1.1. Identify the global health risks (due to either internal or external sources) that threaten the health of the UK population.
Global health is focused on people across the whole planet rather than the concerns of particular nations. It recognises that health is determined by problems, issues and concerns that transcend national boundaries (HM Government (HMG), 2008).
Health risk is a disease precursor associated with a higher than average morbidity or mortality rate. (Mosby’s Medical Dictionary, 2009) Global health risk therefore is the identification of the global and regional mortality and disease burden (Stevens, 2009).
According to statistics, the leading global risks for mortality in the world are high blood pressure, tobacco use, high blood glucose, physical inactivity, and overweight and obesity. They usually affect all income groups across the world (World Health Organization (WHO), 2009).
On the other hand, the global burden of disease is classified into a first group which includes communicable disease, maternal, perinatal and nutritional disorders; a second group which includes non-communicable disease like cardiovascular disorders; and a third group which includes injury (Lindstrand, et al. 2009 p. 131).
Patterns of disease vary across the world. In 2009, in low- and middle countries, as well as in all high-income countries of Central and Eastern Europe, the non-communicable diseases dominate as causes of mortality and DALYs lost (Lindstrand, et al., 2009 p. 131). In the UK, particularly in London, exacerbation of many infectious diseases which are unique to the country has been reported.
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The population of London is increased daily by millions of commuters and visitors, thus to communicable diseases is also increases. Rates of TB, STIs, blood borne infections, malaria and measles has greatly gone up. It is significant to note that London has much higher rates of communicable diseases compared to other capitals in the UK due to dense population (Maguire, 2005-2009).
Donaldson (2007, p.7) states that, “In today’s globalised world, we can no longer consider the health of the UK in isolation. Chronic diseases such as obesity, diabetes, mental ill health, and alcohol- and tobacco-related illness – once deemed the preserve of industrialised nations – are now worldwide problems.
The dramatic increase in the incidence of HIV/AIDS and tuberculosis in some countries, and the emergence of avian influenza in Asia, could pose major threats to the health of the UK population. It may be a cliché, but it is true that infectious diseases do not respect borders.”
1.2. Assess the roles played by international organisations and agencies (both inter-governmental and non-governmental) in health promotion and disease prevention in developing countries.
One of the major reasons why International organizations were formed is to prevent the spread of infectious diseases.It is organised as intergovernmental and non-governmental (Lindstrand, et al., 2009 p.292).
Intergovernmental are those based on several governments. It could be international such as those belonging to the UN family. Non-governmental includes private, not-for-profit and non-governmental organisations (NGOs) (Lindstrand, et al., 2009). These international organisations play a great role in health promotion and disease prevention most especially in developing countries.
The World Health Organisation (WHO) is a specialised UN agency that handles health and medical issues for the world’s nations. Its acts as the directing and coordinating authority on international health work. Its objectives are to promote solutions of international, economic, social health and related problems (Linstrand et al., 2009 p.293).
According to Lindstand, et al (2009, p. 297) population is one of the major problems of developing countries. The United Nations Fund for Population Activities (UNPFA) deals with population division. It has four folded mandate: to build knowledge to respond to the needs in population, to promote awareness on population and family planning, to assist developing countries, and to play a leading role in the UN system coordinate projects in population.
Development issues in the UN system are being dealt with the United Nations Development Programme (UNDP). Its top priority is poverty eradication. This organisation has a special role to coordinate with the UN effort to monitor progress towards Millenium Developmental Goals (MDG) and assit countries to develop their own goals. (Linstrand et al., 2009 p.297-298).
The World Bank (WB) is important in international financing of health services in low and middle income countries. Its role is vital in health promotion and disease prevention. They provide loans and funding to sustain economic development and reduce poverty in low-income countries. The bank has become more active in health policy issues as evidenced by their theme, “Investing in Health” in their annual publication in 1993 (Linstrand et al., 2009 p.298).
Non-governmental organisations (NGOs) are playing an increasingly important role in many countries. They are also active in heath activities and they are prominent at global level like the Red Cross and International Planned Parenthood Federation (Linstrand et al., 2009 p.301-302).
Therefore, we could say that there are several international organisations and each one has their role to play in order to promote health and prevent diseases.
1.3 Evaluate the impact of global contribution in the prevention of HIV/AIDS and Malaria.
HIV infection and malaria are among the top ten causes of healthy life lost and deaths in the world. Thus, international organisations have exerted efforts and contributed in the prevention of these diseases globally.
Today, Aids is one of the main diseases of the world. The transmission is largely through commercial sex and intravenous drug use and as well as from blood transfusion.(Linstrand et al., 2009 p.144-145).
Due to awareness of the rapid increase in the prevalence of HIV/AIDS across the globe, NGOs have run many community-based projects in order to reduce transmission of HIV/Aids. They have programmes to supply condoms to commercial sex workers. Health and social services provide education, care and social support group to most vulnerable people. These projects have decreased the expected spread of infection mainly in Thailand, Tanzania and The US (Linstrand et al., 2009 p.147).
According to Lindstand, et al. (2009 p. 152), antiretroviral (ARV) drugs have been developed to combat or prevent HIV. But due to its high cost, only those who can afford could comply with the treatment. Thus, the Global Fund to fight AIDS, TB and Malaria (GFATM) was created in response to the challenge to finance basic health services. It effect will be judge after some years. It may be an effective prevention or have a low effect due to low compliance.
The UN-AIDS is also one of the agencies established by WHO to deal with AIDS. UNAIDS has been successful in lowering the price of antiretroviral drugs and on improving the monitoring of the HIV pandemic (Linstrand et al., 2009 p.299).
According to WHO, 2001 (cited by Linstrand et al., 2009 p. 165), the malaria parasite is estimated to be the direct cause of about 1.3 million deaths.
Because of the outbreaks, global strategies to prevent and treat malaria have been developed and the main challenge here is to find a method cheap enough to be sustainable among low-income countries. The GFATM is one of the agencies of WHO which help finance the projects against malaria across the world. Its projects have been effective in some areas but it appears that this intervention will only be feasible in only a few areas.
WHO has also responded with a programme called ‘Roll Back Malaria’. The focus is to improve existing drugs and to improve the use of health services by the affected population (Linstrand et al., 2009 p.168). According to the BMJ (2004), Roll Back Malaria is currently a failing global campaign. Support from donors needs to be increased for the Global Fund to provide the best funding method for the fast procurement of malaria tools.
Global contributions have a great impact in the prevention of HIV/AIDS and Malaria. It has greatly helped in the control of spread, treatment and prevention of these diseases although some methods have failed; the international and local sectors still continue to improve their mechanisms.
1.4. Recommend international measures that will assist further health improvements in developing countries.
There are so many international measures that could further help improve health in developing countries.
The general health situation is deterioration in several countries. Health is a good indicator of human life conditions and the health of the population of the country determines its general development. Although global health has deteriorated, improvements never ceased (Linstrand et al., 2009).
International organisation such as the UN continuously develops measures that will assist further health improvement especially in developing countries. It is in the interest of all countries and persons that the global health situations improve, thus UN has established Millennium Development Goals (MDGs). Almost half of the MDGs relate to health and targets the improvement of the least developed countries (Linstrand et al., 2009).
According to the authors of global health (2009), there are two particular difficulties in global development. One is scientific and the other is political. In determining these two, one could understand the culture, social and political structures of a country and actions for a better development will have a greater chance of success.
The World Bank, World Health Organizations and most other UN organisations now express similar view about development in health and alleviation of poverty. They regarded the eradication of poverty, freedom from hunger, access to safe water, basic education for all children, equal human rights for women and men, a healthy life and the sustainable use of natural resources as core aspect of development (Linstrand et al., 2009).
The World Bank stated in its yearbook (cited by Linstrand et al., 2009), that a better life involves more that simply higher income. It stated that, “Development encompasses as ends in themselves better education, higher standards of health and nutrition, less poverty, a cleaner environment, more equality of opportunity, greater individual freedom and a richer cultural life”.
The Non-governmental organisations, also suggests that the local communities should also be involve in order to sustain and achieve broader objectives of development goals and health improvements (Linstrand et al., 2009.
These international measures suggested by international organizations, if properly implemented and complied will greatly assist health improvement not only in developing countries but in the develop countries as well.
2.1. Identify the elements that are the corner stones of healthcare systems
A health care system is defined by Anderson and Frenk (1989 & 1994 respectively, cited by Lassey, et al., 1997), as the combination of health care institutions, supporting human resources, financing mechanisms, information system, organizational structures that link institutions and resources, and management structures that collectively culminate in the delivery of health services to the clients. These are what we call the elements of a health care system which are important in order to be more effective in delivering health care.
These elements are formed in order to provide equity, efficiency and quality or safety in health care. According to Lassey, et al. (1997), the elements should collaborate with each other to produce health outcome or health services. In order to understand each of these elements, we must first discuss and consider their function in the system.
Institutions are organizations that are responsible for the promotion of health, prevention of diseases and production of health care. It includes local, state and federal public health departments; public and private health care services providers such as hospitals and nursing homes; educational/training centres for health professionals; and environmental departments (Lassey, et al., 1997).
Another very important element is the supporting human resources which includes public health professionals and other personnel who work in the field of health care. They are the ones who are directly involved in health promotion, illness prevention or health care (Lassey, et al., 1997).
It is impossible to deliver health care without finance. Thus, financing mechanism is one of the most basic elements in a health care system. It includes direct government financing, private/national health insurance plans, managed care financing arrangements and other taxing systems that generate revenue for health care. Private out-of-pocket expenditures and any other sources that pay for the cost of care are also considered as financing mechanism (Lassey, et al., 1997).
For an easy measurement of expenditure, outcomes for health care procedure and cost control, information system is needed. It facilitates sharing/exchange f information, collates data and contributes to greater understanding (Lassey, et al., 1997).
Linking organizational mechanism is another element wherein association of professionals in school, hospital and other organizations attempt to link together the organizational units related to health care (Lassey, et al., 1997).
But in order for these other components to function and produce health outcomes, it should first have to be managed. An organization should have a management structure or mechanism to function effectively and efficiently. These management structures include public health and administrative system that link multi institutional organizations such as hospital chains, financing administrations and other management mechanism (Lassey, et al., 1997).
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These elements are interrelated and work as a system. Therefore, each of these elements has an important role in operation of a health care system. They are all needed so that health care system could effectively deliver services and produce health outcomes. They are also important for a health care delivery system to be accessible, affordable, attainable and available to all sectors.
2.2. Justify the rationales for diverse forms of health care system
There are many major influences that affect the heath of the population. Therefore, diverse forms of health care systems (HCS) are needed in order to meet the needs of the country.
According to Lassey, et al. (1997), historical and cultural influences identify the political and economic structure of a country. The economic reality greatly influence the kind of health care system a nation can afford.
The HCS of one country either private or public is affected by the combination of their physical, political, cultural, and community environment. Their structure also differs depending on the organization’s health policies and health care delivery; accessibility of services; and economic factors affecting the health care delivery system (Lassey, et al., 1997).
The European Observatory on Health Care Systems (EOHCS) 2002, conducted a study to provide up-to-date information on the health care systems of different countries and compared it to the UK health care system. This is conducted in order to improve the health care system and highlights that despite significant differences in how health systems are financed, organised and provided, all countries face a number of similar challenges.
In the report of EOHCS (2002), diversity in health care system of eight countries has been discussed mainly highlighting the funding and delivering of health care systems.
Denmark and Sweden is an example of a decentralised system of health care in terms of funding and delivery. Germany and the Netherlands have a social health insurance systems combined with private health insurance for high-income earners. France has a more centralised social health insurance model, offering universal coverage and with a mixture of public, private non-profit and for-profit providers
In Australia, there are three tiers of government and there is an essential division of health care system. The economic and functional responsibilities are divided.The Commonwealth collects most of the taxes while the States delivers most of the public services. Australia’s HCS is mainly funded by public revenue. Out-of pocket payment, private health insurance and other sources of finance accounts only for about 30% health care expenditure (Healy, 2002).
Both Australia and New Zealand have predominantly tax-financed systems of health care with differing degrees of decentralisation and privatisation of provision (EOHCS, 2002).
In conclusion, diverse form of health care system is important because each country is different from another. Thus, they have to develop a health care system which responds effectively and appropriately to their needs in order to ensure equal accessibility to health services, to have a sustainable financing system, and to provide quality care to improve health outcome of one’s country.
2.3. Evaluate the healthcare system of the UK making suggestions about facilitating a move from negative to positive outcomes.
The United Kingdom is one of the first countries in Europe to implement a publicly funded National Health Service (NHS). The NHS act, enacted in 1948 adopted three principles for a publicly funded universal health care system. These are equal access to medical acre, Availability of comprehensive preventive and curative care and provision of serve ices to no cost at the point of service (Lassey, et al., 1997).
As mentioned, health care in the UK is mainly funded through national taxation. Hospitals are predominantly owned with independent trust status. Health care services for privately insured patients or those who pay directly from their pocket are provided by private hospitals (EOHCS, 2002).
The NHS covers all the legal residents of the UK and other residents of the European Economic Area and other countries who have reciprocal agreements with the UK. It is basically established to provide care services to the extent that it meets all reasonable requirements.
Patient’s accessibility to health services is also being considered. According to the EOHCS (2002), there are several health care delivery systems in the UK. One of those is the ambulatory care which is provided by the general practitioner. There are walk-in clinics with GPs, practice nurses and other health professionals which provide primary care in several areas. Secondary care is provided by the in general acute NHS trusts, community hospitals, and tertiary level hospitals.
In order to reduce unnecessary hospital admission and to avoid long-hospital stay, the government increased the number of intermediate care beds. This intermediate care is designed to prepare the patient to return home. Social care is also provided for those people with mental illness, learning difficulties and elderly who need domiciliary and residential care (EOHCS, 2002).
There are also challenges that the UK health care system is facing. It has been recognized that the health care in the UK has been under funded as manifested by the long waiting lists for hospital appointments and poor quality hospital buildings.
But the government is committed to straighten the situation. The Chancellor of the Exchequer announced that over the next 4 years, there will be an increased public spending on the NHS. These will represent sustained rates of increased spending if achieved (EOHCS, 2002).
The NHS Plan also aim to increase NHS workforce numbers (consultants, GPs and nurses) as well as to improve services provided like reduced waiting times. In order to drive these changes, a Modernisation Board has been set up. In addition, a Commission for Health Improvement has also been set up to monitor and improve performance and facilitate positive outcomes (EOHCS, 2002).
3.1. Assess the current global health priorities in terms of attainment of health-related MDGs.
The centre of Millennium Development Goals is health. This is supported by the work of (Linstrand, et al., 2009). It is stated in their book that almost half of the MDGs are health related.
There are eight Millennium Development Goals. These are: to eradicate extreme poverty and hunger; to achieve universal primary education; to promote gender equality and to empower women; to reduce child mortality; to improve maternal health; to combat HIV/AIDS, malaria and other diseases; to ensure environmental sustainability; and to develop a global partnership for development, Department of Economic and Social Affairs (DESA), 2010.
By knowing and addressing the current global health priorities, health-related MDGs could be also attained. Blue (2007) identified 20 top global health priorities and categorized it into six clusters.
First priority is raising public awareness. This includes promotion of healthy lifestyle through effective education. It also involves dissemination of valid information via sustained accurate media coverage to improve economic, social and public health awareness (Blue, 2007).
Second health priority is enhancement of economic, legal and environmental policies. It focuses on studying and addressing the impacts government expenditure and taxation (Blue, 2007).
The third priority is modifying the risk factors. This includes deploying a universal measure to reduce tobacco use, promoting physical activity and consumption of healthy food. It is also an important that environmental and cultural factors that change behaviour are better understood (Blue, 2007).
It is also important to prioritize engagement of business and community. Business should be a key partner in health promotion and disease prevention (Blue, 2007).
Mitigating health impacts of poverty and urbanization is also one of the health priorities. This is where poverty related risk factors and the links between the environment, urbanization and chronic non-communicable diseases are being identified and addressed (Blue, 2007).
Reorientation of health system is also an important priority. Allocation of resources should be based on burden of diseases. Moving professional training and practices toward prevention while increasing the number and skills of health care professionals especially in developing countries. Building a health system that incorporate screening and prevention and increases accessibility to medications (Blue, 2007).
By addressing these current global health priorities, there is a greater chance of attaining health-related MDGs.
3.2. Identify the UK contribution to a global health strategy. Give specific example
Tony Blair states that, “Improving global health is clearly in Britain’s interest, and the Commission for Africa and the Gleneagles G8 Summit made several commitments on health and health care. The UK has a major role to play,” (Crisp, 2007).
3.3. Justify the need for international health care organisations operating globally to form partnerships to secure better health for populations (especially women ad children) in the developing countries.
In order to deal with the threats to health worldwide, International Organizations need to collaborate. Global collaboration was originally formed for the purpose of preventing the spread of communicable diseases across the national boarders (Linstrand, et al., 2009).
One of the goals of the MDG is to develop a partnership for development. It basically a global cooperation on aid, trade, debt, access to affordable essential medicines and new technologies and addressing the special needs of the least developed, landlocked and small island states (DESA, 2010).
There are several important reasons why there is a need for international organizations to form partnership. Though it originated from varied self-interest reasons like to combat infections for other countries or to quest for profit or influence for another, they may still not be a bad motivation to develop cooperation (Linstrand, et al., 2009).
One of the most evident examples of multinational health collaboration is the successful work of the United Nations Children’s Fund (UNICEF) in reducing children’s death and suffering through cost-effective interventions and protection of breastfeeding. The UNICEF is a unique organisation that reaches out to all countries through its national committees (Linstrand, et al., 2009).
UNICEF has also broadened its approach and includes the three F’s: female education, food supplements and family planning. WHO has given it support to this intervention of UNICEF (Linstrand, et al., 2009).
Countries cooperating in dealing with outbreaks like Ebola or SARS and the guidance of the World Bank on countries’ expenditures on healthcare justify also the need for global partnership.
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