infections (Hylander, Strobino, & Dhanireddy, 1998; Patel et al., 2013), improved feeding tolerance (Schanler, Shulman, & Lau, 1999; Sisk, Lovelady, Gruber, Dillard, & O’Shea, 2008), lower colonization of pathogenic bacteria (Yoshioka, Iseki, & Fujita, 1983), and increased neurocognitive development (Anderson, Johnstone, & Remley, 1999). However, due to many reasons related to preterm birth, as many as 70% of mothers cannot provide a sufficient amount of breastmilk to meet the demands of these infants, therefore, a supplement is necessary (Callen & Pinelli, 2005). Currently in Canada, either pasteurized donor breastmilk (donor milk) or preterm formula is used as a supplement to mother’s milk.

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Planning and delivery of health services – an article review on urban aboriginal mobility in Canada: examining the association with healthcare utilization

Author: Ankit Dhawan

Abstract

An article from Social Science and Medicine, written by Snyder and Wilson (2012), examined the use of healthcare services by urban Aboriginal populations in Canada. Using the Behavioural Model of Health Services Use (BMHSU), predisposing, enabling, and need factors were organized and used for data analysis. Specifically, a comparison was made between conventional (physicians and nurses) and traditional (traditional healers) health service utilization in Toronto and Winnipeg. In addition to the geographical and educational factors, the results of the research recognized mobility as a significant predisposing complement to healthcare utilization.

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