13 - Nee-Kofi Mould-Millman - Access, Availability, & Outcomes

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University of Colorado System

全球保健基础

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Around the world, we are increasingly socially and economically interdependent. Health on one side of the globe affects people on the other. Global health, once merely an ethical consideration, now dominates discussions and policies of global security. A diverse team of experts in this emerging field has come together to help you contextualize your experiences as a new or seasoned global health responder. By the end of this course, you will be enlightened about the changing world you live in, and have a much better understanding of the machinations on how organizations and governments are striving to improve health worldwide. You'll also learn how to keep yourself safe and be a savvy participant in the global health arena. You'll be prepared to travel and to take your skills to chronic/emergent situations and help respond to the pressing needs while participating in global health activities throughout the world. Week one will serve as an introduction to global health concepts with a look at changing trends in the 21st century; urbanization, environmental stress and resource scarcity. During week two, we will dive into global health security: food, water, energy, and the threats of a changing climate. Week three will cover the global burden of disease, infectious disease, the rise of non-communicable diseases, mental health, and access to care. During week four, we will learn about the stakeholders in global health: NGOs, governments, non-state actors; understanding where the money comes from, how it is allocated and the challenges of measuring results; human rights: what are they and how are they protected? During week five, we move onto complex humanitarian emergencies: forced migrations, wars, response standards, and the legal basis for interventions. Finally, during week six, we will end our course by learning how to be an effective participant--caring for yourself: pre-travel preparation, understanding risks when traveling outside your home country, and physiologic vulnerability. This course also serves as a prerequisite to the hands-on 'Global Health Responder' certification from the University of Colorado School of Medicine. If you're interested in taking this 3-day hands on course-- offered throughout the world-- please go to coloradoWM.org or email our administrator: marisa.burton@ucdenver.edu.

从本节课中

Global Burden of Disease

Last week's lectures focused on the 'preconditions' of health, including food, water, and shelter. This week, we'll get into the substance of the "health" in global health. A stellar line up of clinicians will outline their take on disease burden as well as how healthcare systems have succeeded and failed to meet emerging needs. Dr. Renee King will discuss the rise of non-communicable diseases (hypertension, diabetes, obesity) as well as the often stigmatized illnesses of mental health. Finally, Drs. Mould-Millman and Richards will explain how medical systems are responding to meet the global burden of disease.

Jay Lemery - Weekly Overview0:38

11 - Nee-Kofi Mould-Millman - Healthcare Systems9:35

12 - Renee King - Non-communicable Diseases5:34

13 - Nee-Kofi Mould-Millman - Access, Availability, & Outcomes8:40

14 - David Richards - Urbanization, Urban Diseases7:54

15 - David Richards - Urbanization, Healthcare Systems3:57

16 - Renee King - Mental Health9:00

与讲师见面

Dr. Jay Lemery, MD
Associate Professor
Emergency Medicine, University of Colorado School of Medicine

Nee-Kofi's back to talk about access and

availability within healthcare systems in low-to-middle income countries.

After the lecture he'll be joining us in the studio for

a short question and answer session.

>> We're going to continue our lecture series today on healthcare systems by

focusing on issues of access, availability, and healthcare outcomes.

The four objectives of our talk today are, to highlight some determinants of

health outcomes, to demonstrate a strong correlation of poor outcomes with poverty,

to describe a general structure of healthcare delivery systems in

low-to-middle income countries, and finally to characterize barriers

to accessing healthcare in low-to-middle income countries.

The US Centers for Disease Control and

Prevention, has described five broad determinants for population health.

They include social and societal characteristics, ecology, genes and

biology, health behaviors, and you'll see that medical care actually comprises

less than 20%, of the overall, determinant of health.

However, this is going to be the focus,

of our discussion today, the impact of healthcare systems on outcomes.

So if we look at global health statistics,

you'll notice a strong correlation between poor health outcomes and poverty.

This is most strongly demonstrated in sub-Saharan Africa,

the focal area of my interest and work.

As you'll see on the depicted map, there's clustering of poverty in sub-Saharan

Africa and Southeast and East Asia.

So the following series of maps demonstrate that health outcomes are worse

in poorer regions of the world.

This is true for infant mortality, maternal mortality, trauma and injuries,

specifically deaths from road traffic injuries, and communicable diseases.

In this map we, we demonstrate HIV/AIDS.

So what causes poor health outcomes in the developing world?

Well there are three things.

The dual burden of disease,

which is the rise in non-communicable diseases like cardiovascular disease,

plus the existing high burden of disease from communicable diseases, like HIV.

The second is lack of resources in low-to-middle income countries,

such as poor education, and transportation systems, and inadequate medical resources.

And thirdly, poverty, which we know is an independent risk factor.

All three translate to poor health outcomes for populations.

So what's the role of health care systems in improving outcomes?

The WHO, the World Health Organization, our premier global health organization,

in a joint statement with the Office of the High Commissioner for

Human Rights, declared equitable healthcare as a fundamental human right,

and this includes access to basic and acute healthcare.

In 2012, the United Nations advanced this notion by stating, the function of

a healthcare system is fundamental to achieving universal healthcare.

Nee-Kofi, thanks for joining us in this studio, that was excellent.

My first question is that,

you seem like a really bright guy that can probably do anything.

Why are you dedicating your career to global health?

>> Thanks, Jay.

Well it, it stems from my childhood honestly,

growing up in West Africa for almost 20 years.

And I think bearing you know, sort of first hand witness to

a lot of poor health outcomes, a lot of preventable morbidity and mortality.

And family, friends, and beyond and, and hearing about that daily and, and

I think coming to the US to train, and subsequently seeing the, you know,

the unrealized potential, for helping to prevent some of that morbidity and

immortality overseas.

And I think the disparity in outcomes was both frustrating on one hand, but

also I saw an enormous potential, to be able to go back, overseas to,

lower resource environments, and to really think about cool ways,

of building very innovative, and sustainable,

you know, you know, providing solutions to real problems.

And there are models of these all over the world but very few in emergency care.

And I think that's where I've decided to sort of focus my, my career and-.

>> Can you just talk a little bit about what it is that you're doing?

And just say perhaps that I have $100 million in my pocket and I'm a potential

funder, and you have, you know, 30 seconds or a minute to make the pitch to me.

But just, why is this exciting to you and what is it you are actually doing,

because I think that'd be very interesting for our students.

>> Yeah, absolutely.

So, we know that in low resource environments

people die unnecessarily, before they reach hospitals even.

And my, my career is really focused on how we can prevent mortality.

You know by very simple, low cost, low tech, effective, you know, implementation.

And we call, and that's all around pre-hospital emergency care.

In the US, we think of that as ambulance delivered care, helicopter based care.

But there are other very innovative models,

like delivering care on motorcycles, for exam, motorcycle ambulances, for example,

that, that cost very little, but is able to, you know,

by those interventions are able to improve morbidity and mortality dramatically.

>> Healthcare as a human right is something that's

not necessarily accepted universally across the world.

Can you just speak to that, on what your take is on that?

>> Absolutely. Since the 40s,

I think there have been several large conferences and

international gatherings where prominent organizations like the WHO and

the UN have, have collectively decided that healthcare should be a human right.

And I'd like to make the distinct, the distinction between healthcare

as a human right versus the right to be healthy.

I don't think anybody is saying you have a right to be healthy, that would be nice.

But we're advocating, and I think it makes sense, and it's the right thing to do,

especially as a healthcare provider.

Where we know that people who don't have access to healthcare, for example,

in low resource settings, for example, mothers who are going into labor but

don't have access to transportation because they're poor and have, and have,

and have not had enough prenatal visits die, and their children die.

And there were no mechanisms and services in place to ensure they had,

all the right access, to improve their outcome.

So I think as a healthcare provider, and as a, and as a, a humanitarian,

as just as a good person, it's the right thing to do, to ensure everybody has some

access to one, the healthcare services, two, the financial protections you are,

you are offered as a means of improving your health outcomes.

>> You spoke a little bit about poor outcomes being directly linked to poverty.

Can you speak a little bit about poverty traps, what are they, and

perhaps how do people break the cycle and get out of them?

>> Yeah, Jay, that's a really tough question-.

>> [LAUGH]. >> To to answer.

And, I think a lot of, there is a lot of global attention on how you can improve

poverty, because we know handing a lump sum of cash, for example, to a poor

family in independent of doing anything else, improves their health outcomes.

It's a wonderful question and

there are various micro sort of economic financing schemes.

I mean, there are, there are all sorts of models from an individual, person and

family model all the way up to a societal and a country level, you, you know,

sort of economic interventions.

And I don't know that there's one right answer.

Historically it's been, you know, foreigners coming in and

injecting cash into economies to try and boost the economies.

Unfortunately as we know from the IMF, for

example, there's a link to all sorts of stipulations.

And I think those become constrictive and

really, have an, an adverse you know, effect on growing economies.

So, I think the question is, is good.

I, I think the answer is, is still unknown.

And I think there are, there are a lot of interventions underway to try and

figure out what what good solutions may be to breaking the poverty trap.

But we do know once you are poor it's this vicious cycle where you don't have enough

money to invest and improve your health outcomes.

And it's a cycle that perpetuates itself.

So good question, unfortunately no good answer.

>> That's great.

Thank you, Nee-Kofi, for joining us in the studio.

>> My pleasure, thanks so much for having me.

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