Global Health: what is it?

experts have suggested precautions for reducing worldwide risk

The 6 most important things you should know that may be helpful even after an epidemic.

Health care difficulties now cross international borders as a 2. Environmental Factors

consequence of the effects of a globalized economy,
improvements in transportation, and modifications to What impact might climate change and air pollution have on
agricultural methods. people's health? The majority of the time, sanitation and water
sources are the solution. Diseases spread more quickly among
By concentrating on global health, practicing doctors and huge populations of people during times of storms, flooding,
medical school educators must do their parts to impact droughts, and air pollution. The provision of resources like
preventative initiatives on a global scale. Knowing global bottled water and sanitation technologies is the immediate fix,
health begins with understanding what it is, followed by but global health also has to concentrate on preventing
learning about some associated challenges. environmental problems before they arise.
Many global health specialists believe that the greatest threat to
What exactly is global health? human health is climate change, according to Dr. Macpherson.
Global efforts to lessen human activity's impact on climate
Global health may be thought of as the study change are progressing.
of health care on a worldwide and
multidisciplinary scale, however exact He cites legislation from several nations as proof of this. For
definitions differ depending on the source. It example, there are laws that control how much energy is used
entails the study, investigation, and in individual homes, as well as initiatives to promote large-scale
application of medicine with an emphasis on industrial growth toward ecologically friendly methods,
enhancing global population health and healthcare equity. moreover go% of the world's population lives in metropolitan
areas, thus these adjustments will have a significant positive
Although the World Health Organization (WHO) is one of the impact on their health, according to Macpherson. This estimate
most well-known organizations improving global health, is consistent with World Bank statistics.
attempts to collaborate are being led by academics and leaders
in a number of sectors 3. Differences in income and access to healthcare
The One Health One Medicine program, according to Dr.
Calum Macpherson, dean of the School of Graduate Studies and Communities all across the world continue to lack access to
head of research in the School of Medicine at St. George's fundamental healthcare and health eduçation despite the
University (SGU), is the convergence of human, animal and continual advancements in medicine. As a result, there exist
environment health. health inequalities that are frequently correlated with location,
such as high infant death rates. The inability of certain people
By learning from each other and pooling and families to afford health care that wwuld otherwise be
resources, great progress can be made for the inaccessible is a result of other inequities, which are caused by
benefit of human and animal kind income inequality.
- Calum Macpherson, PhD,
Director of Research at SCU Global health professionals must look into ways to improve the
status of underrepresented communities in public health
There are six major global health challenges to be aware of: forums, encourage medical professionals to practice in rural
arcas, and implement policies
1. Pandemics that lower barriers and broaden access to healthcare in order to
address these economic challenges.
Global disease outbreaks are what are referred to as pandemics,
according to a World Health Organization Bulletin article. 4. Political aspects
Some influenza outbreaks, COVID19, and other vital threats
are examples of pandemics that highlight our susceptibility to International politics exacerbates the lack of proper access to
widespread illnesses-many of which have animal origins. healthcare. Conflicts between or between natics can damage
There are fresh hazards from pandemics every year. Although vital infrastructure, making common people more susceptible
vaccination programs might be helpful, it's crucial to tackle to illness. As a result, they start looking for ways to get out of
problems at their root by focusing on vital areas like health risky situations that endanger their safety.
education and ethical agriculture practices, Additionally,
Migration can make it easier for diseases to spread quickly, but Chronic Illnes
organizations like the WHO emphasize that the goal of Characteristics of a chronic illness:
solutions should be to improve refugee and migrant health ● Complex causes
through ● Many risk factors
initiatives like cross-border advocacy for laws that combine ● Long latency periods( time between onset of the
short-term humanitarian crisis responses with long-term illness and feeling its effects)
improvements in health care access. ● A long illness
● Functional impairment or disability
5. Non-communicable illnesses
Most chronic illnesses do not go away on their own and are
According to the WHO, non communicable diseases (NCDs) typically not fully treated. Heart disease and stroke can be
such as cancer, diabetes, heart discase, stroke, and other lethal. Diabetes persist over time and require intensive
illnesses account for 70% of all fatalities globally. maintenance. Arthritis last for the entirety of a person’s life but
do not result in death.
In order to improve lifestyle issues including poor nutrition,
inactivity, cigarette use, and alcohol intake, education can help Common Chronic illnesses
communities comprehend them. The prevalence of NCDs and ● Heart disease
income level do, ● Stroke
however, also correlate. ● Lung cancer
● Colorectal cancer
85% percent of early NCD-related fatalities, according to the ● Depression
WHO, take place in low- and middle-Income nations. Globally ● Type II Diabetes
lowering the ● Arthritis
incidence of CDs requires lowering the causes that ● Osteoporosis
disproportionately allocate lower-income neighborhoods. ● Asthma
● Chronic Obstructive Pulmonary Disease (COPD)
6. Animal welfare, food supply, and sourcing ● Chronic Kidney Disease
● Oral dsease
Animal and human wellbeing are inextricably linked, as is
made obvious by the study of veterinary public health, which Common stresses of chronic illness
some students ● Live with the physical effects of the illness deal with
pursue by earning a dual degree in veterinary medicine and the treatments
public health. The link between animals and the food chain is ● Make sure there is clear communication with doctors
perhaps the ● Maintain emotional balance to cope with negative
most obvious, but in developing nations, animals are also used feelings
for transportation, draught power, and clothing. ● Maintain confidence and a positive self-image

Disease transmission is an issue at every point in the food Top 10 Most common Chronic Conditions in older adults
supply chain since agricultural practices, such as irrigation, the
use of pesticides, and waste management, can affect animal Things you can do to try to prevent, or reduce, high blood
health. The importance of pressure include:
pathogens derived from animals or animal products in disease * Maintaining a healthy weight. Losing just 10 pounds can
transmission necessitates the inclusion of veterinary medicine reduce blood pressure
in any initiative to advance global health. * Regulate your stress levels
* Limit salt and alcohol consumption
Possibilities to impact global health * Exercise daily, including a combination of moderate to
There are a lot of ways people may have a vigorous-intensity aerobic activities, flexibility and stretching,
positive effect despite the enormous number of global health and muscle strengthening
concerns. * Check your blood pressure regularly-the quicker you catch
Everyone has the power to change the world, pre- hypertension, the more likely you are to prevent high blood
says Dr. Macpherson. "Small contributions add pressure
up quickly if enough people get involved.”
1. Hypertension (high blood pressure)
The most frequent ailment, hypertension, which affects both * Ischemic heart disease, which is brought on by a buildup of
how much blood your heart pumps and how resistant your plaque that narrows the arteries leading to the heart, was treated
arteries are to the blood flow, was treated in 58% of older in 29% of older persons. The volume of blood carrying oxygen
persons. High blood pressure, sometimes referred to as to the heart is reduced by narrow or clogged arteries. Additional
hypertension, occurs when your heart pumps a lot of blood and issues like blood clots, angina, or a heart attack may result from
your arteries are narrow and restrict the blood flow. The danger this.
of hypertension is that it can lead to other major medical To keep you from developing diabetes or to manage this
illnesses like stroke and heart attacks, and you might have it for condition, your doctor may suggest:
years without realizing it.
* Eating a healthy diet, including monitoring your carbohydrate
Lifestyle factors you can control when it comes to preventing and calorie intake, and talking to your doctor about alcohol
or managing high cholesterol include: consumption.
* Abstaining from smoking and excessive alcohol consumption * Exercising for 30 minutes five times a week to keep your
Being active each day blood glucose levels in check, and to control weight gain.
* Managing your weight * Safely losing 5-7% of body weight if you are diagnosed with
* Minimizing saturated fats and trans fats in your diet pre-diabetes.

2. High cholesterol 5. Diabetes

A problem known as high cholesterol, which develops when Diabetes, a condition that develops when your body is resistant
your body has an excess of harmful fats (also known as lipids) to or doesn't make enough insulin, was treated in 27% of older
and causes your arteries to harden, was treated in 47% of older persons. Your body utilizes insulin to transfer the energy from
persons. Heart disease can then ensue from this clogging of the meals to each cell in your body. You get high blood sugar when
arteries. this doesn't happen, which might cause consequences including
kidney disease, heart disease, or blindness. After the age of 45,
* Stay within the recommended weight for your height--losing diabetes risk increases.
one pound can remove four pounds of pressure on your knees.
* Make sure your back, legs, and arms are always supported. 6. Chronic Kidney Disease (CKD)
* Take precautions to avoid joint injuries. ➢ A steady degradation of kidney function over time,
* Do not smoke. was being treated in 18% of older persons. People with
CKD are more likely to get heart disease or renal
3. Arthritis failure.
Thirty-one percent of older adults were treated for arthritis-an
inflammation of your joints, which causes pain and stiffness Action to avoid or lessen CKD symptoms:
and is more common in women. ● Understand what damages your kidney.
● Early detection and treatment
There are steps you can take to delay the onset of arthritis or
manage the symptoms, including: 7. Heart Failure
* Exercise at least 5 times per week, for 30 minutes each time, ➢ A disease that develops when the heart is unable to
to improve function and decrease pain. Try to include a mixture appropriately pump blood and oxygen to all of the
of aerobic, strength building, and stretching movements. body’s organs, was treated in 14% of older persons.
May experience fatigue, lightheadedness, nausea,
Habits you can incorporate to help: confusion or lack of appetite.
* Refrain from saturated and trans fats, and limit sugar and salt
intake 8. Depression
* Get seven to eight hours of sleep each night ➢ A medical illness that can be treated and is not a
* Keep your stress levels in check natural component of aging, was the reason that 14%
* Do regular cardio exercises of older persons sought therapy. Chronic sorrow,
* Abstain from smoking pessimism, despair, exhaustion, trouble making
* Talk to your doctor about the major risk factors, including decisions, changes in appetite, loss of interest in
high cholesterol and high blood pressure activities are all signs of depression.

4. Ischemic heart disease (or coronary heart disease) Steps you can take to help with depression:
● Manage stress levels.
 ● Eat a healthy diet. • Slow blood loss which cause anemia
● Routine exercise. • Esophageal stricture
● Talk to your doctor • Ulceration, bleeding, perforation
• Laryngitis and aspiration
9. Alzheimer’s disease and dementia • Barrett’s esophagus-changes in your cells lining your
➢ Is one particular kind of dementia, a disorder that esophagus.
impairs daily activities by impairing memory and • Esophageal adenocarcinoma - esophageal cancer
making it harder to think or solve problems. Both are
brought on by changes in the brain that occur with age. GERD, PATHOPHYSIOLOGY
• Lower esophageal sphincter (LES)- a ring of muscle
10. Chronic obstructive pulmonary disease (COPD) forms a valve at the lower end of the esophagus where it joins
➢ A chronic illness that encompasses the two primary the stomach.
illnesses emphysema and chronic bronchitis, was • Gastric Emptying Time (GET)- it takes to a lus for the
treated for by 11% of older individuals. Shortness of • food to move out of the stomach and into the small
breath, coughing and chest tightness are all symptoms intestine.
of COPD that make breathing difficult. • Esophageal clearance - must be able to neutralize the
acid
NUTRITIONAL-METABOLIC PATTERNS/RESPONSE • refluxed through the lower esophageal sphincter.
TO ALTERED NUTRITION • Protective esophageal mucosal layer- a stratified
A. Disturbance in Ingestion squamous epithelium that acts as a tight defensive barrier
against noxious components of the gastroesophageal refluxate.
1. Gastro-esophageal Reflux Disease (GERD) • OH pylori-Helicobacter pylori) a type of bacteria that
infects your stomach. It can damage the tissue in the stomach &
Prevalence the first part of the intestine (duodenum).
• About 50% of the general population have GERD
symptoms at least once a month. DIETARY FACTORS
• Up to 10% will experience those symptoms least once • Peppermint, spearmint, chocolates, coffee (even
weekly. decaffeinated), tomato, citrus fruits, onions, and spicy foods.
• Up to 25% of pregnant women suffers from heartburn. • High fat meals will slow the GET Large meals or high
• "More frequent in adults more than 40 YO.. fluid volume.
• --Most patients seeks community pharmacists advice • Cigarette smoking
for mild symptoms. • Alcoholic beverages
FACTORS ASSOCIATED WITH GERD
CLASSICAL SYMPTOMS • Obesity
• -Burning, pressure or pain • Drugs
• Bitter or acid taste in the mouth • Bending forward
• Heartburn worsen after meal • Reclining after meal
• Heartburn is not linked to exercise or improve with • Restrictive clothing
rest.
• Dysphagia (difficult swallowing) GERD, DIAGNOSIS
• Odynophagia (painful swallowing) • Symptoms
• Endoscopy
ATYPICAL SYMPTOMS • 0.24 hours intra-esophageal pH monitoring
• Breathing problems such as asthma, • H. pylori test
• cough, or wheezing
• Aspiration Pneumonia DRUGS WEAKEN LES
• Interstitial fibrosis • a adrenergic agonists- drugs that work by mimicking
• Laryngitis the functioning of the sympathetic nervous system (ex.
• Globus (discomfort in the throat) Dobutamine- Treat cardiac decompensation in patient with
• Earache (burning pain in the ear) heart desease or surgery).
• ß adrenergic agonists- medications that relax muscles
GERD, COMPLICATIONS of the airway, causing widening of the airways and resulting in
• Symptoms causes discomfort easier breathing. (ex. Salbutamol)
• Benzodiazepines- a class of heterocyclic organic • Short duration (up to 1.5 hours)
compounds used as tranquilizers (ex. Diazepam) • Used for mild cases for symptomatic relief
• Calcium channel blockers-Medication used to Lower • Do not promote healing of esophagitis
Blood Pressure • Should not be used for bedtime
• Dopamine-a monoamine neurotransmitter it's made in • Ideally Antacids should be used in PRN basis with
your brain and acts as a chemical messenger, communicating other therapy.
messages between nerve cells in your body and your brain and • Efficacy seems to be similar among different products.
the rest of your body. • Products containing Alginic acid may provide
additional advantage as it's a foaming agents provide physical
• Theophylline- used to treat wheezing, shortness of barrier in top of the stomach.
breath & chest tightness caused by asthma, chronic bronchitis, • The selection is based on SE profile. The selection is
emphysema and other lung diseases. based on SE profile.
• OTCA-Tricyclic antidepressant
• Birth control pills ANTACIDS, TYPES
• Aluminium hydroxide - Constipation; Small amounts
NON PHARMACOLOGICAL TREATMENT absorbed (watch in renal failure)
• Avoid foods that directly irritate esophageal • Magnesium hydroxide- Diarrhea; Small amounts
• Avoid foods that lower LES tone. absorbed (watch in renal failure)
• Avoid high fat meals. • Calcium carbonateCalcium carbonate - Higher doses
• Do not drink large amount of fluids with meals. might produce paradoxical effect
• Try several small meals throughout the day. • Sodium bicarbonateSodium bicarbonate -Systemic
• Avoid drugs that lower LES tone. alkalosis
• Remain upright for 2-3 hours
• Elevate the head of the bed on blocks or use a wedge ANTACIDS, DRUG INTERACTION
pillow. • By alteration in gastric pH, it can interfere with
• Avoid bending forward. absorption of many drugs:
• Wear loose, comfortable clothing. -Digoxin, phenytoin; isoniazide; ketoconazole
• Lose weight if appropriate. -bioavailability of cimitidine by 50%; ranitidine by 30%;
• Stop smoking. famotidine by 20%, and nizatidine by 10%.
• Avoid Alcohol. • It can form complexation with many drugs;
-Ciprofloxacin bioavailability | by 50%.
PHARMACOLOGICAL OPTIONS -Tetracycline
• Antacids • Separate the administration by at least 2 hours.
• H2RA-Ha receptor blockers, or Ha receptor antagonist
(HaRAs), are a class of gastric acid-suppressing agents H₂RA (II₂ RECEPTORS ANTAGONISTS)
frequently used in various gastric conditions. (ex. cimetidine, • Stop stimulation of parietal cells by histamine.
famotidine, nizatidine, ranitidine) • ↓ acidic media and ↓acid volume
• OPPI-Proton Pump Inhibitors, blocks the actions of an • Effective in controlling symptoms.
enzyme in the stomach and reduce the amount of acid made in • ?! Efficacy in healing (! Dose dependent).
the stomach. (ex. Lansoprazole (Prevacid), Omeprazole • Non prescription VS prescription H₂RA.
(Prilosec), Pantoprazole (Protonex), Esomeprazole (Nexium). • Efficacy seems to be the same among different agents.
• Prokinetic drugs - enhances gastrointestinal motility • Selection based on SE (side effect) profile and cost
by increasing the frequency or strength of contractions, but effectiveness.
without disrupting thier rhythm. (Ex. Domperidone,
Metoclopramide)
• Mucosal barrier agents--any drug that protects the
mucosal lining of the stomach from acidic gastric juices
(Aluminum Hydroxide, Sucralfate, Sodium Bicarbonate)

ANTACIDS
• gastric pH
• gastric pH→ LES pressure
OTC, H₂RA

PRESCRIPTION H₂RA
PPIS
• Inhibit the final step of acid production (proton pump)
system on the gastric parietal cell surface.
• Approved for wider range from heartburn to erosive
esophagitis.
• It seems to be related to its capacity of keeping gastric
pH within 4 or greater for long time.
• Though PPIs affects the gastric pH, limited nutrients
and drug interactions are reported!
• Short half life and long duration of action.
• Acid suppression is suerior to H,RA.
• Acid suppression seeems to be similar among different
products.
• Symptoms relief starts within few days.
• Few studies shows that lansoprazole 30mg,
rabeprazole 20mg, and esomeprazole 40mg are faster in action
than omeprazole 20mg.
• Ilealing of esophagitis is achieved in 70-95% of
patients within 4-8 weeks treatment.
• Severe forms might need longer duration.
• If healing not achieved, continue for additional 8-12
weeks.
• Higher dose might be even recommended.
• About 80% of patients stays in remission status.
• Wheter PPis is better in preventing long term
complications, still to be studied.