An introduction to key challenges and concepts important to understanding the current status and determinants of global health.
What are the Roles of Environment and Nutrition? Part I
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The Challenges of Global Health
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Basic Concepts in Global Health
This module covers some of the most important basic concept that you need to know to understand global health. In particular we will focus on key terminology and the determinants underlying health and disease.
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Dr. David BoydHymowitz Family Professor of the Practice of Global Health
Duke Global Health Institute
In my last lecture, we talked about the importance of analyzing and
discovering the underlying determinants that produce the global burden of disease.
And I used a whole bunch of examples looking at nutrition, right?
What people need or what people can find, affordable and good food choices.
I showed you some [FOREIGN], or guinea pig, being eaten in Peru.
Or to how people move, you saw my bike and
I talked about both the benefits and risks of biking.
We talked about that these issues that these
determinants may be at an individual level, they may be at a structural level.
And there are many different types of determinants, and
as the course continues, we will be mentioning quite a few of them.
But I want to draw your attention right now as
examples to two of the most of two of some of the most important.
Important determinants that produce good or
poor health outcomes, and that is the environment and nutrition.
Just draw your attention, if you're interested in this photograph, I took this
in India, I was on, if I remember right, I was on my way to.
because [FOREIGN] it's cow patties, or cow manure, that's been patted out and
dried in the sun, and it will be used for fuel.
Let us move on.
Let's start with the environment.
Environmental determinants actually count for
about one quarter of all DALYs and almost a third of childhood DALYs.
Climate change is actually making it worse.
If you think about environment for example in climate change.
Increase in noxious chemicals you've all probably been following what's been
happening with the environment and with pollution in many cities around the world.
In fact environmental determinants play a role in over 80 disorders types one,
two and three.
And we know from environment alone, when we think about it, when we think about
air, water, hygiene, sanitation, almost a billion people.
750 million people still lack access to improved water sources.
Over two billion people in this world lack access to improved sanitation.
Indoor air pollution as we saw last lecture,
is one of our top risk factors in particular in the global South.
Why is that?
Because many parts of the world.
Solid fuel is used, this may be wood, it may be dung.
As you see here, it's used for cooking, and many of the homes in
which the cooking take place are poorly ventilated, or have no ventilation.
So people the women who are cooking or the men who are cooking, or
the people in the house.
Or actually inhaling, right, or inhaling the fumes,
right, or the toxic vapors and the smoke from the solid fuel.
And it results in lower respiratory irritation,
infection cataracts, right, irritation of the eyes.
Chronic obstructive pulmonary disorder, I talked about,
which is a condition in which you can't, the lungs can't inhale enough oxygen,
heart disease, and cancer, and even stroke.
Why, why heart disease, cancer, and stroke, you say?
Well, in fact some particles actually, as we'll see when we get to
extreme air pollution, can in fact pass through the lungs, into the blood stream.
And also some of these particles and some of the by products of smoke and
of burning this solid fuel are actually carcinogens, can cause cancer.
Now, while many people, whoever's in the house,
can be impacted by this, it's primarily women and children who were most impacted.
And since will occur mostly in Asia and sub-Saharan, here in Africa.
But even where I work in rural regions of Guatemala, we see this phenomenon as well.
Also, just a fast fact that I thought you might be interested in.
Is that indoor cooking and
cooking with fire using a solid fuel is also a significant source.
Of injuries, especially burns for women and children.
Outdoor air pollution, different kettle of fish, just as troubling.
Of course the main causes of outdoor air pollution, I do not need to tell you,
are actually the use of fossil fuels, deforestation by burning.
I say bovine methane production.
That's a nice way of saying flatulence or farting, right?
As we raise more and more cows for use as animal food.
When they're flatulent, they create methane.
anyway, all of these things all together create hundreds of
toxins that go in the air.
Not only creating toxins for
humans, and for animals as well, but actually exacerbating global warming.
We're seeing things happen such as lower respiratory infection,
lung and eye problems, again, COPD.
Heat disease, stroke, cancer and central nervous system damage.
Now again, as I said with indoor pollution.
Why is it that i'm talking about things such as chronic disease,
such as heart disease or stroke?
Well with outdoor air pollution in particular, some of this
particulate matter, especially that that's smaller than 2.5 microns in diameter.
Can actually pass through the lungs into the blood stream, irritating the blood
vessels, and actually causing inflammation and a buildup of plaque.
In fact, we know that outdoor air pollution contributes to
almost 40% of heart attacks.
Now while this impact is global, Asia has the highest burden.
China has the most number of deaths, but cities in India tend to have the highest
level of of particulate matter, smaller than 2.5 microns.
Generally it's been New Delhi but there are many other cities as well.
But the greatest number of deaths is in China.
And the greatest differential number of deaths.
In fact, this is you see, the, some of the pollution here in China.
I'm going to show you a video at some point as well,
where you may see more of that, too.
But there's even, this outdoor air pollution causes a difference in
life expectancy in northern versus southern China.
In fact, northern China has five years.
Less life expectancy, primarily because of air pollution than in southern China.
Unsafe water sanitation and hygiene also play a role.
Here you see some human feces what you see at the bottom, here's a railroad track.
The reason for that is in many parts of the world.
Where people do not have access to latrines and
they have to defecate outside, sometimes in open areas.
Something called open defecation, rail road tracks become great places to
defecate because you can actually squat on the tracks.
I almost stepped in this, but that my friends is a story for another time.
Now, what are the causes of unsafe water, sanitation, hygiene?
Well quite a few.
So there could be water that's contaminated with biological agents.
Such as E coli from human feces.
Chemical agents such as arsenic lead, can be lack of latrines of
rudimentary latrines, where fecal matter can escape.
It can be poor hygiene, whether that's from education or
whether that's lack of opportunities, not having enough soap, say to wash hands.
Lots of, poor health outcomes can result from this, lots of diarrheal diseases,
infectious diseases that can be spread by fecal oral contact.
Such as polio and trachoma, which we're actually going to
learn about a little bit later, and quite a few parasitic diseases as well.
Now, the people who are most affected by this are the bottom billion.
Those people who are are at in terms of part of the world's population,
are at the bottom of the socio-economic ladder.
It's particularly you find this particularly in sub-Saharan Africa.
And many parts of Asia and Central America.
Also, want to point out a nice fast fact, that in terms of,
unsafe water and people have to spend lot of time trying to fetch water.
And in sub-Saharan Africa alone, women and
girls spend 40 billion hours a year fetching water.
That is time that could be spent for girl in particular, in school.
There are many solutions to this, this is
actually an image from Brazil, of how some of these solutions can be put in place.
Ventilating ventilating kitchens for cooking, which you see here.
Putting compost latrines, there's one back here.
So that human waste can be disposed of, and
can be compost in a safe manner, without having an impact on ground sources.
Pumping in water from clean wells, which has happened here.
And, chlorination being used at the point-of-use to kill any
types of, bacteria.
But also things like reducing solid fuel,
using innovative ways of cooking such as solar stoves.
You know what?
I actually have one here I'll show you.
This is actually a solar stove.
I hope you can see this.
You actually can put this out in the sun.
You put the food here in a container.
Can you see that?
Put the food in the container, put it in the sun.
This actually focuses the sun's rays on the container and
will cook food in a few hours.
Very effective, very safe, inexpensive, this can be rolled up and
moved from place to place.
I hope you can see that.
Things like carbon taxes so
that we don't use as many fossil fuels are very important as well.
And even things like hygiene education not only providing things like soap,
but teaching hand-washing.
Teaching people not to defecate in streams or defecate near their
house can play a large role in preventing some of the diseases caused.
By, cause by these, these issues of environmental determinants.
Now in part two of this lecture, we're going to shift away from environment, and
I'm going to talk to you just a little bit about nutrition.
In particular, under nutrition.
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