Whole Course - NAF Curriculum

About This PDF This PDF file is a compilation of all of the Lesson Plan, Teacher Resource, and Student Resource Word documents that make up this NAF course. Please note that there are some course files that are not included here (such as Excel files). This “desk reference” enables you to easily browse these main course materials, as well as search for key terms. For teaching purposes, however, we recommend that you use the actual Word files. Unlike PDF files they are easy to edit, customize, and print selectively. Like all NAF curriculum materials, this PDF is for use only by NAF member academies. Please do not distribute it beyond your academy.

Copyright © 2012–2016 NAF. All rights reserved.

AOHS Global Health

Lesson 1 Course Introduction

This introductory lesson exposes students to some of the key terms and areas of knowledge that they will be studying throughout this course. They also learn about the skills they will develop that are crucial to the field of global health.

Students probe their personal conceptions about global health by judging the accuracy of a variety of statements. They acquire a sense of the course objectives by looking at examples of culminating projects created by previous students, who developed presentations about a global health issue they considered worthy of being the focus of an international summit. Students also set up two course tools: a general taxonomy of key terms in global health, and a notebook that they will use throughout the course.

Advance Preparation

Before you begin this lesson, display a large map of the world in the classroom. As you work through each lesson, use the map to help students locate the countries they learn about.

Print color copies of Teacher Resource 1.4, Maps: Regional Reference Maps (separate Word file), so that all students have a set to place at the beginning of their notebook. If you plan to have students keep an electronic notebook, make Teacher Resource 1.4 available for students to access online and place at the beginning of their notebook.

Determine how you would like students to set up notebooks for this course. We recommend you have them keep their notes and course materials in a computer-based folder, a three-ring binder, or a spiral-bound notebook.

Use the Semester Planning Table for planning purposes throughout the course. This document is included in the Course Planning Tools section of the course. All course materials can be downloaded from the NAF Online Curriculum Library.

This course requires a specific set of computer-related equipment. These requirements are listed in Required Equipment for This Course (available in the Course Planning Tools section of the course materials). Consider reviewing this list with your school’s IT administrator before you begin.

Review the Summary of Annual Course Updates (also included in the Course Planning Tools section), which describes significant changes to the course since the previous year.

Note that guidance for NAFTrack Certification procedures is not included within the lesson plans for this course. Be sure to review the course’s NAFTrack Certification Course Guide, available in the NAFTrack Certification section of the course materials.

This lesson is expected to take 2 class periods.*

* There are a number of introductory activities you may want to add before the first set of course activities, depending upon your own

needs and preferences. Such activities will extend the length of this lesson and may include conducting a favorite icebreaker, setting

course and grading expectations, teaching classroom procedures, and having students learn each other’s names.

AOHS Global Health Lesson 1 Course Introduction

Copyright © 2012–2016 NAF. All rights reserved. - 2 -

Lesson Framework

Learning Objectives Each student will:

Infer the skills and knowledge about global health needed to be successful in an authentic project

Identify global health terms with which to build a taxonomy

Academic Standards None

Assessment None

Prerequisites None

Instructional Materials

Teacher Resources Teacher Resource 1.1, Example: Culminating Project Presentation (separate PowerPoint file)

Teacher Resource 1.2, Answer Key: Global Health Anticipation Guide

Teacher Resource 1.3, Notebook: Table of Contents (separate Word file)

Teacher Resource 1.4, Maps: Regional Reference Maps (separate Word file)

Teacher Resource 1.5, Key Vocabulary: Course Introduction

Teacher Resource 1.6, Bibliography: Course Introduction

Student Resources Student Resource 1.1, Anticipation Guide: Global Health

Student Resource 1.2, Taxonomy: Global Health Terms



Equipment and Supplies One notebook per student for taking notes and holding assignments and handouts (options

include three-ring binder, spiral-bound notebook, or computer-based folder)

Large world map that identifies all countries, to display in classroom for the duration of the course

LCD projector and computer with speakers to show sample project

Whiteboard, blackboard, or flip chart

Chart paper

Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1

35 Presentation: Example of Global Health Culminating Project

This activity introduces students to the Global Health course by showing them an example of the culminating project they will create during the course. It also focuses on the following college and career skill:

Developing awareness of one’s own abilities and performance

Start the class by giving students some overall background on the culminating project. The driving question for the project is, “How can we develop a call to action to address a global health threat for an international summit?” Explain that students will work in groups to research pressing health issues and then choose one issue that the group believes is worthy of being the focus of an international health summit. Then they will create a self-running slideshow designed to convince a panel of experts of the urgency of addressing their issue on an international scale.

Tell the students that they will view a slideshow that is an example of the type of presentation they will be creating for their project. The example focuses on addressing the health issue of lymphatic filariasis, also known as elephantiasis.

Using an LCD projector and a computer with speakers, show Teacher Resource 1.1, Example: Culminating Project Presentation (separate PowerPoint Show file), as a slideshow with audio. When you open the file, the slideshow should begin. (Tip: Right-click the file and select Show. Or, to start the show from within PowerPoint, click the slideshow icon at the bottom of the PowerPoint window. Press Esc to end the show.) Make sure you have speakers turned on so that you can hear the audio narration. During the first showing, students should get an overall sense of the presentation.



Step Min. Activity

Show the slideshow a second time, and this time have students look for the skills and knowledge they need to learn in the course in order to produce a successful culminating project. As they watch the presentation and for a few minutes afterward, have them write down answers to this question, which you can write on the board:

What do you think you need to know about global health, and what skills would you need to have, in order to complete a project like this?

Tell students to work with a partner to discuss their answers to this question. Ask volunteers to share what they wrote, and then list their ideas on the board. As an option, make two lists: one for kinds of knowledge and one for skills needed. Work with the class to whittle down the list to the 10 or so most important skills and/or areas of knowledge that the students believe would be needed for this course. Have them explain their reasons for including each skill or knowledge area.

If students are unsure of how to get started, suggest some of the following:

Strong written and oral presentation skills

Strong research skills

Knowledge about how health issues impact people and populations

Knowledge of global health vocabulary

Write the 10 or so items on chart paper and post the chart on the class wall. Return to this list during the course to evaluate students’ initial expectations. You can also have the class check off skills and areas of knowledge as they encounter them throughout the course.

Ask students to share any final observations about the presentation they just watched. Here are some possible questions you might ask to encourage discussion:

Do the concepts in the presentation fit your idea of the knowledge a global health professional would have? If so, how?

What strengths and knowledge do you have that would help you become successful at developing a presentation like the example?

What skills or knowledge would you need to develop to succeed in creating a presentation like the example?

Advise students that in the last unit of this course, they will focus more closely on the skills and areas of knowledge that are important for professionals who work in the field of global health.

2 15 Anticipation Guide: Global Health

In this activity, students build on prior knowledge and develop curiosity as they begin to engage with some of the topics covered in this course. This activity also focuses on the following college and career skill:

Working effectively with a diversity of individuals and perspectives

Have students read the directions for Student Resource 1.1, Anticipation Guide: Global Health, and answer their questions. Ask students to use the remainder of the class to complete this resource. If they need more time, they should finish it for homework. Explain that it is not important to figure out what an expert would put as the “right” answer, but rather to write down their own reasons. Let students know you’ll be



Step Min. Activity

reviewing the anticipation guide in the next class period.

CLASS PERIOD 2

3 15 Homework Review: Global Health Anticipation Guide

Reviewing the homework from the previous class period gives students a chance to share their work and to continue building on their prior knowledge of key global health concepts. This activity also increases anticipation for learning more about global health.

Have students review their homework in pairs to compare their responses to the statements and discuss their reasoning. Then, with the whole class, ask a couple of students to share their responses to each statement. Note the areas where students are in agreement and disagreement. Use Teacher Resource 1.2, Answer Key: Global Health Anticipation Guide, to tell students how most global health professionals would respond to these statements, but point out that some are open to interpretation. Also note that they will be learning more about each of these topics throughout the course. Tell students to write down what they learned during this discussion in the “I learned” section of the resource.

This is a good moment to note that the terms global health professional and public health professional are not quite the same thing. A public health professional is one kind of global health professional, but global health includes other kinds of professionals as well.

This anticipation guide will be inserted into each student’s course notebook, which students will prepare in the next activity.

4 15 Preparation: Course Notebook and Course Maps

In this activity, students set up the notebook that they will use to keep their materials organized during this course.

Before class begins, prepare the following resources for your students:

If your students are using a paper-based system such as a three-ring binder, print a few copies of Teacher Resource 1.3, Notebook: Table of Contents (separate Word file), for each student.

Print color copies of Teacher Resource 1.4, Maps: Regional Reference Maps (separate Word file), so that you have one set available for each student. Or, if you are having students keep an electronic notebook, make Teacher Resources 1.3 and 1.4 available for students to access.

To begin this activity, advise students that they will be required to keep a notebook with their work for this course. Make sure students understand that their notebook is a place where they will save important work. Tell students they will need to bring their notebook to every class and will use it to keep many kinds of work in, including:

Regional reference maps

Notes

Guides and other resources



Step Min. Activity

Worksheets and other assignments

Reflections

Project plans

Explain to students how to organize their notebook in a way that works for your class. Whatever notebook structure you choose, make sure it provides students with the following:

An orderly way of keeping notes, reflections, project work, and so forth for each lesson so that they can reference their work when necessary.

A place to insert student resource pages such as reference sheets, note-taking tools, graphic organizers, and other materials that they complete during each lesson.

A means of setting up a table of contents so that they can find a page when they need it. One option is to give each student a couple of copies of Teacher Resource 1.3, Notebook: Table of Contents (separate Word file), and ask them to insert the pages at the beginning of their notebook.

When students are clear on how to set up their notebook and have created a table of contents, tell them that the first item to place in their notebook will be a set of maps. Provide each student with the set of maps in Teacher Resource 1.4, Maps: Regional Reference Maps (separate Word file). Ask them to insert their set of maps in their notebook and make an entry for the maps in their table of contents. Make sure each student has a set of five maps (Africa, Asia, Europe, Central America and the Caribbean, and South America).

Explain that an important part of global health involves learning about health issues in different parts of the world. This set of maps will help them identify where the countries they learn about are located and make brief notes on what they learn about different countries. Emphasize that students should keep this set of maps at the beginning of their notebook for the entire course, and that they will be required to identify countries on the maps in every lesson, beginning with Lesson 2.

After students have placed their map set in their notebook, instruct them to place their anticipation guide in their notebook and make an entry for that in the table of contents.

Tell students that they need to keep all of the handouts they receive in this course, and to keep track of them via the table of contents, because they will refer back to many of them and use them for other assignments.

Another important tool that students will keep in their notebook is a taxonomy. They will complete the taxonomy in the next activity.

5 20 Taxonomy: General Course Terms

As they develop a taxonomy during the first unit of this course, students discover more of what they already know about global health and create a place to store new terms. (See The NAF Learning Handbook for more information on this strategy.)

Ask for a show of hands to see which students remember how to create a taxonomy from developing one in a previous AOHS course. Next, ask for a volunteer to explain how taxonomies work for new students and for students who have forgotten. Supplement the student’s explanation as necessary to make the process of developing



Step Min. Activity

a taxonomy clear.

Then ask students to look at Student Resource 1.2, Taxonomy: Global Health Terms.

Direct students to begin independently by thinking of terms that relate to global health. An example is the term public health. Students will write public health next to the letter P. Allow students to work for about five minutes, adding as many terms as they can think of that relate directly to global health. They may write more than one term for each letter; however, they should not worry about finding a term for every letter.

Now organize students in pairs. Ask them to collaborate by sharing terms in order to build their taxonomy. For example, if one student has written public health and the other has not, the second student would add public health to his or her taxonomy.

After five minutes, ask students to leave their taxonomy on their desk and walk around the room to view each other’s taxonomies. Ask students to collect terms from their peers to bring back to their own taxonomy.

Give students a couple of minutes to add the terms they collected to their taxonomy, and then complete the activity with a short discussion. Call on as many pairs as time allows, asking them to share some of the terms that were easy to come up with and some of the terms from peers that were new to them.

Tell students to insert the taxonomy into their notebook after the anticipation guide, and to follow any instructions you provided for numbering pages and adding entries to the table of contents. Inform them that from now on, they will be in charge of remembering to add resources to their notebook and to keep the table of contents up to date.

This taxonomy can be used as time allows and as appropriate until the end of Unit 1. Have students continue to add relevant terms they encounter. This taxonomy should become a solid list of basic terminology that will serve as a resource for future assignments. Adding to the taxonomy will not be explicitly suggested in the lesson plans, so please incorporate this activity at your discretion.

Extensions

Content Enrichment Instruct students to read the article “Commentary: What I Learned Far Away from Public Health

School” (http://commonhealth.wbur.org/2012/03/commentary-what-i-learned-far-away-from-public-health-school). Then ask students to share with a partner what about the author’s experience working in global health appeals to them and what doesn’t. Invite student volunteers to share their responses with the class.

Point students to the collection of dispatches from front-line global health workers at this site: http://www.pbs.org/wgbh/rxforsurvival/series/dispatches/index.html. Ask students to choose one that interests them and read it. Then ask students to prepare a list of questions that they would ask a professional featured in the article if they had the opportunity. When students have completed their list, ask them to share their work with a partner.

Ask students to view the latest news updates on global health issues at the Centers for Disease Control and Prevention (CDC) website (http://www.cdc.gov/globalhealth/inthenews.htm) and the World Health Organization (WHO) website (http://www.who.int/mediacentre/en/). Allow students



time to work with a partner to scan the headlines and skim articles that interest them. Next, have pairs respond to the global health issues featured on the site by answering questions like the following, and then have them share their responses with the class:

o Were there issues featured that you didn’t expect to be considered part of global health?

o Are there certain areas of the world that seem to receive more global health attention than others? Why do you think that is the case?

o Is there a headline that you found particularly interesting? Why?

STEM Integration Technology: Set up your class to reduce paper and encourage student collaboration by using online tools for document sharing and classroom management. Students can access resources and upload their work to a web-based service, making it easier for you to track their progress.

Share and collaborate on documents and presentations using Google Docs or Google Slides.

Track assignments, share resources, and interact with students about their work using an online management learning service like Collaborize Classroom (www.collaborizeclassroom.com).

Take classroom discussions online, connect with other teachers, and keep students on top of their assignments with a tool like eChalk (www.echalk.com) or Edmodo (www.edmodo.com).

Upload, collect, and manage student resources, including photo and video, with services like Haiku Learning (www.haikulearning.com) and LiveBinders (www.livebinders.com).

Many of these tools are cross-platform, so students can stay connected using any type of device (desktop, laptop, tablet, or smartphone). While most paperless solutions are free, some require a small paid subscription. Check with your school or district for low-cost educator price plans.


AOHS Global Health


Teacher Resources

Resource Description

Teacher Resource 1.1 Example: Culminating Project Presentation (separate PowerPoint file)

Teacher Resource 1.2 Answer Key: Global Health Anticipation Guide

Teacher Resource 1.3 Notebook: Table of Contents (separate Word file)

Teacher Resource 1.4 Maps: Regional Reference Maps (separate Word file)

Teacher Resource 1.5 Key Vocabulary: Course Introduction

Teacher Resource 1.6 Bibliography: Course Introduction



Teacher Resource 1.2

Answer Key: Global Health Anticipation Guide

Public health services are mostly for the benefit of people who have chronic illnesses.

My guess: I agree I disagree

My reason:

I learned:

We experience the effect of public health services every day. For example, policies aimed at improving the health of a population, such as laws that ban smoking in public places or laws that require children to ride in car seats, are part of public health services.

After a major natural disaster, like a large earthquake, an affected country works mostly on its own to respond to the damage and destruction.


My reason:

I learned:

After a major natural disaster, an affected country often receives assistance from other countries and aid organizations, like the Red Cross. This type of global cooperation is necessary to address the serious health problems that can be caused by a major natural disaster.

Global health is especially concerned with addressing the needs of vulnerable populations, such as people living in poverty or people without access to medical care.


My reason:

I learned: Many global health initiatives are focused on helping vulnerable populations, or groups of people who are more likely to suffer health problems. Global health often focuses on health issues in low- and middle-income countries.

Medical care is a basic human right.


My reason:

I learned: The Universal Declaration of Human Rights clearly states that medical care is a human right.



A person’s health status may actually be determined by factors like employment and education.


My reason:

I learned:

Many health determinants affect a person’s health status. These include employment and education. They also include gender, climate, and where a person lives. Environmental, nutritional, and behavioral risk factors can also threaten a person’s health status.

Community health interventions are focused mainly on distributing medication or providing basic medical services in a community.


My reason:

I learned:

Community health interventions are aimed at improving the lives of people in a community. These interventions may focus on a wide range of health issues, ranging from cancer screenings to vaccination programs to traffic-safety education campaigns.

Most public health professionals are public health nurses.


My reason:

I learned: There is a wide range of public health professions. These include nurses, but they also include professions such as health education specialists, epidemiologists, and program analysts.




Key Vocabulary: Course Introduction

Term Definition

disease An abnormal condition that affects the body, resulting from infection, poison, nutritional deficiency, unfavorable environmental factors, or the effect of genetic or developmental errors.

global health Health of populations in a global context.

health A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. (This is the World Health Organization definition.)

lymphatic filariasis (LF) A neglected tropical disease, also referred to as elephantiasis, that is transmitted through mosquito bites and can cause permanent disfiguration and disability. Approximately 1.3 billion people in 72 countries are at risk.

population A collection of individuals who have at least one characteristic in common.

taxonomy A categorized list of terms that are related to a particular topic.




Bibliography: Course Introduction

The following source was used in the preparation of this lesson and may be useful for your reference or as a classroom resource.

Print Rothstein, Andrew, Evelyn Rothstein, and Gerald Lauber. Writing as Learning: A Content-Based Approach, 2nd ed. Thousand Oaks, CA: Corwin Press, 2007.


AOHS Global Health


Student Resources


Student Resource 1.1 Anticipation Guide: Global Health

Student Resource 1.2 Taxonomy: Global Health Terms


Copyright ©2012–2016 NAF. All rights reserved.

Student Resource 1.1

Anticipation Guide: Global Health

Student Name:_______________________________________________________ Date:___________

Welcome to the AOHS Global Health course! Over the next few months, you’ll learn a great deal about issues in global health. You will learn about the diseases and conditions that pose serious threats, and you’ll also learn about some of the efforts global health professionals are making to improve the health of people around the world. You will learn about health concerns that must be addressed in the near future and about ways that the focus of health workers is changing as the global population grows and cities around the world expand.

This is a hands-on course. That means you’ll not only learn facts and concepts but also have lots of opportunities to practice using the skills you learn. You will meet professionals in the field and explore ways that you could pursue a career in global health. At the end of the course, you will present a professional proposal about a health issue that you think merits global attention. You will develop professional skills that will give you a head start in your career.

Directions: For each of the statements below, underline “I agree” if you think the statement is accurate or “I disagree” if you disagree with it. Write one reason to explain your guess.

Public health services are mostly for the benefit of people who have chronic illnesses.


My reason:

I learned:

After a major natural disaster, like a large earthquake, an affected country works mostly on its own to respond to the damage and destruction.


My reason:

I learned:



Global health is especially concerned with addressing the needs of vulnerable populations, such as people living in poverty or people without access to medical care.


My reason:

I learned:

Medical care is a basic human right.


My reason:

I learned:

A person’s health status may actually be determined by factors like employment and education.


My reason:

I learned:

Community health interventions are focused mainly on distributing medication or providing basic medical services in a community.


My reason:

I learned:

Most public health professionals are public health nurses.


My reason:

I learned:




Taxonomy: Global Health Terms

Student Name: Date:

Think of terms related to global health. Write them on this list in alphabetical order.

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

P

Q

R

S

T

U

V

W

X

Y

Z


AOHS Global Health

Lesson 2 What Is Health?

In this lesson, students think about how to define health. They begin by learning about one of the greatest public health achievements in history: the eradication of smallpox. They consider the World Health Organization (WHO) definition of health and the 10 essential public health services. They begin to use maps they were introduced to in Lesson 1 to record data about the countries they learn about. They think about how to measure health status and learn about the health status indicators that humanitarian organizations such as the WHO use. Finally, students practice interpreting, creating, and summarizing graphs that present health status data.

Advance Preparation

Prior to Class Period 1, make sure you have Apple’s Quick Time Player to show a YouTube video to the class. These players are included free with the system software and can also be downloaded for free. If you have difficulty using the video player, contact your site administrator. In Class Period 1, you will need access to the video “D.A. Henderson, Leader in Global Smallpox Eradication” at http://www.youtube.com/watch?v=LtQ5JSW2eNk (or alternative video).

If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

In Class Periods 3–5, students will need computers with access to the Internet and Excel or another spreadsheet program, one student per computer. If you are using spreadsheet software other than Excel, you may need to modify the step-by-step instructions in Student Resource 2.6.

This lesson is expected to take 5 class periods.

Lesson Framework


Recall the main components of public health

Demonstrate knowledge of key public health terminology

Explain why it is important to measure health and disease

Describe the most important measures of health status*

AOHS Global Health Lesson 2 What Is Health?


Compare life expectancy at birth and health-adjusted life expectancy (HALE) as measures of health status

Demonstrate the ability to read a graph and convey the graph’s meaning in words

Demonstrate the ability to create bar charts and line graphs using spreadsheet software

*This is one of the 16 key learning objectives assessed by the NAFTrack Certification end-of-course exam for this course.

Academic Standards The relevant Common Core State Standards are too extensive to list here but are an important basis for this lesson. For details, please refer to the separate document “Correlations to the Common Core Standards” (available in the Course Planning Tools section of the course materials).

Demonstrate competency in basic math skills and mathematical conversions as they relate to healthcare (metric system, mathematical, and conversions) (National Health Science Standards 2015, Standard 1.31)

Demonstrate the ability to analyze diagrams, charts, graphs, and tables to interpret healthcare results (National Health Science Standards 2015, Standard 1.32)

Apply basic computer concepts and terminology necessary to use computers and other mobile devices (National Health Science Standards 2015, Standard 11.31)

Demonstrate use of file organization and information storage (National Health Science Standards 2015, Standard 11.33)

Determine the academic subject matter, in addition to high school graduation requirements, necessary for pursuing a health science career (Common Career Technical Core 2012, HL 1)

Assessment

Assessment Product Means of Assessment

Graphs of key health status measurements and a written explanation of the importance of these measurements (Student Resource 2.6)

Assessment Criteria: Health Status Measurement Tables and Graphs (Teacher Resource 2.5)

Prerequisites An understanding of what public health is and how it differs from personal health or medicine

Basic knowledge about how to create a spreadsheet with Excel


Teacher Resources Teacher Resource 2.1, Presentation 1 and Notes: Health Status Indicators: Life Expectancy

(includes separate PowerPoint file)

Teacher Resource 2.2, Presentation 2 and Notes: Health Status Indicators: Illness and Injury (includes separate PowerPoint file)



Teacher Resource 2.3, Guide: Creating Tables and Graphs in Excel

Teacher Resource 2.4, Graphing Data: Prevalence of Obesity and Incidence of Whooping Cough (separate Excel file)

Teacher Resource 2.5, Assessment Criteria: Health Status Measurement Tables and Graphs

Teacher Resource 2.6, Key Vocabulary: What Is Health?

Teacher Resource 2.7, Bibliography: What Is Health?

Student Resources Student Resource 2.1, Checklist: Essential Public Health Services

Student Resource 2.2, Key Word Prediction: Health Status Indicators

Student Resource 2.3, Reading: Health Status Indicators: Life Expectancy

Student Resource 2.4, Summary: Reading and Translating Graphs

Student Resource 2.5, Reading: Health Status Indicators: Illness and Injury

Student Resource 2.6, Assignment Sheet: Health Status Measurement Tables and Graphs

Equipment and Supplies LCD projector and computer to show a video, PowerPoint presentation, and Excel guided practice

Computers with Internet access and Excel or other spreadsheet software for students (one for each student)


Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1

10 Think, Pair, Share: Characteristics of Healthy Populations

The purpose of this activity is to help students start to think about what health is.

Before class begins, set up the projector and make sure you can access one of the smallpox videos needed for Lesson Step 2. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

To begin, write the term World Health Organization (WHO) on the board. Explain to



Step Min. Activity

students that the WHO is a large organization that is part of the United Nations and a leader in global health matters. The WHO directs research on global health issues, monitors health trends, and coordinates responses to global health emergencies, among other important tasks.

Pose the following question to students:

If the WHO set out to describe a healthy population of people, what characteristics do you think they would include?

Students may not understand what you mean by “characteristics.” Use the following examples of characteristics of an unhealthy population to help them (as necessary):

People die young.

There is a lot of disease.

People live in unhealthy conditions (bad sanitation, limited medical care, etc.).

People die from preventable/treatable causes.

Ask students to take a few minutes to write down characteristics of a healthy population in their notebook. After a few minutes, divide the class into pairs and ask them to compare their answers. Encourage students to revise/add to their list of characteristics based on their partner’s answers.

When students have worked in pairs for approximately five minutes, invite each pair to share one characteristic from their lists. Make a list of these on the board.

Next, read aloud the WHO definition of health, which was adopted in 1961, and write it on the board:

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.

Then ask the class the following question:

How does this definition compare with our list of characteristics of a healthy population?

Invite students to suggest any additional characteristics they think of based on the WHO definition (for example, students may not have considered mental or social well-being when making their lists). They may also notice characteristics that might not belong, given the WHO definition.

Instruct students to write down the WHO definition in their notebook. Let them know that they will be referring to this definition throughout this lesson and for the rest of the course. Point out that the WHO is instrumental in every aspect of global health and that they will be learning more about the work of the WHO as they go through this lesson.

2

20 Video: The Eradication of Smallpox

This activity introduces students to what global health is and how it works by showing them an example of a key global health initiative.

Prior to class, prepare to project the video “D. A. Henderson, Leader in Global Smallpox Eradication” at http://www.youtube.com/watch?v=LtQ5JSW2eNk. If you can’t access this video, try to access “Smallpox Eradication Interview Dr. Henderson” at http://www.youtube.com/watch?v=WylK5mcB6U0. If your school does not allow access



Step Min. Activity

to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

Explain to students that they are going to watch a short video about smallpox. Although smallpox is a very serious illness that spreads easily between humans, the last case of smallpox occurred over 30 years ago. Explain that its eradication is one of the greatest achievements in public health in the last 100 years.

Then, using an LCD projector, show students the video at http://www.youtube.com/watch?v=LtQ5JSW2eNk.

After they have watched the video, explain that in 1988 the Institute of Medicine issued a report saying that the public health system in the United States could not be relied upon to provide essential services in its current form. The Institute then developed a new framework for public health describing the essential services of public health, which was published in 1994. Refer students to Student Resource 2.1, Checklist: Essential Public Health Services. Give students a little time to read the list of essential services included on the resource, and ask students the following question:

Which of these services were part of D. A. Henderson’s work on smallpox?

Instruct them to put a check mark next to any services they saw or heard about in the video. For example, D. A. Henderson’s team had to track the spread of the disease, which is the first service: Monitor health status to identify community health problems.

In the field of epidemiology—the branch of public health that deals with the distribution of disease—what Dr. Henderson was doing is known as shoe-leather epidemiology. In other words, he and his team were actually going into the field to track the spread of smallpox. Another way to describe what he was doing is being a disease detective.

Then assign each student one of the services, so that each service will be assigned to two or three students, depending on the size of your class. Tell them that they will watch the video again and that they should put a check mark next to their service if they see or hear about it.

Show the video again. When it’s finished, go through each service and have students say if they put a check mark by it and give their reason.

Point out that almost all of the 10 essential services were a part of the work Henderson and his team did. Use the following for reference if necessary:

They had to track the spread of the disease (monitor health status).

They had to diagnose and investigate the spread of the disease, which was how they came up with their policy of vaccinating people close to an outbreak rather than trying to vaccinate an entire healthy population.

They had to educate people about the disease—what the symptoms were and why the vaccine was safe.

They had to work with people in the community to obtain information about the spread of the disease and to make arrangements to get people vaccinated.

Currently, Henderson is developing plans to prepare for a smallpox outbreak by stockpiling doses of vaccine to be available in the event of a bioterrorist attack.

His team provided health care services that were otherwise unavailable, and they traveled to remote places to provide the vaccine.

They had to evaluate the effectiveness of their approach to eradicating smallpox



Step Min. Activity

and make adjustments to it, and they had to research and come up with innovative solutions to health problems.

Point out to students that they are likely to encounter the name D. A. Henderson frequently as they learn about global health.

3 20 Recording Information: Using Reference Maps

In this activity, students are introduced to reference maps that they will use throughout the course.

Before this activity, make sure you have a large world map on display in the classroom for students to reference throughout the course.

Begin by asking students to consider the following scenario:

Imagine that you are with D. A. Henderson and his team of smallpox experts looking at a map of the world. Your goal is to send professionals to all parts of the world in an effort to vaccinate everyone who is at risk for contracting smallpox. You have to divide the world into sections in order to organize your on-the-ground work. How would you divide up the world? What would the sections be?

Have volunteers share their ideas. Responses might include: “You could divide up the work by continents,” “You could divide up the work by the countries where people are most at risk,” or “You could divide up the work by regions that are most affected.”

Explain that global health professionals think in terms of continents, countries, and regions, and that throughout the course they will be referencing and recording information on maps to help them learn where the places they are learning about are located.

Next, refer students to the regional reference maps they filed in the beginning of their notebook. Ask students to name the country that was mentioned in the smallpox video (Answer: India). Have a volunteer say which continent India is located on (Answer: Asia). Then instruct all students to label India on their Asia map by finding the number associated with India and then writing the country name India next to the corresponding number in the table that goes with the Asia map. Ask volunteers to say what they learned about India in the video. A sample response may be, “The turning point in the effort to eradicate smallpox occurred in India in 1977.” Instruct students to record the information in their own words in the Important Information column next to India. The table of their Asia page should look something like this:

22 India The turning point in the effort to eradicate smallpox occurred in India in 1977.

Emphasize to students that throughout the course, they will continue to add information they learn to their maps.

CLASS PERIOD 2

4 5 Key Word Prediction: Health Status Indicators

Before learning new terminology for measuring health status, students activate prior



Step Min. Activity

knowledge by predicting what they might already know.

Refer students to Student Resource 2.2, Key Word Prediction: Health Status Indicators. Tell them that in this lesson, they are going to view two presentations that introduce the terminology that health professionals use to measure health status. Explain that before they view each presentation, they will try to predict what some of these terms might mean. Instruct students to fill in the I Predict column in Section 1 of Student Resource 2.2. Reassure students that they do not need to know all the terms already, but they might be surprised by how much they can predict based on words they already know.

Have students read the directions, and then answer any questions. Point out that students will complete Section 2 of the resource later in the lesson when they view the second presentation.

5

25 Presentation: Health Status Indicators: Life Expectancy

This activity gives students an in-depth understanding of life expectancy factors that professionals look at to measure health status of global populations. It also develops students’ listening and note-taking skills.

To prepare, make notes to guide class discussion using Teacher Resource 2.1, Presentation 1 Notes: Health Status Indicators: Life Expectancy. Have Teacher Resource 2.1, Presentation 1: Health Status Indicators: Life Expectancy (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Let students know that they will learn about the terms in Section 1 of Student Resource 2.2 during this presentation. As they view the presentation, instruct students to write what they learn about each term in the I Learned column of their worksheet.

Present the slideshow. Use the notes you prepared previously and the questions on the slides to encourage class discussion.

This presentation is duplicated as Student Resource 2.3, Reading: Health Status Indicators: Life Expectancy. If an LCD projector is unavailable, students can read the presentation, answer the discussion questions in their notebook, and discuss their answers as a class. This student resource is also useful for review.

Once students have finished viewing the presentation, pair them up. Ask them to compare their definitions and revise them as necessary. Then review the definitions as a class and answer any questions. Let students know that in the next activity, they will begin to practice working with these health status indicators.

6 20 Translating Graphs to Words: Life Expectancy

In this activity, students practice reading and understanding graphs by writing a summary of a graph. This activity focuses on the following college and career skill:


Refer students to Student Resource 2.4, Summary: Reading and Translating Graphs. First, explain that one of the skills students need to develop in this course is the ability to read a graph and explain what the graph means in words. Then instruct students to examine the example graph and read the example summary.

Next, ask students to work in pairs and fill in the table by explaining how the example



Step Min. Activity

summary accomplishes the points on the checklist. Then call on pairs to share their ideas, and answer any questions students have about what makes a good summary of a graph.

Finally, ask students to work individually analyzing the graph Life Expectancy at Birth, 2007, and writing a one-paragraph summary. Remind students to make sure that their summary accomplishes the points on the checklist.

Instruct students to complete their summaries for homework.

CLASS PERIOD 3

7 10 Homework Review: Translating Graphs to Words

In this activity, students review and respond to each other’s summaries.

Have students work in groups of four. Ask each student to read his or her summary while the other group members consider whether the summary accomplishes the points on the checklist in Student Resource 2.4. As students work, circulate and answer questions.

Finally, ask each group to choose one summary that they think is well written and read it to the class. You may want to gauge student understanding by assessing the summaries on a credit/no-credit basis.

To conclude the activity, advise students that translating graphs into words is a professional skill that they will use often in the course. Explain that it is also a skill they will need for an internship or a job in the field of global health.

8

20 Presentation: Health Status Indicators: Illness and Injury

The objective of this activity is to provide students with an in-depth understanding of how illness and injury affect health and how incidence and prevalence of illness and injury are used to measure health status.

To prepare, make notes to guide class discussion using Teacher Resource 2.2, Presentation 2 Notes: Health Status Indicators: Illness and Injury. Have Teacher Resource 2.2, Presentation 2: Health Status Indicators: Illness and Injury (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Refer students to Student Resource 2.2, Key Word Prediction: Health Status Indicators. Instruct students to complete the I Predict column for the terms in Section 2. Then, as they watch the presentation, have students fill in the I Learned column.

Present the slideshow. This presentation is also duplicated as Student Resource 2.5, Reading: Health Status Indicators: Illness and Injury, to use according to your preferences.

After the presentation, divide the class into pairs and have them compare their definitions and revise them as necessary. Then review them as a class and answer any questions. Let students know that in the next activity, they will begin working with prevalence and incidence.



Step Min. Activity

9

20 Guided Practice: Creating Tables and Graphs Using Spreadsheet Software

In this activity, students learn how to use Excel (or other spreadsheet software) to create a column graph and a line graph that communicate health status measurements. This activity measures the following college and career skill:

Effectively using quantitative reasoning

Before beginning this activity, review Teacher Resource 2.3, Guide: Creating Tables and Graphs in Excel. Use this resource to demonstrate how to create a column graph and a line graph in Excel.

Explain to students that in this activity, they will be creating a column graph that shows the prevalence of obesity among adolescents in the United States and a line graph that shows the incidence of whooping cough in California. Ask students to share with a partner what they remember about the difference between prevalence and incidence, and then have pairs share their ideas with the class. Make sure their answers cover the following points:

Prevalence is how many people in a given population suffer from a specific health condition.

Incidence is the rate of new cases of a health condition in a population over a specific period of time.

Assign each student (or pair of students) to a computer that has Excel. Using your computer connected to an LCD projector, walk students through the procedure for opening a new file in Excel. Explain that they will be using one worksheet for the obesity graph and a second worksheet for the whooping cough graph.

Make sure that students understand what the x-axis and y-axis are. Draw a graph on the board to illustrate that the x-axis is the horizontal axis and the y-axis is the vertical axis, and the point that they connect is called the origin.

Next, project the Excel worksheet for the prevalence of obesity in Teacher Resource 2.4, Graphing Data: Prevalence of Obesity and Incidence of Whooping Cough (separate Excel file). Note that the Centers for Disease Control and Prevention (CDC) tracked the prevalence of obesity among adolescents (ages 12–19) for selected years between1971 and 2008, and this is the data they gathered.

Guide students through the steps on how to enter that data on their Excel worksheet in a table so that their worksheet looks exactly like yours.

When all students have completed their table, create a column graph of the data using your computer and LCD projector, and have students follow along on their own computer. Have students compare their graph to yours and, if necessary, have them work with partners to clear up any discrepancies.

Next, have students open a new worksheet for the whooping cough data. Project the second worksheet of Teacher Resource 2.4, and point out that in 2010 California began experiencing a severe outbreak of pertussis, also known as whooping cough. The statistics provided in the table are the California Department of Public Health’s incidence data for this outbreak, which began in 2010.

Ask students to copy the data onto their worksheet so that it looks exactly like yours.

Next, create a line graph of the data and have students follow along on their own computer. When students have completed their graph, have them check with a partner



Step Min. Activity

to make sure their graph looks exactly like yours. Let students know that in the next class period, they will be using Excel to graph health status data on their own, and encourage them to ask any questions now.

If time permits, ask students to share their ideas about what they can learn by looking at the graphs and why the graphs might be useful to public health workers.

If you are concerned about your students’ comfort level with Excel, you may wish to have them submit their graphs so that you can assess them for credit/no credit. This would give you an opportunity to identify any classwide misunderstandings and correct them before students begin their final assignment for this lesson.

CLASS PERIOD 4

10

50 Independent Practice: Health Status Measurement Tables and Graphs

The purpose of this activity is to help students develop skills with tables and graphs and also teach how a professional might graph infant and child mortality measurements. It also focuses on the following college and career skill:

Utilizing time efficiently when managing complex tasks

Explain that students are going to create bar graphs about life expectancy, infant mortality, and under-5 mortality, and then create a line graph tracing the change in a country’s infant mortality or under-5 mortality rate over the past 60 years. If you have enough computers, it is best to have students work individually on this activity so that all students get practice creating graphs in Excel.

Review Student Resource 2.6, Assignment Sheet: Health Status Measurement Tables and Graphs, as a class. Point out that after students create their graphs, they need to write a brief explanation of why that data is important. For an example, have them refer back to the example graph and summary on Student Resource 2.4. Have students recall the important elements in a summary of a graph.

Point out the assessment criteria on the worksheet. Review the assessment criteria as a class and answer any questions. Give students the rest of the class period to work.

Circulate through the classroom, answering any questions.

Near the end of the class period, remind students to save their work. Let them know they will have about 30 minutes to complete this assignment in the next class period. If they think they need more time, they should work on the assignment for homework. If necessary, help students arrange to have access to Excel outside of class.

CLASS PERIOD 5

11

30 Independent Practice: Health Status Measurement Tables and Graphs (Continued)

In this activity, students continue working on their health status measurement graphs.

Let students know that they will have approximately half the class period to finish up



Step Min. Activity

their assignment. Answer any questions, and then encourage students to get to work.

As students complete their assignment, remind them to check their work and make sure their graphs and summaries meet all of the assessment criteria.

12 10 Peer Review: Health Status Measurement Tables and Graphs

In this activity, students review each other’s work and provide feedback.

Ask students to exchange their graphs with a partner. Students should review their partner’s work, making sure that it meets the assessment criteria. Once students have received their peer feedback, they should take any time left to put the finishing touches on their assignment before turning it in. If necessary, students can polish up the assignment for homework and submit it for assessment at the beginning of the next class period.

When the assignment is complete, assess it using Teacher Resource 2.5, Assessment Criteria: Health Status Measurement Tables and Graphs.

13 10 Reflection: Global Health Definition

In this activity, students reflect on what they have learned in this lesson.

Ask students to reflect on the following prompt:

Think about the health issues that you’ve learned about in this lesson. If you could create change for one health issue, which issue would you choose? What change would you work toward?

Give students a few minutes to write their response in their notebook, and then invite volunteers to share with the rest of the class.

Extensions

Content Enrichment Invite a representative from the local public health department to speak to students about the 10

essential public health services. Encourage the speaker to talk about specific issues that are common in your community to help students personalize their understanding of these important services.

Provide students with the health and wellness section of major newspapers, such as USA Today. Have students find a graph in the newspaper to informally present and explain what it shows to the class. Then, have students practice summarizing the graphs in their notebook.

In response to the whooping cough outbreak, California passed a law requiring students entering grades 7–12 to receive a pertussis booster shot before the 2011–2012 school year. Have students research the specifics of this outbreak through the California Department of Public Health (http://www.cdph.ca.gov/HealthInfo/discond/Pages/Pertussis.aspx). Then ask students to discuss the law. Why was it put into place? Is this good public health policy? Why or why not? Specifically, encourage students to consider the illness rates and death rates for various age groups during this



outbreak (data available at http://www.cdph.ca.gov/programs/immunize/Pages/PertussisSummaryReports.aspx). Ask students what else could have been done to control this outbreak.

Have students research the history of the WHO definition of health—how it came into being and why it has stood the test of time. Good resources include:

o http://www.who.int/suggestions/faq/en/index.html

o http://www.jstor.org/discover/10.2307/3527467?uid

STEM Integration Math: Instruct students to calculate the prevalence and incidence rate of various diseases. For

each calculation, ask them to express their answer as a percentage, showing what percentage of the population is affected.

Math: Have students create different types of graphs for data measuring health indicators. Ask students to determine which types of graphs are best suited for each type of data. Have students write a brief explanation of why they chose each graph type next to the graph. As a class, have students vote by show of hands for which graph type they selected for each type of data. Call on volunteers to share why they chose the type they did.

Additional Cross-Curricular Ideas English Language Arts: Have students read about the Millennium Development Goals

(http://www.un.org/millenniumgoals/). What were the goals? How much progress has been made? Have students write an editorial about one of the goals. They might suggest replacing the goal with something else, offer praise for progress that has been made, or encourage people to pay more attention to a goal that is behind schedule. Make sure students include relevant statistics and use persuasive language to make their argument.


AOHS Global Health


Teacher Resources


Teacher Resource 2.1 Presentation 1 and Notes: Health Status Indicators: Life Expectancy (includes separate PowerPoint file)

Teacher Resource 2.2 Presentation 2 and Notes: Health Status Indicators: Illness and Injury (includes separate PowerPoint file)

Teacher Resource 2.3 Guide: Creating Tables and Graphs in Excel

Teacher Resource 2.4 Graphing Data: Prevalence of Obesity and Incidence of Whooping Cough (separate Excel file)

Teacher Resource 2.5 Assessment Criteria: Health Status Measurement Tables and Graphs

Teacher Resource 2.6 Key Vocabulary: What Is Health?

Teacher Resource 2.7 Bibliography: What Is Health?




Presentation 1 Notes: Health Status Indicators: Life Expectancy

Before you show this presentation, use the text accompanying each slide to develop presentation notes. Writing the notes yourself enables you to approach the subject matter in a way that is comfortable to you and engaging for your students. Make this presentation as interactive as possible by stopping frequently to ask questions and encourage class discussion.

Today we are going to learn about important ways that professionals can measure the health of a population.

Presentation notes



Health professionals use health status indicators to determine the health of different global populations. Health status indicators help them know if they are achieving the World Health Organization’s (WHO’s) goal of total physical, mental, and social well-being for everyone.

Image retrieved from http://commons.wikimedia.org/wiki/File:India_-_Sights_%26_Culture_-_001_-_crowd_shopping_%28342043908%29.jpg on August 9, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Image courtesy of McKay Savage.

Image retrieved from http://commons.wikimedia.org/wiki/File:Chimoio_market_-_banana_sellers.jpg on August 9, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Image courtesy of Ton Rulkins.

Presentation notes



The WHO is the directing and coordinating authority for health within the United Nations system. To perform all of its tasks, the WHO needs to be able to measure health in each region of the world. The WHO divides the world into six regions: Africa, the Americas, the Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific. The WHO has a regional office in each of these areas. These regional map designations are for administrative purposes by the WHO and do not represent political areas or borders.

Health is measured by region because different parts of the world face different problems. For example, polio is a disease that used to affect a lot of people in the United States in the mid-20th century. Even one of our presidents, Franklin Roosevelt, suffered from polio. In the ’50s with the availability of mass-produced polio vaccines, people started to vaccinate their children. The United States has been polio-free since 1979. But there are three countries, Afghanistan, Nigeria, and Pakistan, where polio is still a major problem.

Data from http://www.who.int/about/regions/en.

Presentation notes



In 1945, diplomats met and formed the United Nations. They discussed the importance of setting up a global health organization. In 1948, the World Health Organization was established. It has provided leadership on all global health issues ever since.

Image retrieved from http://phil.cdc.gov/phil/details.asp on August 9, 2013. From CDC/ J. D. Millar, MD.

Presentation notes



Health status indicators provide important information about the health of a population. Indicators give information about what conditions a population suffers from and which of the conditions causes people to be sick or disabled, or to die. Indicators also tell us if a society’s health status is improving. Improvements may be due in part to better health systems, such as the availability of medicine or the accessibility of health centers or hospitals.

Image retrieved from https://commons.wikimedia.org/wiki/File:2007-09-05_Hong_Sang-soo_sur_Nuit_et_Jour.JPG on August 9, 2013, and reproduced here under the terms of the Creative Commons Attribution 3.0 Generic license (http://creativecommons.org/licenses/by/3.0/deed.en). Image courtesy of Étienne André.

Presentation notes



In the next few slides, you will learn why each of these measurements is important.

Presentation notes



Life expectancy is influenced by when you were born. In most countries, people born 100 years ago had a much shorter life expectancy than people born today. You will probably live longer than your grandparents did.

Life expectancy is also influenced by where you were born. The map above shows the average life expectancy for babies born in 2011. As you can see, the average life expectancy for a baby born that year in the United States was 70–79 years. But there were several countries in Africa where a baby born in 2012 was expected to live fewer than 50 years!

Life expectancy is a very important measure of global health. As we continue to make medical breakthroughs, overall life expectancy increases. That is a positive trend, but it is not a universal trend. By looking at data on life expectancy, health professionals can identify quickly which regions of the world are facing the most difficult health challenges.

This map is included under fair-use guidelines of Title 17, US Code. Copyright © World Health Organization. Map available online at http://gamapserver.who.int/mapLibrary/Files/Maps/Global_LifeExpectancy_bothsexes_2012.png.

Presentation notes



Of these three babies, the one born most recently has the lowest life expectancy. The life expectancy of a baby born in South Africa in 2013 is one of the lowest ages in the world, with an average age of 59. The baby born in Japan in 2011 has the longest life expectancy at birth: over 80 years. The life expectancy of a person born in the US in 1930 was only 60.

Data from https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html, http://www.elderweb.com/book/appendix/1900-2000-changes-life-expectancy-united-states, and http://beta2.statssa.gov.za/publications/P0302/P03022013.pdf.

Image retrieved from https://commons.wikimedia.org/wiki/File:Young_mother_%28Klashorst%29.jpg on August 9, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Image courtesy of Peter Klashorst.

Image retrieved from https://commons.wikimedia.org/wiki/File:Best_boy_1857.jpg on August 9, 2013, and reproduced here under the terms of the Creative Commons Attribution 3.0 Generic license (http://creativecommons.org/licenses/by/3.0/deed.en). Image courtesy of Boxears.

Image retrieved from http://commons.wikimedia.org/wiki/File:Poa_Pan-milk.JPG on August 9, 2013. 2012. Image courtesy of Mattes.

Presentation notes



If you were a 15-year-old girl living in the United States in 2013, the probability that you would die before reaching 60 was 77 out of a thousand (or 7.7 out of 100). If you were a 15-year-old girl living in Afghanistan in 2013, the probability that you would die before reaching 60 was much higher: 232 out of a thousand (or 23.2 out of 100).

Mortality rates, or death rates, vary by country because of availability of medical care and quality of life, such as sanitation and access to food and water. Mortality rates also consider non disease-related deaths, including people who are killed in a war or in a natural disaster.

In less developed parts of the world, many people die earlier than expected. Specific types of mortality rates are measured for life expectancy evaluation in a country, as you’ll see on the next few slides. Measuring the mortality rate at different ages can help professionals recognize what kinds of intervention could save more lives.

Data from http://wdi.worldbank.org/table/2.21.

Presentation notes



In the United States, the under-5 mortality rate for 2013 was less than 7 deaths per 1,000 live births. That means that for every 1,000 children in the United States, 7 will die before they reach the age of 5. The under-5 mortality rate is considered to be a leading indicator of the level of child health and overall development in a country. In other words, more-developed countries or wealthier countries have fewer deaths of children under 5.

This map is included under fair-use guidelines of Title 17, US Code. Copyright © World Health Organization. Map available online at http://gamapserver.who.int/mapLibrary/Files/Maps/global_underfivemortality_2013.png.

Presentation notes



The infant mortality rate can provide insight into the quality of infant care available in a specific country or region. It may reflect a need for more parent education, since some causes of death are preventable. And some methods of care, like breastfeeding, can improve childhood immunity to disease. Countries that have high infant mortality or under-5 mortality rates also have lower life expectancy.

This map is included under fair-use guidelines of Title 17, US Code. Copyrights belong to respective owners. Map available online at http://commons.wikimedia.org/wiki/File%3AInfant_Mortality_Rate_World_map.png.

Presentation notes



Infant mortality rates have been decreasing in urban areas of Africa and Asia. For example, the urban poorest 20% in Africa witnessed a decrease in infant mortality rate from 99 per 1,000 live births in the 1990s to 70 per 1,000 live births in 2000–2007, on average. The poorest 20% in urban areas of Asia have also experienced a fall in infant mortality rates. The rates dropped from 81 to 51 per 1,000 live births between the 1990s and 2000–2007, on average.

Data from http://www.who.int/gho/urban_health/outcomes/infant_mortality_text/en/index.html.

Image retrieved from http://phil.cdc.gov/phil/details.asp on August 9, 2013. From Chris Zahniser.

Presentation notes



This exercise will help you see how health professionals use data to come up with statistics. Remember, the infant mortality rate measures how many children die before the age of 1.

Data from: http://www.cdc.gov/nchs/fastats/infant-health.htm.

Presentation notes



First, multiply the number of deaths by 1,000. You should get 23,440,000. Then divide 23,440,000 by the number of live births (i.e., by 3,932,181) to solve for X. The answer is 6 (rounded up from 5.96).

Presentation notes



Many infants deaths that occur in the first 28 days of life are often connected to problems that occurred during the mother’s pregnancy. Maternal and neonatal tetanus is one example.

After a baby is born, the umbilical cord that connects the baby to its mother is cut. If the cut is done with an unclean knife, the baby could get tetanus. In 1988, 787,000 babies died from neonatal tetanus. These deaths were preventable. By immunizing women, it’s possible to dramatically reduce the risk of contracting neonatal tetanus. So, the WHO implemented a program to immunize pregnant women and women of child-bearing age. The program was a huge success. By 2008 there had been a 92% reduction in deaths from neonatal tetanus.

Image retrieved from http://www.unicef.org/health/index_43509.html on August 9, 2013. Image courtesy of UNICEF.

Presentation notes



Pregnancy can be very dangerous for women who have limited access to health care. Many conditions and complications can arise during pregnancy, which can prove life threatening if not treated promptly. In some cases, the process of giving birth to a child can create life-threatening complications if the baby is not coming out easily or the mother begins to bleed too much. In some countries, women who choose to abort a pregnancy may die because the procedure is performed incorrectly or in unsterile and unsanitary circumstances.

In developed and wealthier countries, the maternal mortality rate is much lower. This is because it is far more common to have trained medical professionals available during a birth and, in many cases, because births happen at a medical facility.

Data from http://www.who.int/mediacentre/factsheets/fs348/en/.

Presentation notes



By using these health status indicators, health professionals can better understand the overall status of health around the world. This allows them to make informed decisions about what to do to improve the health and health care of people in all countries.

Presentation notes




Presentation 2 Notes: Health Status Indicators: Illness and Injury


Today we are going to learn about important ways we can measure the health of a population by looking at illness and injury.

Presentation notes



How long people live and how many children die are important health status indicators, but they only give part of the picture. Health status also has to do with quality of life. People who are ill or injured don’t enjoy the same quality of life as people who are healthy.

Data from https://www.cia.gov/library/publications/the-world-factbook/geos/eg.html.

Presentation notes



In the next few slides, you will learn how illness is measured and how measurements of illness are used.

Presentation notes



Morbidity refers to anything that interferes with a person’s good health. Morbidity means sickness, or a change from psychological and physical well-being. It is different from mortality, which refers to death.

Presentation notes



A disability could be the result of a disease, such as muscular dystrophy; an injury, such as a soldier losing a leg in battle; or something a person was born with, such as vision impairment. Disability can also refer to an intellectual disability or a mental disorder.

People with disabilities need health care services as much or more than the average person does, but they often get fewer health services because of their disability. Disabled people may have a harder time getting around, so getting themselves to the doctor can be more difficult. In other cases, people with certain intellectual disabilities or mental illnesses may not be able to understand the need for medical treatment. And in some places, disabled people are rejected by their families or seen as a burden on the community, so they may not have the support they need.

Data from http://www.who.int/mediacentre/factsheets/fs352/en/index.html, http://www.who.int/features/factfiles/global_burden/facts/en/index7.html, and http://thenationshealth.aphapublications.org/content/43/1/1.4.full?sid=e04c4487-13d0-4f3f-89aa-87df7e2adffb.

Presentation notes



As you saw in the video on smallpox, it is important to be able to track a disease. For a disease like smallpox, which is contagious, health professionals need to be able to track how fast it is spreading and where it is spreading. That is how they are able to stop the disease. It’s important to track the spread of all diseases, even noncommunicable (noncontagious) diseases like cancer or heart disease. With this information, organizations like the WHO know where to send professionals, materials, and medicine.

Incidence and prevalence are two health status indicators professionals use to track a disease. The bathtub shown is a good illustration of incidence and prevalence: The water coming in from the faucet is incidence. The water in the tub is prevalence. And water going out the drain is due to cure and/or death.

The next few slides are going to give you more information about what incidence and prevalence rates are and how to calculate them.

Presentation notes



Incidence measures the number of people in a specific population (such as people living in a particular city) who contract a disease over a certain period of time, such as one year. Incidence is usually used to track infectious diseases, acute diseases (diseases that occur suddenly), and outbreaks.

Imagine a small town called Bay Town with a population of 1,000 people. During a specific period of time, the 2013 flu season, 100 people got the flu. The incidence rate is determined by creating a fraction. Put the number of cases of the flu, 100, over the total population, 1,000. The incidence rate is 100 out of 1,000.

Presentation notes



Remember, incidence measures the number of new cases of a disease in a specific population over a specific period of time. Take the example of Grant High School. During the 2012–2013 school year, 10 students got mononucleosis. There might have been other students who had mononucleosis in a previous school year, but that is not what the incidence rate is measuring. This study focuses on new cases.

Presentation notes



Unlike incidence, prevalence focuses on the total number of existing cases of a disease. Prevalence includes both new cases and those who contracted a disease in the past and are still living with it. It is frequently used to measure the amount of chronic disease in a population.

Knowing prevalence is important for professionals who work with people who have terminal diseases. Prevalence allows health professionals to evaluate whether treatments are helping people live longer. In the 1980s, most people diagnosed with HIV didn’t live for very long. Today, people with HIV can live for years, even decades, with the right medications. By studying the prevalence of HIV, doctors can see that the medications are helping patients, even if there is no cure for the disease at this time.

Let’s take the Bay Town example again. The population of Bay Town is 1,000 people. In 2013, 50 people in Bay Town had been diagnosed with depression. This number includes new cases (people who received the diagnosis in 2013) and people who were diagnosed before 2013 and were still living with the condition. The prevalence rate is determined by creating a fraction. The prevalence of depression in Bay Town is 50 out of 1,000.

Presentation notes



Remember, prevalence measures the number of existing cases in a specific population at a moment in time. Take the example of Grant High School. In 2013, 200 students were considered obese. These students include people who were obese before 2013 and people who became obese that year. Prevalence shows the proportion of the population of Grant High that is obese: 200 out of 1,200.

Presentation notes



Arthritis, a form of a joint disorder, is a leading cause of disability in the United States. In 2013, there were 25 new cases in Bay Town. Remember, the incidence shows the number of new cases in a population during a specific period of time. The prevalence shows the total number of cases. So, in 2013 there were in total 200 cases of arthritis. Of those cases, 25 were new, and 175 had been diagnosed prior to 2013.

Presentation notes



To calculate health-adjusted life expectancy, a person’s years of ill health are weighted according to the severity of the illness or condition and then subtracted from the overall life expectancy. HALE is a controversial measurement because not everybody responds to illness in the same way. Still, it’s one of the best ways to account for quality of life as well as life expectancy. As you can see from the statistics above, in both developed and developing nations there is a gap between the years someone is expected to live and the years they are expected to be in good health.

Data from http://apps.who.int/gho/data/node.main.688 .

Presentation notes



Health status indicators that measure illness and injury, as well as indicators that measure life expectancy, give health professionals information needed to improve the health of global populations.

Presentation notes




Guide: Creating Tables and Graphs in Excel

Use this resource in conjunction with Teacher Resource 2.4, Graphing Data: Prevalence of Obesity and Incidence of Whooping Cough (separate Excel file), to guide students in creating graphs that track the prevalence of obesity and the incidence of whooping cough. (The data for the graphs is in Teacher Resource 2.4.) The steps below are a good procedure to follow to create a column graph or a line graph in Excel as students follow along on their computer. The examples on the next page of this resource show what the final graphs should look like.

How to Create Column and Line Graphs in Excel

1. Open Teacher Resource 2.4, Graphing Data: Prevalence of Obesity and Incidence of Whooping Cough (separate Excel file). First, you will use the data on the first worksheet to create a column graph showing the prevalence of adolescent obesity in the United States from 1971 to 2008.

2. Note that the Year data for the x-axis (horizontal axis) of your graph is in the first column, and the top row has the label Year. The Prevalence data for the y-axis of your graph is in the second column. You might want to remind students that the prevalence is expressed as a percentage here. So, for example, in the years 1971–1974, 6.1% of the population was obese.

3. Select the data in the two columns in order to display it in a graph.

4. Click Insert, and select the type of chart you want to create from the Chart section of the ribbon.

5. Look at the chart with your students and make sure it presents the information correctly.

6. Click within the chart area to edit it. On the Labels tab, use the options in the Layout group to add or edit the title, such as Percentage of Adolescents Who Were Obese in the United States from 1971 to 2008, for your graph and to add labels for the x-axis (Years) and the y-axis (Prevalence).

7. Go to the second worksheet in the file and repeat the steps to create a line graph that shows the incidence of whooping cough in California from June 30, 2010, to March 9, 2011. Use the Date data for the x-axis and the Incidence (per 100,000 people) data for the y-axis.



Column Graph: Adolescent Obesity in the United States The column graph you create should look like the following:

Line Graph: Whooping Cough in California The line graph you create should look like the following:

6.15

10.5

14.816.7 17.4 17.8 18.1

02468

101214161820

Prevalence

Years

Prevalence of Obesity

3.4

9.2

16.4

21.4

24.2

0

5

10

15

20

25

30

6/30/2010 8/31/2010 11/2/2010 1/7/2011 3/9/2011

Incidence per 100,000 People

Date of Report

Incidence of Whooping Cough per 100,000 People




Assessment Criteria: Health Status Measurement Tables and Graphs

Student Name:_____________________________________________Date:______________________

Using the following criteria, assess whether students met each one.

Met Partially Met

Didn’t Meet

A column graph accurately and clearly compares life expectancy in six regions of the world. It is easy to compare and contrast life expectancy in the different regions.

□ □ □

A column graph accurately and clearly compares infant mortality in six regions of the world. It is easy to compare and contrast infant mortality rates in the different regions.

□ □ □

A column graph accurately and clearly compares under-5 mortality in six regions of the world. It is easy to compare and contrast the under-5 mortality rate in the different regions.

□ □ □

For each column graph, a one- or two-sentence explanation demonstrates an understanding of the importance of health status indicators.

□ □ □

In the line graph that tracks the progression of infant mortality or under-5 mortality, it is easy to identify the country, the mortality rate for each year, and whether the mortality rate is going up or down.

□ □ □

A one-paragraph summary of the line graph concisely and accurately explains what information the graph conveys and why that information is important.

□ □ □

The assignment is neat and uses proper spelling and grammar.

□ □ □

Additional Comments:

_____________________________________________________________________________

_____________________________________________________________________________




Key Vocabulary: What Is Health?

Term Definition

disability A physical or mental condition that limits a person’s senses, movements, or activities.

epidemiology The branch of medicine that deals with disease and other factors relating to health.

field epidemiology Also known as shoe-leather epidemiology; refers to investigations of urgent public health problems outside of the laboratory, in the field.

health-adjusted life expectancy (HALE)

How many years a person can expect to live in good health. In contrast to life expectancy, HALE focuses on quality of life.

incidence rate of a disease Rate of how quickly a disease spreads; most commonly used with outbreaks.

infant mortality rate How many babies die in their first year of life (measured per 1,000 births).

life expectancy at birth An average prediction for how long someone born in a certain year in a certain country will live (e.g., a baby born in the United States in 1910 had a shorter life expectancy than a baby born in the United States in 2010).

maternal mortality rate The number of women who die while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy.

morbidity Disease, or anything that interferes with a state of good health.

mortality Death.

neonatal mortality rate How many babies die within the first 28 days of life (measured per 1,000 births).

prevalence of a health condition

How many people within a population are living with a disease; most commonly used with chronic illnesses/conditions.



Term Definition

shoe-leather epidemiology Also known as field epidemiology; refers to investigations of urgent public health problems outside of the laboratory, out in the field.

under-5 mortality rate How many children die before they reach the age of 5 (measured per 1,000 births).




Bibliography: What Is Health?

The following sources were used in the preparation of this lesson and may be useful for your reference or as classroom resources. We check and update the URLs annually to ensure that they continue to be useful.

Print Fisher, Melanie, William Markle, and Raymond Smego, Jr. Understanding Public Health. New York: McGraw Hill Medical, 2007.

Harrell, JA and Baker, EL. The Essential Services of Public Health, Leadership Public Health, 1994.

Jacobsen, Kathryn H. Introduction to Global Health. Sudbury, MA: Jones and Bartlett, 2008.

Skolnik, Richard. Global Health 101. Burlington, MA: Jones and Bartlett Learning, 2012.

Online Epidemiologic Research & Information Center, UNC School of Public Health. “Incidence vs. Prevalence.” ERIC Notebook 2 (June 1999), http://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_2.pdf (accessed October 15, 2015).

“Fact Sheet 348: Maternal Mortality.” WHO, http://www.who.int/mediacentre/factsheets/fs348/en/ (accessed October 15, 2015).

“Fact Sheet 352: Disability and Health.” WHO, http://www.who.int/mediacentre/factsheets/fs352/en/index.html (accessed October 15, 2015).

“In Snow’s Footsteps: Commentary on Shoe-Leather and Applied Epidemiology,” American Journal of Epidemiology, http://aje.oxfordjournals.org/content/172/6/737.full (accessed October 15, 2015).

“Infant Mortality.” WHO, http://www.who.int/gho/urban_health/outcomes/infant_mortality_text/en/index.html (accessed October 15, 2015).

"Life Expectancy Data by WHO Region." WHO, http://apps.who.int/gho/data/view.main.690?lang=en (accessed September 25, 2015).

“Mortality Rate, Adult, Female (per 1,000 Female Adults).” The World Bank DataBank, http://data.worldbank.org/indicator/SP.DYN.AMRT.FE?display=graph (accessed October 15, 2015).

“1900–2000: Changes in Life Expectancy in the United States.” Elderweb, http://www.elderweb.com/book/appendix/1900-2000-changes-life-expectancy-united-states (accessed October 15, 2015).

Ogden, Cynthia, and Margaret Carroll. “Prevalence of Obesity Among Children and Adolescents: United States, Trends 1963–1965 through 2007–2008.” Centers for Disease Control and Prevention (CDC), http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm (accessed October 15, 2015).

“Pertussis Summary Reports.” California Department of Public Health, http://www.cdph.ca.gov/programs/immunize/Pages/PertussisSummaryReports.aspx (accessed October 15, 2015).

“10 Facts on the State of Global Health.” World Health Organization (WHO), http://www.who.int/features/factfiles/global_burden/facts/en/index7.html (accessed October 15, 2015).



“The World Factbook: Country Comparison: Infant Mortality Rate.” Central Intelligence Agency (CIA), https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html (accessed October 15, 2015).

“The World Factbook: Country Comparison: Life Expectancy at Birth.” CIA, https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html (accessed October 15, 2015).

“World Health Statistics 2009.” WHO, http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf (accessed October 15, 2015).


AOHS Global Health


Student Resources


Student Resource 2.1 Checklist: Essential Public Health Services

Student Resource 2.2 Key Word Prediction: Health Status Indicators

Student Resource 2.3 Reading: Health Status Indicators: Life Expectancy

Student Resource 2.4 Summary: Reading and Translating Graphs

Student Resource 2.5 Reading: Health Status Indicators: Illness and Injury

Student Resource 2.6 Assignment Sheet: Health Status Measurement Tables and Graphs




Checklist: Essential Public Health Services

Student Name: Date:

Directions: Read the list below and consider which of these services were a part of D. A. Henderson’s work on smallpox. Put a check mark next to any services that you saw or heard about in the video.

American Public Health Association’s List of Essential Services In the Video?

1. Monitor health status to identify community health problems.

2. Diagnose and investigate health problems and health hazards in the community.

3. Inform, educate, and empower people about health issues.

4. Mobilize community partnerships to identify and solve health problems.

5. Develop policies and plans that support individual and community health efforts.

6. Enforce laws and regulations that protect health and ensure safety.

7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.

8. Assure a competent public health and personal health care workforce.

9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

10. Research for new insights and innovative solutions to health problems.




Key Word Prediction: Health Status Indicators

Student Name: Date:

Directions: Before viewing the presentation Health Status Indicators: Life Expectancy, read the terms in Section 1 below. In the I Predict column, do your best to guess or predict what you think that term means. As you view the presentation, add a more detailed definition to the I Learned column. An example is provided.

Next, before viewing the presentation Health Status Indicators: Illness and Injury, read the terms in Section 2 and complete the I Predict column. Then complete the I Learned column as you view the presentation.

Section 1

Term I Predict I Learned

health Not being sick A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

1 World Health Organization (WHO)

2 life expectancy at birth

3 mortality rate

4 under-5 mortality rate

5 infant mortality rate




6 neonatal mortality rate

7 maternal mortality rate

Section 2


8 morbidity

9 disability

10 incidence rate

11 prevalence

12 health-adjusted life expectancy (HALE)




Reading: Health Status Indicators: Life Expectancy

Today we are going to learn about important ways that professionals can measure the health of a population.



Health professionals use health status indicators to determine the health of different global populations. Health status indicators help them know if they are achieving the World Health Organization’s (WHO’s) goal of total physical, mental, and social well-being for everyone.

Image retrieved from http://commons.wikimedia.org/wiki/File:India_-_Sights_%26_Culture_-_001_-_crowd_shopping_%28342043908%29.jpg on August 9, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Image courtesy of McKay Savage.

Image retrieved from http://commons.wikimedia.org/wiki/File:Chimoio_market_-_banana_sellers.jpg on August 9, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Image courtesy of Ton Rulkins.



The WHO is the directing and coordinating authority for health within the United Nations system. To perform all of its tasks, the WHO needs to be able to measure health in each region of the world. The WHO divides the world into six regions: Africa, the Americas, the Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific. The WHO has a regional office in each of these areas. These regional map designations are for administrative purposes by the WHO and do not represent political areas or borders.

Health is measured by region because different parts of the world face different problems. For example, polio is a disease that used to affect a lot of people in the United States in the mid-20th century. Even one of our presidents, Franklin Roosevelt, suffered from polio. In the ’50s with the availability of mass-produced polio vaccines, people started to vaccinate their children. The United States has been polio-free since 1979. But there are three countries, Afghanistan, Nigeria, and Pakistan, where polio is still a major problem.

Data from http://www.who.int/about/regions/en.



In 1945, diplomats met and formed the United Nations. They discussed the importance of setting up a global health organization. In 1948, the World Health Organization was established. It has provided leadership on all global health issues ever since.

Image retrieved from http://phil.cdc.gov/phil/details.asp on August 9, 2013. From CDC/ J. D. Millar, MD.



Health status indicators provide important information about the health of a population. Indicators give information about what conditions a population suffers from and which of the conditions causes people to be sick or disabled, or to die. Indicators also tell us if a society’s health status is improving. Improvements may be due in part to better health systems, such as the availability of medicine or the accessibility of health centers or hospitals.

Image retrieved from https://commons.wikimedia.org/wiki/File:2007-09-05_Hong_Sang-soo_sur_Nuit_et_Jour.JPG on August 9, 2013, and reproduced here under the terms of the Creative Commons Attribution 3.0 Generic license (http://creativecommons.org/licenses/by/3.0/deed.en). Image courtesy of Étienne André.



In the next few slides, you will learn why each of these measurements is important.



Life expectancy is influenced by when you were born. In most countries, people born 100 years ago had a much shorter life expectancy than people born today. You will probably live longer than your grandparents did.

Life expectancy is also influenced by where you were born. The map above shows the average life expectancy for babies born in 2011. As you can see, the average life expectancy for a baby born that year in the United States was 70–79 years. But there were several countries in Africa where a baby born in 2012 was expected to live fewer than 50 years!

Life expectancy is a very important measure of global health. As we continue to make medical breakthroughs, overall life expectancy increases. That is a positive trend, but it is not a universal trend. By looking at data on life expectancy, health professionals can identify quickly which regions of the world are facing the most difficult health challenges.

This map is included under fair-use guidelines of Title 17, US Code. Copyright © World Health Organization. Map available online at http://gamapserver.who.int/mapLibrary/Files/Maps/Global_LifeExpectancy_bothsexes_2012.png.



Of these three babies, the one born most recently has the lowest life expectancy. The life expectancy of a baby born in South Africa in 2013 is one of the lowest ages in the world, with an average age of 59. The baby born in Japan in 2011 has the longest life expectancy at birth: over 80 years. The life expectancy of a person born in the US in 1930 was only 60.

Data from https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html, http://www.elderweb.com/book/appendix/1900-2000-changes-life-expectancy-united-states, and http://beta2.statssa.gov.za/publications/P0302/P03022013.pdf.

Image retrieved from https://commons.wikimedia.org/wiki/File:Young_mother_%28Klashorst%29.jpg on August 9, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Image courtesy of Peter Klashorst.

Image retrieved from https://commons.wikimedia.org/wiki/File:Best_boy_1857.jpg on August 9, 2013, and reproduced here under the terms of the Creative Commons Attribution 3.0 Generic license (http://creativecommons.org/licenses/by/3.0/deed.en). Image courtesy of Boxears.

Image retrieved from http://commons.wikimedia.org/wiki/File:Poa_Pan-milk.JPG on August 9, 2013. 2012. Image courtesy of Mattes.



If you were a 15-year-old girl living in the United States in 2013, the probability that you would die before reaching 60 was 77 out of a thousand (or 7.7 out of 100). If you were a 15-year-old girl living in Afghanistan in 2013, the probability that you would die before reaching 60 was much higher: 232 out of a thousand (or 23.2 out of 100).

Mortality rates, or death rates, vary by country because of availability of medical care and quality of life, such as sanitation and access to food and water. Mortality rates also consider non disease-related deaths, including people who are killed in a war or in a natural disaster.

In less developed parts of the world, many people die earlier than expected. Specific types of mortality rates are measured for life expectancy evaluation in a country, as you’ll see on the next few slides. Measuring the mortality rate at different ages can help professionals recognize what kinds of intervention could save more lives.

Data from http://wdi.worldbank.org/table/2.21.



In the United States, the under-5 mortality rate for 2013 was less than 7 deaths per 1,000 live births. That means that for every 1,000 children in the United States, 7 will die before they reach the age of 5. The under-5 mortality rate is considered to be a leading indicator of the level of child health and overall development in a country. In other words, more-developed countries or wealthier countries have fewer deaths of children under 5.

This map is included under fair-use guidelines of Title 17, US Code. Copyright © World Health Organization. Map available online at http://gamapserver.who.int/mapLibrary/Files/Maps/global_underfivemortality_2013.png.



The infant mortality rate can provide insight into the quality of infant care available in a specific country or region. It may reflect a need for more parent education, since some causes of death are preventable. And some methods of care, like breastfeeding, can improve childhood immunity to disease. Countries that have high infant mortality or under-5 mortality rates also have lower life expectancy.

This map is included under fair-use guidelines of Title 17, US Code. Copyrights belong to respective owners. Map available online at http://commons.wikimedia.org/wiki/File%3AInfant_Mortality_Rate_World_map.png.



Infant mortality rates have been decreasing in urban areas of Africa and Asia. For example, the urban poorest 20% in Africa witnessed a decrease in infant mortality rate from 99 per 1,000 live births in the 1990s to 70 per 1,000 live births in 2000–2007, on average. The poorest 20% in urban areas of Asia have also experienced a fall in infant mortality rates. The rates dropped from 81 to 51 per 1,000 live births between the 1990s and 2000–2007, on average.

Data from http://www.who.int/gho/urban_health/outcomes/infant_mortality_text/en/index.html.

Image retrieved from http://phil.cdc.gov/phil/details.asp on August 9, 2013. From Chris Zahniser.



This exercise will help you see how health professionals use data to come up with statistics. Remember, the infant mortality rate measures how many children die before the age of 1.

Data from: http://www.cdc.gov/nchs/fastats/infant-health.htm.



First, multiply the number of deaths by 1,000. You should get 23,440,000. Then divide 23,440,000 by the number of live births (i.e., by 3,932,181) to solve for X. The answer is 6 (rounded up from 5.96).



Many infants deaths that occur in the first 28 days of life are often connected to problems that occurred during the mother’s pregnancy. Maternal and neonatal tetanus is one example.

After a baby is born, the umbilical cord that connects the baby to its mother is cut. If the cut is done with an unclean knife, the baby could get tetanus. In 1988, 787,000 babies died from neonatal tetanus. These deaths were preventable. By immunizing women, it’s possible to dramatically reduce the risk of contracting neonatal tetanus. So, the WHO implemented a program to immunize pregnant women and women of child-bearing age. The program was a huge success. By 2008 there had been a 92% reduction in deaths from neonatal tetanus.

Image retrieved from http://www.unicef.org/health/index_43509.html on August 9, 2013. Image courtesy of UNICEF.



Pregnancy can be very dangerous for women who have limited access to health care. Many conditions and complications can arise during pregnancy, which can prove life threatening if not treated promptly. In some cases, the process of giving birth to a child can create life-threatening complications if the baby is not coming out easily or the mother begins to bleed too much. In some countries, women who choose to abort a pregnancy may die because the procedure is performed incorrectly or in unsterile and unsanitary circumstances.

In developed and wealthier countries, the maternal mortality rate is much lower. This is because it is far more common to have trained medical professionals available during a birth and, in many cases, because births happen at a medical facility.

Data from http://www.who.int/mediacentre/factsheets/fs348/en/.



By using these health status indicators, health professionals can better understand the overall status of health around the world. This allows them to make informed decisions about what to do to improve the health and health care of people in all countries.




Summary: Reading and Translating Graphs

Student Name: Date:

Directions: Look at the example graph Infant Mortality Rates in North America, 2013. Then read the example summary of the graph. Follow your teacher’s instructions to fill in the table explaining how the example summary accomplishes the points given in the checklist.

Example Summary The graph Infant Mortality Rates in North America compares the estimated infant mortality rates from 2013 for all three North American countries: Canada, the United States, and Mexico. The infant mortality rate is the estimated number of infants that died per 1,000 live births. Canada has the lowest infant mortality rate in North America. At more than 15, Mexico’s infant mortality rate is significantly higher than that of both Canada and the United States. This graph raises questions about why Mexico’s infant mortality rate is so much higher than Canada’s and the United States’, and what efforts could be taken to lower the rate.

0 5 10 15 20

United States

Canada

Mexico

Infant Mortality Rates in North America, 2013

Estimated number of deaths ofinfants per 1,000 live births, 2013



Summary Example Checklist

Checklist How the example summary accomplishes this point

The summary mentions the title of the graph.

The summary explains the purpose of the graph.

The summary explains the health status indicator expressed in the graph.

Infant mortality rate is the health status indicator expressed in the graph. The second sentence of the summary explains that the infant mortality rate is the estimated number of infants that died per 1,000 live births.

The summary puts into words important statistics shown in the graph.

The summary points out why the graph is important.

Create Your Summary Now that you’ve reviewed the example summary, write one yourself. First, analyze the graph Life Expectancy at Birth, 2013 at the top of the next page. Then write a short paragraph that summarizes the information given in the graph. Make sure that your paragraph includes all the points on the checklist shown at the end of this resource.



My Summary

Make Sure Your Summary Covers These Items ___The summary mentions the title of the graph.

___The summary explains the purpose of the graph.

___The summary explains the health status indicator expressed in the graph.

___The summary puts into words important statistics shown in the graph.

___The summary points out why the graph is important.

58

7768

7668

76

0102030405060708090

Expectancyin

Years

WHO Region

Life Expectancy at Birth, 2013




Reading: Health Status Indicators: Illness and Injury

Today we are going to learn about important ways we can measure the health of a population by looking at illness and injury.



How long people live and how many children die are important health status indicators, but they only give part of the picture. Health status also has to do with quality of life. People who are ill or injured don’t enjoy the same quality of life as people who are healthy.

Data from https://www.cia.gov/library/publications/the-world-factbook/geos/eg.html.



In the next few slides, you will learn how illness is measured and how measurements of illness are used.



Morbidity refers to anything that interferes with a person’s good health. Morbidity means sickness, or a change from psychological and physical well-being. It is different from mortality, which refers to death.



A disability could be the result of a disease, such as muscular dystrophy; an injury, such as a soldier losing a leg in battle; or something a person was born with, such as vision impairment. Disability can also refer to an intellectual disability or a mental disorder.

People with disabilities need health care services as much or more than the average person does, but they often get fewer health services because of their disability. Disabled people may have a harder time getting around, so getting themselves to the doctor can be more difficult. In other cases, people with certain intellectual disabilities or mental illnesses may not be able to understand the need for medical treatment. And in some places, disabled people are rejected by their families or seen as a burden on the community, so they may not have the support they need.

Data from http://www.who.int/mediacentre/factsheets/fs352/en/index.html, http://www.who.int/features/factfiles/global_burden/facts/en/index7.html, and http://thenationshealth.aphapublications.org/content/43/1/1.4.full?sid=e04c4487-13d0-4f3f-89aa-87df7e2adffb.

.



As you saw in the video on smallpox, it is important to be able to track a disease. For a disease like smallpox, which is contagious, health professionals need to be able to track how fast it is spreading and where it is spreading. That is how they are able to stop the disease. It’s important to track the spread of all diseases, even noncommunicable (noncontagious) diseases like cancer or heart disease. With this information, organizations like the WHO know where to send professionals, materials, and medicine.

Incidence and prevalence are two health status indicators professionals use to track a disease. The bathtub shown is a good illustration of incidence and prevalence: The water coming in from the faucet is incidence. The water in the tub is prevalence. And water going out the drain is due to cure and/or death.

The next few slides are going to give you more information about what incidence and prevalence rates are and how to calculate them.



Incidence measures the number of people in a specific population (such as people living in a particular city) who contract a disease over a certain period of time, such as one year. Incidence is usually used to track infectious diseases, acute diseases (diseases that occur suddenly), and outbreaks.

Imagine a small town called Bay Town with a population of 1,000 people. During a specific period of time, the 2013 flu season, 100 people got the flu. The incidence rate is determined by creating a fraction. Put the number of cases of the flu, 100, over the total population, 1,000. The incidence rate is 100 out of 1,000.



Remember, incidence measures the number of new cases of a disease in a specific population over a specific period of time. Take the example of Grant High School. During the 2012–2013 school year, 10 students got mononucleosis. There might have been other students who had mononucleosis in a previous school year, but that is not what the incidence rate is measuring. This study focuses on new cases.



Unlike incidence, prevalence focuses on the total number of existing cases of a disease. Prevalence includes both new cases and those who contracted a disease in the past and are still living with it. It is frequently used to measure the amount of chronic disease in a population.

Knowing prevalence is important for professionals who work with people who have terminal diseases. Prevalence allows health professionals to evaluate whether treatments are helping people live longer. In the 1980s, most people diagnosed with HIV didn’t live for very long. Today, people with HIV can live for years, even decades, with the right medications. By studying the prevalence of HIV, doctors can see that the medications are helping patients, even if there is no cure for the disease at this time.

Let’s take the Bay Town example again. The population of Bay Town is 1,000 people. In 2013, 50 people in Bay Town had been diagnosed with depression. This number includes new cases (people who received the diagnosis in 2013) and people who were diagnosed before 2013 and were still living with the condition. The prevalence rate is determined by creating a fraction. The prevalence of depression in Bay Town is 50 out of 1,000.



Remember, prevalence measures the number of existing cases in a specific population at a moment in time. Take the example of Grant High School. In 2013, 200 students were considered obese. These students include people who were obese before 2013 and people who became obese that year. Prevalence shows the proportion of the population of Grant High that is obese: 200 out of 1,200.



Arthritis, a form of a joint disorder, is a leading cause of disability in the United States. In 2013, there were 25 new cases in Bay Town. Remember, the incidence shows the number of new cases in a population during a specific period of time. The prevalence shows the total number of cases. So, in 2013 there were in total 200 cases of arthritis. Of those cases, 25 were new, and 175 had been diagnosed prior to 2013.



To calculate health-adjusted life expectancy, a person’s years of ill health are weighted according to the severity of the illness or condition and then subtracted from the overall life expectancy. HALE is a controversial measurement because not everybody responds to illness in the same way. Still, it’s one of the best ways to account for quality of life as well as life expectancy. As you can see from the statistics above, in both developed and developing nations there is a gap between the years someone is expected to live and the years they are expected to be in good health.

Data from http://apps.who.int/gho/data/node.main.688 .



Health status indicators that measure illness and injury, as well as indicators that measure life expectancy, give health professionals information needed to improve the health of global populations.




Assignment Sheet: Health Status Measurement Tables and Graphs

Student Name: Date:

Directions: Using Excel or the spreadsheet program your teacher provides, create the graphs described in this resource and write a summary describing each graph. Before you begin, read through all of the instructions and the assessment criteria to make sure you understand how your work will be assessed.

Column Graphs: Comparison of Life Expectancy in Different Regions of the World Follow the steps listed below to create three column graphs showing the following:

Comparison of life expectancy in the six different regions of the world

Comparison of infant mortality rates in the six different regions of the world

Comparison of under-5 mortality rates in the six different regions of the world

All of the data you need for these graphs is provided in the following table:

Health Measurement Data from 2005–2010

Africa Asia Europe

Life expectancy at birth: 55.16 years

Infant mortality rate: 79 (out of 1,000)

Under-5 mortality rate: 125 (out of 1,000)







Latin America and the Caribbean Northern America Oceania










Depending on your version of Excel, the procedure may vary slightly. If you run into difficulties, try using the Excel online help, get help from a classmate, or get help from your teacher.

1. Open a new file in Excel and save it.

2. On the first worksheet, create the life expectancy graph. What data will you need on the x-axis of your chart? Put a label for the data in the top row of a column, and then put the data in the rows below the label. Remember, the x-axis is the horizontal axis, and the y-axis is the vertical axis. An example of the x- and y-axes is shown in the image.



3. What data will you need on the y-axis of your chart? Put a label for the data in the top row of a column, and then put the data in the rows below the label.

4. Select the data in both columns to tell Excel you want to display this data in a chart.

5. Click Insert, and select the type of chart you want to create in the Charts section of the ribbon. (For this exercise, select Column, since you want to create a column chart.)

6. Look at the chart that is created. Does it make sense? Does it present the information well? If not, try to figure out what went wrong, and create a new chart if necessary.

7. Click within the chart area to edit it. Use Chart Tools > Layout to add a title for your graph, add data labels, and label each axis.

8. Underneath (or next to) the graph, write a one- or two-sentence explanation of why the information in the graph is important.

9. Create new worksheets and repeat this process to create the infant mortality and under-5 mortality column graphs.

Line Graph: Progression of Heath Indicators Over Time In the column graphs you created for this activity, you compared life expectancy by looking at statistics for different regions at the same point in time. Now you are going to create a line graph that shows how one health indicator, such as infant mortality or under-5 mortality, has increased or decreased over the past 50 years or so in a specific country.

Follow these steps to create your line graph:

1. Choose either the infant mortality rate or the under-5 mortality rate to research in more detail. You also need to choose a country to focus on for this part of the activity.

Circle the indicator you will graph:

infant mortality under-5 mortality

The country you will graph is:

2. Visit the following site: http://esa.un.org/unpd/wpp/DVD/. This site provides data from the United Nations’ Department of Economic and Social Affairs.

3. Click on the Mortality indicators tab. Select the report that covers your chosen health indicator (infant mortality and under-5 mortality are the first two lines of the table). The report will open in an Excel file, and you will see a lot of data. Scan the report to find the country you chose to focus on.

4. In the Excel file, you will see data from the last 65 years (1950 to 2015). Use all of the data you find for your country. Copy that data for your country into an Excel worksheet and use it to create a line graph, following the same steps you used to create your column graphs.

5. When you have finished the graph, write a summary of the information in your graph. Refer to Student Resource 2.4 for a checklist of what to include in your summary. Write your summary directly in your Excel file and place the text below your graph.



Make sure your assignment meets or exceeds the following assessment criteria:

A column graph accurately and clearly compares life expectancy in six regions of the world. It is easy to compare and contrast life expectancy in the different regions.

A column graph accurately and clearly compares infant mortality in six regions of the world. It is easy to compare and contrast infant mortality rates in the different regions.

A column graph accurately and clearly compares under-5 mortality in six regions of the world. It is easy to compare and contrast the under-5 mortality rate in the different regions.

For each column graph, a one- or two-sentence explanation demonstrates an understanding of the importance of health status indicators.

In the line graph that tracks the progression of infant mortality or under-5 mortality, it is easy to identify the country, the mortality rate for each year, and whether the mortality rate is going up or down.

A one-paragraph summary of the line graph concisely and accurately explains what information the graph conveys and why that information is important.



AOHS Global Health

Lesson 3 Types of Disease and Injury

In this lesson, students learn about the major types of disease and injury that concern global health professionals. Students begin by learning about the chain of infection and methods of breaking the chain through proper hygiene and other means. This leads students to an exploration of communicable disease, and students learn about major types of communicable disease that are a global threat today. Students then study noncommunicable disease and compare and contrast it with communicable disease. They also learn about the most common types of injury and violence that are a public health problem. Students finish this lesson by developing maps that illustrate a statistic about disease or injury for two different countries.

Advance Preparation

In Class Periods 4 and 5, students will need computers with Internet access, one student per computer, and a printer.

Students design a pair of maps for this lesson’s assessment product. Have atlases or printed copies of examples of different kinds of maps and legends for students to study to get ideas for how best to create their own maps.


Lesson Framework


Identify the diseases and health conditions that have a major global health impact and categorize them as communicable, noncommunicable, or injury*

Diagram the basic chain of infection and explain ways to prevent the spread of communicable disease

Characterize the individual and global impact and preventive measures for a major noncommunicable disease

Explain why preventive measures for both communicable and noncommunicable diseases are important to global health*

Analyze the relative importance of injury as a cause of death and disability globally

AOHS Global Health Lesson 3 Types of Disease and Injury


Describe the global health impact and some individual impacts of violence



Describe common diseases and disorders of each body system (National Health Science Standards 2015, Standard 1.21)

Explain principles of infection control (National Health Science Standards 2015, Standard 7.11)

Describe strategies for prevention of disease (National Health Science Standards 2015, Standard 9.12)


Describe the content and diverse uses of health information (Common Career Technical Core 2012, HL-HI 2)

Assessment


Demographic exploration maps (Student Resource 3.8)

Assessment Criteria: Demographic Exploration Maps (Teacher Resource 3.4)

Prerequisites Knowledge of the WHO and its regions

Familiarity with the concepts of prevalence and mortality rates


Teacher Resources Teacher Resource 3.1, Presentation and Notes: Communicable Disease (includes separate

PowerPoint file)

Teacher Resource 3.2, Stations: Noncommunicable Disease (separate PDF file)

Teacher Resource 3.3, Answer Key: Injuries

Teacher Resource 3.4, Assessment Criteria: Demographic Exploration Maps

Teacher Resource 3.5, Key Vocabulary: Types of Disease and Injury

Teacher Resource 3.6, Bibliography: Types of Disease and Injury



Student Resources Student Resource 3.1, Investigation: The Chain of Infection

Student Resource 3.2, Note Taking: Communicable Disease

Student Resource 3.3, Reading: Communicable Disease

Student Resource 3.4, Stations: Noncommunicable Disease

Student Resource 3.5, Venn Diagram: Communicable and Noncommunicable Disease

Student Resource 3.6, Reading: Injuries

Student Resource 3.7, Note Taking: Injuries

Student Resource 3.8, Assignment: Demographic Exploration Maps

Equipment and Supplies LCD projector and computer for PowerPoint presentation


Computers with Internet access (one for each student)

Printer

Atlases and other maps that illustrate different kinds of data

Colored markers and other drawing supplies

Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1 15 Deductive Investigation: Breaking the Chain of Infection

The purpose of this activity is to introduce students to the chain of infection.

Begin class by explaining that students are going to learn about the chain of infection. Refer them to Student Resource 3.1, Investigation: The Chain of Infection, and ask them to read the first section, titled “The Chain of Infection in Everyday Life.”

When students have finished reading the story, ask them to look at the chain of infection illustration with a partner. Explain that the chain has six links, and each link enables the infection to spread. Instruct students to read the explanation about each link and fill in the third column with examples from the story.



Step Min. Activity

When they are finished, ask pairs to share their examples for each link in the chain with the class. Then write the following questions on the board to introduce the idea of breaking the chain:

Can you think of ways to break this chain of infection at different points?

How many times would you have to break it to prevent Tony from being infected?

Ask students to share their answers to the questions with a partner, and then have partners share with the class. Make sure students understand that the chain can be broken by breaking any link; if any one link is broken, infection will not occur.

2

35 Presentation and Discussion: What Is Communicable Disease?

This activity provides students with a more in-depth understanding of the characteristics of communicable diseases, and it gets them thinking about the vital role of global cooperation in overcoming communicable diseases. It also develops students’ listening and note-taking skills.

To prepare, make notes to help you guide class discussion using Teacher Resource 3.1, Presentation Notes: Communicable Disease. Have Teacher Resource 3.1, Presentation: Communicable Disease (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Refer students to Student Resource 3.2, Note Taking: Communicable Disease. Instruct them to take notes during the presentation by filling out this resource. Ask students to read the directions, and then answer any questions.


This presentation is duplicated as Student Resource 3.3, Reading: Communicable Disease. If an LCD projector is unavailable, students can read the presentation, answer the discussion questions in their notebook, and discuss their answers as a class. This student resource is also useful for review.

After the presentation, tell students to pair with a neighbor and compare their notes for completeness and accuracy. Call on different pairs to share their responses for each disease. Answer any questions.

If time allows or for homework, have students add information to their regional reference maps about countries they learned about in the presentation.

Let students know that communicable disease is only one of the major global health concerns they will learn about in this lesson. In the next class period, they will learn about noncommunicable disease.

CLASS PERIOD 2

3 45 Stations: Noncommunicable Disease

The purpose of this activity is to provide students with an understanding of noncommunicable disease and how to reduce its prevalence.



Step Min. Activity

Before class begins, print out Teacher Resource 3.2, Stations: Noncommunicable Disease (separate PDF file). Set up five stations around the room that students can visit, and post the appropriate set of pages at each station. Depending on the size of your class, you may wish to print and post two sets.

Students will use the Defining Format literacy strategy to define noncommunicable disease at the beginning of Student Resource 3.4, Stations: Noncommunicable Disease. For more information about this strategy, see The NAF Learning Handbook. If your students are unfamiliar with this strategy, take a moment to explain how to use it before they begin their station work, using the example from the Handbook or another example of your choice.

Tell students that today they will be learning about noncommunicable disease. Point out the stations around the room. Explain that students will visit each of these stations to gather information about noncommunicable diseases. Divide the class into five groups and assign each group to start at one of the stations. (To avoid having more than four or five students at a station at the same time, you may want to set up two sets of stations if you have more than 25 students in your class.)

Refer students to Student Resource 3.4. Point out that there is a set of questions to answer about what they see at each station. They should answer the questions while they are visiting the station, but they can go back and revise their answers if they learn new information at another station. Tell students they have seven minutes at each station. Explain that you will act as timekeeper and tell them when to move on to the next station.

When students have visited all of the stations, assign each station to one group. Ask each group of students to share with the class what they learned at the station assigned to them (based on their answers to the questions on the resource). Allow other students to add information or ask questions. Clear up any questions that may arise. You may wish to gauge student understanding by assessing this assignment on a credit/no-credit basis.

Point out that noncommunicable disease is one of the biggest challenges facing global health professionals today. As students continue to study global health, they will spend a lot of time focusing on noncommunicable diseases.

4 5 Homework: Venn Diagram of Communicable and Noncommunicable Disease

Students assimilate the similarities and differences between communicable and noncommunicable disease by completing a Venn diagram for homework.

Refer students to Student Resource 3.5, Venn Diagram: Communicable and Noncommunicable Disease. Tell them to complete this diagram for homework and to bring it to the next class period.

Remind students that a Venn diagram is a compare/contrast tool. Each circle is labeled; in this case, the circles represent communicable disease and noncommunicable disease. Inside the circle, students should write characteristics of the type of disease. For example, they might write “infectious” in the communicable disease circle. The section in the middle where the two circles overlap should be filled with statements that are true of both, such as “kills millions of people each year.” If necessary, do a practice diagram as a class, comparing something simple (cats and dogs, for example).



Step Min. Activity

Encourage students to use Student Resources 3.2, 3.3, and 3.4 as references.

CLASS PERIOD 3

5 5 Homework Review: Venn Diagram of Communicable and Noncommunicable Disease

Students compare their Venn diagrams to ensure a thorough understanding of the differences and similarities between communicable and noncommunicable disease.

Tell students to get out their homework. Draw a large version of the Venn diagram in Student Resource 3.5 on the board. Call on volunteers to share one characteristic they wrote in their diagram and tell what section they wrote it in. Add items to the diagram on the board as students share them. Continue until you have a good sample of the information students included in their diagrams; use this information to correct any apparent misunderstandings.

You may want to gauge student understanding by assessing Student Resource 3.5 on a credit/no-credit basis. Use the diagram at prezi.com/dkwjtjetdqi-/copy-of-communicable-and-non-communicable-diseases-venn-diagram/ for reference.

Point out to students that being able to distinguish between communicable and noncommunicable disease is an important skill for all health care professionals, and it is especially important when dealing with issues of global health.

6 10 List, Label: Injuries

In this activity, students consider injuries as a global health issue.

Begin by posting the following definition on the board or on a sheet of chart paper:

The result of an act that damages, harms, or hurts; unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygen

Ask students if they can guess what word is being defined. Call on a few volunteers before revealing the answer: injury. (This definition of injury comes from the National Highway Traffic Safety Administration.)

Ask students to brainstorm all the types of injuries that would fall under this definition. Write down their ideas on the board or on a sheet of chart paper.

Once students have listed 15–20 types of injuries, stop taking suggestions. Write two headings on the board: Intentional and Unintentional. Pair students with a neighbor and have them write these column headings on a page in their notebook.

Point out that the WHO divides injuries into two groups: unintentional injuries (things we might call accidents) and intentional injuries (things that happen on purpose). Review the injuries on the board and ask students: Which of these injuries would be intentional? Which would be unintentional? Give pairs a few minutes to organize the list of injuries on the board according to these two categories. Then call on pairs to offer a suggestion and fill in ideas on the board. Clear up any misunderstanding regarding the



Step Min. Activity

difference between intentional and unintentional injuries.

Explain that injuries, both intentional and unintentional, are the third major area of concern in global health, right alongside communicable disease and noncommunicable disease. In the next activity, students will have the opportunity to think more about injuries from a global health perspective.

7 35 Reading: Injuries

In this activity, students learn more about the global health problem posed by injuries, both intentional and unintentional.

Refer students to Student Resource 3.6, Reading: Injuries. Explain that this reading will give students more insight into how the WHO works to address injuries as a global health problem. Ask students to read over the questions on Student Resource 3.7, Note Taking: Injuries. Instruct students to answer the questions as they read.

When students have finished the reading and note-taking resource, review the answers as a class, using Teacher Resource 3.3, Answer Key: Injuries, for guidance.

To conclude this activity, remind students that we live in a country that has an abundance of laws, safeguards, and services to protect us from both intentional and unintentional injury.

CLASS PERIOD 4

8

50 Assignment: Demographic Exploration Maps

Students build their data visualization skills as they create maps comparing an injury or disease statistic for two different countries. This activity also focuses on the following college and career skill:


To prepare for this activity, have atlases and other examples of maps and legends available for students to use to gather ideas.

Refer students to Student Resource 3.8, Assignment: Demographic Exploration Maps. Tell them to pick a partner to work on this assignment with (or choose partners for students, according to your preference).

Point out that they have already seen many maps in this course that present different sets of data. In this lesson, students saw several maps that showed the prevalence of a specific disease in various regions of the world. Explain that this is their opportunity to create two country maps of their own to illustrate a statistic about a disease or injury.

Review the resource with students and answer questions. Also point out the examples of different kinds of maps that they can use to generate ideas.

Make sure students understand the importance of a clear, easy-to-read legend for their maps. Review the assessment criteria by which the maps will be assessed. Suggest that each partner be in charge of drawing one country map. After they decide on their legend and what to say in their summary, one partner should make the final draft of the



Step Min. Activity

legend and the other should write the final draft of the summary.

The information on the WHO website may seem overwhelming to some students. Circulate around the room, helping students to choose charts, tables, and maps that are appropriate for this assignment.

When the class period is ending, tell students that they will have only half an hour to complete their assignment in the next class period. If they have a lot of work still to do, tell the partners to divide up some responsibilities and complete them for homework.

CLASS PERIOD 5

9

35 Assignment: Demographic Exploration Maps (Continued)

Students complete their maps and summaries.

Give students about half an hour to finish their assignment. When time is up, tell students to stop working and to display their maps on their desks.

10 15 Gallery Walk: Demographic Exploration Maps

Students have an opportunity to see each other’s maps and to reflect on what they have learned in this lesson.

Tell students to walk around the room and view their classmates’ maps. As they view the maps, ask them to keep the following questions in mind:

Does this set of maps relay information that is easy to understand?

Which set of maps does the best job of illustrating a statistic about disease or injury in two different countries? Why do I think so?

Once students have had a chance to view many maps, ask them to sit down. Invite volunteers to share which maps were their favorites and why. Encourage them to answer the prompts.

Note that map making is actually a sophisticated skill. It is not so easy to make maps that are easy to understand when they are illustrating concepts or complex data. As they study more maps in this course, suggest to students that they keep notes on which design elements appeal to them and which ones don’t.

Collect the maps and assess them using Teacher Resource 3.4, Assessment Criteria: Demographic Exploration Maps.

Extensions

Content Enrichment In 2014, the WHO published a report titled “Global Status Report on Noncommunicable Diseases

2014.” It contains a wealth of information on global efforts to reduce rates of noncommunicable



disease. Download the document at http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_eng.pdf?ua=1. Assign each student to one type of noncommunicable disease and ask them to summarize the information for the class.

Ask students to recall US laws that are intended to prevent injury to citizens. Have students reflect in their notebook on ways that countries try to protect citizens from injury.

Have students view the movie Contagion, which came out in 2011. After they view the movie, lead a discussion on one or more of the following topics:

o How is the chain of infection demonstrated in this movie? Is it accurate?

o How does this movie demonstrate the need for global cooperation in the face of a pandemic? Does this change your perspective about global health?

STEM Integration Technology: Showcase student maps with QR code links to the class blog or website. A QR code

(quick response code) is a two-dimensional barcode that is readable by smartphones and tablets with cameras. To understand the utility of these codes and to see how they work in a classroom, see “Twelve Ideas for Teaching with QR Codes” on Edutopia at http://www.edutopia.org/blog/QR-codes-teaching-andrew-miller. Generate your own codes for free using a site like www.qrcode-monkey.com or Google QR Code Generator. Student devices require the appropriate reader software and are also available free from the iTunes App Store or Google Play.

Technology: Show students this Ted Talk short video about the eradication of small pox: https://www.youtube.com/watch?v=oBSandHijDc. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see www.keepvid.com) or a similar program. It brings together many of the concepts students have learned in this lesson about the chain of infection and modes of transmission. After the video, hold a discussion about the current controversy regarding vaccinations in the United States. Tell students to conduct research into why some parents have not vaccinated their children by going to this website: http://vaccines.procon.org/.

Additional Cross-Curricular Ideas English Language Arts: Have students read The Zombie Autopsies: Secret Notebooks from the

Apocalypse, a medically accurate zombie novel by Steven Schlozman, MD. The novel chronicles the WHO’s efforts to find a cure for a new pandemic that sweeps the globe: ataxic neurodegenerative satiety deficiency syndrome, otherwise known as zombiism. After students finish the book, have them evaluate it based on what they currently know about the WHO’s efforts to combat communicable disease and pandemics. How accurate is it? How does that affect the overall experience of reading the book?

English Language Arts: Have students read The Emperor of All Maladies by Siddhartha Mukherjee. After they read it, have students analyze the book from two perspectives: as a scientist and as a writer. What makes the book so effective from a scientist’s perspective? After all, the author is a practicing oncologist. What makes the book so effective from a literary perspective? After all, it won the 2011 Pulitzer Prize. Have students write a review that evaluates the book from both perspectives and makes a recommendation about who should read this book.

History/Social Studies: Have students examine the impact that pandemic disease had on various periods in history, from the Black Death of the Middle Ages to the 1918 Spanish flu pandemic. Divide the class into groups and give each group a specific disease or outbreak to research. Use excerpts from Jared Diamond’s Guns, Germs, and Steel: The Fates of Human Societies to help students recognize that the spread of germs has played a pivotal role several times in human history.



Art: Have students work together with art or graphic design students to create public health posters that might be appropriate for use in their local community.


AOHS Global Health


Teacher Resources


Teacher Resource 3.1 Presentation and Notes: Communicable Disease (includes separate PowerPoint file)

Teacher Resource 3.2 Stations: Noncommunicable Disease (separate PDF file)

Teacher Resource 3.3 Answer Key: Injuries

Teacher Resource 3.4 Assessment Criteria: Demographic Exploration Maps

Teacher Resource 3.5 Key Vocabulary: Types of Disease and Injury

Teacher Resource 3.6 Bibliography: Types of Disease and Injury




Presentation Notes: Communicable Disease


Today, you are going to learn about what a communicable disease is, how communicable diseases travel from person to person, and which diseases pose the most significant threats to global health today.

Presentation notes



Communicable diseases, which are also called contagious or infectious diseases, can be passed from one person to another or from an infected source to a person.

Presentation notes



An infection can come from different sources, which include bacteria, viruses, fungi, and parasites. We’re going to focus on bacteria and viruses.

Bacteria are single-celled creatures that have lived on earth for millions of years. Most bacteria are harmless: fewer than 1% of bacteria cause us to get sick. We have bacteria inside us, living in our intestines and helping us digest our food. Bacteria can do things like fight cancer cells and destroy microbes that cause disease. However, some bacteria can cause infections and make us ill. Strep throat is caused by bacteria, as is tuberculosis.

Viruses usually do make us sick. Viruses cannot survive without a host, unlike bacteria, and a virus is very small. The largest virus is smaller than the smallest bacteria.

Why does this matter? Well, how we treat a disease varies depending on whether it is a bacterial infection or a viral infection. For example, a bacterial infection can be treated with antibiotics, but antibiotics do not help with viral infections. The common cold is a viral infection, which is why you can’t take antibiotics to get over your cold. Viral infections can be prevented, in some cases by vaccines, or treated with antiviral medications.

The way a disease travels from one place to another is called its mode of transmission.

Presentation notes



Knowing how a disease travels means that you can take the proper precautions to slow down or stop an outbreak.

Direct contact means that to get infected you must have direct contact with an infected person or his or her blood or body fluids. Sexually transmitted diseases are passed through direct contact.

Airborne diseases are passed through the air. Many types of influenza are transmitted through the air.

Vectorborne diseases are spread through animals and insects like mosquitoes. Malaria, which is spread by mosquitos, is one of the most common vectorborne diseases in the world. In the United States, West Nile Virus is an example of a vectorborne disease that has become more common recently.

Food-borne and waterborne illnesses come from eating contaminated food or drinking contaminated water. Salmonella and E. coli are food-borne illnesses.

During pregnancy and delivery, a baby is exposed to everything in the mother’s body—including disease. After birth, the baby can get some diseases through drinking the mother’s breast milk. Mother-to-child transmission of HIV is considered a major health problem, particularly in developing countries.

Fomites are objects or substances that transmit disease, especially viruses. Examples include door knobs, toys, the change in your pocket, and unsterile medical equipment.

Presentation notes



Communicable diseases are not usually a major cause of death in developed countries. Better access to health care, safer food supplies, and better sanitation all reduce the risk of dying from an infectious disease in regions like North America and Europe.

However, that doesn’t mean that we shouldn’t be concerned about the spread of communicable disease. People in some regions of the world are dying from preventable causes. Also, in today’s world, where people can hop on a plane and be on the other side of the planet 24 hours later, a communicable disease from Asia or Africa could spread throughout the world very quickly. So it’s important to understand how communicable diseases work.

Data from the WHO Global Health Observatory, http://apps.who.int/gho/data/view.main.CODREG6AMRV?lang=en.

Presentation notes



The WHO tracks influenza because it is such a common, easily spread disease that has the potential to cause harm. Whereas influenza is not usually life threatening, the other diseases listed on this slide are responsible for most of the world’s deaths from communicable disease.

In the slides that follow, we will look at each of these diseases in more detail.

Presentation notes



Did you know that one of the worst pandemics in human history was an outbreak of the flu? In 1918, an outbreak of the Spanish flu killed between 50 and 100 million people. The Spanish flu is not the same kind of flu that you’ve probably had. There are specific strains of influenza that are more dangerous. The Spanish flu was one of those strains.

The best way to control the spread of influenza is through vaccination. Every year a new flu vaccine is released. It is designed specifically for the strains of flu that doctors expect will be most common during the upcoming year. By getting vaccinated, you reduce your own risk of getting the flu as well as your likelihood of spreading it to other people.

Presentation notes



In 2009, the world faced another unique strain of the flu: H1N1. The WHO tracked the spread of H1NI to try to stop it from spreading. As you can see in this map, H1N1 was first discovered in North America in April 2009.

This map is included under fair-use guidelines of Title 17, US Code. Copyright © World Health Organization.

Presentation notes



This map shows why it is important for countries to work together on global health issues. A disease that started out just in a few countries spread—and killed people—all over the world. This is because we live in such a globalized and highly mobile world where people travel back and forth rapidly. The WHO and the governments of dozens of countries needed to work together to track how the disease was spreading and share information about how it could be contained and cured.

An unusual strain of the flu can do serious damage. The Centers for Disease Control and Prevention (CDC) estimates that if an influenza strain similar to the Spanish flu started spreading today, it could kill more than 100 million people.

H1N1 didn’t kill nearly that many people, but it was still a serious pandemic.


Presentation notes



Diarrhoea is defined as the passage of three or more loose or liquid stools per day. It is usually a sign of intestinal illness. Although it is both preventable and treatable, diarrhoeal disease kills 760,000 children every year.

Data from WHO, “Fact Sheet 330: Diarrhoeal Disease,” http://www.who.int/mediacentre/factsheets/fs330/en/index.html.

Presentation notes



Death from diarrhoeal disease is easily preventable. Many people in the United States will get some type of diarrhoeal disease this year. Most cases can be treated at home by hydrating with water or electrolyte replacements like Pedialyte. For more severe cases, a trip to the emergency room and treatment with intravenous (IV) fluids will fix the problem.

In developing countries, particularly in Africa and South-East Asia, many people don’t have clean water at home, the money to buy replacement drinks, or access to medical care with IV therapy. That is why deaths from diarrhoeal disease are so much more common in those regions.

Data from WHO, http://apps.who.int/gho/data/view.main.CODREG6AFRV?lang=en.

Presentation notes



Rotavirus is a diarrhoeal disease. From 2006 to 2008, it was responsible for almost half of all hospitalizations for diarrhoea in Bolivia. Then the country began immunizing children free of charge at health centers across Bolivia. A study done between 2010 and 2011 showed that the vaccine was 70%–76% effective in preventing the disease in Bolivian children. Experts expect to see fewer cases in the future, as the country continues to immunize against this preventable condition.

Data from GAVI Alliance, “Bolivia’s Successful Rotavirus Vaccine Initiative,” http://www.gavialliance.org/library/news/roi/2010/bolivia-s-successful-rotavirus-vaccine-initiative/.

Image retrieved from http://commons.wikimedia.org/wiki/File:Mother_and_child_in_Bolivia.jpg on August 18, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Image courtesy of Peter van der Sluijs.

Presentation notes



There are cases of cholera in countries all over the world. The majority of cases, and the highest death rates from cholera, are in parts of Africa and South-East Asia.

The WHO has a special task force on cholera. It focuses on distributing oral vaccines to at-risk populations as well as on longer term efforts to improve sanitation and drinking water.

Data from: http://www.who.int/gho/epidemic_diseases/cholera/cases_text/en/

Presentation notes



One of the most recent cholera outbreaks occurred in Haiti. Haiti suffered a major earthquake in January 2010. Water and sewage systems were severely damaged and/or destroyed, and many people continue to live in refugee camps. In late October 2010, an outbreak of cholera began that continued throughout 2011. Some reports suggest that over 6,000 people died from the outbreak. The exact source of the cholera was undetermined, but the poor quality of sanitation and lack of clean drinking water were cited as probable reasons for its spread.

Data from WHO, “Fact Sheet 107: Cholera,” http://www.who.int/mediacentre/factsheets/fs107/en/index.html.

Image retrieved from http://commons.wikimedia.org/wiki/File:Haiti_Earthquake_building_damage.jpg on August 29, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Image courtesy of Marco Dormino/The United Nations.

Presentation notes



Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is transmitted through direct contact. This could include unprotected sexual intercourse or oral sex, contact with contaminated blood through the sharing of needles, or a transfusion with contaminated blood. HIV/AIDS can also be transmitted from mother to child during pregnancy, childbirth, and breast-feeding.

AIDS is the syndrome HIV causes, which is marked by a severely weakened immune system and/or HIV-related condition. HIV develops into AIDS over time, although that progress can be slowed by the use of specific antiretroviral drugs. There is no cure at this time. Because HIV attacks the immune system, people with the disease also frequently develop other infections, such as tuberculosis (TB). The combination of TB and HIV is particularly dangerous and difficult to treat, and many HIV/AIDS patients die from this combination.

According to estimates by the WHO and UNAIDS, 37 million people were living with HIV at the end of 2014. That same year, some 2 million people became newly infected, and 1.2 million died of AIDS-related causes, including 150,000 children. More than two-thirds of new HIV infections are in sub-Saharan Africa.

Data from WHO, http://www.who.int/hiv/data/epi_core_july2015.png?ua=1.

Presentation notes



As you can see, HIV infections are common across the globe. This map shows the prevalence of the disease among people ages 15–49 in 2011.

Even in developed countries, HIV is an incurable disease. However, people in developed countries have better access to medication that can help slow the progress of the disease, so their quality of life is better.

The WHO and the United Nations AIDS programs work together to increase community awareness about HIV prevention measures and oversee the distribution of drugs to infected populations, particularly in developing or impoverished regions.

This map is included under fair-use guidelines of Title 17, US Code. Copyright © World Health Organization. Map available online at http://www.who.int/gho/hiv/hiv_013.jpg?ua=1.

Presentation notes



A person infected with TB doesn’t always show symptoms. Sometimes people can carry the disease without getting sick from it, which is part of what makes it so difficult to control the spread of TB.

Tuberculosis is treated with antibiotics. Patients must take several different drugs every day for many months to kill all of the bacteria. The WHO puts a lot of effort into ensuring that patients follow through with their treatment.

There are strains of TB that are drug resistant—in other words, the strain no longer responds to a drug that used to treat or cure the disease. Drug-resistant strains of TB make treatment and cure even more difficult.

Data from WHO, “Fact Sheet 104: Tuberculosis,” http://www.who.int/tb/publications/factsheet_global.pdf?ua=1.

Presentation notes



The symptoms of malaria may start out mild and grow more severe. In some cases, people can have malarial relapses weeks or months after the first time they were sick. Travelers from malaria-free areas can get infected easily, which means cases sometimes show up in countries that do not ordinarily have a malaria problem.

Malaria is considered a vectorborne illness because it is spread through the bite of mosquitos infected with the parasite.

Due to improved treatment, worldwide mortality rates have fallen by 47% since 2000 (54% in the WHO African region and 58% among African children).

Data from WHO, “Fact Sheet 94: Malaria,” http://www.who.int/mediacentre/factsheets/fs094/en/.

Presentation notes



This map shows the WHO’s assessment of which countries had the greatest risk of malaria transmission in 2013.

This map is included under fair-use guidelines of Title 17, US Code. Copyright © World Health Organization. Map available online at http://www.who.int/gho/malaria/malaria_003.jpg?ua=1.

Presentation notes



The WHO has focused much of its malaria work on prevention. The two key preventive measures are the spraying of insecticides and the distribution of insecticide-treated mosquito nets. People who sleep under these nets at night have a much lower risk of contracting malaria. There is an antimalarial medication that is effective as a preventive measure, but it is not always available to those who need it.

Image retrieved from http://commons.wikimedia.org/wiki/File:Malaria_prevention-Insecticide_treated_bed_net-PMI.jpg on August 30, 2013. From President’s Malaria Initiative (PMI).

Data from CDC, “Insecticide-Treated Bed Nets,” http://www.cdc.gov/malaria/malaria_worldwide/reduction/itn.html.

Presentation notes



Communicable diseases continue to take the lives of people around the world. But progress is being made. For example, the number of people falling ill and dying from TB and malaria is on the decline. Experts expect those trends to continue.

Data from WHO, “HIV/AIDS” (http://www.who.int/mediacentre/factsheets/fs360/en/); WHO, “Fact Sheet 94: “Malaria” (http://www.who.int/mediacentre/factsheets/fs094/en/); and WHO, “Fact File: 10 Facts about Tuberculosis” (http://www.who.int/features/factfiles/tb_facts/en/index4.html).

Presentation notes




Answer Key: Injuries

1. How many people die of injuries each year worldwide?

More than 5.8 million.

2. Name two reasons why poor people are disproportionately affected by injuries.

Possible answers include: they live in a more dangerous environment, they have less access to quality medical care, there are more people living in low- and middle-income countries than in high-income countries.

3. What is one of the most common accidental causes of death?

Traffic accidents.

4. What are the three categories of intentional injury?

Self-inflicted, interpersonal, and collective.

5. How many people die every day as a result of intentional injury or violence?

4,000.

6. What does genocide mean?

The deliberate killing of a large group of people, usually because they belong to a specific ethnic or religious group.

7. Is suicide a serious problem among the teenage population in the United States?

Yes, suicide is one of the top five causes of death for people between the ages of 15 and 24 in the United States.

8. Besides the people killed during the fighting, describe two other health impacts of war.

Possible answers include: refugees flee the fighting and end up in camps with poor sanitation, which leads to increased disease; children are orphaned.

9. Name two things the WHO supports to reduce unintentional injuries.

Possible answers include: supports laws against drunk driving; encourages the use of seatbelts, helmets, child safety seats; educates the public about household safety precautions; educates the public about childproofing.

10. Name two things the WHO does to reduce violence and intentional injuries.

Possible answers include: promotes school programs about mental health, depression, abuse; trains parents about child development and appropriate forms of discipline; provides low-cost counseling services; conducts home visits for at-risk children.




Assessment Criteria: Demographic Exploration Maps

Student Names:____________________________________________Date:________________


Met Partially Met

Didn’t Meet

The two countries’ maps are labeled and clearly drawn. □ □ □

The method of demonstrating the statistic about a disease or injury on the maps is clear and easy to understand.

□ □ □

The legend is thoughtfully rendered and appropriate for the information included in the maps.

□ □ □

The summary enhances our understanding of the information included in the maps.

□ □ □


□ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Key Vocabulary: Types of Disease and Injury

Term Definition

cardiovascular disease A disease of the heart or blood vessels.

cerebrovascular disease Disease of the blood vessels in the brain that can cause strokes.

communicable disease A disease that is contagious or infectious; examples include influenza, cholera, HIV.

fomite Any inanimate object that can transmit disease.

genocide The deliberate killing of a large group of people, usually because they belong to a specific ethnic or religious group.

ischemic heart disease Disease marked by reduced blood supply to the heart, usually from clogged arteries; can lead to heart attacks. One of the most common types of heart disease.

lower respiratory infection Infections in the lungs, including pneumonia and acute bronchitis.

mode of transmission How a disease moves from one person to another or from an infected source to a person.

noncommunicable disease A disease that is not contagious (e.g., cardiovascular disease, cancer, diabetes).

pandemic An epidemic of an infectious disease that spreads through a large region or multiple continents.

public service announcement (PSA)

A brief, persuasive message in the form of a video, radio announcement, or print material that is intended to raise the public awareness about an issue or to change attitudes or beliefs.

respiratory disease A disease of the lungs or airways.




Bibliography: Types of Disease and Injury





Online “Bacterial and Viral Infections.” WebMD, http://www.webmd.com/a-to-z-guides/bacterial-and-viral-infections (accessed April 8, 2015).

“Bolivia’s Successful Rotavirus Vaccine Initiative.” GAVI Alliance, http://www.gavialliance.org/library/news/roi/2010/bolivia-s-successful-rotavirus-vaccine-initiative/ (accessed April 8, 2015).

“Causes of Death in 2008.” WHO Global Health Observatory, http://www.who.int/gho/mortality_burden_disease/causes_death_2008/en/index.html (accessed April 8, 2015).

“Deaths from NCDs.” WHO Global Health Observatory, http://www.who.int/gho/ncd/mortality_morbidity/ncd_total_text/en/index.html (accessed April 8, 2015).

“Fact File: 10 Facts about Tuberculosis.” WHO, http://www.who.int/features/factfiles/tb_facts/en/index4.html (accessed April 8, 2015).

“Fact File: 10 Facts on Violence Prevention.” WHO, http://www.who.int/features/factfiles/violence/violence_facts/enc/index.html (accessed April 8, 2015).

“Fact Sheet 94: Malaria.” WHO, http://www.who.int/mediacentre/factsheets/fs094/en/index.html (accessed April 8, 2015).

“Fact Sheet 104: Tuberculosis.” WHO, http://www.who.int/mediacentre/factsheets/fs104/en/index.html (accessed April 8, 2015).

“Fact Sheet 107: Cholera.” WHO, http://www.who.int/mediacentre/factsheets/fs107/en/index.html (accessed April 8, 2015).

“Fact Sheet 211: Influenza (Seasonal).” WHO, http://www.who.int/mediacentre/factsheets/fs211/en/index.html (accessed April 8, 2015).

“Fact Sheet 297: Cancer.” WHO, http://www.who.int/mediacentre/factsheets/fs297/en/ (accessed April 8, 2015).

“Fact Sheet 307: Asthma.” WHO, http://www.who.int/mediacentre/factsheets/fs307/en/index.html (accessed April 8, 2015).

“Fact Sheet 310: The Top 10 Causes of Death.” WHO, http://www.who.int/mediacentre/factsheets/fs310/en/index2.html (accessed April 8, 2015).



“Fact Sheet 312: Diabetes.” WHO, http://www.who.int/mediacentre/factsheets/fs312/en/index.html (accessed April 8, 2015).

“Fact Sheet 315: Chronic Obstructive Pulmonary Disease (COPD).” WHO, http://www.who.int/mediacentre/factsheets/fs315/en/index.html (accessed April 8, 2015).

“Fact Sheet 317: Cardiovascular Diseases (CVDs).” WHO, http://www.who.int/mediacentre/factsheets/fs317/en/index.html (accessed April 8, 2015).

“Fact Sheet 330: Diarrhoeal Disease.” WHO, http://www.who.int/mediacentre/factsheets/fs330/en/index.html (accessed April 8, 2015).

Fact Sheet: Noncommunicable Diseases.” WHO, http://www.who.int/mediacentre/factsheets/fs355/en/ (accessed April 8, 2015).

“Fact Sheet 360: HIV/AIDS.” WHO, http://www.who.int/mediacentre/factsheets/fs360/en/ (accessed April 8, 2015).

“Fun with Fomites,” Microbe World, http://www.microbeworld.org/microbeworld-experiments/fun-with-fomites (accessed April 8, 2015).

“Global Status Report on Noncommunicable Disease 2010.” WHO, http://www.who.int/nmh/publications/ncd_report2010/en/ (accessed April 8, 2015).

“HIV/AIDS.” WHO, July 2015, http://www.who.int/features/qa/71/en/index.html (accessed April 8, 2015).

“Injuries.” WHO, http://www.who.int/topics/injuries/about/en/index.html (accessed April 8, 2015).

“Injuries and Violence: The Facts.” WHO, 2010, http://whqlibdoc.who.int/publications/2010/9789241599375_eng.pdf (accessed April 8, 2015).

“Injury Prevention and Control: Division of Violence Prevention,” CDC, http://www.cdc.gov/violenceprevention/acestudy/findings.html (accessed April 8, 2015).

“The Lost Boys of the Sudan.” UNICEF, The State of the World’s Children 1996: panel 3. http://www.unicef.org/sowc96/closboys.htm (accessed April 8, 2015).

“Malaria: Insecticide-Treated Bed Nets.” CDC Global Health, Division of Parasitic Diseases and Malaria, http://www.cdc.gov/malaria/malaria_worldwide/reduction/itn.html (accessed April 8, 2015).

“Non-communicable Disease.” Wikipedia, http://en.wikipedia.org/wiki/Non-communicable_disease (accessed April 8, 2015).

“Policy Impact: Seat Belts.” CDC, January 2011, http://www.cdc.gov/motorvehiclesafety/seatbeltbrief/ (accessed April 8, 2015).

“Q&As: Injuries.” WHO, http://www.who.int/topics/injuries/qa/en/index.html (accessed April 8, 2015).

“Q&A: Sudan’s Darfur Conflict.” BBC News, February 23, 2010, http://news.bbc.co.uk/2/hi/africa/3496731.stm (accessed April 8, 2015).

“Sudan.” New York Times, http://topics.nytimes.com/top/news/international/countriesandterritories/sudan/index.html (accessed April 8, 2015).

“Suicide: Facts at a Glance.” CDC, 2015, http://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.PDF (accessed April 8, 2015).

Taubenberger, Jeffery, and David Morens. “1918 Influenza: The Mother of All Pandemics.” Emerging Infectious Diseases, January 2006, CDC, http://wwwnc.cdc.gov/eid/article/12/1/05-0979_article.htm (accessed April 8, 2015).

“Transmission of Influenza Virus via Aerosols and Fomites in the Guinea Pig Model, The Journal of Infectious Diseases, http://jid.oxfordjournals.org/content/199/6/858.full (accessed April 8, 2015).


AOHS Global Health


Student Resources


Student Resource 3.1 Investigation: The Chain of Infection

Student Resource 3.2 Note Taking: Communicable Disease

Student Resource 3.3 Reading: Communicable Disease

Student Resource 3.4 Stations: Noncommunicable Disease

Student Resource 3.5 Venn Diagram: Communicable and Noncommunicable Disease

Student Resource 3.6 Reading: Injuries

Student Resource 3.7 Note Taking: Injuries

Student Resource 3.8 Assignment: Demographic Exploration Maps




Investigation: The Chain of Infection

Directions: Read the story below and think about how infection can be passed along a chain, from one person or object to another. Then study the chart on the next page of this resource that describes the chain of infection, and match up elements from the story with links in the chain of infection. Throughout the course, refer to this resource when you need information about the chain of infection.

The Chain of Infection in Everyday Life On Saturday Angela woke up with a cold, but she still decided to go to her weekend job at a popular lunch restaurant.

Angela kept tissues in her back pocket and blew her nose as she worked. When she ran out of tissues, she just wiped her nose on the back of her sleeve. Throughout the busy lunch hour, Angela refilled ingredients in the salad bar, like shredded carrots and sliced tomatoes. She didn’t wear gloves, and she didn’t wash her hands until the end of her shift.

Tony came into the restaurant. Angela knew him from school. She waved at him before going into the kitchen to get some more spinach.

Tony was really hungry, so he grabbed an empty plate and piled up lettuce, carrots, beans, and avocado from the salad bar. His salad was delicious.

Two days later, Tony woke up with a sore throat and a stuffy nose. He couldn’t figure out how he got sick.

The Chain of Infection

The chain of infection has six links, as shown in this illustration. If the chain is broken at any point, infection will not occur. The table below tells about each link in the chain. Read the description of each link, and then fill in the third column with an example of the link from the story you read. The first one has been completed for you.



Link in the Chain of Infection

What It Is/What It Does Example from the Story

Infectious agent Any microorganism capable of producing an infection (bacteria, virus, fungus, etc.).

Angela’s cold germs

Reservoir Where the microorganism lives—it could be within the human body, in food or water, or in waste products like feces.

Portal of exit How the microorganism leaves the reservoir. In the human body, portals of exit include the mouth, nose, genitals, or open wounds.

Mode of transmission

How the microorganism gets from one place to another. This can include direct contact between people, airborne transmission (through sneezing or coughing), or transmission by an inanimate object (for example, a medical instrument that is not sterilized). A fomite is anything nonorganic that can transmit disease, such as a nonsterile medical instrument.

Portal of entry How the microorganism enters a new body—for example, through an open wound or the mucous membranes.

Susceptible host Person who carries an infection. This person may or may not show signs of illness.




Note Taking: Communicable Disease

Student Name: Date:

Directions: As you view the presentation Communicable Disease, answer the questions and fill out the chart below. In the next class period, you will use the information you learned to form a definition of the term communicable disease.

1. What causes communicable diseases?

2. What are the six “modes of transmission” for communicable diseases?

Disease Facts about the Disease

Influenza Bacteria, virus, or parasite?

Mode of transmission:

Difference between seasonal flu and unique strains like H1N1:

Prevention and treatment:

Diarrhoeal disease Bacteria, virus, or parasite?





Disease Facts about the Disease

Cholera Bacteria, virus, or parasite?


Typical symptoms:

Places in the world that are mostly affected:

HIV/AIDS Bacteria, virus, or parasite?



Tuberculosis Bacteria, virus, or parasite?


Why it is difficult to control the spread:

Progress being made to stop TB:

Malaria Bacteria, virus, or parasite?






Reading: Communicable Disease

Today, you are going to learn about what a communicable disease is, how communicable diseases travel from person to person, and which diseases pose the most significant threats to global health today.



Communicable diseases, which are also called contagious or infectious diseases, can be passed from one person to another or from an infected source to a person.



An infection can come from different sources, which include bacteria, viruses, fungi, and parasites. We’re going to focus on bacteria and viruses.

Bacteria are single-celled creatures that have lived on earth for millions of years. Most bacteria are harmless: fewer than 1% of bacteria cause us to get sick. We have bacteria inside us, living in our intestines and helping us digest our food. Bacteria can do things like fight cancer cells and destroy microbes that cause disease. However, some bacteria can cause infections and make us ill. Strep throat is caused by bacteria, as is tuberculosis.

Viruses usually do make us sick. Viruses cannot survive without a host, unlike bacteria, and a virus is very small. The largest virus is smaller than the smallest bacteria.

Why does this matter? Well, how we treat a disease varies depending on whether it is a bacterial infection or a viral infection. For example, a bacterial infection can be treated with antibiotics, but antibiotics do not help with viral infections. The common cold is a viral infection, which is why you can’t take antibiotics to get over your cold. Viral infections can be prevented, in some cases by vaccines, or treated with antiviral medications.

The way a disease travels from one place to another is called its mode of transmission.



Knowing how a disease travels means that you can take the proper precautions to slow down or stop an outbreak.

Direct contact means that to get infected you must have direct contact with an infected person or his or her blood or body fluids. Sexually transmitted diseases are passed through direct contact.

Airborne diseases are passed through the air. Many types of influenza are transmitted through the air.

Vectorborne diseases are spread through animals and insects like mosquitoes. Malaria, which is spread by mosquitos, is one of the most common vectorborne diseases in the world. In the United States, West Nile Virus is an example of a vectorborne disease that has become more common recently.

Food-borne and waterborne illnesses come from eating contaminated food or drinking contaminated water. Salmonella and E. coli are food-borne illnesses.

During pregnancy and delivery, a baby is exposed to everything in the mother’s body—including disease. After birth, the baby can get some diseases through drinking the mother’s breast milk. Mother-to-child transmission of HIV is considered a major health problem, particularly in developing countries.

Fomites are objects or substances that transmit disease, especially viruses. Examples include door knobs, toys, the change in your pocket, and unsterile medical equipment.



Communicable diseases are not usually a major cause of death in developed countries. Better access to health care, safer food supplies, and better sanitation all reduce the risk of dying from an infectious disease in regions like North America and Europe.

However, that doesn’t mean that we shouldn’t be concerned about the spread of communicable disease. People in some regions of the world are dying from preventable causes. Also, in today’s world, where people can hop on a plane and be on the other side of the planet 24 hours later, a communicable disease from Asia or Africa could spread throughout the world very quickly. So it’s important to understand how communicable diseases work.

Data from the WHO Global Health Observatory, http://apps.who.int/gho/data/view.main.CODREG6AMRV?lang=en.



The WHO tracks influenza because it is such a common, easily spread disease that has the potential to cause harm. Whereas influenza is not usually life threatening, the other diseases listed on this slide are responsible for most of the world’s deaths from communicable disease.

In the slides that follow, we will look at each of these diseases in more detail.



Did you know that one of the worst pandemics in human history was an outbreak of the flu? In 1918, an outbreak of the Spanish flu killed between 50 and 100 million people. The Spanish flu is not the same kind of flu that you’ve probably had. There are specific strains of influenza that are more dangerous. The Spanish flu was one of those strains.

The best way to control the spread of influenza is through vaccination. Every year a new flu vaccine is released. It is designed specifically for the strains of flu that doctors expect will be most common during the upcoming year. By getting vaccinated, you reduce your own risk of getting the flu as well as your likelihood of spreading it to other people.



In 2009, the world faced another unique strain of the flu: H1N1. The WHO tracked the spread of H1NI to try to stop it from spreading. As you can see in this map, H1N1 was first discovered in North America in April 2009.




This map shows why it is important for countries to work together on global health issues. A disease that started out just in a few countries spread—and killed people—all over the world. This is because we live in such a globalized and highly mobile world where people travel back and forth rapidly. The WHO and the governments of dozens of countries needed to work together to track how the disease was spreading and share information about how it could be contained and cured.

An unusual strain of the flu can do serious damage. The Centers for Disease Control and Prevention (CDC) estimates that if an influenza strain similar to the Spanish flu started spreading today, it could kill more than 100 million people.

H1N1 didn’t kill nearly that many people, but it was still a serious pandemic.




Diarrhoea is defined as the passage of three or more loose or liquid stools per day. It is usually a sign of intestinal illness. Although it is both preventable and treatable, diarrhoeal disease kills 760,000 children every year.

Data from WHO, “Fact Sheet 330: Diarrhoeal Disease,” http://www.who.int/mediacentre/factsheets/fs330/en/index.html.



Death from diarrhoeal disease is easily preventable. Many people in the United States will get some type of diarrhoeal disease this year. Most cases can be treated at home by hydrating with water or electrolyte replacements like Pedialyte. For more severe cases, a trip to the emergency room and treatment with intravenous (IV) fluids will fix the problem.

In developing countries, particularly in Africa and South-East Asia, many people don’t have clean water at home, the money to buy replacement drinks, or access to medical care with IV therapy. That is why deaths from diarrhoeal disease are so much more common in those regions.

Data from WHO, http://apps.who.int/gho/data/view.main.CODREG6AFRV?lang=en.



Rotavirus is a diarrhoeal disease. From 2006 to 2008, it was responsible for almost half of all hospitalizations for diarrhoea in Bolivia. Then the country began immunizing children free of charge at health centers across Bolivia. A study done between 2010 and 2011 showed that the vaccine was 70%–76% effective in preventing the disease in Bolivian children. Experts expect to see fewer cases in the future, as the country continues to immunize against this preventable condition.

Data from GAVI Alliance, “Bolivia’s Successful Rotavirus Vaccine Initiative,” http://www.gavialliance.org/library/news/roi/2010/bolivia-s-successful-rotavirus-vaccine-initiative/.

Image retrieved from http://commons.wikimedia.org/wiki/File:Mother_and_child_in_Bolivia.jpg on August 18, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Image courtesy of Peter van der Sluijs.



There are cases of cholera in countries all over the world. The majority of cases, and the highest death rates from cholera, are in parts of Africa and South-East Asia.

The WHO has a special task force on cholera. It focuses on distributing oral vaccines to at-risk populations as well as on longer term efforts to improve sanitation and drinking water.

Data from: http://www.who.int/gho/epidemic_diseases/cholera/cases_text/en/



One of the most recent cholera outbreaks occurred in Haiti. Haiti suffered a major earthquake in January 2010. Water and sewage systems were severely damaged and/or destroyed, and many people continue to live in refugee camps. In late October 2010, an outbreak of cholera began that continued throughout 2011. Some reports suggest that over 6,000 people died from the outbreak. The exact source of the cholera was undetermined, but the poor quality of sanitation and lack of clean drinking water were cited as probable reasons for its spread.

Data from WHO, “Fact Sheet 107: Cholera,” http://www.who.int/mediacentre/factsheets/fs107/en/index.html.

Image retrieved from http://commons.wikimedia.org/wiki/File:Haiti_Earthquake_building_damage.jpg on August 29, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Image courtesy of Marco Dormino/The United Nations.



Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is transmitted through direct contact. This could include unprotected sexual intercourse or oral sex, contact with contaminated blood through the sharing of needles, or a transfusion with contaminated blood. HIV/AIDS can also be transmitted from mother to child during pregnancy, childbirth, and breast-feeding.

AIDS is the syndrome HIV causes, which is marked by a severely weakened immune system and/or HIV-related condition. HIV develops into AIDS over time, although that progress can be slowed by the use of specific antiretroviral drugs. There is no cure at this time. Because HIV attacks the immune system, people with the disease also frequently develop other infections, such as tuberculosis (TB). The combination of TB and HIV is particularly dangerous and difficult to treat, and many HIV/AIDS patients die from this combination.

According to estimates by the WHO and UNAIDS, 37 million people were living with HIV at the end of 2014. That same year, some 2 million people became newly infected, and 1.2 million died of AIDS-related causes, including 150,000 children. More than two-thirds of new HIV infections are in sub-Saharan Africa.

Data from WHO, http://www.who.int/hiv/data/epi_core_july2015.png?ua=1.



As you can see, HIV infections are common across the globe. This map shows the prevalence of the disease among people ages 15–49 in 2011.

Even in developed countries, HIV is an incurable disease. However, people in developed countries have better access to medication that can help slow the progress of the disease, so their quality of life is better.

The WHO and the United Nations AIDS programs work together to increase community awareness about HIV prevention measures and oversee the distribution of drugs to infected populations, particularly in developing or impoverished regions.

This map is included under fair-use guidelines of Title 17, US Code. Copyright © World Health Organization. Map available online at http://www.who.int/gho/hiv/hiv_013.jpg?ua=1.



A person infected with TB doesn’t always show symptoms. Sometimes people can carry the disease without getting sick from it, which is part of what makes it so difficult to control the spread of TB.

Tuberculosis is treated with antibiotics. Patients must take several different drugs every day for many months to kill all of the bacteria. The WHO puts a lot of effort into ensuring that patients follow through with their treatment.

There are strains of TB that are drug resistant—in other words, the strain no longer responds to a drug that used to treat or cure the disease. Drug-resistant strains of TB make treatment and cure even more difficult.

Data from WHO, “Fact Sheet 104: Tuberculosis,” http://www.who.int/tb/publications/factsheet_global.pdf?ua=1.



The symptoms of malaria may start out mild and grow more severe. In some cases, people can have malarial relapses weeks or months after the first time they were sick. Travelers from malaria-free areas can get infected easily, which means cases sometimes show up in countries that do not ordinarily have a malaria problem.

Malaria is considered a vectorborne illness because it is spread through the bite of mosquitos infected with the parasite.

Due to improved treatment, worldwide mortality rates have fallen by 47% since 2000 (54% in the WHO African region and 58% among African children).

Data from WHO, “Fact Sheet 94: Malaria,” http://www.who.int/mediacentre/factsheets/fs094/en/.



This map shows the WHO’s assessment of which countries had the greatest risk of malaria transmission in 2013.

This map is included under fair-use guidelines of Title 17, US Code. Copyright © World Health Organization. Map available online at http://www.who.int/gho/malaria/malaria_003.jpg?ua=1.



The WHO has focused much of its malaria work on prevention. The two key preventive measures are the spraying of insecticides and the distribution of insecticide-treated mosquito nets. People who sleep under these nets at night have a much lower risk of contracting malaria. There is an antimalarial medication that is effective as a preventive measure, but it is not always available to those who need it.

Image retrieved from http://commons.wikimedia.org/wiki/File:Malaria_prevention-Insecticide_treated_bed_net-PMI.jpg on August 30, 2013. From President’s Malaria Initiative (PMI).

Data from CDC, “Insecticide-Treated Bed Nets,” http://www.cdc.gov/malaria/malaria_worldwide/reduction/itn.html.



Communicable diseases continue to take the lives of people around the world. But progress is being made. For example, the number of people falling ill and dying from TB and malaria is on the decline. Experts expect those trends to continue.

Data from WHO, “HIV/AIDS” (http://www.who.int/mediacentre/factsheets/fs360/en/); WHO, “Fact Sheet 94: “Malaria” (http://www.who.int/mediacentre/factsheets/fs094/en/); and WHO, “Fact File: 10 Facts about Tuberculosis” (http://www.who.int/features/factfiles/tb_facts/en/index4.html).




Stations: Noncommunicable Disease


Directions: As you visit each station, answer the questions on this resource.

Station 1: What Are Noncommunicable Diseases (NCDs)?

1. Using the information at this station, complete the Defining Format chart for the term noncommunicable disease. You may want to add information you learn at other stations to the Characteristics column.

Term Category Characteristics

A noncommunicable disease is… a_________________________ that

1.

2.

3.

2. Below are some examples of noncommunicable diseases. Using the list of causes at Station 1, fill in the Possible Causes column for any diseases that you know about. Some NCDs have more than one possible cause, and for some, the cause is not known. You can share information with classmates at your station.

NCD Possible Causes

Heart disease

Stroke

Cancer

Asthma

Chronic kidney disease

Osteoporosis



NCD Possible Causes

Alzheimer’s disease

Epilepsy

Diabetes

Cataracts

Blindness

Multiple sclerosis

Cerebral palsy

Station 2: Noncommunicable Diseases Affect Global Health

1. Based on the graph, what is the only WHO region where there are more deaths due to communicable diseases than noncommunicable diseases?

2. What are some reasons the percentage of deaths due to NCDs worldwide is going up?

3. Look at the picture of the shantytown in South Africa. Based on what you read, why do you think people in this type of setting might be likely to die from NCDs?



Station 3: The Four Deadliest Noncommunicable Diseases In the chart below, write three key points you learn about each of the four deadliest noncommunicable diseases.

Cardiovascular Disease

Respiratory Disease

Cancer

Diabetes, Type 1

Diabetes, Type 2



Station 4: Living with Noncommunicable Disease In what ways do you think your experience would be different from Noemia’s if you had skin cancer? What things would be the same for you and Noemia?

Station 5: Preventing and Treating Noncommunicable Diseases

1. What do you think is the most promising way to reduce the number of deaths from NCDs?

2. If you were a global health professional working in the field of NCD prevention and treatment, what kind of program would you like to be involved in?




Venn Diagram: Communicable and Noncommunicable Disease

Student Names:_______________________________________________________ Date:___________

Directions: Use this diagram to compare communicable and noncommunicable disease.

Communicable Disease

Noncommunicable Disease

Similaritie




Reading: Injuries

Communicable and noncommunicable diseases are responsible for most of the mortality and morbidity in the world today. However, global health professionals must also address injuries, which account for 10% of global mortality as of 2010. That means that more than 5.8 million people a year die due to injuries. Injuries can be unintentional (accidental) or intentional (done on purpose). Let’s take a closer look at these categories.

Unintentional Injuries (Accidents) Abidemi is a six-month-old baby girl who lives with her family in Nigeria. Her family lives in a hut and cooks over an open fire. One night as her mother prepared dinner, the wind blew a spark from the fire onto the wall of the hut and set it ablaze. Abidemi was sleeping inside. Her mother went into the burning hut to bring her out, but Abidemi suffered serious burns on her legs.

This was an accident—nobody tried to burn Abidemi on purpose. Unintentional injuries such as this are a major public health issue, especially in low- and middle-income countries. Over 90% of deaths that result from injuries occur in low- and middle-income countries like Nigeria. This may be because people in such countries live in less safe environments. It may also be because people with less money have less access to quality medical care and preventive services. Less developed countries also don’t have the same safety precautions as more developed countries. Abidemi was of course not wearing flame-retardant pajamas. Her house had no smoke detector or sprinklers, and the walls easily caught fire. Even in high-income countries, poor people are disproportionately affected by injuries because they don’t have all the resources that wealthier people have to protect themselves. Sometimes they lack the education they need to be able to read labels or make informed choices.

In low- and middle-income countries, it is also more difficult for people to get their injuries treated. Take Abidemi as an example. Her family is poor. They live in a hut, far from a city, and they cook over an open fire. When she got burned, her mother had to walk several miles to get her to a doctor. Her mother got her to the doctor as soon as she could, but it was too late. Abidemi’s legs would be scarred for the rest of

Injuries

Unintentional

Traffic accidents

Household accidents

(burns, poisonings,

falls)

Drowning

Intentional

Self‐inflictedInterpersonal

violenceCollective violence



her life, and the doctors weren’t even sure if she would be able to walk normally. If Abidemi’s family were wealthier, they probably wouldn’t have been cooking over an open flame, and they might have lived closer to medical care. Although Nigeria is a middle-income country, its health care system still has a long way to go. If a baby in the United States suffered similar burns, her chances of walking would be much greater. She probably would be able to get enough medical treatment to reduce the amount of scarring.

Burns aren’t the only kind of accident that is a health concern. One of the most common accidental causes of death is traffic accidents. They may result from drunk or drugged driving, the use of cell phones while driving, poorly maintained roads, or lack of safety procedures that we take for granted in the United States. For example, many countries do not require seat belts or child safety seats in cars, and those countries typically have higher fatality rates because of car accidents.

Drowning, poisoning, and falls are also important types of unintentional injury. If you study these types of injury, you will learn that much can be done to prevent them.

Intentional Injuries (Violence) Intentional injuries usually result from some form of violence. They can be divided into three categories: self-inflicted (when people hurt themselves), interpersonal (when people hurt other people), and collective (when a war or other large-scale conflict occurs). Countries with greater economic inequality tend to have higher rates of death by violence. Violence of all types is responsible for the deaths of approximately 4,000 people every day (source: WHO, “10 Facts on Violence Prevention”).

Although burns are usually accidental, people have been known to set themselves on fire as a form of protest. In that case, the injury is the same as for an accident, but it would be intentional rather than unintentional. It would be a self-inflicted injury. Suicide is another type of self-inflicted injury.

Suicide is among the top 20 leading causes of death worldwide. The risk factors that predispose a person to suicide exist in almost every population. The risk factors include mental illness, alcohol or substance abuse, physical illness, and social isolation. In many countries, measures such as treating mental illness are put in place to reduce the number of suicides. In the United States, suicide is one of the top five causes of death for people between the ages of 15 and 24 (source: CDC, “Suicide: Facts at a Glance,” 2012). The highest risk is for teenagers struggling with illness, isolation, or abuse. [If you are experiencing these struggles and need to talk to someone, you should reach out to a parent, a teacher, a social worker, or the national Suicide Prevention Hotline (1-800-273-TALK).]

Interpersonal violence occurs when one person or a small group of people hurts another. Homicide, or killing another person, is the ultimate form of interpersonal violence. Worldwide, 90% of deaths due to violence occur in low- or middle-income countries (source: WHO, “10 Facts on Violence Prevention”). In the United States, the majority of homicides occur in low- or middle-income neighborhoods. According to the CDC, the main reason for homicide is personal conflict.

Interpersonal violence frequently involves abusive situations: a husband who beats his wife, a parent who beats her child, or a caregiver who does not give an elderly person needed care and food. Women are at particularly high risk in societies where gender inequality exists. They are also more at risk wherever intimate-partner violence is not adequately penalized.

Adverse childhood experiences (ACE) include child abuse, neglect, and exposure to trauma. ACE is highly correlated with a wide range of health and social problems upon reaching adulthood. For example, people who report even one ACE are more likely to abuse alcohol or drugs, start smoking, develop depression, and have more unplanned pregnancies.

Countries with greater economic inequality tend to have higher rates of death by violence. People who are struggling to find enough money to feed themselves and their families may be more prone to depression or anger, which can lead to self-inflicted and interpersonal violence. Because of lack of education and less access to medical care, people may not get the support and treatment they need, and therefore resort to violence.



Collective Violence (War) War is also a global health problem. In the United States, we often experience war as something far away that we see on television. But in many parts of the world, war is a part of daily life. For example, the people of Sudan have been experiencing war on and off since the middle of the 20th century!

In the 2000s, Darfur, a region of Sudan, experienced particularly heavy fighting and genocide. Genocide means the deliberate killing of a large group of people, usually because they belong to a specific ethnic or religious group. The genocide in Darfur caused more than 2.7 million people to leave their homes.

In war, people are killed, injured, or raped. Wars frequently create a refugee crisis as people are forced to leave their homes to escape the fighting. These refugees may move into other countries; many people left Sudan for neighboring Chad. Wherever they settle, refugees often end up in camps. Refugee camps frequently don’t have good sanitation or enough food, water, and medical supplies. This situation can lead to an increase in communicable diseases like cholera.

Another side effect of war is an increased number of orphans: children left behind when their parents are killed by war. The Lost Boys of the Sudan are an estimated 20,000 children who were orphaned as a result of the conflict. Many of these boys died as they tried to make their way to refugee camps in other countries—a journey of 6 to 10 weeks on foot.

Injury and Violence Prevention Car crashes take the lives of tens of thousands of people and injure millions each year in the United States. But it could be much worse. More than half of the people killed in car crashes were not using a seat belt at the time of the crash. Studies show that wearing a seat belt is the most effective way to prevent death and serious injury in a crash. (Data source: CDC, “Policy Impact: Seat Belts,” January 2011.) For that reason, most states have laws requiring drivers and passengers to wear seat belts. These laws have been effective. Seat belt use increased from 11% in 1981 to 85% in 2013, saving hundreds of thousands of lives.

Injuries are among the leading causes of death for people between the ages of 5 and 44, so finding ways to reduce injuries and violence—like seat belt use—is an important global health initiative. The WHO supports many different injury- and violence-prevention efforts. Some of its key programs focus on the following:

Reducing traffic accidents by the following means:

o Support laws against drunk driving.

o Encourage use of seat belts.

o Encourage use of helmets.

Reducing home accidents, such as falls, poisonings, and drowning by the following means:

o Educate the public about ways to reduce these risks, such as installing hand rails for staircases.

o Promote childproofing measures, such as child-resistant containers for medicine or childproof fencing for pools.

Reducing suicides, child abuse, and partner abuse by the following means:

o Promote school programs about mental health, depression, and abuse.

o Train parents about child development and appropriate forms of discipline.

o Provide low-cost counseling services.

o Conduct home visits of at-risk children.




Note Taking: Injuries

Student Name: Date:

Directions: As you read Student Resource 3.6, answer the questions below.

1. How many people die of injuries each year worldwide?

2. Name two reasons why poor people are disproportionately affected by injuries.

3. What is one of the most common accidental causes of death?

4. What are the three categories of intentional injury?

5. How many people die every day as a result of intentional injury or violence?

6. What does genocide mean?

7. Is suicide a serious problem among the teen population in the United States?

8. Besides the people killed during the fighting, describe two other health impacts of war.

9. Name two things the WHO supports to reduce unintentional injuries.

10. Name two things the WHO does to reduce violence and intentional injuries.




Assignment: Demographic Exploration Maps

Student Names: Date:

Directions: In this assignment, you will create a poster. It will show simple outline maps of two countries with different per capita incomes. You will choose one disease or injury statistic to compare for these countries and show the difference on your maps, along with a brief written summary.

Step 1: Conduct Your Research

Go to the WHO site for data and statistics: http://www.who.int/gho/en/. Click the “Country statistics” link in the left-hand column titled Global Health Observatory. This brings you to the names of countries in the world. Start researching which countries you want to focus on, and which statistic, from here. The WHO also publishes worldwide maps showing the incidence or prevalence of certain diseases; you can refer to these when creating your comparison of two specific countries. Use the chart below to keep track of your findings and to make your choices about which two countries and statistics you want to focus on.

Country Per Capita Income; Other Relevant Statistics (optional)

Disease or Injury Statistic We Might Illustrate on Our Maps



Now write down the decisions you’ve made with your partner here:

The two countries we will compare are:

The statistic we will illustrate is:

Step 2: Make Your Outline Maps

If you search for outline maps of countries, websites will come up with free maps that you can legally use to make your own maps from. The URL for About.com Geography is: http://geography.about.com/library/blank/blxindex.htm. This site has blank outline maps of countries that work well for this assignment.

Step 3: Decide How to Illustrate Your Statistic

How will you illustrate your statistic on your maps? There are many options. Look at the different kinds of maps on the WHO site. There are two examples of illustrating statistics on maps in Student Resource 3.3, Reading: Communicable Disease, as well as in other readings you have completed in this course.

You also need to include a legend that explains how to interpret the information in your map. For example, if you are using different colors, what do the colors mean? Look at the maps in your readings for ways to create a legend that is simple and easy to understand.

Step 4: Write Your Summary

Your summary can be brief, but it needs to add to the reader’s understanding of what your maps are illustrating. For example, you should note the difference in economic status between the two countries; where they are located on a worldwide map in comparison to each other; and whether you saw any trends regarding your disease or injury during your research. If the incidence or prevalence has changed over the past few years, you can note that in your summary.


The two countries’ maps are labeled and clearly drawn.

The method of demonstrating the statistic about a disease or injury on the maps is clear and easy to understand.

The legend is thoughtfully rendered and appropriate for the information included in the maps.

The summary enhances our understanding of the information included in the maps.



AOHS Global Health

Lesson 4 World Populations and Disease

In this lesson, students consider how different populations are affected by disease. They explore both demographic and epidemiological transition theories, and they learn how fertility, mortality, and disease change as a country’s economy improves. Students also learn about vulnerable populations that may be especially likely to suffer from disease and health issues. They finish the lesson by writing a health report on a specific country, evaluating its demographic and epidemiological transition as well as its vulnerable populations.

Advance Preparation

In Class Period 1, you will need access to the video “As Bangladesh’s Population Grows, Slum Dwellers Struggle” at http://video.pbs.org/video/1853981311/.

In Class Periods 5 and 6 students will need computers with Internet access and word processing software, with one student per computer.


Lesson Framework


Compare and contrast the leading causes of death and disability in different regions of the world

Translate data tables and graphs of health status measurements into words, and written data descriptions into charts

Describe the demographic transition as countries develop economically*

Describe the epidemiological transition as countries develop economically*

Characterize the rates of death and disease for vulnerable populations within countries and regions

Display understanding of the personal importance of showing compassion to people facing great socioeconomic and health challenges


AOHS Global Health Lesson 4 World Populations and Disease




Assess the impact of emerging issues on healthcare delivery systems (such as: technology, epidemiology, bioethics, socioeconomics) (National Health Science Standards 2015, Standard 3.13)


Describe the content and diverse uses of health information (Common Career Technical Core 2012, HL-HI 2)

Construct an argument supported by empirical evidence that changes to physical or biological components of an ecosystem affect populations (Next Generation Science Standards 2013, MS-LS2-4, Ecosystems: Interactions, Energy, and Dynamics)

Construct an argument supported by evidence for how increases in human population and per-capita consumption of natural resources impact Earth’s systems (Next Generation Science Standards 2013, MS-ESS3-4, Earth and Human Activity)

Construct an explanation based on evidence for how the availability of natural resources, occurrence of natural hazards, and changes in climate have influenced human activity (Next Generation Science Standards 2013, HS-ESS3-1, Earth and Human Activity)

Assessment


Population health report describing life expectancy, mortality rates, and vulnerable populations for a specific country (Student Resource 4.9)

Assessment Criteria: Population Health Report (Teacher Resource 4.4)

Prerequisites Knowledge of communicable and noncommunicable diseases

Understanding of noncommunicable disease risk factors

Understanding of health measurements such as mortality rate, incidence rate, and prevalence of disease


Teacher Resources Teacher Resource 4.1, Answer Key: World Populations and Disease Anticipation Guide



Teacher Resource 4.2, Presentation 1 and Notes: Demographic Transition (includes separate PowerPoint file)

Teacher Resource 4.3, Presentation 2 and Notes: Vulnerable Populations (includes separate PowerPoint file)

Teacher Resource 4.4, Assessment Criteria: Population Health Report

Teacher Resource 4.5, Prompts: Learning Objective Reflection (separate PowerPoint slide)

Teacher Resource 4.6, Guide: Teaching Reflection

Teacher Resource 4.7, Key Vocabulary: World Populations and Disease

Teacher Resource 4.8, Bibliography: World Populations and Disease

Student Resources Student Resource 4.1, Anticipation Guide: World Populations and Disease

Student Resource 4.2, Graphs: Socioeconomic Development and Causes of Death

Student Resource 4.3, Note Taking: Demographic Transition

Student Resource 4.4, Reading: Demographic Transition

Student Resource 4.5, Reading and Note Taking: Epidemiological Transition

Student Resource 4.6, Note Taking: Vulnerable Populations

Student Resource 4.7, Reading: Vulnerable Populations

Student Resource 4.8, Assignment: Population Health Report

Student Resource 4.9, Guide: Citing Sources

Equipment and Supplies LCD projector and computer for PowerPoint presentations and to show a PowerPoint slide and a

video

Computers with Internet access and word processing software (one for each student)


Lesson Steps

Step Min. Activity

CLASS PERIOD 1



Step Min. Activity

1 10 Anticipation Guide: World Populations and Disease

This activity is designed to get students thinking about how the socioeconomic status of a country impacts the types of disease and injury that are most common, how this impacts fertility and mortality rates, and how demographic transition works.

Refer students to Student Resource 4.1, Anticipation Guide: World Populations and Disease. Instruct students to read each statement and mark whether they agree or disagree with the statement. They should also write a brief explanation in the “My reason” space.

Tell students that they can make good guesses about these statements based on what they have already learned in this course.

After students have read the statements and completed their guesses, explain that they will have opportunities throughout the lesson to find out if their answers are correct and to fill in the “I learned” sections of the guide. Let students know that you will review this anticipation guide at the end of the lesson. To answer any questions that arise, use Teacher Resource 4.1, Answer Key: World Populations and Disease Anticipation Guide.

Point out that many of the statements in their anticipation guide are about how socioeconomic status impacts health. Ask students to explain what they think socioeconomic means, and then explain that socioeconomic status is related to or concerned with the interaction of social and economic factors. Let students know that in the next two activities, they will look more closely at the connection between disease and economic status or development.

2

20 Video and Analysis: Causes of Death and Disease in Low-Income Countries

In this activity, students consider how economic issues in Bangladesh affect causes of death and disease.

Prior to class, prepare to project the video “As Bangladesh’s Population Grows, Slum Dwellers Struggle” at http://video.pbs.org/video/1853981311/.

Refer students to Student Resource 4.2, Graphs: Socioeconomic Development and Causes of Death, and direct their attention to the pie chart. Explain that this chart shows the years of life lost by causes of death in Bangladesh, and point out that Bangladesh has a low-income economy. Then point out the three categories of causes of death on the pie chart: communicable diseases, noncommunicable diseases, and injuries.

Ask students to speculate on what Years of Life Lost means. After taking some suggestions, write the following definition on the board:

Years of Life Lost: a health indicator that equals Life Expectancy minus actual Age of Death for a population. It shows loss from premature mortality.

Then paraphrase the following explanation for your students. Encourage them to ask questions, because this is a fairly abstract concept that is important for students to understand, as it is key to global health:

In developed countries such as the United States, you are considered to have lived a full life if you reach the age of 75. If you live longer than that, it’s a bonus. If you



Step Min. Activity

die before the age of 75, your death is considered premature.

If you look at the whole population of a country, you can see what proportion dies prematurely (before the age of 75), and you can assign a cause for each of these premature deaths. The calculation is weighted, however. The younger people are when they die, the more heavily weighted their deaths are, because they have lost the most years of life prematurely.

If you assign causes of death according to the categories of communicable disease, noncommunicable disease, and injuries, you can see patterns that correspond to how developed a country is. That’s why Years of Life Lost is a useful measurement: the more developed a country is, the smaller the proportion of deaths from communicable disease and injury.

Tell students that an explanation of Years of Life Lost is included in Student Resource 4.2 for their reference.

Point out that the percentages in the pie chart add up to 100%. Each percentage expresses what part of the total premature deaths was due to each cause. Ask a volunteer to say which category accounted for the greatest percentage of death (communicable) and recall examples of communicable diseases (cholera, HIV, tuberculosis).

Next, ask students to volunteer their thoughts on why the death rate for communicable diseases is so high in Bangladesh. Take some answers.

Tell students that they are going to watch a video about a key reason for the high death rate in Bangladesh.

Show the video at http://video.pbs.org/video/1853981311/ using an LCD projector.

After the video, use questions like the following to lead a discussion about the connection between Bangladesh’s low-income economy and its high rate of communicable disease.

What makes the slum dwellers in Dhaka so vulnerable to diahhroeal and other communicable disease?

Do you think the poor people of Dhaka should have to pay for clean water? Why or why not?

If Dhaka’s economy improves, do you think the health status of the population will also improve? Why or why not?

Tell students that they will explore the relationship between causes of death and socioeconomic status more fully in the next activity.

3 20 Analysis: Relationship Between Socioeconomic Development and Causes of Disease and Death

In this activity, students study data to consider how causes of death differ between countries of different socioeconomic status.

To begin, ask a student volunteer to recall and explain in his or her own words what years of life lost measures. Then refer students to the table on the third page of Student Resource 4.2. Give students time to study the table. Then ask volunteers to explain what information is given in the table. Make sure students understand the following



Step Min. Activity

points:

The table gives information about four countries in each of four economic levels.

Cause of death is categorized by communicable disease, noncommunicable disease, and injuries.

The table provides the percentage of years of life lost by cause of death for each country.

Then ask students to study the data and discuss their response to the following question with a partner:

What pattern do you see about the cause of death in low- or lower-middle income countries? How is that different from the cause of death in higher-income countries?

Ask pairs to share their ideas with the class. Students should be able to recognize that higher-income countries have a greater proportion of deaths from noncommunicable disease.

Then write the following question on the board, and instruct students to write down their thoughts in their notebook:

Why do you think there is a higher percentage of deaths from noncommunicable disease in developed countries?

Let them know that in the next class period, they will learn more about what happens to a country’s overall health as income increases, and they will have the opportunity to reevaluate their ideas.

To conclude the activity, allow students to revisit their anticipation guide (Student Resource 4.1) and make note of anything they have learned. Also instruct students to add information about at least three countries to the regional reference maps at the beginning of their notebook.

CLASS PERIOD 2

4

35 Presentation: Demographic Transition

This activity gives students a more in-depth understanding of how a country’s health problems change as the country’s economy changes, and it introduces them to the concept of the population pyramid. It also develops students’ listening and note-taking skills.

To prepare, make notes to guide class discussion using Teacher Resource 4.2, Presentation 1 Notes: Demographic Transition. Have Teacher Resource 4.2, Presentation 1: Demographic Transition (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Refer students to Student Resource 4.3, Note Taking: Demographic Transition. Ask them to try to answer the questions on the resource while they view the presentation. Let students know they will have time to finish the questions and review their answers when the presentation is over.

Present the slideshow. Use the notes you prepared previously and the questions on the



Step Min. Activity

slides to encourage class discussion.

This presentation is duplicated as Student Resource 4.4, Reading: Demographic Transition. If an LCD projector is unavailable, students can read the presentation, answer the discussion questions in their notebook, and discuss their answers as a class. This student resource is also useful for review.

After the presentation, review student responses to Student Resource 4.3 as a class. Project the slides again as necessary to help students understand the stages of demographic transition.

5 15 Interpretation: Population Pyramids

Students practice interpreting population pyramids.

Point out the three population pyramids at the end of Student Resource 4.3. Ask students to work with a partner on answering the questions, and then review them as a class. Tell students that the first one is for the United Kingdom in 2011 (a developed country). The second is for Sierra Leone in 2011 (a developing country). The third one is for Greece in 2050, showing a country with a graying population (more old people than young people).

Point out that population pyramids are an effective visual way to present information about the changes in a population over time.

If time allows, have students revisit their anticipation guide (Student Resource 4.1) and make note of anything they have learned.

CLASS PERIOD 3

6 35 Reading: The Epidemiological Transition

In this activity, students learn about epidemiological transition and the shift from an era of out-of-control infectious disease to an era of degenerative, noncommunicable disease.

To begin, write the following stages of epidemiological transition on the board in this order:

Age of Pestilence and Famine

Age of Delayed Degenerative Disease

Age of Obesity Epidemic

Age of Receding Pandemics

Age of Degenerative and Man-Made Diseases

Then explain that these are different stages of health and disease that all countries go through. The United States has gone through all of these stages. Ask students to use what they know to predict the chronological order of these “ages” and write their guess at the order in their notebook. Then have volunteers share their lists and briefly explain why they listed them in the order they did. Students will learn about the correct order in the reading.



Step Min. Activity

Next, refer students to Student Resource 4.5, Reading and Note Taking: Epidemiological Transition. Explain that epidemiological transition, like demographic transition, is a theory that explains how the health of a country changes over time because of industrialization and improvements in health care.

Have students read the instructions on Student Resource 4.5 and answer any questions.

After students complete the reading and note-taking chart, divide them into pairs or small groups and have them compare their charts. Allow a few minutes for students to make changes based on feedback from their peers, and then review the chart with students. Invite students to share one thing they learned, and answer any questions. Make sure students understand how the country’s development leads to each stage, from the early stages of infectious disease to the growth of noncommunicable diseases and the eventual management of some noncommunicable disease risk.

7 15 Review: Applying Epidemiological Phases to Bangladesh

Students practice applying their understanding of epidemiological phases.

Tell students to think back to what they learned about Bangladesh in Class Period 1. Ask them to consider the following question:

Which stage of the epidemiological transition is Bangladesh in? Explain your reasoning.

Invite volunteers to share their thoughts. While it may be difficult for students to say precisely which stage the country is in, students should be able to guess whether the country is in the Age of Pestilence and Famine, the Age of Degenerative Disease, or moving toward the Age of Obesity Epidemic, based on what they know about the country’s mortality rate, top causes of death, and general level of development.

Explain that while epidemiological transition affects the country as a whole, there are certain segments of a country’s population that will always be at greater risk from health problems. These groups are called vulnerable populations, and students will learn more about them in the next class period.

Have students revisit their anticipation guide (Student Resource 4.1) and make note of anything they have learned.

CLASS PERIOD 4

8

30 Presentation: Vulnerable Populations

This activity provides students with a more in-depth understanding of what a vulnerable population is. It also gets them thinking about how important it is to develop global health initiatives that are designed specifically to help vulnerable populations.

To prepare, make notes to guide class discussion using Teacher Resource 4.3, Presentation 2 Notes: Vulnerable Populations. Have Teacher Resource 4.3, Presentation 2: Vulnerable Populations (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.



Step Min. Activity

Tell students to think about what they know about life for women in Afghanistan. Ask them the following questions:

Do you think women in Afghanistan get all the health care services they need? Why or why not?

Call on volunteers to share their thoughts. Students will probably say that women in Afghanistan do not get all the health care services they need, and they may have a variety of explanations. Tell students that women in Afghanistan are a vulnerable population, and that providing health care for vulnerable populations is an important part of global health initiatives. Explain that they will learn more about vulnerable populations during this activity.

Refer students to Student Resource 4.6, Note Taking: Vulnerable Populations. Ask them to use this resource to take notes as they view the presentation.

Present the slideshow. This presentation is also duplicated as Student Resource 4.7, Reading: Vulnerable Populations, to use according to your preferences.

After the presentation, divide the class into pairs or groups of three and have them compare their answers in Student Resource 4.6. Then call on volunteers to share their answers to each question with the whole class, and use this time to correct any misunderstandings.

Point out that many global health initiatives focus on reaching specific vulnerable populations. If we can help a vulnerable population, such as children or poor people, we can increase the overall health of the country and the world. In the United States, professionals sometimes talk about health disparities between different groups of people. A disparity is a very large difference. It’s another way of describing how the health of our vulnerable populations is not as good as populations that are not vulnerable.

If time allows, have students revisit their anticipation guide (Student Resource 4.1) and note anything they have learned. Also instruct students to add at least one country they learned about to the regional reference maps at the beginning of their notebook.

9 20 Defining Format: Demographic Transition, Epidemiological Transition, Vulnerable Populations

In this activity, students solidify their understanding of several complex terms by completing Defining Format charts.

This activity focuses on the following career skill:


The Defining Format exercise provides a way for students to define terms and concepts by using a frame that mimics how a dictionary defines a word. This approach allows students to discuss the terms and concepts and create their own understanding. The students are asked to identify a category for each term and three (or more) characteristics. See The NAF Learning Handbook for more information on this strategy.

If your students are not familiar with Defining Format charts, complete a practice chart on the board using the term cardiovascular disease.




Step Min. Activity

Cardiovascular disease is a noncommunicable disease that

(1) involves the heart or blood vessels

(2) is one of the leading causes of death worldwide

(3) can be prevented (the risk of it can be reduced) by a healthy diet and exercise

Once you are confident that students know how to create a Defining Format chart, divide the class into groups of three and give each group a sheet of chart paper. Ask them to create a Defining Format chart on their chart paper and use it to define each of the following terms:

demographic transition

epidemiological transition

vulnerable populations

Tell students that this activity helps them create detailed and accurate definitions of the terminology that they will need to know before completing their assessment activity for this lesson.

Give students 5–10 minutes to work in their group, and then ask them to post their chart. Start with demographic transition, and ask groups to share their category for that term. As a class, select the best category from those suggested by the groups. Repeat the process with the characteristics for demographic transition. The goal is to create the best possible definition of the term.

Once demographic transition has been defined, repeat the process for the other two terms. Point out that this is an excellent opportunity for students to really make sure they understand what these terms mean before moving on to the next activity, where they will be using these terms and discussing them in great detail. Encourage students to ask questions and clear up any misunderstandings before moving on to the next activity.

CLASS PERIOD 5

10 15 Research Preparation: Health of a Population Report

In this activity, students prepare to conduct an analysis of the health of a country’s population. They research where the country is in terms of demographic and epidemiological transition and identify the country’s vulnerable populations.

This activity focuses on the following college and career skills:


Locating, evaluating, and applying information

Refer students to Student Resource 4.8, Assignment: Population Health Report.



Step Min. Activity

Explain that they are going to research a country in the Americas and write a report about the overall health of the country, using what they’ve learned about health indicators, demographic and epidemiological transition, and vulnerable populations.

Tell students that they are going to begin by doing research, primarily using two sites that they will use frequently for research in the class: The CIA World Factbook site (https://www.cia.gov/library/publications/the-world-factbook/) and the WHO site (www.who .int). If you feel that students would benefit from instruction in navigating the sites, use the LCD projector to visit both sites with students. Search for a particular country on the WHO site, such as Angola, and ask students to identify types of information that they see on the country home page, such as statistics, a map, and a downloadable health profile. Then search for the same country on the CIA World Factbook site and have students do the same exercise. Point out that on the CIA World Factbook, each tab expands to show multiple headings.

Then allow students a few minutes to read the instructions and the assessment criteria on Student Resource 4.8. Explain that in this class period, they will be focusing on the research and that you will talk as a class about writing the report later.

11 10 Research Preparation: How to Cite Sources

Students examine the correct way to cite and format sources that they use as they conduct research.

Refer students to Student Resource 4.9, Guide: Citing Sources. Ask them to read the resource through and answer any questions. As they read, put the following incorrectly cited sources on the board (or choose a couple of your own):

Susan Brownmiller, The Art of Italian Cooking, Brown and Co., 1927.

Accessed June 26, 2014, Women, Infants, and Children, Colorado Dept. of Public Health and Environment, http://www.colorado.gov.

Ask volunteers to come up and correct them. Use this time to make sure students understand proper formatting of sources.

12

25 Research: Health of a Population Report

Students conduct research to prepare for writing their population reports.

Have students choose a country from the list and then begin their research following the instructions in Student Resource 4.8. Circulate as they work, answering questions about their research.

In the final five minutes of the activity, have students work with a partner to compare notes. Ask them to discuss the information they have found and identify any more research that needs to be done. Explain that if they have more research, they should complete it for homework. Tell them to come to the next class period with their research notes complete and prepared to write their report.

CLASS PERIOD 6



Step Min. Activity

13 15 Discussion: Sample Report

In this activity, students review the sample essay in preparation for writing their reports.

Direct students’ attention to the sample report in Student Resource 4.8. Tell students that the report gives an overview of the health status of Rwanda, a country in Africa. Allow students a few minutes to read it independently. Then go through the report one paragraph at a time and ask students to identify the purpose of each paragraph. Make sure that students deduce the following:

The first paragraph introduces the report and gives background information about Rwanda.

The second paragraph gives information about health status indicators.

The third paragraph gives information about the stage of demographic transition for the country.

The fourth paragraph gives information about the stage of epidemiological transition for the country.

The fifth paragraph gives information about vulnerable populations.

The last paragraph concludes the report.

Then ask students to share their ideas about what makes the report a strong source of information about the health status of Rwanda. Ask students to also share their ideas about what might make the report better.

14

35 Writing: Population Report

Students use the example report and the research they have gathered to write population reports.

Give students the rest of this class period to write their reports. Have them review the instructions in Step 3 of Student Resource 4.8, as well as the assessment criteria.

Circulate among the students as they write, answering questions and resolving any difficulties.

Tell students that if they haven’t finished writing drafts of their reports, they need to do so for homework.

CLASS PERIOD 7

15 15 Peer Review and Revision: Health of a Population Report

In this activity, students get peer feedback on their reports before turning them in. This helps them think about the strengths and weaknesses of their writing and research.

Ask students to trade reports with a partner and read each other’s report. Instruct students to keep the assessment criteria handy as they read so that they can consider how well their partner’s work matches up to the assessment criteria.

Instruct students to identify two effective aspects of the report—for example, “I think your analysis of the population pyramid was really clear and easy to understand”—and



Step Min. Activity

two things that could be improved—for example, “I got confused about why you thought the country was at this stage of demographic transition.”

Tell students to return the report to their partner and share their feedback. Tell students to make revisions to their draft for homework, and then ask them to turn in the final draft of their report by the due date you set. Collect and assess the reports using Teacher Resource 4.4, Assessment Criteria: Population Health Report.

Point out that this kind of in-depth analysis of a country is often an important first step that the WHO or other organizations undertake before they send help to a country in need. They need to know what the country’s true needs and problems are in order to send the right kind of aid. Let students know that in the upcoming lesson, they will think more about how an organization determines when and where to send aid.

16 10 Review: Anticipation Guide

In this activity, students return to the anticipation guide they did at the start of this lesson and consider what they have learned.

Ask students to return to Student Resource 4.1, the anticipation guide they have been completing during the lesson. Give students a few minutes to add additional information to the “I learned” section, and then review the guide as a class, using Teacher Resource 4.1, Answer Key: World Populations and Disease Anticipation Guide.

You may want to gauge student understanding by assessing the anticipation guides on a credit/no-credit basis.

Reiterate that countries are always experiencing some degree of demographic and epidemiological transition. One of the challenges of working in the global health field is that new diseases and new health issues are appearing all the time. By using theories and tools like population pyramids to track changes over time, global health professionals can be better prepared to face the challenges of tomorrow.

If time remains, allow students to add information about their country to the regional reference maps at the beginning of their notebook.

17

25 Reflection: Key Learning Objective

Students reflect on whether they met a specific learning objective for this lesson.

Prior to class, prepare to project Teacher Resource 4.5, Prompts: Learning Objective Reflection (separate PowerPoint slide), during this activity.

Note: If your students lack experience with reflecting on their learning or reflecting on whether they met a learning objective for a lesson, refer to Teacher Resource 4.6, Guide: Teaching Reflection. Allocate more time for this reflection activity in order to integrate more direct instruction and practice.

Write the following learning objective on the board:

Characterize the rates of death and disease for vulnerable populations within countries and regions

Project Teacher Resource 4.5, Prompts: Learning Objective Reflection. Tell students to choose one of the prompts and think about it in connection with the learning objective



Step Min. Activity

on the board. They should then write their reflection in their notebook.

Give students a few minutes to write down their thoughts. Ask for a show of hands to see who chose the first prompt. Place these students in pairs or triads to compare their reflections. Do the same for each of the other prompts. Their task is to choose the reflection that is most complete, on topic, and thoughtful.

Ask a member of each group to share the reflection that the group feels best fits these criteria. Generate a brief class discussion to help students develop their metacognitive skills. Complete this activity by reminding students that this type of practice will help them when they have to complete professional self-evaluations in their internships or jobs. If your students are participating in NAFTrack Certification, it also prepares them for the reflection component of the culminating project.

Extensions

Content Enrichment Have students bring closure to the vocabulary taxonomy they started in Lesson 1. Instruct them to

spend five minutes adding any new terms that they have not yet included. Next, have students do a gallery walk to collect more terms from their classmates. Conduct a brief class review and discussion on the additions they made. Conclude by reminding students that they now have a resource for future assignments that will help them to remember and use new terminology.

Instruct students to expand their population health reports into a PowerPoint presentation that includes images of their country as well as highlights of the data they found.

Ask students to choose a country and create a population pyramid for it using the graphing functions of Excel.

Ask students to select a vulnerable population and research its status around the world. In which countries is the population vulnerable? Are there countries in which this population is thriving? Have students report back to the class on what they learned. Use this information to discuss whether there are truly universal vulnerable populations, populations that are in danger throughout the world, or whether the distinction of vulnerability is really tied to the specifics of the society in which the population exists.

Ask students to create an alphabetical taxonomy of terms related to demographic and epidemiological transitions. They can place this taxonomy in their notebook and add to it in future lessons.

STEM Integration Math: Have students use the data on the country they reported on to create several different types

of graphs, such as column graphs showing life expectancy, line graphs showing changes in life expectancy over time, population pyramids, and so forth.

Technology: Instruct students to watch one of the following videos and complete the activity described. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.



o Instruct students to watch this video about population growth: http://www.youtube.com/watch?v=DCPCQrxBUOU&NR=1. Then ask students to choose an aspect of population growth to research and illustrate with a graph.

o Instruct students to watch this video about the graying population in Japan: http://www.youtube.com/watch?v=vBWsLdDlyI4. Have students create cause and effect diagrams that show how an aging society affects the population’s health status and the economy.

o Instruct students to watch this video about India, a country at Stage 2 in the demographic transition: http://www.youtube.com/watch?NR=1&v=NmRcJ18-Etc. Ask students to write a paragraph explaining how migration from rural to urban environments changes the economy and the health status of the population, based on the story told in the video.

o Instruct students to watch the video series Women, War and Peace (http://www.pbs.org/wnet/women-war-and-peace/) and report back to the class on what they learn about women as both a vulnerable population and a population of change-makers. Ask students to point out what elements made them feel compassion for the women they saw, and what elements made them feel proud of the strides women are making.

Math: Use the data available at http://www.census.gov to give students math problems based in the real world. Using the data from 2000 and 2010, students can do math problems to determine the growth rate of the country, the rate of growth or shrinking of specific populations/ethnic groups, the percentage of people in their state who have a certain level of income, and so on.

Additional Cross-Curricular Ideas Social Studies, History, Geography: Have students research the history and geography of the

country they reported on and add an introduction to their report that summarizes what they learned and how they think it may impact the country’s overall health—for example, how geography increases or decreases the risk of specific illnesses or injuries, how the history of the government and/or the existence of civil unrest has affected public health.

History, Geography: Revisit the terms developing country and developed country. Ask students to categorize the countries they are currently studying in history or geography as developing or developed, and give their reasons. Depending on the period of history you are studying, students may need to rethink what constitutes a developed country. Have students create a Venn diagram to compare a developing country and a developed country.


AOHS Global Health


Teacher Resources


Teacher Resource 4.1 Answer Key: World Populations and Disease Anticipation Guide

Teacher Resource 4.2 Presentation 1 and Notes: Demographic Transition (includes separate PowerPoint file)

Teacher Resource 4.3 Presentation 2 and Notes: Vulnerable Populations (includes separate PowerPoint file)

Teacher Resource 4.4 Assessment Criteria: Population Health Report

Teacher Resource 4.5 Prompts: Learning Objective Reflection (separate PowerPoint slide)

Teacher Resource 4.6 Guide: Teaching Reflection

Teacher Resource 4.7 Key Vocabulary: World Populations and Disease

Teacher Resource 4.8 Bibliography: World Populations and Disease




Answer Key: World Populations and Disease Anticipation Guide

People in low-income countries have higher mortality rates than people in high-income countries.


Answer: True. People in low-income countries have higher mortality rates. This is because of poor living conditions, limited access to medical care, and more exposure to dangerous situations (war, refugee camps, etc.).

There are more people living in low- and middle-income countries than in high-income countries.


Answer: True. There are fewer high-income countries in the world, and low- and middle-income countries tend to have higher birth rates, leading to a larger population. Since low- and middle-income countries face different health challenges than high-income countries, it is important to be aware of how much of the world faces those challenges on a daily basis.

Making sure girls get an education improves the health of a country.


Answer: True. Educated women generally have better access to health care. Also, a country that educates its girls is likely to have a better overall record on women’s rights, which probably means less violence against women as well. Educated women are also usually able to provide better care for their children because they typically have more financial stability. They also have a better understanding of how to care for their children; since they have been educated, they will more easily understand concepts like proper hygiene and food safety.

As a country gets richer, its health care improves.


Answer: This is true. As a country gets wealthier, some improvements happen as living conditions improve. In some cases, the industry that leads to wealth in a country also leads to some improvements, such as better roads.



The main causes of death in a low-income country are the same as the main causes of death in a high-income country.


Answer: This is false. Although some of the same diseases, particularly noncommunicable diseases like heart disease and cancer, kill people in every country, in low-income countries far more people die from communicable diseases and violence.

Health problems like heart disease and car accidents have a higher incidence in high-income countries than in low-income countries.


Answer: While many people think this is true, it actually isn’t. Noncommunicable diseases are major killers of people in all countries. Car accidents actually can be a bigger problem in low-income countries, because roads may not be maintained and safety practices like using seat belts may not be as common.

Fertility rates are lower in wealthier countries because it costs more to raise children in those countries.


Answer: Fertility rates are lower in high-income countries because those countries generally have better access to medical care and better educational opportunities for women. Both of these things generally contribute to lower fertility rates.




Presentation 1 Notes: Demographic Transition


Today we are going to learn what demographic transition is and practice using a tool called a population pyramid.

Presentation notes



Before we learn about demographic transition, first let’s look at the definition of demography. Demography is the statistical study of human populations. In other words, demography uses statistics to understand the growth and development of populations.

Presentation notes



Demographic transition is the shift in a country’s population.

Stage 1: Both the birth rate and the death rate are high, so the population is fairly stable.

Stage 2: Death rates drop due to improvements in sanitation and food supply.

Stage 3: Birth rates drop due to increased urbanization, education of women, and access to contraception.

Stage 4: Death rates and birth rates continue to drop and the population growth levels off.

Presentation notes



Think about what you know about life and health in the developing parts of the world. In a developing country, birth and death rates are both high.

Disease is commonplace. Many children die before they reach the age of 5. Adult mortality (death between the ages of 15 and 60) is also high.

In a developing country, birth and death rates are both high.

"DTM Pyramids" by Dtm_pyramids.png: User:SuzanneKnderivative work: NikNaks93 (talk) - Dtm_pyramids.png. Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:DTM_Pyramids.svg#/media/File:DTM_Pyramids.svg

Presentation notes



As the country’s economy begins to improve, the quality of life for people in the country also begins to improve.

Hygiene is usually one of the first improvements, as sewage is cleaned up and people get clean drinking water. Nutrition also improves. As people have more money, they can buy more food and better-quality food for themselves.

Infectious disease begins to decrease. This is partially because of the improvements in hygiene and nutrition, and partially because the improvements in the economy also lead to improvements in health care.

As fewer people get sick and better health care is available to treat those who do get sick, the overall mortality rate decreases.


Presentation notes



By Stage 3, fertility rates are beginning to slow down. In a developed nation, there are fewer births than in a developing nation. There are many reasons for more births in a developing nation: Families may have many children to help them work their family land. A couple may choose to have many children because they know that not all their children will live to reach adulthood.

One of the biggest reasons for lower fertility rates in developed countries is the education and financial independence of women. An educated woman is more likely to be employed outside the home. She is more likely to have her own money and be able to make her own decisions. She may choose not to have children at all. If she does want children, she is likely to have them later in life. She may also choose to have fewer children so that she can have a career. When women have the choice, they often have fewer children but pour their resources (time, money, energy) into their well-being instead of spreading the available resources over many children. These factors have a major impact on birth rates. Continuing improvements in medical care also play a major role as birth control options become more widely available.

Presentation notes



By this stage, a country has a lower birth rate and a lower death rate because better health care and nutrition are helping people to live longer. The combination of these two factors results in the graying of the population, which is increasing numbers of older people within the population.

Presentation notes



This is an example of a population pyramid. A population pyramid is a type of bar graph that looks at one country and tracks how many people of each gender are within a specific age range. The age ranges are listed down the center of the graph. Each bar represents an age increment. The numbers at the bottom represent the population in millions, so you can see how much of the population is within a specific age range. The blue bands represent the number of men and the pink bands represent the number of women.

The example above shows a population pyramid for Saudi Arabia. Looking at the very bottom line of the pyramid, you can see that less of the population is composed of babies and children than young adults. You can see that there are more men in the 25-29 year age group than in any other age group.

Image from: www.Census.gov/population/international/data

Presentation notes



Niger is a low-income country. It has a high birth rate. You can tell because the largest part of the pyramid is at the bottom, with most of the population under 15 years of age. This country also has a high mortality rate (people dying between the ages of 15 and 60). You can tell that because the pyramid gets smaller toward the top and the sides are concave. People are dying in large numbers before they get old.

Presentation notes



Ecuador’s population pyramid shows a high birth rate, like Niger, but the death rate is slowing. You can see the sides of the pyramid are straight, not concave.

Presentation notes



Iceland is a high-income country. Its birth rate is much lower than the birth rates in developing countries. In fact, this graph tells us there are fewer people being born in Iceland today than there were 60 years ago.

Iceland also has a much lower death rate than the other two countries. You can tell because there are so many people who are still alive in their 50s, 60s, 70s, and even 80s, compared with the other graphs.

Presentation notes



Australia is a high income country like the United States. The death rate is low and the birth rate is starting to slow.

You can see the sides of the pyramid are convex and the rows for the youngest ages at the bottom of the graph are shorter, reflecting the lower birth rate.

Presentation notes



This population pyramid is an example of a phenomenon that many developed countries are facing—what is called the graying of the population. Because birth rates have been declining, at some point there will be more old people than young people. This means a greater demand for medical care for the elderly, and if the country has a government-supported retirement program, like Social Security in the United States, it means a greater financial demand for the government to manage.

On a more personal level, this population shift can mean that children and grandchildren have a greater responsibility to take care of the elderly. This is especially true in countries like China. China has tried for years to decrease its birth rate. In 1979 the Chinese government instituted a policy restricting most families to having no more than one child. However, this policy has had the unintended consequence of creating what are called 1-2-4 families: one child who must grow up to support his or her two parents and four grandparents.

Presentation notes



The United States has been a developed country for a long time, but it still experiences demographic transition. Even though the graphs are small, you can see how the population has shifted. In 1980 the birth rate was fairly stable, but the death rate was relatively high. In 2010 the birth rate was about the same as in 1980, but the death rate had decreased dramatically. Looking ahead to 2040, the birth rate declines a little bit, and the death rate continues to decline. However, unlike some other countries, the United States is not expected to develop an inverted pyramid that shows that the birth rate has declined so much that the older people outnumber the younger people.

Presentation notes



Using statistical population models like this can help global health professionals prepare for the expected changes within a country. If the WHO or other organizations use the information in this type of model, they know that in countries like Niger, which is in Stage 1, they need to work toward decreasing the mortality rate, while in Ecuador, which is already in Stage 2, they should prepare for Stage 3.

Not every country makes it through all four stages, but this model is still a useful way of looking at how economics affect a country’s overall health.

Presentation notes




Presentation 2 Notes: Vulnerable Populations


Many global health initiatives are focused on helping vulnerable populations. In this presentation, you will learn more about what a vulnerable population is and why these groups need special help.

Presentation notes



Many health care programs focus on vulnerable populations. These are groups of people that are more likely to suffer health problems and may be less able to get themselves the health care they need.

A group may be vulnerable because of age. Children and elderly people are both considered vulnerable groups; both have unique risks associated with their age, and both may not be able to get themselves to a doctor without assistance.

Genetic predisposition may also play a role. For example, some women have a specific gene mutation that makes them more likely to develop breast cancer. Women with this gene mutation are a vulnerable population. Certain ethnic groups also have a genetic predisposition to specific conditions.

People with disabilities or chronic illnesses are vulnerable to complications that result from their disability or illness. For example, people with diabetes or HIV can develop other conditions because of their primary illness. In the case of diabetes, people can go blind or need a limb amputated. People with a mental disability or with mental illness may not be competent to get themselves the medical treatment they need.

Presentation notes



Poor people are a far more vulnerable population group. They may not be able to afford health insurance or medical care, and they may face risks from unhealthy lifestyles or work/living environments. In many countries, poor people are more likely to get malaria because they cannot afford the mosquito nets that protect them from being bitten.

People who live a long distance from medical care are also vulnerable, because they may not get help until a condition has become very serious.

Immigrants and refugees may struggle to get assistance because they do not speak the language of the country in which they are now living. They may also be afraid to ask for help because of their legal status. If they are in the country illegally, they don’t want to call attention to themselves by asking for medical care.

Refugees also frequently face dangerous and unhealthy conditions in refugee camps, which may increase the likelihood of catching an infectious disease like cholera.

Presentation notes



Groups that are discriminated against often face greater health risks and have more difficulty obtaining medical care. Vulnerable populations differ by society. A group that is vulnerable in one country might be very well cared for in another country.

For example, women are not universally a vulnerable population. Women in many developed countries have equal rights, the freedom to work and earn their own money, and the opportunity to seek their own medical care. So it’s important to remember that a vulnerable population in one country might not be vulnerable all over the world.

However, there are some populations that are universally vulnerable. For example, children are almost always a vulnerable population because they need special care.

Presentation notes



Homeless children are a vulnerable population all over the world. However, in places like the Philippines, street children are especially common. A 2010 UNICEF study estimated that there were 250,000 street children in the Philippines. They often work the streets to earn money by begging or, in some cases, working as child prostitutes.

These street children are at serious risk of contracting an infectious disease. Their living conditions are unsanitary and their nutrition is poor. They get limited medical care, so getting an ordinary childhood illness could be fatal. For children working as prostitutes, the risks are even higher, including the risk of contracting HIV. Worse still, these children are not educated about the risks of HIV. A UNICEF study found that 73% of children thought it was impossible to get HIV, and 28% believed that HIV was curable.

Presentation notes



UNICEF works in the Philippines to improve the lives of children, particularly street children. UNICEF has worked with local governments to change laws so that street children convicted of petty crimes go to rehabilitation centers for counseling rather than to jail. It has many programs designed to reduce child prostitution and is also working on HIV education for these children.

In one program, educators go into the streets and make contact with children. They win their trust. They provide them with basic education. They help them access information and services that will hopefully lead to their getting off the streets.

Image retrieved from http://www.unicef.org/philippines/reallives_11786.html on August 29, 2013, and included here under fair-use guidelines of Title 17, US Code. Image © 2009 UNICEF Philippines/Andy Brown.

Presentation notes



In the United States, the largest vulnerable population is people living in poverty. Ethnic minorities, the elderly, the homeless, and people living in rural areas are other vulnerable populations in the United States. What do many of these groups have in common? They are less likely to have health insurance or access to health care.

One vulnerable population in the United States is African American men. They tend to have very high rates of hypertension, a key factor in cardiovascular disease. Between 2009 and 2012 approximately 42% of African American men reported that they had hypertension. This compares to 30% of white males. African American men have a slight genetic predisposition to hypertension, but they are also more likely to live in areas with few places where they can safely exercise. And they are also more likely to live in communities with limited nutritional resources. In these communities, there are also fewer good jobs that pay well and provide health insurance. All of these factors put together mean that African American men are a vulnerable population for hypertension.

Data from http://www.cdc.gov/nchs/data/hus/hus14.pdf, Table 60.

Presentation notes



It seems obvious that vulnerable populations may suffer more from communicable diseases. Refugees or poor people may face unhealthy living conditions. As you just learned, street children may not realize the dangers they face from sexually transmitted diseases like HIV. However, noncommunicable diseases are also a serious problem for vulnerable populations.

These populations have less access to health care. So, in many cases an NCD will not be diagnosed as quickly as in populations that have better access to health care. While a person may know he doesn’t feel very well, he may dismiss it as “just a hard time catching my breath” or “pains in my chest once in a while,” without realizing that this could be the sign of something serious like chronic obstructive pulmonary disease (COPD) or heart disease.

Lack of access to health care means that even if an illness is diagnosed, the condition may not be managed as well as it should be. Imagine a poor child with asthma. She may be diagnosed and given an inhaler to treat her symptoms. Children with asthma can live very normal, comfortable lives with the proper treatment. But if money is tight in her family, they may not be able to afford the prescription refills. So the child simply suffers with the disease. If a child’s asthma becomes severe, her parents might take her to the emergency room, which then means they have a large bill to try to pay. In this case, a relatively manageable disease makes life much more difficult for someone who is part of two different vulnerable populations.

Presentation notes



In the United Nations report “World Populations Ageing, 1950-2050,” researchers point out that not only are there more people living into their 60s and 70s, but more people are living into their 80s and even older. As the graph here shows, by 2050 researchers estimate that there will be close to 400 million people in the world who are over the age of 80.

As you already learned when you studied demographic transitions, a graying population can pose some serious challenges. This pattern of aging will create new vulnerable populations. Groups that are already discriminated against will now also be dealing with the increased health problems of old age. The strain of caring for older generations may also mean that fewer resources are available to help younger vulnerable groups. To make things even more complicated, the aging rate in developing countries is becoming more rapid than in developed countries. Developing countries, which are already struggling to meet the needs of their population, now have an additional challenge with growing vulnerable groups.

Data from UN publication “World Population Ageing, 1950–2050,” available online at http://www.un.org/esa/population/publications/worldageing19502050/pdf/90chapteriv.pdf.

Presentation notes



City dwellers face three major health risks: communicable diseases that thrive in crowded and unsanitary conditions, noncommunicable diseases that increase due to unhealthy lifestyles more common in the city, and an increased number of accidents and injuries due to violence and crime. However, well-planned urban environments can mitigate these problems, and city dwellers can also benefit from increased access to medical care, healthy food, and good sanitation.

Vulnerable populations are more likely to live in these slum environments. The existence of such living conditions may also lead to an increasingly large vulnerable population, as the people who live in these slums face an increased risk of health problems.

Presentation notes



Vulnerable populations frequently have less healthy eating habits. They may not have adequate education to know what foods are better for them. They may not have access to healthier food, because in some low-income communities there are a lot of fast-food restaurants and not a lot of grocery stores or other sources of healthy foods such as vegetables and fruit. Areas with poor access to healthy foods are known as “food deserts.” They may not have the money to buy healthier food, since it is often more expensive than unhealthy food.

The result is a worldwide epidemic of obesity. Today more than 40 million preschool children are obese or overweight. As you have learned, obesity increases the risk of heart disease, cancer, diabetes, and many other diseases. Vulnerable populations that already face higher risks for disease now have one more risk factor.

Presentation notes



The United Nations, UNICEF, and other nongovernmental organizations (NGOs) focus much of their work on helping vulnerable populations. These populations are more likely to contract infectious diseases. If they already have a chronic disease, they may suffer more complications and setbacks because of their limited access to medical care. Since many of these groups are discriminated against in their community, they struggle to get the help they need. They are also at greater risk from the broad global trends of demographic aging and unplanned urbanization, and the global spread of unhealthy lifestyles.

It is important to remember that a vulnerable population in one community or country may not be vulnerable in another. However, vulnerable populations exist in every country in the world, and they need special help.

Presentation notes



Dedicated global health workers are reaching out to the world’s vulnerable populations. For example, the children who live in the Kunene region of Namibia are especially vulnerable. The rural area where they live is very isolated and the terrain is rough. When medical help is needed, it often doesn’t get there fast enough. UNICEF worked with groups in Namibia to train community workers in health issues. These workers were then deployed to the region, where they could provide hands-on help.

Programs such as these are seeing success across the globe in the quest to reach and aid vulnerable populations.

Image retrieved from http://www.usaid.gov/namibia/global-health on October 23, 2013, and included here under fair-use guidelines of Title 17, US Code. Image copyright © USAID.

Presentation notes




Assessment Criteria: Population Health Report

Student Name:______________________________________________________________

Date:_______________________________________________________________________

Using the following criteria, assess whether the student met each one.

Met Partially Met

Didn’t Meet

The report’s introductory paragraph gives relevant and accurate background information on the country that will help the reader understand the country’s health status.

□ □ □

The report uses current and accurate life expectancy and mortality data to explain the country’s health status.

□ □ □

The report uses at least one graph to display relevant and accurate data.

□ □ □

The report describes the country’s population pyramid and uses that data to make an informed and logical guess about which state of demographic transition the country is in.

□ □ □

The report describes the causes of years of life lost and uses that data to make an informed and logical guess about which state of epidemiological transition the country is in.

□ □ □

The report demonstrates knowledge of what makes a vulnerable population.

□ □ □

The data in the report supports the summary of the country’s health status given in the report’s concluding paragraph.

□ □ □

The completed assignment is neat and uses proper spelling and grammar.

□ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Guide: Teaching Reflection

This guide provides ideas for improving students’ ability to reflect on their learning. It includes specific suggestions for helping students reflect on meeting the learning objectives of a lesson. Students participating in NAFTrack Certification will benefit from practicing reflective writing, since they will respond to reflection prompts as part of the NAFTrack Certification process.

All thinking requires some type of reflection in order for learning to take place. Reflection is a cluster of skills that involves observing, questioning, and putting ideas and experiences together to give a fresh meaning to them all. The reflection activities throughout this course bring students a sense of ownership of what they have learned and a better understanding of themselves and their abilities.

Build your students’ reflection skills by starting with easier reflection questions that lead to more complex ones. The list below, based on Bloom’s Taxonomy, helps students break down what they need to think about so that they gain confidence and strengthen their metacognition. Because each question takes the previous answer a step further, students can come up with answers to each question and eventually wind up with everything they need to work with to craft an answer for the highest-level reflection questions.

Learning Levels (From Lower to Higher Order) Examples of Reflection Questions

Remembering (retrieving, recognizing, recalling) What can I remember? What did I do?

Understanding (constructing meaning) What do I think it means? What conclusions did I come to? What are my takeaways? What did I get out of it?

Applying (extending learning to a new setting) How could I use this [knowledge, experience] again? In what new way could this be valuable?

Analyzing (breaking material apart, seeing how the parts fit together and what the overall purpose is)

What are the different parts of this [experiment, assignment, project, experience]? As a whole, what is the purpose/main idea?

Evaluating What has this [project, assignment, experience, experiment] taught me about myself—my strengths, my challenges? What am I proud of? What could I do better next time? What are my contributions? I used to think…but now I think….

Creating Is there another, better way to put the pieces of this [project, assignment, experience, experiment] together? What could I [create, write, plan] next?

Another source of ideas for teaching reflection: http://www.visiblethinkingpz.org/

Follow these tips to guide students in responding to reflection questions on learning objectives:



Read the reflection question aloud to the class and have students rephrase the question using their own words.

Explain that they should use the reflection question to describe what they have learned during the lesson as it relates to the learning objective.

Review the meaning of the learning objective before students get started on their reflections.

Refer to the examples below, which represent good responses to these types of reflection questions.

Example Below is an example learning objective with example student reflection prompts and responses. Although students only encounter the actual NAFTrack Certification prompts once they are on the NAFTrack Certification assessment platform, examples like these give students a sense of the type of reflection they will be asked to engage in. You can copy and paste these examples into a Word document for students to review and discuss as a class. You can add more prompts for students to answer, or customize this content to best suit your students and your goals for them.

Learning objective

Identify major public health issues and explain why they are important

Prompts and responses

Think of the assignments that you completed during this lesson. Choose one to use as your work sample as you answer the questions below.

Explain how completing this work sample helped you to meet this learning objective. Describe the ideas and skills that you used.

I chose the informational profile that I wrote as my work sample. It helped me meet this learning objective because it is about a major public health issue: HIV. My profile explains that HIV affects millions of people around the world. HIV is also a big problem because it is so difficult to treat. To write my profile, I learned about many ideas that were new to me. I read about what researchers think causes HIV, how it affects the body, and what cures they are working on. The skills I used are writing and researching. I had to practice putting the articles I read into my own words so that I wouldn’t plagiarize. Being able to organize information is another skill I used.

Describe what you could improve about your work sample.

I tried really hard to make my profile organized, but now I see ways I could have laid information out to make it easier to read. I don’t think I wrote enough about how HIV is transmitted from one person to another. It would have been good to include my favorite websites so people could learn more if they want to.

Promoting Reflection in the Classroom You can also use the following sample questions to promote a culture of reflection in your classroom—during class and small-group oral reflections, during PowerPoint presentations, and when students are having a discussion and you want to draw them out more.

Can you discuss that more?

Why do you think that happens?

What evidence do you have to support that?

Do you see a connection between this and _________?

Does this remind you of anything else?



How else could you approach that?

How could you do that?




Key Vocabulary: World Populations and Disease

Term Definition

degenerative Marked by gradual deterioration of organs or cells and loss of function.

demographic transition An economic theory that explains how the population of a country changes in relation to its economic, educational, and health care development.

epidemiological transition A theory that explains how the types of illnesses a country’s population experiences will change as the country’s economy improves.

genetic predisposition Genes that make a person more likely to develop a certain condition or illness.

pestilence A deadly epidemic of disease.

population aging Current trend of large populations growing older, putting increased strain on medical and governmental infrastructure.

population pyramid A tool that provides a visual example of demographic transition that may be occurring within a country.

socioeconomic Related to or concerned with the interaction of social and economic factors.

urbanization Trend of increasing numbers of people living in cities.

vulnerable population A group that is more likely to have health problems and less likely to be able to obtain medical care without assistance.




Bibliography: World Populations and Disease





Online “Afghanistan: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/afg.pdf (accessed October 19, 2015).

“As Bangladesh’s Population Grows, Slum Dwellers Struggle.” PBS NewsHour, 6:47. March 22, 2011. http://video.pbs.org/video/1853981311/ (accessed October 19, 2015).

“Australia: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/aus.pdf (accessed October 19, 2015).

“Bangladesh: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/bgd.pdf (accessed October 19, 2015).

“Brazil: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/bra.pdf (accessed October 19, 2015).

“Cambodia: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/khm.pdf (accessed October 19, 2015).

Chan, Margaret. “Noncommunicable Diseases Damage Health, Including Economic Health.” WHO, September 19, 2011, http://www.who.int/dg/speeches/2011/un_ncds_09_19/en/index.html (accessed October 19, 2015).

“Country and Lending Groups.” The World Bank, http://data.worldbank.org/about/country-classifications/country-and-lending-groups#Low_income (accessed October 19, 2015).

“Dominican Republic: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/dom.pdf (accessed October 19, 2015).

Gaziano, J. Michael. “Fifth Phase of the Epidemiological Transition: The Age of Obesity and Inactivity.” Journal of the American Medical Association 303, no. 3 (January 20, 2010): 275–276. http://jama.jamanetwork.com/article.aspx?articleid=185220 (accessed October 19, 2015).

“Global Burden of Disease.” WHO, http://www.who.int/trade/glossary/story036/en/ (accessed October 19, 2015).

“Haiti: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/hti.pdf (accessed October 19, 2015).

“HIV/AIDS.” UNICEF Philippines, http://www.unicef.org/philippines/activities/act_7.html (accessed October 19, 2015).



Journeyman Pictures. “Ageing Economy—Japan.” YouTube, 7:14. October 26, 2007. http://www.youtube.com/watch?v=vBWsLdDlyI4 (accessed October 19, 2015).

“Latvia: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/lva.pdf (accessed October 19, 2015).

“Malaysia: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/mys.pdf (accessed October 19, 2015).

“On World Day, Ban Spotlights Health Burdens on Urban Populations.” UN News Centre, April 7, 2010, http://www.un.org/apps/news/story.asp?NewsID=34296&Cr=world+health&Cr1 (accessed October 19, 2015).

“Periodicals.” Online Writing Lab, Purdue Owl, https://owl.english.purdue.edu/owl/resource/717/4/ (accessed October 19, 2015).

“Saudi Arabia: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/sau.pdf (accessed October 19, 2015).

ScienceMag. “9 Billion? A Whirlwind Trip through Population Trends.” YouTube, 7:24. July 28, 2011. http://www.youtube.com/watch?v=DCPCQrxBUOU&NR=1 (accessed October 19, 2015).

Shi, Leiyu, Gregory D. Stevens, Pegah Faed, and Jenna Tsai. “Rethinking Vulnerable Populations in the United States: An Introduction to a General Model of Vulnerability.” Harvard Health Policy Review 9, no. 1 (Spring 2008): 43–48. http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-primary-care-policy-center/Publications_PDFs/2008%20HHPR%20p43.pdf (accessed October 19, 2015).

“Sri Lanka: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/lka.pdf (accessed October 19, 2015).

“Sweden: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/swe.pdf (accessed October 19, 2015).

“Thailand: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/tha.pdf (accessed October 19, 2015).

“Ukraine: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/ukr.pdf (accessed October 19, 2015).

UNFPA. “India: A Booming Population.” YouTube, 3:40. October 26, 2011. http://www.youtube.com/watch?NR=1&v=NmRcJ18-Etc (accessed October 19, 2015).

“UNICEF Philippines Annual Country Report 2010.” UNICEF, http://www.unicef.org/philippines/UNICEF_Philippines_Annual_Report_2010_web_version(2).pdf (accessed October 19, 2015).

“Vulnerable Populations: Who Are They?” American Journal of Managed Care, November 1, 2006, http://www.ajmc.com/publications/supplement/2006/2006-11-vol12-n13Suppl/Nov06-2390ps348-s352 (accessed October 19, 2015).

Women, War & Peace. PBS video series, http://www.pbs.org/wnet/women-war-and-peace/ (accessed October 19, 2015).

“Working with Street Children, Module 1: A Profile of Street Children.” WHO, http://apps.who.int/iris/bitstream/10665/66756/2/WHO_MSD_MDP_00.14_Module1_eng.pdf (accessed October 19, 2015).

“World Population Ageing 1950–2050.” United Nations, http://www.un.org/esa/population/publications/worldageing19502050/pdf/62executivesummary_english.pdf (accessed October 19, 2015).

“Years of Life Lost.” HealthKnowledge, http://www.healthknowledge.org.uk/public-health-textbook/research-methods/1a-epidemiology/years-lost-life (accessed October 19, 2015).



“Yemen: WHO Statistical Profile.” WHO, http://www.who.int/gho/countries/yem.pdf (accessed October 19, 2015).


AOHS Global Health


Student Resources


Student Resource 4.1 Anticipation Guide: World Populations and Disease

Student Resource 4.2 Graphs: Socioeconomic Development and Causes of Death

Student Resource 4.3 Note Taking: Demographic Transition

Student Resource 4.4 Reading: Demographic Transition

Student Resource 4.5 Reading and Note Taking: Epidemiological Transition

Student Resource 4.6 Note Taking: Vulnerable Populations

Student Resource 4.7 Reading: Vulnerable Populations

Student Resource 4.8 Assignment: Population Health Report

Student Resource 4.9 Guide: Citing Sources




Anticipation Guide: World Populations and Disease


Directions: For each of the statements below, underline “I agree” if you think the statement is accurate or “I disagree” if you disagree with it. Write one reason to explain your guess.

People in low-income countries have higher mortality rates than people in high-income countries.


My reason:

I learned:

There are more people living in low- and middle-income countries than in high-income countries.


My reason:

I learned:

Making sure girls get an education improves the health of a country.


My reason:

I learned:



As a country gets richer, its health care improves.


My reason:

I learned:

The main causes of death in a low-income country are the same as the main causes of death in a high-income country.


My reason:

I learned:

Health problems like heart disease and car accidents have a higher incidence in high-income countries than in low-income countries.


My reason:

I learned:

Fertility rates are lower in wealthier countries because it costs more to raise children in those countries.


My reason:

I learned:




Graphs: Socioeconomic Development and Causes of Death


Directions: Read the explanation of Years of Life Lost provided below. Then use the graphs in this resource to respond to questions your teacher gives you about the connection between socioeconomic status and causes of disease, injury, and death.

Years of Life Lost: a health indicator that equals Life Expectancy minus actual Age of Death for a population. It shows loss from premature mortality.

In developed countries such as the United States, you are considered to have lived a full life if you reach the age of 75. If you live longer than that, it’s a bonus. If you die before the age of 75, your death is considered premature.

If you look at the whole population of a country, you can see what proportion dies prematurely (before the age of 75), and you can assign a cause for each of these premature deaths. The calculation is weighted, however. The younger that people are when they die, the more heavily weighted their deaths are, because they have lost the most years of life prematurely.

If you assign causes of death according to the categories of communicable disease, noncommunicable disease, and injuries, you can see patterns that correspond to how developed a country is. That’s why Years of Life Lost is a useful measurement: the more developed a country is, the smaller the proportion of deaths from communicable disease and injury.



Communicable52%Noncommunicable

34%

Injuries14%

Years of Life Lost by Causes of Death: Bangladesh (2008)



Distribution of Years of Life Lost by Causes (2008)

Low-income economies Communicable Noncommunicable Injuries

Afghanistan 74% 18% 9%

Bangladesh 52% 34% 14%

Cambodia 60% 31% 10%

Haiti 72% 27% 6%

Lower-middle-income economies Communicable Noncommunicable Injuries

Honduras 42% 43% 14%

Yemen 61% 26% 13%

Sri Lanka 11% 39% 50%

Ukraine 14% 70% 17%

Upper-middle-income economies Communicable Noncommunicable Injuries

Brazil 20% 56% 24%

Dominican Republic 42% 42% 17%

Malaysia 28% 58% 16%

Thailand 24% 55% 22%

High-income economies Communicable Noncommunicable Injuries

Australia 6% 79% 15%

Latvia 5% 77% 17%

Saudi Arabia 20% 55% 25%

Sweden 5% 83% 12%




Note Taking: Demographic Transition

Student Name: Date:

Directions: As you view the first part of the presentation on demographic transition, complete the first table by describing the three stages of demographic transition. Then as you continue to view the presentation, complete the second table by describing the population pyramids of three countries. After the presentation, your teacher will instruct you to answer the questions about the population pyramids at the end of this resource.

Demographic Transition

What happens to:

Stage One The mortality rate:

The economy:

Hygiene and nutrition:

Stage Two The population:

The child mortality rate:

The health care system:

Stage Three The birth rate:

Percentage of the population that is older:

The status of women:



Population Pyramid

Population Pyramid for Bangladesh

At what stage is Bangladesh?

How can you tell from the graph?

Population Pyramid for India

At what stage is India?


Population Pyramid for Finland

At what stage is Finland?




Population Pyramid Practice

1. Is the population pyramid below for a developed country or a developing country? How can you tell?

2. Is the population pyramid below for a developed country or a developing country? How can you tell?

6 4 2 0 2 4 6

0‐45‐9

10‐1415‐1920‐2425‐2930‐3435‐3940‐4445‐4950‐5455‐5960‐6465‐6970‐7475‐7980‐8485‐8990‐9495‐99100+

% Female

% Male

10 5 0 5 10

0‐45‐9

10‐1415‐1920‐2425‐2930‐3435‐3940‐4445‐4950‐5455‐5960‐6465‐6970‐7475‐7980‐8485‐8990‐9495‐99100+

% Female

% Male



3. What problem will a country face when its population pyramid looks like this?

4 2 0 2 4 6

0‐45‐9

10‐1415‐1920‐2425‐2930‐3435‐3940‐4445‐4950‐5455‐5960‐6465‐6970‐7475‐7980‐8485‐8990‐9495‐99100+

% Female

% Male




Reading: Demographic Transition

Today we are going to learn what demographic transition is and practice using a tool called a population pyramid.



Before we learn about demographic transition, first let’s look at the definition of demography. Demography is the statistical study of human populations. In other words, demography uses statistics to understand the growth and development of populations.



Demographic transition is the shift in a country’s population.

Stage 1: Both the birth rate and the death rate are high, so the population is fairly stable.

Stage 2: Death rates drop due to improvements in sanitation and food supply.

Stage 3: Birth rates drop due to increased urbanization, education of women, and access to contraception.

Stage 4: Death rates and birth rates continue to drop and the population growth levels off.



Think about what you know about life and health in the developing parts of the world. In a developing country, birth and death rates are both high.

Disease is commonplace. Many children die before they reach the age of 5. Adult mortality (death between the ages of 15 and 60) is also high.

In a developing country, birth and death rates are both high.




As the country’s economy begins to improve, the quality of life for people in the country also begins to improve.

Hygiene is usually one of the first improvements, as sewage is cleaned up and people get clean drinking water. Nutrition also improves. As people have more money, they can buy more food and better-quality food for themselves.

Infectious disease begins to decrease. This is partially because of the improvements in hygiene and nutrition, and partially because the improvements in the economy also lead to improvements in health care.

As fewer people get sick and better health care is available to treat those who do get sick, the overall mortality rate decreases.




By Stage 3, fertility rates are beginning to slow down. In a developed nation, there are fewer births than in a developing nation. There are many reasons for more births in a developing nation: Families may have many children to help them work their family land. A couple may choose to have many children because they know that not all their children will live to reach adulthood.

One of the biggest reasons for lower fertility rates in developed countries is the education and financial independence of women. An educated woman is more likely to be employed outside the home. She is more likely to have her own money and be able to make her own decisions. She may choose not to have children at all. If she does want children, she is likely to have them later in life. She may also choose to have fewer children so that she can have a career. When women have the choice, they often have fewer children but pour their resources (time, money, energy) into their well-being instead of spreading the available resources over many children. These factors have a major impact on birth rates. Continuing improvements in medical care also play a major role as birth control options become more widely available.



By this stage, a country has a lower birth rate and a lower death rate because better health care and nutrition are helping people to live longer. The combination of these two factors results in the graying of the population, which is increasing numbers of older people within the population.



This is an example of a population pyramid. A population pyramid is a type of bar graph that looks at one country and tracks how many people of each gender are within a specific age range. The age ranges are listed down the center of the graph. Each bar represents an age increment. The numbers at the bottom represent the population in millions, so you can see how much of the population is within a specific age range. The blue bands represent the number of men and the pink bands represent the number of women.

The example above shows a population pyramid for Saudi Arabia. Looking at the very bottom line of the pyramid, you can see that less of the population is composed of babies and children than young adults. You can see that there are more men in the 25-29 year age group than in any other age group.

Image from: www.Census.gov/population/international/data



Niger is a low-income country. It has a high birth rate. You can tell because the largest part of the pyramid is at the bottom, with most of the population under 15 years of age. This country also has a high mortality rate (people dying between the ages of 15 and 60). You can tell that because the pyramid gets smaller toward the top and the sides are concave. People are dying in large numbers before they get old.



Ecuador’s population pyramid shows a high birth rate, like Niger, but the death rate is slowing. You can see the sides of the pyramid are straight, not concave.



Iceland is a high-income country. Its birth rate is much lower than the birth rates in developing countries. In fact, this graph tells us there are fewer people being born in Iceland today than there were 60 years ago.

Iceland also has a much lower death rate than the other two countries. You can tell because there are so many people who are still alive in their 50s, 60s, 70s, and even 80s, compared with the other graphs.



Australia is a high income country like the United States. The death rate is low and the birth rate is starting to slow.

You can see the sides of the pyramid are convex and the rows for the youngest ages at the bottom of the graph are shorter, reflecting the lower birth rate.



This population pyramid is an example of a phenomenon that many developed countries are facing—what is called the graying of the population. Because birth rates have been declining, at some point there will be more old people than young people. This means a greater demand for medical care for the elderly, and if the country has a government-supported retirement program, like Social Security in the United States, it means a greater financial demand for the government to manage.

On a more personal level, this population shift can mean that children and grandchildren have a greater responsibility to take care of the elderly. This is especially true in countries like China. China has tried for years to decrease its birth rate. In 1979 the Chinese government instituted a policy restricting most families to having no more than one child. However, this policy has had the unintended consequence of creating what are called 1-2-4 families: one child who must grow up to support his or her two parents and four grandparents.



The United States has been a developed country for a long time, but it still experiences demographic transition. Even though the graphs are small, you can see how the population has shifted. In 1980 the birth rate was fairly stable, but the death rate was relatively high. In 2010 the birth rate was about the same as in 1980, but the death rate had decreased dramatically. Looking ahead to 2040, the birth rate declines a little bit, and the death rate continues to decline. However, unlike some other countries, the United States is not expected to develop an inverted pyramid that shows that the birth rate has declined so much that the older people outnumber the younger people.



Using statistical population models like this can help global health professionals prepare for the expected changes within a country. If the WHO or other organizations use the information in this type of model, they know that in countries like Niger, which is in Stage 1, they need to work toward decreasing the mortality rate, while in Ecuador, which is already in Stage 2, they should prepare for Stage 3.

Not every country makes it through all four stages, but this model is still a useful way of looking at how economics affect a country’s overall health.




Reading and Note Taking: Epidemiological Transition

Student Name: Date:

Directions: Read this history of health in the United States. As you read, underline each stage of epidemiological transition. Then complete the chart by describing each of the five stages.

Epidemiological Transition in the United States Epidemiology is the study of the causes, distribution, and control of diseases in a population. Epidemiological transition, like demographic transition, is a theory. It tries to explain how changes in a country, such as economic improvements or medical innovations, affect the population’s health. For example, around 1900 infrastructure in American cities was improving. (Infrastructure refers to the key structures in a community, such as roads, sewage systems, and power supplies.) People also had better access to water, and this improved the population’s health. You’ll learn more about this stage of epidemiological transition below.

Demographic transition focuses on how long people live. Epidemiological transition focuses on what diseases are responsible for the most deaths within a population.

The United States, like most of today’s developed countries, has experienced several stages of epidemiological transition. For approximately the first 125 years of its existence as a country, the United States experienced an Age of Pestilence and Famine. Pestilence is another word for a fatal epidemic disease. During this time, most people died from infectious diseases, especially tuberculosis. Noncommunicable diseases, like cardiovascular disease, accounted for fewer than 10% of deaths.

By around 1900, the country was becoming more urbanized. People were wealthier, and life expectancy was increasing. While the average life expectancy had been close to 35 years, it was now approaching 50 years. Around this time, improvements in the water supply and the establishment of a public health system combined to decrease the risk from infectious diseases. At the same time, deaths from noncommunicable diseases were beginning to increase. This era is called the Age of Receding Pandemics.

By around 1950, noncommunicable diseases were the major cause of death, particularly cardiovascular disease. People were exercising less and eating a diet increasingly high in fat. Smoking was at an all-time high. Coronary heart disease and stroke were the leading causes of death, which made this the Age of Degenerative and Man-Made Disease. A degenerative disease is characterized by slow deterioration of organs or cells, combined with loss of function. Degenerative diseases are more common in older people. Since people were now living longer than they had lived before, they faced more problems from degenerative diseases.

By the year 2000, people had become better able to manage the risks of cardiovascular disease and other noncommunicable diseases. Noncommunicable diseases remained the leading cause of death, but people were more aware of how to reduce their risks by not smoking and by watching their diet. People



were able to stay healthier for longer. This era is called the Age of Delayed Degenerative Disease.

However, there are signs that the United States and similar countries may be entering a new fifth phase, characterized by rising obesity rates and a decrease in physical activity. This era could be called the Age of Obesity Epidemic. In the last 40 years, the percentage of Americans who are considered overweight or obese has grown consistently. This could change the trend of delayed degenerative disease, since being overweight or obese raises the risks for heart disease, diabetes, some types of cancer, and many other health problems.

Fill in the characteristics of the five stages of epidemiological transition.

Stage of Epidemiological Transition Characteristics

Age of Pestilence and Famine Most people died from infectious diseases.

Age of Receding Pandemics

Age of Degenerative and Man-Made Diseases

Age of Delayed Degenerative Disease

Age of Obesity Epidemic




Note Taking: Vulnerable Populations

Student Name: Date:

Directions: Take notes on this resource as you view the presentation on vulnerable populations.

1. Name three characteristics that might make a population vulnerable.

2. Give two examples of a universal vulnerable population.

3. Name two reasons women and girls are a vulnerable population in some cultures.

4. Why are vulnerable populations more likely to suffer from communicable diseases?

5. What is population aging and why is it a global health problem?

6. Why is rapid unplanned urbanization a global health problem?

7. Why are vulnerable populations more likely to suffer from noncommunicable diseases?

8. Describe one effort being taken to address the issue of vulnerable populations.




Reading: Vulnerable Populations

Many global health initiatives are focused on helping vulnerable populations. In this presentation, you will learn more about what a vulnerable population is and why these groups need special help.



Many health care programs focus on vulnerable populations. These are groups of people that are more likely to suffer health problems and may be less able to get themselves the health care they need.

A group may be vulnerable because of age. Children and elderly people are both considered vulnerable groups; both have unique risks associated with their age, and both may not be able to get themselves to a doctor without assistance.

Genetic predisposition may also play a role. For example, some women have a specific gene mutation that makes them more likely to develop breast cancer. Women with this gene mutation are a vulnerable population. Certain ethnic groups also have a genetic predisposition to specific conditions.

People with disabilities or chronic illnesses are vulnerable to complications that result from their disability or illness. For example, people with diabetes or HIV can develop other conditions because of their primary illness. In the case of diabetes, people can go blind or need a limb amputated. People with a mental disability or with mental illness may not be competent to get themselves the medical treatment they need.



Poor people are a far more vulnerable population group. They may not be able to afford health insurance or medical care, and they may face risks from unhealthy lifestyles or work/living environments. In many countries, poor people are more likely to get malaria because they cannot afford the mosquito nets that protect them from being bitten.

People who live a long distance from medical care are also vulnerable, because they may not get help until a condition has become very serious.

Immigrants and refugees may struggle to get assistance because they do not speak the language of the country in which they are now living. They may also be afraid to ask for help because of their legal status. If they are in the country illegally, they don’t want to call attention to themselves by asking for medical care.

Refugees also frequently face dangerous and unhealthy conditions in refugee camps, which may increase the likelihood of catching an infectious disease like cholera.



Groups that are discriminated against often face greater health risks and have more difficulty obtaining medical care. Vulnerable populations differ by society. A group that is vulnerable in one country might be very well cared for in another country.

For example, women are not universally a vulnerable population. Women in many developed countries have equal rights, the freedom to work and earn their own money, and the opportunity to seek their own medical care. So it’s important to remember that a vulnerable population in one country might not be vulnerable all over the world.

However, there are some populations that are universally vulnerable. For example, children are almost always a vulnerable population because they need special care.



Homeless children are a vulnerable population all over the world. However, in places like the Philippines, street children are especially common. A 2010 UNICEF study estimated that there were 250,000 street children in the Philippines. They often work the streets to earn money by begging or, in some cases, working as child prostitutes.

These street children are at serious risk of contracting an infectious disease. Their living conditions are unsanitary and their nutrition is poor. They get limited medical care, so getting an ordinary childhood illness could be fatal. For children working as prostitutes, the risks are even higher, including the risk of contracting HIV. Worse still, these children are not educated about the risks of HIV. A UNICEF study found that 73% of children thought it was impossible to get HIV, and 28% believed that HIV was curable.



UNICEF works in the Philippines to improve the lives of children, particularly street children. UNICEF has worked with local governments to change laws so that street children convicted of petty crimes go to rehabilitation centers for counseling rather than to jail. It has many programs designed to reduce child prostitution and is also working on HIV education for these children.

In one program, educators go into the streets and make contact with children. They win their trust. They provide them with basic education. They help them access information and services that will hopefully lead to their getting off the streets.

Image retrieved from http://www.unicef.org/philippines/reallives_11786.html on August 29, 2013, and included here under fair-use guidelines of Title 17, US Code. Image © 2009 UNICEF Philippines/Andy Brown.



In the United States, the largest vulnerable population is people living in poverty. Ethnic minorities, the elderly, the homeless, and people living in rural areas are other vulnerable populations in the United States. What do many of these groups have in common? They are less likely to have health insurance or access to health care.

One vulnerable population in the United States is African American men. They tend to have very high rates of hypertension, a key factor in cardiovascular disease. Between 2009 and 2012 approximately 42% of African American men reported that they had hypertension. This compares to 30% of white males. African American men have a slight genetic predisposition to hypertension, but they are also more likely to live in areas with few places where they can safely exercise. And they are also more likely to live in communities with limited nutritional resources. In these communities, there are also fewer good jobs that pay well and provide health insurance. All of these factors put together mean that African American men are a vulnerable population for hypertension.

Data from http://www.cdc.gov/nchs/data/hus/hus14.pdf, Table 60.



It seems obvious that vulnerable populations may suffer more from communicable diseases. Refugees or poor people may face unhealthy living conditions. As you just learned, street children may not realize the dangers they face from sexually transmitted diseases like HIV. However, noncommunicable diseases are also a serious problem for vulnerable populations.

These populations have less access to health care. So, in many cases an NCD will not be diagnosed as quickly as in populations that have better access to health care. While a person may know he doesn’t feel very well, he may dismiss it as “just a hard time catching my breath” or “pains in my chest once in a while,” without realizing that this could be the sign of something serious like chronic obstructive pulmonary disease (COPD) or heart disease.

Lack of access to health care means that even if an illness is diagnosed, the condition may not be managed as well as it should be. Imagine a poor child with asthma. She may be diagnosed and given an inhaler to treat her symptoms. Children with asthma can live very normal, comfortable lives with the proper treatment. But if money is tight in her family, they may not be able to afford the prescription refills. So the child simply suffers with the disease. If a child’s asthma becomes severe, her parents might take her to the emergency room, which then means they have a large bill to try to pay. In this case, a relatively manageable disease makes life much more difficult for someone who is part of two different vulnerable populations.



In the United Nations report “World Populations Ageing, 1950-2050,” researchers point out that not only are there more people living into their 60s and 70s, but more people are living into their 80s and even older. As the graph here shows, by 2050 researchers estimate that there will be close to 400 million people in the world who are over the age of 80.

As you already learned when you studied demographic transitions, a graying population can pose some serious challenges. This pattern of aging will create new vulnerable populations. Groups that are already discriminated against will now also be dealing with the increased health problems of old age. The strain of caring for older generations may also mean that fewer resources are available to help younger vulnerable groups. To make things even more complicated, the aging rate in developing countries is becoming more rapid than in developed countries. Developing countries, which are already struggling to meet the needs of their population, now have an additional challenge with growing vulnerable groups.

Data from UN publication “World Population Ageing, 1950–2050,” available online at http://www.un.org/esa/population/publications/worldageing19502050/pdf/90chapteriv.pdf.



City dwellers face three major health risks: communicable diseases that thrive in crowded and unsanitary conditions, noncommunicable diseases that increase due to unhealthy lifestyles more common in the city, and an increased number of accidents and injuries due to violence and crime. However, well-planned urban environments can mitigate these problems, and city dwellers can also benefit from increased access to medical care, healthy food, and good sanitation.

Vulnerable populations are more likely to live in these slum environments. The existence of such living conditions may also lead to an increasingly large vulnerable population, as the people who live in these slums face an increased risk of health problems.



Vulnerable populations frequently have less healthy eating habits. They may not have adequate education to know what foods are better for them. They may not have access to healthier food, because in some low-income communities there are a lot of fast-food restaurants and not a lot of grocery stores or other sources of healthy foods such as vegetables and fruit. Areas with poor access to healthy foods are known as “food deserts.” They may not have the money to buy healthier food, since it is often more expensive than unhealthy food.

The result is a worldwide epidemic of obesity. Today more than 40 million preschool children are obese or overweight. As you have learned, obesity increases the risk of heart disease, cancer, diabetes, and many other diseases. Vulnerable populations that already face higher risks for disease now have one more risk factor.



The United Nations, UNICEF, and other nongovernmental organizations (NGOs) focus much of their work on helping vulnerable populations. These populations are more likely to contract infectious diseases. If they already have a chronic disease, they may suffer more complications and setbacks because of their limited access to medical care. Since many of these groups are discriminated against in their community, they struggle to get the help they need. They are also at greater risk from the broad global trends of demographic aging and unplanned urbanization, and the global spread of unhealthy lifestyles.

It is important to remember that a vulnerable population in one community or country may not be vulnerable in another. However, vulnerable populations exist in every country in the world, and they need special help.



Dedicated global health workers are reaching out to the world’s vulnerable populations. For example, the children who live in the Kunene region of Namibia are especially vulnerable. The rural area where they live is very isolated and the terrain is rough. When medical help is needed, it often doesn’t get there fast enough. UNICEF worked with groups in Namibia to train community workers in health issues. These workers were then deployed to the region, where they could provide hands-on help.

Programs such as these are seeing success across the globe in the quest to reach and aid vulnerable populations.

Image retrieved from http://www.usaid.gov/namibia/global-health on October 23, 2013, and included here under fair-use guidelines of Title 17, US Code. Image copyright © USAID.




Assignment: Population Health Report


Directions: Research the health of one of the countries in the WHO Region of the Americas in preparation for writing a report that evaluates the vulnerable populations in that country and where the country is in terms of demographic and epidemiological transition. Before you begin your research, read through all of the instructions in this resource and read the assessment criteria at the end of it to make sure you understand how your work will be assessed. Be sure to go over the sample essay before you start writing.

Step One: Select a Country WHO Region of the Americas

Argentina

Bahamas

Bolivia

Chile

Colombia

Costa Rica

Ecuador

El Salvador

Guatemala

Guyana

Jamaica

Nicaragua

Panama

Paraguay

Peru

Suriname

Uruguay

Venezuela

Step Two: Research Your Country

1. As you research, keep track of the sources you use here. You will need to list your sources in your report. Refer to Student Resource 4.9, Guide: Citing Sources, to make sure that you include all of the information you need and that you format citations properly.

My sources:

2. Collect demographic data on the country you have selected. Go to the CIA World Factbook (https://www.cia.gov/library/publications/the-world-factbook/). Select the country that you have chosen. Expand the “People and Society” section by clicking it. Find the data for the life expectancy at birth and the infant mortality rate, and take note of the information. What does this tell you about the health of your country?



3. Go to the heading “Age Structure” in the “People and Society” section. Click on the population pyramid. What does the population pyramid tell you about the health of your country? What stage of demographic transition do you think your country is in?

4. Scroll through the other headings under “People and Society” and take note of other information you think may be important to include in your report, such as languages spoken or the total population of the country.

5. To find out where your country is in terms of its epidemiological transition, find your country’s page on the WHO site (for a list of countries, see http://www.who.int/gho/countries/en/). Download the country’s health profile (the title is usually something like “Country name: health profile”). Look at the chart at the top called “Distribution of years of life lost by causes.” Take note of your country’s percentage of years of life lost for communicable disease, noncommunicable disease, and injury. Based on this information, which stage of epidemiological transition do you think your country is in? If you are having difficulty accessing the report, use the report “Noncommunicable Diseases Country Profiles 2011” as an alternative source (www.who.int/nmh/publications/ncd_profiles_report.pdf). First find your country, and then look at the information in the pie chart about mortality at the top of the page.

6. Look for information about your country’s vulnerable populations. Remember, some populations are considered vulnerable in every country. Take note of those populations, but also think about specific populations, such as women or war refugees, that may be vulnerable. Take note of any initiatives that you read about that are helping vulnerable populations in your country. Look for information about vulnerable populations under the “Introduction” tab on your country’s CIA World Factbook page, on your country’s Wikipedia page, or on your country’s WHO page.

7. You will need background information about your country for the report. You will especially want to include information that has affected the country’s economy and health status, such as the income group of your country (lower income, middle income, etc.), wars or natural disasters that have affected your country, the geography and climate, and major health innovations. Look for information under the About tab on your country’s CIA World Factbook page, on your country’s Wikipedia page, or on your country’s WHO page.



Step Three: Write Your Report Now that you’ve done your research, it’s time to write your report. Your report should be a total of six short paragraphs plus one graph (and one image if time allows). Read the descriptions below of what each paragraph should contain and take notes about what you want to include in each paragraph before you begin writing. Make sure to also include your sources at the bottom of your report.

If you have time, include an image to illustrate your report (in addition to the graph mentioned above), such as a map, the country’s population pyramid, or a photograph of a member of a vulnerable population. Include a caption with the image.

Paragraph 1: Introduction. Use this paragraph to give some background information about your country, such as what its geography and climate are like, what languages are spoken, and what the total population is. The background information should include information that may be linked to the country’s health status or that may help the reader better understand the state of the country, such as recent wars it has engaged in or natural disasters it has endured.

Paragraph 2: Health Indicators. In this paragraph, give the life expectancy and infant mortality rate for your country and explain what these statistics say about the health status of your country. This would also be a good place to present some data as a graph.

Paragraph 3: Demographic Transition. In this paragraph, use what you learned from the country’s population pyramid to explain what stage of demographic transition you think your country is in.

Paragraph 4: Epidemiological Transition. In this paragraph, give the data you collected about years of life lost and explain what stage of epidemiological transition you think your country is in.

Paragraph 5: Vulnerable Populations. In this paragraph, explain what you’ve learned about specific vulnerable populations in your country and any initiatives you learned about that are in place to help these populations.

Paragraph 6: Conclusion. Conclude your report by summarizing the health status of your country.


The report’s introductory paragraph gives relevant and accurate background information on the country that will help the reader understand the country’s health status.

The report uses current and accurate life expectancy and mortality data to explain the country’s health status.

The report uses at least one graph to display relevant and accurate data.

The report describes the country’s population pyramid and uses that data to make an informed and logical guess about which state of demographic transition the country is in.

The report describes the causes of years of life lost and uses that data to make an informed and logical guess about which state of epidemiological transition the country is in.

The report demonstrates knowledge of what makes a vulnerable population.



The data in the report supports the summary of the country’s health status given in the report’s concluding paragraph.


Sample Analytical Report: Rwanda Rwanda is a country in Africa with a population of more than 11 million people. In the 1990s it experienced civil war and genocide, and an estimated 800,000 people were killed. Since then the country has made many changes, including revising its constitution and establishing a court system to prosecute people who committed genocide. In the 2000s Rwanda’s economy grew rapidly, and more tourists began to visit as well.

Rwanda’s life expectancy numbers are not very good. The life expectancy at birth is 58.85. This means that people do not live very long. The country’s infant mortality rate is 61 deaths per 1,000 live births. That is very high.

Rwanda is in the earliest stages of demographic transition. The country has very high birth rates and high mortality rates. There are nearly 1 million children born each year of each gender, but there are fewer than 200,000 people of each gender who are age 50 or above.

Most deaths in Rwanda are from communicable diseases, especially HIV/AIDS, which is a leading cause of death. In fact, three of the top causes of death are communicable diseases like tuberculosis, malaria, and even measles. This means that Rwanda is probably in the first stage of epidemiological transition, the Age of Pestilence and Famine, because there are so many deaths due to infectious disease.

Source (http://www.cdc.gov/globalhealth/countries/rwanda/)

Poor people in Rwanda are a vulnerable population. A UN report showed that 60% of the adult population lives below the poverty line, with 42% in extreme poverty. Many households are headed by widows because men were killed during the genocide in the 1990s. Other vulnerable groups include uneducated

0%

2%

4%

6%

8%

10%

12%

14%

Top Causes of Death in Rwanda (2008)



young people and the elderly. The government has set up a fund to help victims of the genocide. It has also formed specific policies to care for the elderly, in addition to creating laws to protect the elderly and programs to help them get food and medical care.

Rwanda suffered tremendous losses during its civil war and genocide. Since then it has been fighting to remake itself as a country. It has made progress, but it still has a long way to go. Rwanda remains in the earliest stages of demographic and epidemiological transition, with high infant mortality rates and deaths due to communicable diseases. Also, as a result of the civil war and genocide, it has a lot of vulnerable populations, particularly people living in poverty, and the elderly, who need special care and attention.

A woman visits the Nyamata Genocide Memorial Church in Rwanda where tens of thousands of people were killed and buried. The country is still struggling to recover from the economic, social, and health costs of the genocide.

Sources

“International Programs: International Data Base.” United States Census Bureau, http://www.census.gov/population/international/data/idb/region.php?N=%20Results%20&T=13&A=separate&RT=0&Y=2013&R=-1&C=RW (accessed October 19, 2015).

“Rwanda.” Wikipedia, http://en.wikipedia.org/wiki/Rwanda (accessed October 19, 2015).

“Rwanda WHO Country Office.” World Health Organization, http://www.afro.who.int/en/rwanda/who-country-office-rwanda.html (accessed October 19, 2015).

“The World Factbook.” Central Intelligence Agency, https://www.cia.gov/library/publications/the-world-factbook/ (accessed October 19, 2015).




Guide: Citing Sources

Use this guide to help you cite references correctly. It is useful for all of the reports you write in high school and college. It is also the way health professionals cite their sources of information when they submit their work for publication.

Creating a List of References

Any source you use for information in your article must be included in the list of references at the end. You want to cite the information in a way that would allow someone else to look it up easily. Here are some checklists for information to keep track of while you’re researching:

For a printed book, newspaper, or magazine:

Names of authors, in alphabetical order

Title of book, magazine, or newspaper. Put the title in italics.

If a magazine, include volume and issue numbers

If a book, include the publisher

Publication date

Page numbers where you found the information

Example of a book:

Erickson, John. An Introduction to Anatomy & Physiology, 103–107. Dubuque, Iowa: Kendall/Hunt Publishing Company, 2010.

Example of a magazine:

McMillian, Tracie. “The New Face of Hunger: Why Are People Malnourished in the Richest Country on Earth?” National Geographic Magazine, July 18, 2014: 47-72.

For a website:

Authors, if they are named

Name of website

URL of website

Date of publication, if available

Date that you accessed the website in parentheses

Example:

“All About Rosacea.” National Rosacea Society website, http://www.rosacea.org/patients/allaboutrosacea.php (accessed October 19, 2015).

Put your references in alphabetical order according to last names of authors or the first letter of the title if no author is given.


AOHS Global Health

Lesson 5 Human Rights, Ethics, and

Global Health In this lesson, students learn about the ethical principles that guide health care workers. Students begin by considering the concept of health as a human right, as expressed in the Universal Declaration of Human Rights. Students explore the connections between human rights and ethics and study the ethical principles of health care. They research and present their findings on real health initiatives, focusing on ethical principles. Students consider how ethical guidelines are implemented in the real world, specifically in the distribution of limited resources.

Advance Preparation

In Class Period 1, you will need access to the YouTube video about the food crisis in North Korea: http://www.youtube.com/watch?v=RYYKvpr1uTw. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

In Class Periods 2 and 4, students will need access to computers for Internet research, with one computer for every two to three students.


Lesson Framework


Describe human rights guaranteed by the Universal Declaration of Human Rights

Explain the relationship between health and basic human rights*

Describe ethical guidelines for research and explain why they are necessary

Evaluate how ethical considerations influence public health decisions

Develop an ethical argument related to a global health dilemma


AOHS Global Health Lesson 5 Human Rights, Ethics, and Global Health



Define informed consent (National Health Science Standards 2015, Standard 5.24)

Identify ethical issues and their implications related to healthcare (such as: organ donation, in vitro fertilization, euthanasia, scope of practice, ethics committee) (National Health Science Standards 2015, Standard 6.12)

Discuss religious and cultural values as they impact healthcare (such as: ethnicity, race, religion, gender) (National Health Science Standards 2015, Standard 6.21)


Assessment


Research findings chart on human rights and health initiatives (Student Resource 5.7)

Assessment Criteria: Human Rights and Health Initiatives Research Findings Chart (Teacher Resource 5.2)

Prerequisites Knowledge of current significant communicable disease challenges to global health (malaria,

HIV/AIDS, etc.)

Basic understanding of demographic transition and epidemiological transition


Teacher Resources Teacher Resource 5.1, Presentation 1 and Notes: Health Ethics and Human Rights (includes

separate PowerPoint file)

Teacher Resource 5.2, Assessment Criteria: Human Rights and Health Initiatives Research Findings Chart

Teacher Resource 5.3, Presentation 2 and Notes: Distribution of Scarce Resources (includes separate PowerPoint file)

Teacher Resource 5.4, Answer Key: Distribution of Scarce Resources Scenarios

Teacher Resource 5.5, Key Vocabulary: Human Rights, Ethics, and Global Health

Teacher Resource 5.6, Bibliography: Human Rights, Ethics, and Global Health

Student Resources Student Resource 5.1, Scenarios: Human Rights Violations



Student Resource 5.2, Reference: Universal Declaration of Human Rights

Student Resource 5.3, K-W-L Chart: Ethics and Human Rights

Student Resource 5.4, Reading: Health Ethics and Human Rights

Student Resource 5.5, Analysis: Ethical Guidelines in Refugee Camps

Student Resource 5.6, Reading: Ethical Treatment of Participants in Research Studies

Student Resource 5.7, Research Findings Chart: Human Rights and Health Initiatives

Student Resource 5.8, Scenarios: Distribution of Scarce Resources

Student Resource 5.9, Reading: Distribution of Scarce Resources

Equipment and Supplies LCD projector and computer for PowerPoint presentation and to show a video

Computers with Internet access and word processing software (one for every two to three students)


Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1 20 Scenarios: Human Rights Violations

Students begin to understand the concepts of ethics and human rights by considering examples of human rights violations across the globe.

To begin, write the following questions on the board and ask students to spend a few minutes reflecting on them in their notebook:

What are rights?

What rights do you have?

What kinds of rights should every human have?

After students have a chance to write down their answers, invite volunteers to share their thoughts. Students may have a limited understanding of rights, and their ideas may stem from what they know about the US Bill of Rights or the Constitution. Point out that those are American documents. Does everybody in the whole world get those same rights? Should they? Why or why not?



Step Min. Activity

Next, refer students to Student Resource 5.1, Scenarios: Human Rights Violations. Explain that these are short descriptions of real-world situations or events. Ask students to work in pairs or small groups, and assign each group one scenario. (There are five scenarios total, so more than one pair or group will be assigned each scenario.) Ask students to read their scenario and discuss in their group what the scenario has to do with human rights.

After a few minutes, ask groups to share what the scenario they read has to do with human rights. Guide students to recognize that these are all examples of what are called “human rights violations”—in other words, these are situations where people are not treated with the dignity and respect they deserve.

Refer students to Student Resource 5.2, Reference: Universal Declaration of Human Rights. Explain that after World War II, countries worked together to draft a Universal Declaration of Human Rights, which lists specific rights that every human being deserves to have. Tell students that the United Nations was responsible for drafting this declaration and that Eleanor Roosevelt, former first lady of the United States, was one of the leaders of the effort to develop this document. Point out that while this is meant to be a worldwide document, unfortunately not every country follows these guidelines.

Explain that each of the scenarios they read in Student Resource 5.1 describes a violation of one or more articles of the declaration, and point out the list of articles under each scenario. Ask students to work in their groups to discuss why their assigned scenario violates each of the articles. Then have groups share their ideas with the class. For groups that have the same scenario, you may wish to have different groups address different articles. As you discuss their ideas, continue to encourage students to think about why human rights matter and how governments and international bodies enforce (or don’t enforce) the guidelines of the Universal Declaration.

2

20 Analysis: Universal Declaration of Human Rights

In this activity, students begin to develop an understanding of what human rights are by considering examples of human rights violations across the globe. They compare these violations with the Universal Declaration of Human Rights and discuss why human rights are important, particularly in the field of global health.

Prior to class, prepare to project the video about the food crisis in North Korea at http://www.youtube.com/watch?v=RYYKvpr1uTw.

If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program. Or, if you cannot access this video, prepare to show another video that gives a human face to human rights violations.

Next, have students focus their attention on Article 25, which is the primary article concerning people’s right to health and medical care. Using an LCD projector, show the video “North Korean Children Bear Brunt of Food Crisis” (http://www.youtube.com/watch?v=RYYKvpr1uTw).

Lead a discussion to help students develop a more in-depth understanding of Article 25 by using questions like the following:

What are the key points of Article 25?

How did the video show that North Korea is in violation of these points?



Step Min. Activity

Using North Korea as an example, why do you think that motherhood and childhood are emphasized in Article 25?

Explain that this lesson will focus on human rights and ethics in relation to global health, and that Article 25 guides much of the WHO’s and other organizations’ work in global health care. Instruct students to reference the Universal Declaration of Human Rights as an ethical guideline throughout this course.

If time allows, ask students to add information on countries they learned about in this activity to their regional reference maps.

3 10 K-W-L: Ethics and Human Rights

As preparation for viewing a presentation on ethics and human rights, students consider what they already know about these topics and what they would like to know more about.

Refer students to Student Resource 5.3, K-W-L Chart: Ethics and Human Rights. Review how to use a K-W-L chart as necessary. Then instruct students to complete the What I Know and What I Want to Know columns for both topics.

After students have written a few items on their chart, ask them to share their chart with a partner and to write down anything they learn from their partner. Then explain that they will complete the What I Learned column with the information they learn during the next class period.

CLASS PERIOD 2

4

30 Presentation: Health Ethics and Human Rights

This activity provides students with a more in-depth understanding of ethics and human rights and how the two are related. It also gets them thinking about ethical and human rights issues in global health. In addition, it develops students’ listening and note-taking skills.

To prepare notes to guide class discussion using Teacher Resource 5.1, Presentation 1 Notes: Health Ethics and Human Rights. Have Teacher Resource 5.1, Presentation 1: Health Ethics and Human Rights (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Instruct students to get out their K-W-L chart and add to it as they view the presentation.


This presentation is duplicated as Student Resource 5.4, Reading: Health Ethics and Human Rights. If an LCD projector is unavailable, students can read the presentation, answer the discussion questions in their notebook, and discuss their answers. This student resource is also useful for review.

After the presentation, divide the class into pairs or triads and have them compare their K-W-L charts for accuracy and completeness. Answer any questions. You may want to



Step Min. Activity

gauge student understanding by assessing Student Resource 5.3, K-W-L Chart: Ethics and Human Rights, on a credit/no-credit basis.

Explain that in the next activity, they will find out how the ethical guidelines they have learned about are applied in real life.

5

20 Analysis: Ethical Guidelines in Refugee Camps

In this activity, students think about how the ethical guidelines they just learned about are (or are not) applied in real life by analyzing photographs of the world’s largest refugee camp, located in Kenya.

Divide the class into pairs or triads and assign each group to a computer. Refer students to Student Resource 5.5, Analysis: Ethical Guidelines in Refugee Camps.

Assign each group one of the ethical guidelines listed on the resource (or allow students to choose). Keep in mind that some of the guidelines, such as beneficence and honesty, may be more difficult for this activity. Instruct students to begin by writing down what they already know about their guideline based on the lesson so far. Students may wish to refer back to Student Resource 5.4, Reading: Health Ethics and Human Rights, for guidance.

Ask students to imagine themselves as members of the UN High Commission for Refugees. Their job is to find evidence indicating whether or not the Dadaab camp is being run in an ethical way, focusing on their specific guideline.

Go through the instructions on the resource with the students, and answer questions.

Give students time to complete the resource, and then ask each group to share which photograph they chose. Use an LCD projector connected to your computer to project each chosen photograph while the group explains what they see in the photograph indicating that their guideline is or is not being observed.

Guide students to recognize that while some photographs may have made it very clear whether or not the guidelines were being followed, ethics are very complicated, and the UN High Commission would probably conduct several visits to a camp in order to evaluate its management. Also point out that ethics can be a personal topic, and different people may interpret the same ethical guideline in different ways. Tell students that in the next class period, they will continue to explore how different perspectives can be brought to the same ethical issue.

CLASS PERIOD 3

6 30 Reading: Ethical Health Issues

In this activity, students learn more about how ethics are important in the practice of medicine.

Before class begins, read over Student Resource 5.6, Reading: Ethical Treatment of Participants in Research Studies, and familiarize yourself with the content.

Draw the two following charts on the board, and ask students to create these charts in their notebook:



Step Min. Activity

Characteristics of Ethical Research Study

Characteristics of Unethical Research Study

Ethical Aspects of AZT Trials

Unethical Aspects of AZT Trials

Instruct students to read Student Resource 5.6 and take notes on the first part of the reading in the first chart, and take notes on the AZT trials in the second chart. Tell them that as they read and take notes, they should decide if they think the AZT short course trials were ethical, in preparation for a debate in the next activity.

Ask students to talk briefly with a partner about their decision in preparation for the debate.

7 20 Vote with Your Feet Debate: Ethical Health Issues

Students apply what they have learned about medical ethics to a real-life medical controversy by holding a debate. This activity also provides them with a chance to practice persuasive argument and impromptu speaking. This activity focuses on the following college and career skills:

Thinking critically and systemically to solve difficult problems


To begin, post the following statement on the board:

The AZT short course trials were ethical.

Next, explain to the students that they are going to have a Vote with Your Feet debate. Ask students to stand up and move to the left side of the room if they agree with the statement on the board. If they disagree with the statement on the board, they should move to the right side of the room. If they are undecided, they should stay in their seats. Allow students to take their notes with them.

Once students have moved, explain that they are going to debate this topic. Their goal should be to convince their peers to stand on their side of the room. They can do this either by persuading the undecided people or by convincing people on the other side to change their views.

Set a time limit of six minutes for the debate. Call on a volunteer from the right side of the room to share one reason he or she chose that side. Remind students to keep the sharing brief, one minute tops, since they need to allow time for other people to speak. When that person stops talking, allow students to move to a different side if they wish. Then invite a volunteer from the other side to respond, and allow students to move after that speaker finishes. Repeat the process, allowing someone from the left side of the room to speak first and someone from the right to respond, allowing students to move after each speaker if they wish.

When the six minutes are over, note which side has the most students. That side wins the debate. When the debate is over, ask students:

How did what you know about the ethical principles of autonomy, beneficence, justice, dignity, and honesty come into play in this debate? Did they affect your



Step Min. Activity

opinion? Why or why not?

If time allows, invite a few students to share their thoughts.

CLASS PERIOD 4

8

50 Research: Current Initiatives to Promote Human Rights Related to Health

In this activity, students explore programs currently in place to promote human rights and improve global health.

Before beginning this activity, review the list of global health initiatives provided in Student Resource 5.7, Research Findings Chart: Human Rights and Health Initiatives. Consider providing additional resources to students based on your own reading and research.

To start the activity, divide the class into pairs and refer students to Student Resource 5.7. Point out that there are many people working in governments or nongovernmental organizations (NGOs) to address human rights and health issues in countries all over the world, and explain that students are going to look at one specific initiative and report back to the class on it.

Assign each pair one of the initiatives listed on the resource (or let them choose), and ask students to read the instructions for the assignment. Next, have students look at the assessment criteria, and then read over the example with students and answer any questions they have about how the example meets the assessment criteria.

Instruct students to access the site for the initiative assigned to them and fill in their chart. Circulate while students are working and answer questions.

Near the end of the class period, tell pairs to take a few minutes to think about how they will present the information to their classmates in the next class period. Point out that they should plan to briefly explain where the initiative took place, what disease was treated, and how the health initiative worked. They should also share which ethical principles apply to the initiative.

If necessary, instruct students to finish up their chart for homework and come to the next class period ready to share their findings with the class. Remind students to make sure that their assignment meets the assessment criteria.

CLASS PERIOD 5

9 35 Class Discussion: Health Initiatives

In this activity, students share what they learned during their research on global health initiatives and discuss how global health priorities are established.

Have students regroup with their partners from the last class period, and give them one or two minutes to rehearse what they want to report to the class.

Call on pairs to present the initiative they reviewed. As time allows, encourage students



Step Min. Activity

to ask questions about each report.

Collect the health initiative charts and assess them using Teacher Resource 5.2, Assessment Criteria: Human Rights and Health Initiatives Research Findings Chart. Then compile the charts in a binder or notebook so that there is a class list of health initiatives to refer to for future activities.

To conclude this activity, help students recognize that certain diseases or conditions, especially malaria and HIV/AIDS, get a lot of attention, whereas others do not. Invite students to talk about why they think some diseases get more attention than others. Point out that in many of the countries they reported on, resources are extremely limited, so the question of how to draw attention to a disease or condition is really important. Getting funding, supplies, or donations could mean the difference between life and death for some people. Let students know that they will next look more closely at how to allocate limited resources.

10 15 Homework: Distribution of Scarce Resources

The objective of this activity is to have students consider the ethics involved in distributing scarce resources.

Refer students to Student Resource 5.8, Scenarios: Distribution of Scarce Resources. Ask students to read over the scenarios on Student Resource 5.8 and decide whether these choices are ethical. Why or why not?

Tell them that they will be working with these scenarios in the next class period and will learn more about the ethics involved in distributing scarce resources. If they don’t finish reading the resource in class, tell students to complete it for homework.

CLASS PERIOD 6

11

50 Presentation: Distribution of Scarce Resources

This activity gives students a more in-depth understanding of the four principles of distributing scarce resources.

To prepare, make notes to guide class discussion using Teacher Resource 5.3, Presentation 2 Notes: Distribution of Scarce Resources. Have Teacher Resource 5.3, Presentation 2: Distribution of Scarce Resources (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Ask several students to offer their opinions on the scenarios in Student Resource 5.8, Scenarios: Distribution of Scarce Resources. They should explain why they think the choices are or are not ethical.

Explain that there are general principles that global health professionals have developed. These principles help them determine who receives help first. Tell students to keep the scenarios they just read in mind as they view this presentation, and to note anything they learn that relates to ethical distribution of resources in a particular scenario on their resource. Advise them that you will be revisiting the scenarios when the presentation is over.

Present the slideshow. Use your preferred method for presenting this material. This



Step Min. Activity

presentation is also duplicated as Student Resource 5.9, Reading: Distribution of Scarce Resources, to use according to your preferences.

After the presentation, ask students to work with a neighbor and return to Student Resource 5.8 to reevaluate the scenarios. Write the following questions on the board for students to consider:

Are the resources being distributed ethically in each scenario?

Which principle or principles for distributing resources are at work in each scenario?

As necessary, go through the slide presentation again while students reevaluate the scenarios. Answer any questions using Teacher Resource 5.4, Answer Key: Distribution of Scarce Resources Scenarios.

Point out that how to use limited resources is an extremely challenging decision but one that global health professionals are faced with on a regular basis.

You may want to gauge student understanding by assessing Student Resource 5.8 on a credit/no-credit basis.

Extensions

Content Enrichment Have students research the specific codes governing scientific research, such as the Nuremberg

Code and the Declaration of Helsinki. Ask students to compare/contrast these codes with the ethical principles they learned in this lesson. How much do the codes overlap? What additional ethical principles apply to research (for example, having review boards monitor research, and avoiding plagiarism)?

Ask students to write personal responses to the clarification of the right to health by the United Nations High Commissioner for Refugees (UNHCR):

o The right to health does not mean the right to be healthy, nor does it mean that poor governments must put in place services for which they have no resources. But it does require governments and public authorities to put in place policies and action plans that will lead to available and accessible health care for all in the shortest time possible. To ensure that this happens is the challenge facing both the human rights community and public health professionals.

Student responses can answer such questions as: Whose responsibility is it to work toward providing a decent level of health care for all populations? What obstacles do you think the responsible parties face?

Ask students to write a persuasive ethical argument on which populations should receive a new malaria vaccine first. Explain to the class that in August 2014, researchers announced that they had made major strides in developing a malaria vaccine, and they anticipate that a vaccine will be available relatively soon. Tell students that often when a new vaccine is released, the supply is limited, and ethical decisions must be made about whom to give it to first. Ask students to say, based on what they already know about vulnerable populations, which populations they think should be the first to receive the malaria vaccine. Possible populations to receive the vaccine first: the US military; the pharmaceutical company that manufactures the vaccine; child health



advocates; maternal health advocates; HIV advocates; health ambassadors from Africa; and medical providers.

Divide the class into groups and have each group research a controversial topic connected to health, such as the issue of generic drugs vs. intellectual property rights, or the distribution of donated organs. Ask each group to give a short presentation to the class on a controversial issue. Have students vote on an issue or issues they are interested in, and hold a debate (or a series of debates).

Ask students to watch one of the following brief documentaries on the Tuskegee syphilis experiment (https://www.youtube.com/watch?v=FFWiLKA-91s or https://www.youtube.com/watch?v=vCHU1-UKNQg), and then have them identify the human rights articles violated by the experiments. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

Have students read The Immortal Life of Henrietta Lacks by Rebecca Skloot. As students read, ask them to keep a list of ethical questions that the book raises. After they have completed reading, have them choose one of the questions to explore further in an essay.

STEM Integration Technology: Take virtual field trips to places that are connected to the people or places students

researched for their global health initiatives.

Additional Cross-Curricular Ideas English Language Arts: Have students take notes during the Vote with Your Feet debate and use

those notes to write a persuasive essay about the AZT short trials. Guide students to recognize that sometechniques for oral debate are the same as the techniques used in a persuasive essay, while other techniques work better in a public-speaking format than in a written format.

English Language Arts: Have students watch the movie Miss Evers’ Boys. Then ask them to write a review of the movie, focusing on whether the movie was effective in showing several sides of an ethical issue.

History/Social Studies: Have students research the historical context of the Universal Declaration of Human Rights. Why was this document created at this specific time in history? What events preceded it? What impact has it had on events since its creation? You may wish to broaden the activity to include a greater analysis of the existence of (and efficacy of) the United Nations as a whole, or compare the UN to the League of Nations.

History: Ask students to conduct research on the Geneva Convention, which established humanitarian principles for all nations to follow during armed conflict. Tell students to compare the Geneva Convention protocols with the Universal Declaration of Human Rights. How do they support each other? How are they the same or different? Ask students to write comparative essays exploring these questions.


AOHS Global Health


Global Health

Teacher Resources


Teacher Resource 5.1 Presentation 1 and Notes: Health Ethics and Human Rights (includes separate PowerPoint file)

Teacher Resource 5.2 Assessment Criteria: Human Rights and Health Initiatives Research Findings Chart

Teacher Resource 5.3 Presentation 2 and Notes: Distribution of Scarce Resources (includes separate PowerPoint file)

Teacher Resource 5.4 Answer Key: Distribution of Scarce Resources Scenarios

Teacher Resource 5.5 Key Vocabulary: Human Rights, Ethics, and Global Health

Teacher Resource 5.6 Bibliography: Human Rights, Ethics, and Global Health




Presentation 1 Notes: Health Ethics and Human Rights


Note: For this particular presentation, you will need to make a point of reading aloud the ethical scenarios presented in the notes of Slide 6 and on Slides 7, 9, and 10.

What are ethics? How are ethics different from human rights? In this presentation, you will learn about how ethics and human rights impact the work of global health professionals.

Presentation notes



People learn and develop their own personal set of ethics in various ways.

Most people learn their basic ethical foundation from family members. These childhood teachings shape our most fundamental attitudes about what is right and what is wrong. Sometimes a person’s ethics come from a spiritual or religious belief or a certain way of doing things in their community.

Culture also affects a person’s ethics. Imagine a business in the United States where a salesperson uses a bribe to influence somebody to use the business. In the United States, that practice would be considered unethical. But in many countries, bribes are seen as “gifts” and are a customary part of a business transaction.

Most people in the United States would say their personal code of ethics includes things like:

• Don’t hurt anybody (unless it’s self-defense).

• Be kind to children and animals.

• Don’t discriminate against people because of their race, religion, or gender.

Some people also have a specific code of ethics for their job. For example, firefighters, police officers, and soldiers have a code of ethics that reflects the dangerous job they do. Teachers have ethical guidelines—for example, a teacher shouldn’t flunk a student based on his or her dislike of that student.

Doctors, nurses, and health professionals have their own code of ethics, too. You may have heard the phrase, “First, do no harm.” That means that a health professional’s first job is to make sure not to make things worse by his or her treatment of the patient. That is part of a code of medical ethics.

Presentation notes



In a world where millions of people and communities face discrimination and violence, it is essential to have a shared value system that calls on governments, institutions, and individuals to respect the fundamental rights of all people. Human rights are intrinsic and belong to everyone. There are no exceptions based on religion, caste, gender, class, sexuality, geographic location, or any other factor. Human rights are part of our everyday lives, and each one of us is responsible for their protection and promotion.

The Universal Declaration of Human Rights is a statement of human rights principles that was adopted by the United Nations on December 10, 1948. It says that “all human beings are born free and equal in dignity and in rights” and covers a wide range of different types of rights, including political rights, legal rights, equality rights, and economic rights.

Adapted from International Human Rights Funders Group, interviews conducted with board members, 2011. https://www.ihrfg.org/human-rights-funding/faqs-about-human-rights#faq4 (accessed October 20, 2015).

Presentation notes



Human rights are an expression of ethical values. It is unethical to deprive someone of his or her human rights. The UDHR clearly states that medical care is a human right, so refusing to treat someone is a violation of that individual’s human rights. But what if a patient doesn’t want to be treated? What is the ethical thing to do in that situation?

What do you do if a patient has a serious illness and no way to pay for the expensive drugs or treatment? Does that patient simply not get treated? Is that a violation of the patient’s rights? If patients receive treatment they cannot afford, who pays for that cost? And what do you do in situations where there are hundreds or thousands of sick people who cannot pay? There are not enough resources to treat them all. What is the ethical thing to do in that situation?

You just heard about the idea of “First, do no harm.” But what if a dangerous operation gives a surgeon the chance to cure a patient of an otherwise incurable illness? What is the ethical thing to do in that situation?

Health ethics or medical ethics can serve as a guide when managing difficult situations like these.

Presentation notes



These five principles are common throughout medical practices around the world. Many countries have laws about medical practice that are based on these principles.

Presentation notes



Autonomy means patients have the right to refuse or choose their treatment. This requires that medical professionals respect the wishes of their patients. This may be difficult under some circumstances. What if someone with a terminal illness has also become depressed? This patient might not be in the right frame of mind to make a good decision. Or what if a patient is mentally ill or disabled? The person might not be able to make good decisions. And what if someone is in a coma? That patient is unable to make decisions for him- or herself and may need a family member to make difficult decisions. However, if a patient is conscious and in his or her “right mind,” medical professionals have a responsibility to present an overview of choices and then let the person make the decision about the course of treatment.

In Brazil, there are many tribes of indigenous people who follow the traditional ways of their ancestors. Imagine you are a doctor treating members of a tribe. One of the women is having complications in her pregnancy. If she is not taken to a hospital to have her baby, she and the baby might die. But her wish is to have the baby in her village, and she feels that if one of them dies, that is what is supposed to happen. The ethical principle of autonomy means that she should be allowed to make that decision.

Image retrieved from http://commons.wikimedia.org/wiki/File:%C3%8Dndia_da_etnia_Terena.jpg and reproduced here under the terms of the Creative Commons Attribution 3.0 Brazil (http://creativecommons.org/licenses/by/3.0/br/deed.en). Image courtesy of Valter Campanato/ABr.

Presentation notes



There are two parts to the concept of beneficence: (1) taking actions that serve the best interest of a patient and (2) balancing benefit against risk.

In Bangladesh, diarrhoea is a major cause of death in children under 5. Mothers could treat this with a liquid mixture that rehydrates. An NGO wanted to teach mothers to do this. But the mothers were illiterate, and an improperly prepared mixture could make the children sicker. In this example, providing the liquid mixture to sick children is clearly in the children’s best interest. However, the NGO had to find a way to balance the benefit against the risk.

In this case, the NGO decided to try to find a way to educate the mothers so they would make the mixture properly. They created a chart that used pictures to demonstrate how to make the solution. Then they practiced with the mothers, showing them how to make the correct liquid mixture, and they had the mothers make it under supervision. Once they were satisfied that the mothers understood, the NGO workers moved on to another village, but they came back to check up on the mothers and to make sure they remembered how to make the solution correctly. This approach worked. When tested later, approximately 90% of the women remembered how to make the solution. Within the next decade, experts estimate that close to 50% of the cases of diarrhoea in the country were treated with this solution.

Presentation notes



Justice means providing medical care to everyone, no matter who they are. It is about fairness and equality among all groups of society. It requires thinking about how to use health resources that are in short supply so that they reach as many people as possible. Justice also means that health care professionals treat every patient the same, regardless of age, race, sex, personality, or income.

Justice is often difficult to achieve because of competing needs, rights, and obligations. Sometimes ignorance and prejudice get in the way. For example, in some countries in Africa, people are ignorant about how HIV is passed from one person to another. Many local hospital workers are scared that they can catch it, so they have refused to treat people with HIV. In order to follow the ethical principle of justice, you would need to educate all the local workers so that they understand that they can safely treat the patient.

Providing justice in health care is often difficult or impossible because of many other factors, too: poor nutrition, bad housing, war, or discrimination. One doctor, nurse, or health care worker cannot solve these massive problems alone. But ethically, medical professionals are obligated to do their part to help make sure that health care is distributed as fairly and as equally as possible.

Presentation notes



The ethical principle of dignity means that every person is born with the right to be treated with respect and to receive medical care. But right now in many places in the world, poor people, illiterate people, and people of various races and religions do not receive the health care they need. Or they may receive undignified treatment while seeking health care.

Dignity also means respecting other people’s beliefs, even if they are different from yours. For example, by 2005 polio was almost wiped out globally. But people began to refuse the vaccine in Nigeria because of rumors that the vaccine would sterilize patients, or make them unable to have children.

Health care workers in Nigeria knew that the vaccine would protect people from polio, but they also understood the need to show respect for the local people. So the health care workers treated the patients with dignity and explained why the vaccine was safe and effective. Yet in spite of their efforts, polio remains a problem in some parts of the world today.

Sometimes medical professionals have to find a balance between respecting beliefs and doing what is right, and ethical values do not always give the answers. But they do provide a useful framework for dealing with difficult situations like the ones on this slide.

Image courtesy of Khalid Mahmood and retrieved from http://commons.wikimedia.org/wiki/File:A_Pakistani_Woman.JPG. Reproduced here under the terms of the GNU Free Documentation License (http://commons.wikimedia.org/wiki/Commons:GNU_Free_Documentation_License_1.2).

Presentation notes



How much information is a patient entitled to receive before accepting or refusing treatment? Is a physician or other health provider ever permitted to deceive or withhold information from a patient? In years gone by, information was given or withheld as doctors thought best.

People have a right to know what is happening to their own bodies. WHO guidelines for treating diseases like tuberculosis and HIV/AIDS make it clear that people need to be informed about risks to themselves as well as risks to the community.

Honesty is also connected to the principle of autonomy. Autonomy means people have the right to make their own decisions about their health care, but they need to understand their conditions and their treatment options before they can make a good decision. This is called informed consent or informed refusal. It means a patient has enough information to make an informed decision about his or her treatment.

In the case of the young woman in Guatemala, the ethical obligation as a health care worker is to be honest with her and tell her about her condition and treatment options. You would also have an obligation not to share this information with other people—that is doctor-patient confidentiality.

Honesty also plays a role in medical research, which you will learn about later in this lesson.

Presentation notes



Autonomy: In health care, this is the right of a patient to make decisions about his or her own care.

Beneficence: This is the balancing of good vs. risk. If the woman is part of an isolated tribe, bringing her into a city hospital would expose her and the baby to germs they have no resistance to. Not only could the woman or her baby get sick, but they could bring those germs back with them to the vulnerable tribe. So bringing her to the hospital could do good, yet it could also do a lot of harm.

Justice: This woman and her baby deserve medical treatment, even though they are part of an isolated and poor tribe. If the woman cannot be taken to a hospital, the principle of justice means she deserves the best medical care possible under the circumstances.

Dignity: The woman’s refusal has to do with ancient traditions that may not make sense to our modern perspective, but she deserves to be respected and treated with dignity.

Honesty: The woman cannot make an informed decision unless medical professionals are honest with her. If you tell her truthfully that she or the baby might die, and if she would rather take that risk than go to a hospital, then you have behaved ethically and she has made an informed refusal. All of these principles together guide medical professionals in decision making every day.

Presentation notes




Assessment Criteria: Human Rights and Health Initiatives Research Findings Chart

Student Names:______________________________________________________________

Date:_______________________________________________________________________


Met Partially Met

Didn’t Meet

The research chart demonstrates an understanding of a global health initiative by accurately describing the place served, the population that benefited, the important steps taken, and any known results.

□ □ □

The research chart clearly identifies and explains the ethical principles that apply to the initiative.

□ □ □

The research chart is neat and uses correct spelling and grammar.

□ □ □

The summary for the class clearly explains how the initiative worked and what ethical principles apply to the initiative.

□ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Presentation 2 Notes: Distribution of Scarce Resources


Global health professionals often have to make decisions about how to distribute health resources, because there are not enough resources to go around. In this presentation, you will learn about the guiding principles that health professionals use to make these difficult choices.

Presentation notes



A limited supply of medical resources is a challenge for all countries, developing and developed. Often there isn’t enough to meet the need.

In the United States, there were more than 29,000 organ transplants performed in 2014. Yet organ donation groups estimate that there are more than 122,000 people in the United States alone currently waiting for an organ donation. Imagine you are in charge of an organ donation program. Someone dies and donates his organs: how do you decide which person gets his heart? His liver? His eyes?

Some decisions involve the distribution of financial resources or material. What if you are a government official who is in charge of building a new hospital? How do you decide where to build it? Do you build in the country, where you have more space? Or in the city, where there is a higher population density and therefore more people who need help?

Or maybe you’re a doctor or nurse working with HIV patients in South Africa, where 2012 estimates suggest that 6.1 million people are suffering from HIV and AIDS. The antiretroviral drugs they need are very expensive, and you can only get a limited supply. How do you decide who gets treated?

In the spring of 2011, Colombia was devastated by floods. Almost 7,500 homes were destroyed and more than 225 health institutions were damaged. If you were part of a disaster relief group sent into Colombia to help, what would you do? Where would you start?

Source of data: https://www.unos.org, http://www.organdonor.gov/about/data.html, and http://www.avert.org/hiv-aids-south-africa.htm.

Presentation notes



Sometimes health resources are distributed by unfair methods. Some countries have used a first come, first served approach, meaning that the first people to ask for help received what they needed.

This can sound fair, but in practice it can favor those people with political connections. In low-income countries that may already have very corrupt governments, this can lead to government officials and their families being well cared for, while less well-connected people who are truly suffering get no help at all. In other cases, groups of people are prevented from getting the care they need because of poverty or discrimination.

To prevent this, global health professionals use these four guiding principles to help them make good decisions when distributing medical resources. On the following slides, we will consider each of these principles in more depth.

Presentation notes



The principle of health maximization states that a health professional should use resources in the way that will have the greatest overall impact on health. In this example, the principle would lead you to buy the mosquito nets because you could have a greater overall impact by providing a preventive tool to 200 families rather than drugs to 50 people. You also have to consider whether the people who need the most help are the people who you are best able to help.

In 2010 a serious earthquake struck Haiti. Large portions of the capital city, Port-au-Prince, were destroyed. Because a lot of people live in the capital city, the principle of health maximization would dictate that relief groups focus on helping the people there.

But there were people who lived out in the country, and before the earthquake they had been even poorer than those living in the city. When the earthquake happened, the people in the countryside were suffering, and they had fewer resources to help them. So, in this case, health maximization might actually lead to more people dying in the country. The people health professionals were best able to help (the city dwellers) were not necessarily the people who needed the most help (the country people).

That is why health professionals consider more than one principle when determining how to distribute scarce resources. In this situation, another principle might override the principle of health maximization.

Presentation notes



This principle recognizes that some people need more help because they were disadvantaged to begin with. In other cases, people need more help because they are more directly impacted by the disease, violence, or natural disaster. In the case of the Japanese earthquake and tsunami, the principle of priority to the worst off meant that people in smaller towns got more aid than people in Tokyo because they were more directly affected.

That sounds fair. However, this principle has its difficulties, too. First of all, how do you determine who is the “worst off”? Imagine there is a pandemic flu outbreak and you have to decide who will get drugs that can treat the disease. Do you give the drugs to the people who are sickest right now? Or do you give the drugs to people who just got sick but who have preexisting conditions that make them more likely to die from the flu, like pregnant women or the elderly? Which group is the worst off?

What if the worst-off group is already terminally ill? If you are working with HIV patients in South Africa, do you spend your money on antiretroviral drugs for people with HIV or on preventive measures to stop more people from getting HIV in the first place? The principle of priority to the worst off doesn’t always solve the problem, either.

Presentation notes



Equality is an important principle in the distribution of resources. In some countries, international supervision is needed to make sure resources are distributed equally. For example, Rwanda experienced a civil war and genocide during the 1990s. At one time, the people responsible for the genocide were in control of parts of the country. If you were running an NGO that wanted to donate food or medical supplies, you wouldn’t want to rely on those people to distribute your supplies, because they would likely not hand out the supplies equally.

Like the other principles, equality doesn’t address every problem. Imagine you are in charge of distributing donated organs. If you wanted to follow the principle of equality, you might hold a lottery. That way, everyone who needed a kidney had the same chance of getting one. You would just draw a name at random and that person would get a transplant. It sounds fair, but is it the best use of resources? What if the person who wins the lottery is very ill and likely to die soon? Does it still make sense for that person to get a transplant? What if someone who had been on the list to get a kidney for only a month won out over someone who had been on the list for six months? Distributing organs is a complicated process that involves several of these principles of distribution of scarce resources, not just one.

Presentation notes



The principle of personal responsibility states that people need to make an effort to take care of their own health. In the case of the donated liver, the liver would go to the woman with hereditary liver disease, because she did not cause her illness and she tries to take care of her health.

This principle sounds logical: if resources are limited, you should give the resources to people who will use them properly, not waste them on people who don’t take responsibility for their own health. However, in real life it isn’t always so easy to determine who is being responsible and who isn’t.

HIV/AIDS is one of the diseases where this principle is frequently cited. Many people acquire HIV because of lifestyle choices; for example, using drugs or having unprotected sex with multiple partners. But sometimes people acquire HIV through no fault of their own. What if a woman’s husband contracts HIV because he cheats on her and she gets the disease from sleeping with him? She did not do anything irresponsible, but she now has the disease.

When applying the principle of personal responsibility, it is important to consider whether the person knew that what he or she was doing was a health risk. People who are illiterate or poorly educated may not understand the risks they are taking. In other cases, they may not have had much choice. Children living on the streets will eat and drink whatever they can get her hands on. If they get sick from eating bad food or drinking dirty water, that isn’t really their fault.

Presentation notes



As you have seen, each of these principles can be used to make a good argument for how to distribute scarce resources, but each of them has its own weaknesses as well. When trying to determine how to distribute resources, health professionals use a combination of all of these principles to guide them.

For example, imagine that a major earthquake has struck Los Angeles. The first aid that arrives would probably go to the people who lived closest to the epicenter, where the shaking was the worst (priority to the worst off). Aid might be distributed through local hospitals or at relief shelters where the greatest number of people could get assistance (health maximization). Hospitals and Red Cross clinics would care for anyone who was injured, whether it was a street person who was cut by broken glass or a millionaire whose expensive house collapsed in the quake (equality). And the first people cared for would be the ones injured by the quake, not looters or people who took foolish chances after the quake hit (personal responsibility). By using all four principles, resources would be distributed fairly, even under difficult circumstances.

Presentation notes




Answer Key: Distribution of Scarce Resources Scenarios

Scenario 1 An NGO has obtained a stock of drugs to treat HIV in African countries. There are thousands of people dying from HIV each year. The NGO’s staff decides to use their medications to treat HIV-positive pregnant women so that their children will be less likely to be born with HIV.

Which principle or principles guided that decision?

Principle of health maximization: Children born without HIV will have a greater positive impact on the overall health of the country.

(Optional) Principle of personal responsibility: The children did nothing to infect themselves with the disease, so they deserve to be protected from it.

Scenario 2 An obese woman visits a doctor and requests gastric bypass surgery, a procedure that alters the process of digestion and can help people lose weight. She explains that she doesn’t like to diet and she’s too tired to exercise, so she thinks the surgery will help. The doctor examines her and agrees that she needs to lose weight but refuses to do the surgery. The doctor explains that the surgery will not solve her weight problem unless she also makes an effort to watch what she eats and takes time to exercise. He tells her to begin a diet and exercise regimen and return to him in six months if she has not seen any results from those efforts.


Principle of personal responsibility: The woman doesn’t want to take responsibility for her weight, so the doctor refused to treat her.

Scenario 3 A massive tornado tore through Alabama, Mississippi, Georgia, and Tennessee in April 2011, leaving dozens of people dead and many homes and businesses destroyed. Tuscaloosa, one of the largest cities in Alabama, was one of the hardest hit places. The tornado went through the center of town, where it flattened buildings, killed people, and left thousands without electricity.

The University of Alabama is located in Tuscaloosa. It is a large campus, and while many of its students suffered tremendously because of the tornado, some campus buildings were undamaged. Many people gathered at the university because they had nowhere else to go. While there were many towns in need of assistance, volunteer groups decided to begin distributing aid and relief supplies at the university first.


Principle of health maximization: They can help the most people in the shortest amount of time by going to the university since there were many people there already.

Principle of priority to the worst off: Tuscaloosa was one of the hardest hit cities. By setting up shelters and such there, they could help the people in the most difficult circumstances first.



Scenario 4 In the United States, organ donation is managed by the United Network for Organ Sharing (UNOS), a nonprofit overseen by the federal government. UNOS maintains a national waiting list of all people who are waiting to receive organs. When an organ becomes available, UNOS uses computer software to determine which people on the waiting list are matches for that organ. UNOS notifies the medical teams for those people and the transplant is arranged. UNOS distributes organs on the basis of that biological match—whether a person is rich or poor, young or old, does not matter as much as having the right match so that the transplant will be more likely to be successful.


Principle of equality: The network distributes on the basis of biological match, not using any other criteria.




Key Vocabulary: Human Rights, Ethics, and Global Health

Term Definition

antiretroviral A substance or drug that suppresses the activity of retroviruses such as HIV.

autonomy In health care, the right of a patient to make decisions about his or her own care.

AZT (Zidovudine) A drug (formerly called azidothymidine) used against HIV.

beneficence In health care, the principle of balancing the opportunity to do good vs. the chance of doing harm.

dignity In health care, treating each patient with respect.

ethics Moral principles that govern a person or group’s behavior.

human rights Rights that are believed to justifiably belong to every person.

informed consent The idea that patients or research subjects must be informed of what will happen to them and what the risks are before they consent to participate in a study/undergo treatment. Patients/research subjects must also be competent to give informed consent, which rules out certain groups such as children, mentally ill or disabled people, and unconscious people.

justice In health care, being fair or equal in the distribution of care.

NGO Nongovernmental organization, such as a not-for-profit group or group of volunteers; some NGOs are very active in developing countries and provide resources that impoverished governments cannot.

PEPFAR President’s Emergency Plan for AIDS Relief.

retrovirus An RNA virus (a virus composed of RNA, not of DNA). Retroviruses have an enzyme that allows them to transcribe their RNA into DNA. The retroviral DNA can then integrate into the chromosomal DNA of the host cell to be expressed there. HIV is a retrovirus.

scarce Limited; insufficient for the demand.



Term Definition

UNICEF United Nations Children’s Fund.

USAID US Agency for International Development.




Bibliography: Human Rights, Ethics, and Global Health





Online “About.” UNOS, http://www.unos.org/about/index.php (accessed October 20, 2015).

“Chlamydia Infection.” Wikipedia, http://en.wikipedia.org/wiki/Chlamydia_infection (accessed October 20, 2015).

“Colombia Situation Reports.” WHO, http://www.who.int/hac/crises/col/sitreps/en/ (accessed October 20, 2015).

“Definition of AZT.” MedicineNet, http://www.medterms.com/script/main/art.asp?articlekey=11435 (accessed October 20, 2015).

“Definition of Retrovirus.” MedicineNet. http://www.medterms.com/script/main/art.asp?articlekey=5344 (accessed October 20, 2015).

“Fighting Malaria: Stories from Two Villages.” WHO, May 3, 2005, http://www.who.int/features/2005/malaria/en/index.html (accessed October 20, 2015).

Foster, Peter. “North Korea Faces Famine: ‘Tell the World We Are Starving.’” Telegraph, July 16, 2011, http://www.telegraph.co.uk/news/worldnews/asia/northkorea/8641946/North-Korea-faces-famine-Tell-the-world-we-are-starving.html (accessed October 20, 2015).

“Guidance on Ethics of Tuberculosis Prevention, Care and Control.” WHO, 2010, http://whqlibdoc.who.int/publications/2010/9789241500531_eng.pdf (accessed October 20, 2015).

“Health for All.” Wikipedia, http://en.wikipedia.org/wiki/Health_For_All (accessed October 20, 2015).

“HIV & AIDS in South Africa.” Avert, http://www.avert.org/aidssouthafrica.htm (accessed October 20, 2015).

Hopper, Jessica. “Digging for Gold, Children Work in Harsh Conditions, Paid with Bags of Dirt.” Rock Center, December 5, 2011, http://rockcenter.nbcnews.com/_news/2011/12/05/9213056-digging-for-gold-children-work-in-harsh-conditions-paid-with-bags-of-dirt (accessed October 20, 2015).

“In Pictures: Life in Poverty-Stricken North Korea.” BBC News, September 22, 2009, http://news.bbc.co.uk/2/hi/8256890.stm (accessed October 20, 2015).

Jeong, Eunyoung. “North Korean Children Bear Brunt of Food Crisis.” YouTube video, 2:16. October 21, 2011. http://www.youtube.com/watch?v=RYYKvpr1uTw (accessed October 20, 2015).



“Learn the Facts.” Donate Life, http://donatelife.net/understanding-donation/learn-the-facts/ (accessed October 20, 2015).

Luhn, Alec. “Russian Anti-Gay Law Prompts Rise in Homophobic Violence.” Guardian, September 1, 2013, http://www.theguardian.com/world/2013/sep/01/russia-rise-homophobic-violence (accessed October 20, 2015).

“Medical Ethics.” Wikipedia, http://en.wikipedia.org/wiki/Medical_ethics (accessed October 20, 2015).

“Nazi Human Experimentation.” Wikipedia, http://en.wikipedia.org/wiki/Nazi_human_experimentation (accessed October 20, 2015).

“North Korea: Kim Jong-il’s Death Could Be Opportunity for Human Rights.” Amnesty International, December 19, 2011, http://www.amnesty.org/en/news/north-korea-kim-jong-il-s-death-opportunity-improving-human-rights-2011-12-19 (accessed October 20, 2015).

“Russia: Reject Homophobic Bill.” Human Rights Watch, January 26, 2013, https://www.hrw.org/news/2013/01/26/russia-reject-homophobic-bill (accessed October 20, 2015).

“Syria.” New York Times, http://topics.nytimes.com/top/news/international/countriesandterritories/syria/index.html (accessed October 20, 2015).

Williams, Timothy, and Anahad O’Connor. “Scores Die in Storms across South; Tornado Ravages City.” New York Times, April 27, 2011, http://www.nytimes.com/2011/04/28/us/28storm.html (accessed October 20, 2015).

“Yemen: Child Marriage Spurs Abuse of Girls and Women.” Human Rights Watch, December 8, 2011, http://www.hrw.org/news/2011/12/08/yemen-child-marriage-spurs-abuse-girls-and-women (accessed October 20, 2015).


AOHS Global Health


Global Health

Student Resources


Student Resource 5.1 Scenarios: Human Rights Violations

Student Resource 5.2 Reference: Universal Declaration of Human Rights

Student Resource 5.3 K-W-L Chart: Ethics and Human Rights

Student Resource 5.4 Reading: Health Ethics and Human Rights

Student Resource 5.5 Analysis: Ethical Guidelines in Refugee Camps

Student Resource 5.6 Reading: Ethical Treatment of Participants in Research Studies

Student Resource 5.7 Research Findings Chart: Human Rights and Health Initiatives

Student Resource 5.8 Scenarios: Distribution of Scarce Resources

Student Resource 5.9 Reading: Distribution of Scarce Resources




Scenarios: Human Rights Violations

Student Name: Date:

Directions: Your teacher will assign you a scenario. First, read the scenario. Then look at the list of articles of the Universal Declaration of Human Rights listed below your scenario. Discuss with your group why you think the articles are being violated, and write down your ideas. Refer to Student Resource 5.2, Reference: Universal Declaration of Human Rights, as you work.

Mining for Gold in Mali Mali is the third largest gold producer in Africa. Mali has artisanal mines, which are extremely dangerous and difficult to work in. Artisanal mines are small, often illegal, and operate with little or no machinery or safety procedures. Human Rights Watch estimates that 100,000–200,000 people work in Mali’s artisanal mines, including approximately 20,000 children.

The work includes digging mines with a pickax, lifting and carrying heavy bags of dirt that may contain gold, and then panning for gold using a process that involves hazardous chemicals that can poison the miners.

The average pay for adult workers is about US$1,500 per year. Children are often paid nothing other than a scavenged bag of dirt from the mine site. Children suffer from serious health issues related to hard labor.

Article 23

Protests in Syria In 2011, protests against longstanding and brutal governments erupted in countries around the Arab world. One of those countries was Syria, where the protests led to war.

A UN report in November 2011 stated that at that point children were detained and tortured because they had painted antigovernment graffiti on a wall. Unarmed protestors were shot and killed by government troops. Troops were told to disrupt protests and even to disrupt funeral processions for people who had been killed while protesting.

People were arrested and held without any explanation. Journalists and bloggers who tried to share information about the protests were arrested and held in jails. Detainees were tortured and forced to sign confessions for crimes they did not commit. In addition to the clear physical dangers, many Syrians were suffering from mental health issues, such as depression, because of the violence in their country.

Article 3

Article 5

Article 9

Article 19

Article 20

Article 21



Child Marriage in Yemen In Yemen, girls are forced to get married, sometimes when they are as young as eight years old. Information from the Yemeni government and the UN shows that approximately 14% of girls are married before the age of 15, and 52% are married before the age of 18. Boys are rarely forced into child marriages.

Once these girls are married, they also have little or no control over how many children they have or how often they have children. This can lead to health problems for both the mother and the child.

In addition, these child brides lose the opportunity for an education. In many cases, girls are removed from school as soon as they hit puberty, and they are married off soon after that.

In other cases, child brides face increased risks of domestic violence from their much older husbands or from their husband’s family members. Married women and girls often live with their husband’s family, and reports of domestic abuse or sexual violence are common.

Article 16

Article 25

Article 26

Life in North Korea North Korea is one of the most isolated and repressed countries in the world. Under the leadership of Kim Jong-il—and now his son, Kim Jong-un—the people are allowed little communication with the outside world. They are taught to look upon their leaders as almost godlike creatures who take care of them, but the truth is that the government has mishandled things and the people are starving.

The UN World Food Program (WFP) estimated in 2011 that close to 6 million people would face severe food shortages in North Korea, and a 2012 WFP report showed that 27.9% of children under age 5 were chronically malnourished and had stunted growth. The government tightly controls businesses, imports, and exports, and it has mismanaged the economy. Much of the country relies on its own agriculture, but bad harvests and flooding have diminished how much the people can grow for themselves. The government refuses to invest in supplies to help people survive. In fact, government programs that provide food to some people have been cut so drastically that the recipients barely get enough food to live.

People are forced to gather edible grasses from the side of the road and eat those to stay alive, and there are reports of children and elderly people dying because they cannot get enough to eat. The health care system is also in bad condition. Amnesty International reports include descriptions of people using unsterilized needles and surgeries being done without anesthetic. When people are hospitalized, they must pay additional fees to get any medicine, and even more fees just to get food to eat. At the same time, the government continues to invest in military spending and other programs, including pursuing nuclear weapons and continuing to threaten South Korea.

Article 22

Article 25



Law in Russia In 2013, Russia adopted a law that bans “homosexual propaganda” and the promotion of “nontraditional” sexual relations among minors. Activists say the laws have essentially legalized violence against gay people. There are reports of supporters of the law using the Internet to lure gay people to support groups and then publically humiliating or even attacking them. People in the LGBT (Lesbian, Gay, Bisexual, Transgender) community report needing to keep their relationships discreet or secret for fear of violence and humiliation.

Russia as a country is known to be hostile to LGBT activists, including consistently refusing them the right to hold parades or other demonstrations. This hostility can possibly lead to mental health issues for LGBT members of the community.

Article 2

Article 7

Article 19




Reference: Universal Declaration of Human Rights

PREAMBLE

Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,

Whereas disregard and contempt for human rights have resulted in barbarous acts which have outraged the conscience of mankind, and the advent of a world in which human beings shall enjoy freedom of speech and belief and freedom from fear and want has been proclaimed as the highest aspiration of the common people,

Whereas it is essential, if man is not to be compelled to have recourse, as a last resort, to rebellion against tyranny and oppression, that human rights should be protected by the rule of law,

Whereas it is essential to promote the development of friendly relations between nations,

Whereas the peoples of the United Nations have in the Charter reaffirmed their faith in fundamental human rights, in the dignity and worth of the human person and in the equal rights of men and women and have determined to promote social progress and better standards of life in larger freedom,

Whereas Member States have pledged themselves to achieve, in co-operation with the United Nations, the promotion of universal respect for and observance of human rights and fundamental freedoms,

Whereas a common understanding of these rights and freedoms is of the greatest importance for the full realization of this pledge,

Now, Therefore THE GENERAL ASSEMBLY proclaims THIS UNIVERSAL DECLARATION OF HUMAN RIGHTS as a common standard of achievement for all peoples and all nations, to the end that every individual and every organ of society, keeping this Declaration constantly in mind, shall strive by teaching and education to promote respect for these rights and freedoms and by progressive measures, national and international, to secure their universal and effective recognition and observance, both among the peoples of Member States themselves and among the peoples of territories under their jurisdiction.

Article 1.

All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.

Article 2.

Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.

Article 3.

Everyone has the right to life, liberty and security of person.

Article 4.

No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms.

Article 5.

No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.



Article 6.

Everyone has the right to recognition everywhere as a person before the law.

Article 7.

All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.

Article 8.

Everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the constitution or by law.

Article 9.

No one shall be subjected to arbitrary arrest, detention or exile.

Article 10.

Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal, in the determination of his rights and obligations and of any criminal charge against him.

Article 11.

(1) Everyone charged with a penal offence has the right to be presumed innocent until proved guilty according to law in a public trial at which he has had all the guarantees necessary for his defence.

(2) No one shall be held guilty of any penal offence on account of any act or omission which did not constitute a penal offence, under national or international law, at the time when it was committed. Nor shall a heavier penalty be imposed than the one that was applicable at the time the penal offence was committed.

Article 12.

No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.

Article 13.

(1) Everyone has the right to freedom of movement and residence within the borders of each state.

(2) Everyone has the right to leave any country, including his own, and to return to his country.

Article 14.

(1) Everyone has the right to seek and to enjoy in other countries asylum from persecution.

(2) This right may not be invoked in the case of prosecutions genuinely arising from non-political crimes or from acts contrary to the purposes and principles of the United Nations.

Article 15.

(1) Everyone has the right to a nationality.

(2) No one shall be arbitrarily deprived of his nationality nor denied the right to change his nationality.



Article 16.

(1) Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution.

(2) Marriage shall be entered into only with the free and full consent of the intending spouses.

(3) The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.

Article 17.

(1) Everyone has the right to own property alone as well as in association with others.

(2) No one shall be arbitrarily deprived of his property.

Article 18.

Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.

Article 19.

Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.

Article 20.

(1) Everyone has the right to freedom of peaceful assembly and association.

(2) No one may be compelled to belong to an association.

Article 21.

(1) Everyone has the right to take part in the government of his country, directly or through freely chosen representatives.

(2) Everyone has the right of equal access to public service in his country.

(3) The will of the people shall be the basis of the authority of government; this will shall be expressed in periodic and genuine elections which shall be by universal and equal suffrage and shall be held by secret vote or by equivalent free voting procedures.

Article 22.

Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international co-operation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his personality.

Article 23.

(1) Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment.

(2) Everyone, without any discrimination, has the right to equal pay for equal work.

(3) Everyone who works has the right to just and favourable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection.

(4) Everyone has the right to form and to join trade unions for the protection of his interests.



Article 24.

Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.

Article 25.

(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

Article 26.

(1) Everyone has the right to education. Education shall be free, at least in the elementary and fundamental stages. Elementary education shall be compulsory. Technical and professional education shall be made generally available and higher education shall be equally accessible to all on the basis of merit.

(2) Education shall be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms. It shall promote understanding, tolerance and friendship among all nations, racial or religious groups, and shall further the activities of the United Nations for the maintenance of peace.

(3) Parents have a prior right to choose the kind of education that shall be given to their children.

Article 27.

(1) Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits.

(2) Everyone has the right to the protection of the moral and material interests resulting from any scientific, literary or artistic production of which he is the author.

Article 28.

Everyone is entitled to a social and international order in which the rights and freedoms set forth in this Declaration can be fully realized.

Article 29.

(1) Everyone has duties to the community in which alone the free and full development of his personality is possible.

(2) In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society.

(3) These rights and freedoms may in no case be exercised contrary to the purposes and principles of the United Nations.

Article 30.

Nothing in this Declaration may be interpreted as implying for any State, group or person any right to engage in any activity or to perform any act aimed at the destruction of any of the rights and freedoms set forth herein.




K-W-L Chart: Ethics and Human Rights


Directions: Use this chart to help you think about what you already know and what you still need to find out about ethics and human rights. You will complete the What I Learned section later in this lesson.

What I Know What I Want to Know What I Learned




Reading: Health Ethics and Human Rights

What are ethics? How are ethics different from human rights? In this presentation, you will learn about how ethics and human rights impact the work of global health professionals.



People learn and develop their own personal set of ethics in various ways.

Most people learn their basic ethical foundation from family members. These childhood teachings shape our most fundamental attitudes about what is right and what is wrong. Sometimes a person’s ethics come from a spiritual or religious belief or a certain way of doing things in their community.

Culture also affects a person’s ethics. Imagine a business in the United States where a salesperson uses a bribe to influence somebody to use the business. In the United States, that practice would be considered unethical. But in many countries, bribes are seen as “gifts” and are a customary part of a business transaction.

Most people in the United States would say their personal code of ethics includes things like:

• Don’t hurt anybody (unless it’s self-defense).

• Be kind to children and animals.

• Don’t discriminate against people because of their race, religion, or gender.

Some people also have a specific code of ethics for their job. For example, firefighters, police officers, and soldiers have a code of ethics that reflects the dangerous job they do. Teachers have ethical guidelines—for example, a teacher shouldn’t flunk a student based on his or her dislike of that student.

Doctors, nurses, and health professionals have their own code of ethics, too. You may have heard the phrase, “First, do no harm.” That means that a health professional’s first job is to make sure not to make things worse by his or her treatment of the patient. That is part of a code of medical ethics.



In a world where millions of people and communities face discrimination and violence, it is essential to have a shared value system that calls on governments, institutions, and individuals to respect the fundamental rights of all people. Human rights are intrinsic and belong to everyone. There are no exceptions based on religion, caste, gender, class, sexuality, geographic location, or any other factor. Human rights are part of our everyday lives, and each one of us is responsible for their protection and promotion.

The Universal Declaration of Human Rights is a statement of human rights principles that was adopted by the United Nations on December 10, 1948. It says that “all human beings are born free and equal in dignity and in rights” and covers a wide range of different types of rights, including political rights, legal rights, equality rights, and economic rights.

Adapted from International Human Rights Funders Group, interviews conducted with board members, 2011. https://www.ihrfg.org/human-rights-funding/faqs-about-human-rights#faq4 (accessed October 20, 2015).



Human rights are an expression of ethical values. It is unethical to deprive someone of his or her human rights. The UDHR clearly states that medical care is a human right, so refusing to treat someone is a violation of that individual’s human rights. But what if a patient doesn’t want to be treated? What is the ethical thing to do in that situation?

What do you do if a patient has a serious illness and no way to pay for the expensive drugs or treatment? Does that patient simply not get treated? Is that a violation of the patient’s rights? If patients receive treatment they cannot afford, who pays for that cost? And what do you do in situations where there are hundreds or thousands of sick people who cannot pay? There are not enough resources to treat them all. What is the ethical thing to do in that situation?

You just heard about the idea of “First, do no harm.” But what if a dangerous operation gives a surgeon the chance to cure a patient of an otherwise incurable illness? What is the ethical thing to do in that situation?

Health ethics or medical ethics can serve as a guide when managing difficult situations like these.



These five principles are common throughout medical practices around the world. Many countries have laws about medical practice that are based on these principles.



Autonomy means patients have the right to refuse or choose their treatment. This requires that medical professionals respect the wishes of their patients. This may be difficult under some circumstances. What if someone with a terminal illness has also become depressed? This patient might not be in the right frame of mind to make a good decision. Or what if a patient is mentally ill or disabled? The person might not be able to make good decisions. And what if someone is in a coma? That patient is unable to make decisions for him- or herself and may need a family member to make difficult decisions. However, if a patient is conscious and in his or her “right mind,” medical professionals have a responsibility to present an overview of choices and then let the person make the decision about the course of treatment.

In Brazil, there are many tribes of indigenous people who follow the traditional ways of their ancestors. Imagine you are a doctor treating members of a tribe. One of the women is having complications in her pregnancy. If she is not taken to a hospital to have her baby, she and the baby might die. But her wish is to have the baby in her village, and she feels that if one of them dies, that is what is supposed to happen. The ethical principle of autonomy means that she should be allowed to make that decision.

Image retrieved from http://commons.wikimedia.org/wiki/File:%C3%8Dndia_da_etnia_Terena.jpg and reproduced here under the terms of the Creative Commons Attribution 3.0 Brazil (http://creativecommons.org/licenses/by/3.0/br/deed.en). Image courtesy of Valter Campanato/ABr.



There are two parts to the concept of beneficence: (1) taking actions that serve the best interest of a patient and (2) balancing benefit against risk.

In Bangladesh, diarrhoea is a major cause of death in children under 5. Mothers could treat this with a liquid mixture that rehydrates. An NGO wanted to teach mothers to do this. But the mothers were illiterate, and an improperly prepared mixture could make the children sicker. In this example, providing the liquid mixture to sick children is clearly in the children’s best interest. However, the NGO had to find a way to balance the benefit against the risk.

In this case, the NGO decided to try to find a way to educate the mothers so they would make the mixture properly. They created a chart that used pictures to demonstrate how to make the solution. Then they practiced with the mothers, showing them how to make the correct liquid mixture, and they had the mothers make it under supervision. Once they were satisfied that the mothers understood, the NGO workers moved on to another village, but they came back to check up on the mothers and to make sure they remembered how to make the solution correctly. This approach worked. When tested later, approximately 90% of the women remembered how to make the solution. Within the next decade, experts estimate that close to 50% of the cases of diarrhoea in the country were treated with this solution.



Justice means providing medical care to everyone, no matter who they are. It is about fairness and equality among all groups of society. It requires thinking about how to use health resources that are in short supply so that they reach as many people as possible. Justice also means that health care professionals treat every patient the same, regardless of age, race, sex, personality, or income.

Justice is often difficult to achieve because of competing needs, rights, and obligations. Sometimes ignorance and prejudice get in the way. For example, in some countries in Africa, people are ignorant about how HIV is passed from one person to another. Many local hospital workers are scared that they can catch it, so they have refused to treat people with HIV. In order to follow the ethical principle of justice, you would need to educate all the local workers so that they understand that they can safely treat the patient.

Providing justice in health care is often difficult or impossible because of many other factors, too: poor nutrition, bad housing, war, or discrimination. One doctor, nurse, or health care worker cannot solve these massive problems alone. But ethically, medical professionals are obligated to do their part to help make sure that health care is distributed as fairly and as equally as possible.



The ethical principle of dignity means that every person is born with the right to be treated with respect and to receive medical care. But right now in many places in the world, poor people, illiterate people, and people of various races and religions do not receive the health care they need. Or they may receive undignified treatment while seeking health care.

Dignity also means respecting other people’s beliefs, even if they are different from yours. For example, by 2005 polio was almost wiped out globally. But people began to refuse the vaccine in Nigeria because of rumors that the vaccine would sterilize patients, or make them unable to have children.

Health care workers in Nigeria knew that the vaccine would protect people from polio, but they also understood the need to show respect for the local people. So the health care workers treated the patients with dignity and explained why the vaccine was safe and effective. Yet in spite of their efforts, polio remains a problem in some parts of the world today.

Sometimes medical professionals have to find a balance between respecting beliefs and doing what is right, and ethical values do not always give the answers. But they do provide a useful framework for dealing with difficult situations like the ones on this slide.

Image courtesy of Khalid Mahmood and retrieved from http://commons.wikimedia.org/wiki/File:A_Pakistani_Woman.JPG. Reproduced here under the terms of the GNU Free Documentation License (http://commons.wikimedia.org/wiki/Commons:GNU_Free_Documentation_License_1.2).



How much information is a patient entitled to receive before accepting or refusing treatment? Is a physician or other health provider ever permitted to deceive or withhold information from a patient? In years gone by, information was given or withheld as doctors thought best.

People have a right to know what is happening to their own bodies. WHO guidelines for treating diseases like tuberculosis and HIV/AIDS make it clear that people need to be informed about risks to themselves as well as risks to the community.

Honesty is also connected to the principle of autonomy. Autonomy means people have the right to make their own decisions about their health care, but they need to understand their conditions and their treatment options before they can make a good decision. This is called informed consent or informed refusal. It means a patient has enough information to make an informed decision about his or her treatment.

In the case of the young woman in Guatemala, the ethical obligation as a health care worker is to be honest with her and tell her about her condition and treatment options. You would also have an obligation not to share this information with other people—that is doctor-patient confidentiality.

Honesty also plays a role in medical research, which you will learn about later in this lesson.



Autonomy: In health care, this is the right of a patient to make decisions about his or her own care.

Beneficence: This is the balancing of good vs. risk. If the woman is part of an isolated tribe, bringing her into a city hospital would expose her and the baby to germs they have no resistance to. Not only could the woman or her baby get sick, but they could bring those germs back with them to the vulnerable tribe. So bringing her to the hospital could do good, yet it could also do a lot of harm.

Justice: This woman and her baby deserve medical treatment, even though they are part of an isolated and poor tribe. If the woman cannot be taken to a hospital, the principle of justice means she deserves the best medical care possible under the circumstances.

Dignity: The woman’s refusal has to do with ancient traditions that may not make sense to our modern perspective, but she deserves to be respected and treated with dignity.

Honesty: The woman cannot make an informed decision unless medical professionals are honest with her. If you tell her truthfully that she or the baby might die, and if she would rather take that risk than go to a hospital, then you have behaved ethically and she has made an informed refusal. All of these principles together guide medical professionals in decision making every day.




Analysis: Ethical Guidelines in Refugee Camps


Directions: Now that you have learned about ethical guidelines, you are going to look at how they are applied in real-life situations. Follow your teacher’s instructions for selecting one of the ethical guidelines below. Then examine the photos of the world’s largest refugee camp, which is located in Kenya, and look for clues in the photos that could indicate whether or not your guideline is being followed in the refugee camp. Finally, choose one of the photos and answer the set of questions for that particular photo.

Select an Ethical Guideline Autonomy

Beneficence

Justice

Dignity

Honesty

The guideline we will focus on is:

What we already know about this guideline:

Access the Link to “The World’s Largest Refugee Camp Turns 20” http://www.theatlantic.com/infocus/2011/04/the-worlds-largest-refugee-camp-turns-20/100046/

Look through the photographs and choose one to focus on. You want to pick a photograph that connects to your guideline, either because it shows how the guideline is being followed, or because it is an example of the guideline not being followed.

The Questions Answer the following questions about the photograph.

1. What is the number and caption of the photograph you chose?



2. What are the potential ethical issues in the photo that are relevant to your guideline?

3. What recommendations would you make? For example, you might recommend a way to distribute food, ensure children are cared for, prevent disease, or inform the refugees about their future in the camp. Explain your reasoning for the recommendations you make.

4. What further information do you need to make more specific and/or accurate recommendations? When you look at your picture, what questions do you ask yourself? Maybe you want to know if medical help is available, for example.




Reading: Ethical Treatment of Participants in Research Studies

In order to learn about diseases and how to cure them, it is sometimes necessary to conduct medical research using human subjects. However, the ethics of doing research on human beings is very complicated. There is a code of ethics that guides this type of research. This code came into being in part because of unethical research studies that were done in the past.

Unethical Research Studies

In the 1930s and 1940s, Nazi scientists conducted research on prisoners of war and people in concentration camps. Sometimes they deliberately infected people with diseases like malaria and tuberculosis. They exposed prisoners to freezing cold temperatures, simulated high altitudes, or chemical agents that soldiers might face in battle. Then the Nazi doctors tried out different ways to survive those harsh conditions. Most of the methods failed, leaving the prisoners dead or permanently disabled. In the most infamous example, Dr. Joseph Mengele conducted experiments on children. He did things like operate on them without anesthetic and inject them with infectious materials.

Another example of unethical research was the Tuskegee Study, which took place in the United States. Beginning in 1932, the US Public Health Service studied syphilis, a sexually transmitted disease, by observing 600 African American men—approximately 400 of them had syphilis and 200 did not. The Public Health Service told these men they would be treated for their disease, but they were not. In fact, the doctors running the study gave them aspirin and iron treatments, which wouldn’t do anything to cure them. The doctors didn’t want to cure them; they wanted to study what happened when a person had syphilis for a long time without treatment. They chose African American men because in the 1930s African Americans usually had limited access to medical care, so they weren’t likely to be cured.

Research Ethics

After World War II, the horrors of the Nazi “research” led to the development of the first set of ethical principles to guide research on human subjects. Later on, additional sets of guidelines were developed as people learned more about the Tuskegee Study and other unethical research projects. All of these codes of ethics have some of the same basic principles:

1. The research must be socially beneficial. In other words, the research has to be on an important question that can help humanity. Otherwise, it can put people at risk for no good reason.

2. The research must be scientifically valid. For example, a research study done on five people is not big enough to give a good statistical sample. If research is done on human subjects, it needs to be scientifically sound research.

3. The subjects of the research must be selected in a fair way. Researchers shouldn’t use vulnerable populations for risky research because they think the vulnerable population is more expendable. In the same way, researchers working on a potentially beneficial treatment shouldn’t restrict their studies to wealthier or more important people they think should benefit. Both the Nazi and Tuskegee studies fail this test.

4. The study should have an acceptable risk/benefit ratio. This means that the patients should be subject to the least amount of risk possible with the greatest amount of reward. For example, you wouldn’t conduct a study where you asked people with cancer to stop getting treatment. That’s too high risk. However, people who have already tried conventional cancer treatments and not been cured might be willing to try a new experimental treatment that has the potential to cure them. In



their case, the potential reward is greater than the risk, since the conventional treatments have not helped them. This connects to the ethical principle of beneficence you learned about earlier.

5. Study participants must give informed consent. That means that people participating in the study need to be competent to make a decision, they need to know what the study will do, and they need to agree to it. Informed consent also means that people have to be informed in a way they can understand. For example, an illiterate population must still be informed about the study. They could be informed through pictures or illustrations or through a verbal explanation. The Nazi research fails on all of these counts. Children legally are not competent to make this kind of decision; they were not told what would happen to them during the study, and they did not agree to it. Aside from children, people might be incompetent to make a decision because of linguistic issues (if the explanation is in English and they don’t speak English, for example), because of educational limitations, or because of a mental disability or mental health problem that results in a person being unable to make good decisions about his or her own health. This principle connects to the ethical principle of honesty you learned about earlier.

6. Researchers must behave with respect for the subjects. This means that they should allow participants to quit the study if they want to. They should keep patients’ information confidential. Informed consent is another part of showing respect for the participants, because it makes sure the participants are aware of what’s happening. This is related to the ethical principle of dignity you learned about earlier.

The Short Course AZT Trials

In the 1990s, a research study demonstrated that the antiretroviral drug AZT could be used to reduce the transmission of HIV from pregnant women to their unborn children. This led to the development of the 076 regimen, a pattern of care that involved regular doses of AZT for HIV-positive pregnant women and their babies. This regimen was considered the most effective way to care for this patient group. However, the regimen was very expensive and difficult to use in impoverished nations. That was a problem because those countries had very high rates of mother-to-child transmission of HIV.

In an effort to find another method of treatment that would work in these countries, 15 trials were planned. These were called the Short Course Trials because they would consist of limited usage of AZT over a shorter period of time. The trials were planned for several developing countries, including many countries in Africa.

These trials became the source of much controversy. They would not be done in developed countries, where the 076 regimen was already considered the standard of care, but they were being done in developing countries. Were participants being selected in a fair way? Weren’t the participants being prevented from getting the best care possible if they weren’t being given the 076 regimen?

The people planning the study claimed that they were doing it in developing countries because a different method of care was needed there. The 076 regimen was not available in these countries, so the participants wouldn’t get that course of treatment whether or not they took part in the study. And people in these developing countries had unique circumstances, so research from a developed country might not be useful. For example, women in developed countries might give their baby formula, while women in developing countries would breastfeed. Because breastfeeding increases the risk of transmitting HIV, something like that could skew the study results.

But other questions remained. Could the people of these countries, who were mostly poor and uneducated, give an informed consent? What would happen to the participants after the study was over? If you give an HIV-positive person AZT, they start to feel better. If you stop giving them AZT, they will get sick again. So what would happen when the study ended and the participants no longer received free AZT? On the other hand, these people would not receive AZT under normal circumstances, and if the research was successful, the scientists might discover a new method for reducing mother-to-child transmission of the disease, which could save thousands or even millions of lives. What would be the ethical thing to do?




Research Findings Chart: Human Rights and Health Initiatives


Directions: Follow your teacher’s instructions to select a health initiative to research and report on. Choose one of the initiatives listed below, or choose a current health initiative that you know about and would like to research. As you conduct your research, record your findings on the research findings chart on the next page of this resource. Before you begin work, study the example on the last page of this resource, and go over the assessment criteria to make sure you know how your work will be assessed.

Possible Health Initiatives for Your Research Findings Chart UNICEF: Sanitation in India, http://www.unicef.org/india/wes_1457.htm

UNICEF: Malnutrition in Kenya, http://www.unicef.org/infobycountry/kenya_60547.html

UNICEF: Vaccinations in Somalia, http://www.unicef.org/infobycountry/somalia_60749.html

WHO: Tuberculosis in Lesotho, http://www.who.int/features/2011/tb_lesotho/en/index.html

WHO: Road Safety in Rwanda, http://www.who.int/features/2007/road_safety/en/index.html

Jhpiego: Infection Prevention Project to Combat Ebola in Central and Southern Liberia, http://www.jhpiego.org/content/jhpiego-launches-infection-prevention-project-combat-ebola

WHO: Ensuring a Worm-Free Childhood in Nepal, http://www.who.int/features/2008/worm_control/en/index.html

WHO: Cholera in Zimbabwe, http://www.who.int/features/galleries/zimbabwe_cholera_photogallery/en/index.html

Gates Foundation: Vaccine Delivery Strategy Overview, http://www.gatesfoundation.org/vaccines/Pages/overview.aspx

Gates Foundation: Neglected Infectious Diseases Overview, http://www.gatesfoundation.org/topics/Pages/neglected-diseases.aspx

ONE: Fighting HIV/AIDS in Mauritius, http://www.one.org/us/2011/12/05/fighting-hivaids-in-mauritius/

PEPFAR (The US President’s Emergency Plan for AIDS Relief): The Power of Support in Cote d’Ivoire, http://www.pepfar.gov/press/docs/135657.htm

PEPFAR: In Vietnam, Legal Clinics Combat Stigma and Help HIV-Positive Children Access Education, http://www.pepfar.gov/press/docs/126826.htm



Health Initiative Research Findings Chart

Name of the organization

Source of your information

What diseases or conditions are being addressed?

What country or countries are being served?

What specific steps are being taken?

How many people are being helped?

What are the results (if known)?

What ethical principles apply to this initiative?



Example: Health Initiative Research Findings Chart

Name of the organization WHO (World Health Organization)

Source of your information http://www.who.int/features/2005/malaria/en/index.html

What diseases or conditions are being addressed?

Malaria

What country or countries are being served? Cambodia

What specific steps are being taken? People in remote villages are being recruited to serve as “malaria workers.” These people get trained in how to diagnose and treat malaria. They attend a monthly workshop to improve their diagnosis and treatment skills and to collect medicines and diagnostic kits. Then they return to their village and work to diagnose and treat any cases of malaria in their village.

How many people are being helped? 135 villages are participating in the program; a specific number of people was not mentioned.

What are the results (if known)? The number of reported cases of malaria that must be treated in health centers has dropped by nearly one-third in four years.

What ethical principles apply to this initiative? Justice, because these are poor people living in isolated villages, and they weren’t receiving the same kind of care as other people in the country until this program was started.

Beneficence, because the program uses regular trainings to make sure the malaria workers are diagnosing and treating correctly, so the program is doing more good than harm.


The research chart demonstrates an understanding of a global health initiative by accurately describing the place served, the population that benefited, the important steps taken, and any known results.

The research chart clearly identifies and explains the ethical principles that apply to the initiative.

The research chart is neat and uses correct spelling and grammar.

The summary for the class clearly explains how the initiative worked and what ethical principles apply to the initiative.




Scenarios: Distribution of Scarce Resources

Student Name: _______________________________________________________ Date:___________

Directions: Before you view a presentation on the distribution of scarce resources, read through the following scenarios and decide if you think they are ethical or not. After you view the presentation, determine which principle or principles are being used in each scenario.

Scenario 1 An NGO has obtained a stock of drugs to treat HIV in African countries. There are thousands of people dying from HIV each year. The NGO’s staff decides to use their medications to treat HIV-positive pregnant women so that their children will be less likely to be born with HIV.

Do you think this is an ethical decision? Why or why not?


Scenario 2 An obese woman visits a doctor and requests gastric bypass surgery, a procedure that alters the process of digestion and can help people lose weight. She explains that she doesn’t like to diet and she’s too tired to exercise, so she thinks the surgery will help. The doctor examines her and agrees that she needs to lose weight but refuses to do the surgery. The doctor explains that the surgery will not solve her weight problem unless she also makes an effort to watch what she eats and takes time to exercise. He tells her to begin a diet and exercise regimen and return to him in six months if she has not seen any results from those efforts.





Scenario 3 A massive tornado tore through Alabama, Mississippi, Georgia, and Tennessee in April 2011, leaving dozens of people dead and many homes and businesses destroyed. Tuscaloosa, one of the largest cities in Alabama, was one of the hardest-hit places. The tornado went through the center of town, where it flattened buildings, killed people, and left thousands without electricity.

The University of Alabama is located in Tuscaloosa. It is a large campus, and while many of its students suffered tremendously because of the tornado, some campus buildings were undamaged. Many people gathered at the university because they had nowhere else to go. While there were many towns in need of assistance, volunteer groups decided to begin distributing aid and relief supplies at the university first.



Scenario 4 In the United States, organ donation is managed by the United Network for Organ Sharing (UNOS), a nonprofit overseen by the federal government. UNOS maintains a national waiting list of all people who are waiting to receive organs. When an organ becomes available, UNOS uses computer software to determine which people on the waiting list are matches for that organ. UNOS notifies the medical teams for those people and the transplant is arranged. UNOS distributes organs on the basis of that biological match—whether a person is rich or poor, young or old, does not matter as much as having the right match so that the transplant will be more likely to be successful.






Reading: Distribution of Scarce Resources

Global health professionals often have to make decisions about how to distribute health resources, because there are not enough resources to go around. In this presentation, you will learn about the guiding principles that health professionals use to make these difficult choices.



A limited supply of medical resources is a challenge for all countries, developing and developed. Often there isn’t enough to meet the need.

In the United States, there were more than 29,000 organ transplants performed in 2014. Yet organ donation groups estimate that there are more than 122,000 people in the United States alone currently waiting for an organ donation. Imagine you are in charge of an organ donation program. Someone dies and donates his organs: how do you decide which person gets his heart? His liver? His eyes?

Some decisions involve the distribution of financial resources or material. What if you are a government official who is in charge of building a new hospital? How do you decide where to build it? Do you build in the country, where you have more space? Or in the city, where there is a higher population density and therefore more people who need help?

Or maybe you’re a doctor or nurse working with HIV patients in South Africa, where 2012 estimates suggest that 6.1 million people are suffering from HIV and AIDS. The antiretroviral drugs they need are very expensive, and you can only get a limited supply. How do you decide who gets treated?

In the spring of 2011, Colombia was devastated by floods. Almost 7,500 homes were destroyed and more than 225 health institutions were damaged. If you were part of a disaster relief group sent into Colombia to help, what would you do? Where would you start?

Source of data: https://www.unos.org, http://www.organdonor.gov/about/data.html, and http://www.avert.org/hiv-aids-south-africa.htm.



Sometimes health resources are distributed by unfair methods. Some countries have used a first come, first served approach, meaning that the first people to ask for help received what they needed.

This can sound fair, but in practice it can favor those people with political connections. In low-income countries that may already have very corrupt governments, this can lead to government officials and their families being well cared for, while less well-connected people who are truly suffering get no help at all. In other cases, groups of people are prevented from getting the care they need because of poverty or discrimination.

To prevent this, global health professionals use these four guiding principles to help them make good decisions when distributing medical resources. On the following slides, we will consider each of these principles in more depth.



The principle of health maximization states that a health professional should use resources in the way that will have the greatest overall impact on health. In this example, the principle would lead you to buy the mosquito nets because you could have a greater overall impact by providing a preventive tool to 200 families rather than drugs to 50 people. You also have to consider whether the people who need the most help are the people who you are best able to help.

In 2010 a serious earthquake struck Haiti. Large portions of the capital city, Port-au-Prince, were destroyed. Because a lot of people live in the capital city, the principle of health maximization would dictate that relief groups focus on helping the people there.

But there were people who lived out in the country, and before the earthquake they had been even poorer than those living in the city. When the earthquake happened, the people in the countryside were suffering, and they had fewer resources to help them. So, in this case, health maximization might actually lead to more people dying in the country. The people health professionals were best able to help (the city dwellers) were not necessarily the people who needed the most help (the country people).

That is why health professionals consider more than one principle when determining how to distribute scarce resources. In this situation, another principle might override the principle of health maximization.



This principle recognizes that some people need more help because they were disadvantaged to begin with. In other cases, people need more help because they are more directly impacted by the disease, violence, or natural disaster. In the case of the Japanese earthquake and tsunami, the principle of priority to the worst off meant that people in smaller towns got more aid than people in Tokyo because they were more directly affected.

That sounds fair. However, this principle has its difficulties, too. First of all, how do you determine who is the “worst off”? Imagine there is a pandemic flu outbreak and you have to decide who will get drugs that can treat the disease. Do you give the drugs to the people who are sickest right now? Or do you give the drugs to people who just got sick but who have preexisting conditions that make them more likely to die from the flu, like pregnant women or the elderly? Which group is the worst off?

What if the worst-off group is already terminally ill? If you are working with HIV patients in South Africa, do you spend your money on antiretroviral drugs for people with HIV or on preventive measures to stop more people from getting HIV in the first place? The principle of priority to the worst off doesn’t always solve the problem, either.



Equality is an important principle in the distribution of resources. In some countries, international supervision is needed to make sure resources are distributed equally. For example, Rwanda experienced a civil war and genocide during the 1990s. At one time, the people responsible for the genocide were in control of parts of the country. If you were running an NGO that wanted to donate food or medical supplies, you wouldn’t want to rely on those people to distribute your supplies, because they would likely not hand out the supplies equally.

Like the other principles, equality doesn’t address every problem. Imagine you are in charge of distributing donated organs. If you wanted to follow the principle of equality, you might hold a lottery. That way, everyone who needed a kidney had the same chance of getting one. You would just draw a name at random and that person would get a transplant. It sounds fair, but is it the best use of resources? What if the person who wins the lottery is very ill and likely to die soon? Does it still make sense for that person to get a transplant? What if someone who had been on the list to get a kidney for only a month won out over someone who had been on the list for six months? Distributing organs is a complicated process that involves several of these principles of distribution of scarce resources, not just one.



The principle of personal responsibility states that people need to make an effort to take care of their own health. In the case of the donated liver, the liver would go to the woman with hereditary liver disease, because she did not cause her illness and she tries to take care of her health.

This principle sounds logical: if resources are limited, you should give the resources to people who will use them properly, not waste them on people who don’t take responsibility for their own health. However, in real life it isn’t always so easy to determine who is being responsible and who isn’t.

HIV/AIDS is one of the diseases where this principle is frequently cited. Many people acquire HIV because of lifestyle choices; for example, using drugs or having unprotected sex with multiple partners. But sometimes people acquire HIV through no fault of their own. What if a woman’s husband contracts HIV because he cheats on her and she gets the disease from sleeping with him? She did not do anything irresponsible, but she now has the disease.

When applying the principle of personal responsibility, it is important to consider whether the person knew that what he or she was doing was a health risk. People who are illiterate or poorly educated may not understand the risks they are taking. In other cases, they may not have had much choice. Children living on the streets will eat and drink whatever they can get her hands on. If they get sick from eating bad food or drinking dirty water, that isn’t really their fault.



As you have seen, each of these principles can be used to make a good argument for how to distribute scarce resources, but each of them has its own weaknesses as well. When trying to determine how to distribute resources, health professionals use a combination of all of these principles to guide them.

For example, imagine that a major earthquake has struck Los Angeles. The first aid that arrives would probably go to the people who lived closest to the epicenter, where the shaking was the worst (priority to the worst off). Aid might be distributed through local hospitals or at relief shelters where the greatest number of people could get assistance (health maximization). Hospitals and Red Cross clinics would care for anyone who was injured, whether it was a street person who was cut by broken glass or a millionaire whose expensive house collapsed in the quake (equality). And the first people cared for would be the ones injured by the quake, not looters or people who took foolish chances after the quake hit (personal responsibility). By using all four principles, resources would be distributed fairly, even under difficult circumstances.


AOHS Global Health

Lesson 6 Health and Socioeconomic

Development In this lesson, students consider the impact that socioeconomic development has on health. Students begin by using socioeconomic data to make predictions about a country’s health and using health data to make predictions about the country’s socioeconomic level. Students look more closely at the relationship between health and development and create a public service announcement (PSA) featuring recommendations for improving the socioeconomic status and health problems of a country. They learn about the concepts of health equity and social justice. Students also explore some of the most important NGOs and governmental agencies working in the field of global health today.

Advance Preparation

In Class Period 2, students will need access to computers for Internet research, with one student per computer.

In Class Periods 3, 4, and 5, students use mobile devices that record video to create public service announcements. At least one student in each group of three needs to have a mobile device that records video. You may want to advise students of this at the beginning of the lesson. If mobile devices are not allowed in your classroom, you will need to adapt this activity slightly and have students perform their PSA for the class rather than recording it.

In Class Period 3, you will need access to the following three short YouTube videos:

o https://www.youtube.com/watch?v=874ajWbX05Q

o https://www.youtube.com/watch?v=91f_I1UBdH4

o https://www.youtube.com/watch?v=FqDHWeufajU

If your school does not allow access to YouTube, you may wish to download the videos to your computer in advance using KeepVid (see keepvid.com) or a similar program.

Prior to Class Period 6, print out Teacher Resource 6.4, Information Stations: Organizations that Promote Global Health (separate PowerPoint file). If possible, print out the station signs in color. If you have a large class, you may want to print two sets so that no more than four students are visiting a station at one time.


AOHS Global Health Lesson 6 Health and Socioeconomic Development


Lesson Framework


Generalize about the relationship between health and socioeconomic development for a community or country*

Characterize the various relationships between an individual’s health, education, and income

Identify organizations that promote and improve global health and describe their roles and functions*

Explain the relationships between health, equity, and social justice





Assessment


PSA video on health and socioeconomic development (Student Resources 6.4 and 6.5)

Assessment Criteria: Health and Socioeconomic Development PSA (Teacher Resource 6.3)

Prerequisites Knowledge of ethical principles of global health

Familiarity with demographic and epidemiological transition

Awareness of the common health problems faced by developing and developed nations


Teacher Resources Teacher Resource 6.1, Answer Key: Health and Socioeconomic Development Predictions



Teacher Resource 6.2, Presentation and Notes: Health and Socioeconomic Development (includes separate PowerPoint file)

Teacher Resource 6.3, Assessment Criteria: Health and Socioeconomic Development PSA

Teacher Resource 6.4, Information Stations: Organizations that Promote Global Health (separate PowerPoint file)

Teacher Resource 6.5, Key Vocabulary: Health and Socioeconomic Development

Teacher Resource 6.6, Bibliography: Health and Socioeconomic Development

Student Resources Student Resource 6.1, Predictions: Health and Socioeconomic Development

Student Resource 6.2, Note Taking: Health and Socioeconomic Development

Student Resource 6.3, Reading: Health and Socioeconomic Development

Student Resource 6.4, PSA Research: Health and Socioeconomic Development

Student Resource 6.5, Planning Guide: Producing a PSA

Student Resource 6.6, Reading: Equity and Social Justice in the United States

Student Resource 6.7, Note Taking: Equity and Social Justice in the United States

Student Resource 6.8, Stations: Organizations that Support Global Health

Equipment and Supplies LCD projector and computer for PowerPoint presentation and to show videos



At least one mobile device that records video for each group of three students

Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1 15 Predictions: Health and Socioeconomic Development

In this activity, students draw on prior knowledge to make predictions about the relationship between a country’s health and its socioeconomic status.



Step Min. Activity

Point out that students have already learned something about the relationship between the health of a country and its socioeconomic development. As a review, ask a few students to share what they remember about developing and developed countries.

Next, divide the class into groups of three and refer students to Student Resource 6.1, Predictions: Health and Socioeconomic Development. Instruct students to use what they already know to make their best predictions about the unidentified countries in the resource. For two countries, socioeconomic data is provided and students need to make predictions about the health status of these countries; for the other two countries, health data is provided and students need to make predictions about the socioeconomic development of the countries.

Give students time to work, and then have each group share their answers with another group. Next, go over the answers as a class using Teacher Resource 6.1, Answer Key: Health and Socioeconomic Development Predictions, as a guide. As you go over the answers, identify the four countries in this exercise. Have students write the name of each country on their resource, and ask them what they know about those countries. Help students to recognize that two of the countries, Finland and Qatar, are considered developed countries, whereas the other two, Uganda and India, are considered developing. Encourage students to add information about the countries to their regional reference maps. Then ask students:

Based on what you learned in this activity and what you have learned earlier in the course, how does socioeconomic development correlate with health?

Give students a few moments to discuss the question with their groups, and then call on groups to share their ideas. Let students know that in the next activity, they will be learning more about the relationship between health and socioeconomic development, and they can see if their ideas are accurate while they view the presentation.

2

25 Presentation: Health and Socioeconomic Development

This activity provides students with a more in-depth understanding of the considerations that link health and socioeconomic development. It also develops students’ listening and note-taking skills.

To prepare, make notes to guide class discussion using Teacher Resource 6.2, Presentation Notes: Health and Socioeconomic Development. Have Teacher Resource 6.2, Presentation: Health and Socioeconomic Development (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Refer students to Student Resource 6.2, Note Taking: Health and Socioeconomic Development. Instruct students to take notes in the right column about the relationship between the two concepts listed in each row of the left column as they view the presentation.


This presentation is duplicated as Student Resource 6.3, Reading: Health and Socioeconomic Development. If an LCD projector is unavailable, students can read the presentation, answer the discussion questions in their notebook, and discuss their answers as a class. This student resource is also useful for review.

After the presentation, divide the class into pairs and have students discuss and check



Step Min. Activity

their notes for accuracy and completeness.

Explain that students have learned about the broad concepts of how socioeconomic development affects health. In the next activity, they will apply those concepts to a specific country.

3 10 PSA Video Assignment Introduction: Correlating Health and Socioeconomic Development

Students learn about their assignment to create a public service announcement (PSA) that makes recommendations for improving a country’s health and socioeconomic status.

Place students in groups of three and refer them to Student Resource 6.4, PSA Research: Health and Socioeconomic Development. Ask students to imagine that they are from one of the countries listed on the resource and that the WHO has recruited their team to create a PSA about health and development in their country. Their PSA will be shown at an important WHO convention, where the recommendations they make will be taken under consideration for funding. Go through the different elements of the PSA as a class, and answer any questions. Review the assessment criteria and answer any questions.

Explain that in the next class period, students will choose a country and conduct research to prepare for producing their PSA.

CLASS PERIOD 2

4

50 PSA Assignment: Conducting Research

Students choose a country and conduct research on its socioeconomic status and health indicators. This activity focuses on the following college and career skills:



Ask students to convene in their groups of three. Have students choose which country they will work on (or assign them to a country). Make sure that groups are working on different countries. Instruct them to use Student Resource 6.4, PSA Research: Health and Socioeconomic Development, to divide up responsibilities and work efficiently.

Explain to students that this is their only class period to do research for their PSA. Assign students to computers. As students work, circulate around the classroom, keeping students on task and answering any questions. Remind students to think about which essential service their recommendation is addressing. Tell them to refer back to Lesson 2 for the list of essential services.

As the class period comes to an end, tell students that if they have not finished their research, they need to complete it for homework. If necessary, make arrangements for students to have access to the computers during lunch or after school so that they can complete any research tasks.

Before the class period ends, check in with each group to see whose mobile device the group will use to produce the PSA. Make sure each group is equipped with a mobile



Step Min. Activity

device that can shoot video.

CLASS PERIOD 3

5

15 PSA Assignment: Qualities of an Effective PSA

Students consider the qualities of an effective PSA in preparation for creating one of their own.

Prior to class, prepare to project the example PSAs linked to below (or similar PSAs) using an LCD projector. These PSA examples are on YouTube; if your school does not allow access to YouTube, you may wish to download the videos to your computer in advance using KeepVid (see keepvid.com) or a similar program.

Explain to students that a PSA is a brief, persuasive message intended to raise awareness, change attitudes, or jump-start change. Point out that PSAs are also an effective means of providing the public with information about health. Before they produce their own PSA, they will watch a few and notice what techniques the PSAs use to make their points. Tell students to take notes on which tricks of the trade they might want to incorporate into their own PSA.

Write the following header on the board: Effective PSA Techniques

Tell students to watch for elements of each PSA that they think make it effective at getting its message across.

Using an LCD projector, show students the following example PSAs:

https://www.youtube.com/watch?v=874ajWbX05Q

https://www.youtube.com/watch?v=91f_I1UBdH4

https://www.youtube.com/watch?v=FqDHWeufajU

After showing each video, ask volunteers to suggest elements to place on the list. Examples might be citing research to support a recommendation; having actors show a positive change; and clear, easy-to-follow narration. Also ask them to articulate what action the PSA is recommending. They will notice that some are more indirect than others, but they all provide a means of change toward positive outcomes.

6 35 PSA Assignment: Producing a PSA

Students learn the steps of making a PSA and then plan and produce their own. This activity focuses on the following college and career skills:

Demonstrating teamwork and collaboration

Demonstrating adaptability and flexibility

Effectively using technology relevant to a profession

Ask groups to read Student Resource 6.5, Planning Guide: Producing a PSA. Tell them to note their questions in the margins. Then hold a class discussion to ensure that everyone is clear on what they need to do.

Devote the rest of this class time to circulating among the groups, troubleshooting and



Step Min. Activity

making suggestions as they work on filling out their planning guides.

At the end of the class period, tell students that they will have the next class period to work on their PSAs. For homework, students should gather any materials or create any props they need for their PSA. They need to be ready to shoot video next class period.

CLASS PERIOD 4

7 50 PSA Assignment: Producing a PSA (Continued)

Students produce their PSAs.

To begin class, ask each group to report on their progress and say what their next steps will be. Use this information to determine which groups need your assistance the most. Then instruct students to keep working on their PSAs.

Remind students to check their work against the assessment criteria in Student Resource 6.4, and remind them that their PSA should be between one and two minutes long. Let students know that in the next class period, they will show their PSAs to the class, so they need to use this time efficiently. Assign students to quiet, well-lit locations where they can film their videos.

At the end of the class period, tell students that next class period, they will have only a few minutes to check their PSA and make sure they are ready to present it. If they have a lot more work left to do, they will need to do it for homework. Encourage students to make plans to get together and finish their PSA outside of class if they need to.

CLASS PERIOD 5

8 10 PSA Video: Final Production Steps

Students review their PSA and ensure that it is ready to present to their classmates. This activity focuses on the following college and career skill:


Tell students to spend a few minutes making any last-minute adjustments to their PSA. When groups complete their PSA, assign them a table in the classroom where they should place their mobile device with the PSA ready for viewing by the other groups in a media walk.

9 35 Media Walk: Health and Socioeconomic Development PSAs

In this activity, students demonstrate their understanding of the correlation between socioeconomic status and health status by showing their peers the PSA they produced about the country they researched.

To begin the activity, write the following questions on the board:

In what ways was the PSA effective in communicating a recommendation?



Step Min. Activity

Which set of recommendations do you think the professionals at the WHO meeting would be most likely to fund? Why do you think so?

Inform students that they will be viewing the PSAs that their peers have created, and instruct them to think about these questions as they view the PSAs. They can take notes in their notebook on the first question, and keep the second one in mind until they’ve seen all the PSAs. Then they should write down their opinion.

Make sure each group of students has their mobile device with the PSA video ready for viewing on a table in the classroom. Space the devices around the classroom as much as possible so that everyone can hear. Tell each group to assemble at a table where another group’s video is ready for viewing.

Give groups time to view the video and note down their ideas. This should take five minutes at most. Then instruct groups to move on to the next station. You should accompany one of the groups so that you can view all of the videos.

After students have viewed all of the PSAs, go back to the questions on the board, and ask students to share their observations.

If time allows, ask students to share their impressions of creating a PSA. Do they feel that they were able to communicate their message? What could they do more effectively next time?

Give students instructions on how to submit their PSA for assessment. For example, you may wish to have them upload it to YouTube or email it to you, depending on the capabilities of their mobile devices.

Assess each PSA using Teacher Resource 6.3, Assessment Criteria: Health and Socioeconomic Development PSA.

10 5 Homework: Reading on Equity and Social Justice in the United States

Students complete a reading that introduces them to the concepts of health equity and social justice.

Tell students to read Student Resource 6.6, Reading: Equity and Social Justice in the United States, for homework. Tell them to complete Student Resource 6.7, Note Taking: Equity and Social Justice in the United States, as they read. Ask students to read the instructions, and answer questions about the assignment.

CLASS PERIOD 6

11 25 Reading: Equity and Social Justice in the United States

In this activity, students explore the concepts of health equity and social justice.

To begin this activity, write the WHO definition of equity on the board:

Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically.

Circle the words avoidable and remediable, and ask students to work in pairs to come



Step Min. Activity

up with at least one difference between groups of people that could be avoided or remedied. You might want to ask them to think about the country they featured in their PSA. If necessary, give them the following example: In some countries, boys get an education, but girls do not. This is a difference that could probably be fixed, or remedied. Ask pairs to share their examples with the class.

Place students in pairs. Tell them to share what they wrote down in Student Resource 6.7, Note Taking: Equity and Social Justice in the United States, for homework. Next, ask students to work together and write a list of the inequities they learned about in the reading. Ask each pair to contribute an inequity and write those on the board, until all inequities have been named. Ask volunteers to give their ideas about how to address the inequities presented in the reading.

Conclude this activity by explaining that there are many organizations around the world currently working to reduce health inequities and create social justice. Tell students that in the next activity, they will look at a few of the most important organizations.

12 25 Information Stations: Organizations That Promote Global Health

In this activity, students learn basic information about several important organizations that promote global health.

Before class begins, print out Teacher Resource 6.4, Information Stations: Organizations that Promote Global Health (separate PowerPoint file). If possible, print out the station signs in color. If you have a large class, you may want to print two sets so that no more than four students are visiting a station at one time.

Begin this activity by posting the signs around the room. Refer students to Student Resource 6.8, Stations: Organizations that Support Global Health. Ask students to circulate around the room, viewing each information station and answering the corresponding questions on Student Resource 6.8.

Give students approximately 15 minutes to complete the resource, and then review the answers as a class. Point out that students have already learned about some of these organizations in this course, while others may be new to them. Guide students to recognize that all of these organizations are working to address global health and/or socioeconomic inequality. Some, like the World Bank, are focused more on socioeconomics, while others, like the Centers for Disease Control and Prevention (CDC), are focused more on health—but as students should be starting to realize, both types of work are essential to creating a healthier world.

At the end of the class period, make sure students save their resources in their notebook for future reference.

Point out to students that if they pursue a career in global health, they will most likely work closely with one or more of these organizations.



Extensions

Content Enrichment Have students track the relationship between obesity and socioeconomic development in a

population. When does obesity appear most prevalent in low-, middle-, and high-income sectors of a population? Draw connections between this information and what they have learned about equity and social justice.

Ask students to research and create a presentation on one of the following modern social justice movements. Have them explain why it is a social justice movement and what the movement’s position is on health-related issues.

o The Occupy Wall Street movement

o The Slow Food movement

o The DREAM Act movement

o The Fair Trade movement

STEM Integration Technology: If time allows, students can prepare for filming their PSAs by creating online

storyboards first. They can use tools such as Simplebooklet (www.simplebooklet.com), UtellStory (www.utellstory.com), or Narrable (www.narrable.com).

Technology: Send students to the website Do Something (https://www.dosomething.org/). It enables young people to work for social change according to their interests, skills, and time availability. The campaigns are inventive and fun; they will broaden students’ ideas of what it takes to instigate change.

Additional Cross-Curricular Ideas English Language Arts: Ask students to imagine that they have been asked to give a speech to a

group of foreign global health workers visiting the United States. The purpose of the speech is to inform the workers about major health inequities among American populations. Explain that the speech should provide information about three major issues related to health inequities.

History: Ask students to report on the socioeconomic development of the countries and time period they are currently studying. Ask them to note the following:

o Any relationships they can discern between socioeconomic development and health

o The positive and negative aspects in the socioeconomic situation


AOHS Global Health


Development

Teacher Resources


Teacher Resource 6.1 Answer Key: Health and Socioeconomic Development Predictions

Teacher Resource 6.2 Presentation and Notes: Health and Socioeconomic Development (includes separate PowerPoint file)

Teacher Resource 6.3 Assessment Criteria: Health and Socioeconomic Development PSA

Teacher Resource 6.4 Information Stations: Organizations that Promote Global Health (separate PowerPoint file)

Teacher Resource 6.5 Key Vocabulary: Health and Socioeconomic Development

Teacher Resource 6.6 Bibliography: Health and Socioeconomic Development




Answer Key: Health and Socioeconomic Development Predictions

These answers are based on information in the CIA World Factbook, updated in September 2015 (https://www.cia.gov/library/publications/the-world-factbook/index.html). On this site, you can select the country from the box at the top of the page to access information about health and socioeconomic development in that country.

Country #1: Finland

1. Predict the life expectancy at birth in this country. 80.77 years

2. Predict the infant mortality rate in this country. Remember, it’s measured per 1,000 live births. 2.52 deaths per 1,000 live births

Country #2: Kenya

1. Predict the life expectancy at birth in this country. 63.77 years

2. Predict the infant mortality rate in this country. Remember, it’s measured per 1,000 live births. 39.38 deaths per 1,000 live births

Country #3: India

1. Predict the school life expectancy for people in this country. 12 years

2. Predict the unemployment rate in this country. 8.6%

3. Predict the GDP – per capita for this country. $5,900

Country #4: Qatar

1. Predict the school life expectancy for people in this country. 14 years

2. Predict the unemployment rate in this country. 0.4%

3. Predict the GDP – per capita for this country. $143,400




Presentation Notes: Health and Socioeconomic Development


In this presentation, you will learn about the relationship between health and economic development, and how that affects global health.

Presentation notes



This graph shows the relationship between a country’s gross domestic product (GDP) and the life expectancy in that country. The data is from 2010.

GDP per capita is the average total value of goods produced and services provided by each person within a country in one year. So, for example, in the United States in 2010, every person produced, on average, goods and services valued at $47,184. It’s one way to measure a country’s level of economic development.

Each dot on the graph represents a country. As you can see in the graph, if the GDP is low, the life expectancy is also likely to be low. The countries represented by dots on the left side, such as Congo, start with life expectancy below 50 and a GDP that is less than $1,000 per year. The graph curves upward, because as the GDP rises, so does the life expectancy. But economic development is only one factor in determining life expectancy. As you can see, some of the wealthiest countries are not necessarily highest in life expectancy.

The general trend corresponds with what you have already learned: that developed countries tend to have healthier populations. Developed countries are usually farther along in demographic and epidemiological transition. Their people have longer life expectancies and lower birth rates. They generally die from noncommunicable diseases rather than from infectious diseases.

The data used to compile this graph is available from the United Nations Development Program (UNDP) site at http://hdr.undp.org/en/data.

Presentation notes



A person’s or a family’s socioeconomic status can have a significant impact on their health. There is no single way to determine someone’s SES; instead a range of different factors can be considered:

Ownership – What a person owns can tell us a lot about how much money that person has and how he or she chooses to spend it. SES can be evaluated based on whether someone owns a home, a car, a bicycle, a television, a radio, or livestock (cows, pigs, sheep, other farm animals).

Occupation – Different jobs require different levels of training, earn different salaries, and command different levels of respect. Occupation is often closely tied to education.

Education – If a person is literate, that person is much better equipped to make good health decisions than someone who cannot read and write. Typically, the more education someone has, the more likely he or she is to be able to access goods and services (such as health care).

Residential area – Where does someone live? In a rural environment? An urban environment? Is it a safe area? How much access does the person have to clean drinking water or healthy foods?

Presentation notes



Income, education, and employment are all interconnected. If you have a good job, you will make a good income. If you have a good income, you can afford to educate your children. If your children are well educated, they have a better chance to get a good job for themselves.

All of these things together affect your health. On the next few slides, we will look at each of these factors more closely.

Presentation notes



People who lack income live in poverty. More than 1 billion people, approximately 1 out of every 6 people in the world, try to survive on less than $1 per person per day. The 1995 World Health Report named extreme poverty “the world’s biggest killer and the greatest cause of ill-health and suffering across the globe.”

Poverty can have a major impact on health. It affects:

• The type of dwelling someone lives in (which might be unstable, made with dangerous materials, or unventilated—all health risks)

• How crowded a home is (which can cause the spread of infectious disease)

• Where a home is located (does it have access to clean drinking water, good sanitation, schools, or public transportation?)

Poor communities frequently suffer from unsafe drinking water, poor sanitation, or a lack of water for personal hygiene. Some communities may lack enough wood to boil water or cook food. Many poor people live without electricity, which means there is no way to safely store food or medicines. Plus, many poor people lack the money to buy medicine or pay for a doctor’s visit, or to pay for an education or the supplies needed to educate their children.

Images retrieved from http://commons.wikimedia.org/wiki/File:India_poverty.jpg and http://commons.wikimedia.org/wiki/File:Urban_Poverty.jpg, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Images courtesy of Steve Evans and Nikkul, respectively.

Presentation notes



Literacy means functional literacy; that is, a person can read and write well enough to handle everyday tasks. The map above shows literacy rates worldwide. If you think about other maps you have seen in the course—maps that show levels of infection for illnesses like HIV, for example, or maps showing infant mortality rates—you may notice that the dark blue areas (the areas with the highest literacy rates) generally have better health indicators.

Education level refers to the amount of education a person has completed and the type of education the person received. Education level and literacy both have a significant impact on health. For one thing, people with a better education tend to have a higher income. This means they are less likely to experience the problems of poverty that you just learned about. They are also likely to work in less dangerous jobs, eat better-quality food, and be able to access medical care when they need it.

Literacy plays an important role in health care because literate people are better able to read and understand information about medical issues. They have an easier time understanding instructions from the doctor and are better equipped to learn about preventive measures they can take. Illiterate people not only struggle to understand medical information but also may be reluctant to seek medical care, not wanting to admit that they cannot read or write.

Map retrieved from http://commons.wikimedia.org/wiki/File:Literacy_rate_world.PNG and reproduced here under the terms of the GNU Free Documentation License (http://en.wikipedia.org/wiki/GNU_Free_Documentation_License).

Presentation notes



You can probably recognize that the areas with the highest literacy rates generally have lower rates of under-5 mortality. Literacy rates, particularly for women, affect infant and under-5 mortality rates.

Presentation notes



Educated and literate women improve the health of a country in many ways. As you can see in the graph above, more-educated women tend to have fewer children. Maternal education levels are also connected to decreased levels of under-5 child mortality, as you just saw, and to improved levels of childhood growth and nutrition. Educated women also tend to have an easier time obtaining help for their own health care needs.

Graph retrieved from the Population Reference Bureau at http://www.prb.org/Educators/TeachersGuides/HumanPopulation/Women.aspx on August 14, 2012, and reproduced here under fair-use guidelines of Title 17, US Code. Copyrights belong to respective owners.

Presentation notes



Jobs are rated based on skill and education level. Low-skill jobs, such as manual labor, may be the only work available for people with limited education or people who are illiterate.

These photos show some types of manual labor jobs, including building a road and farming. Unfortunately, these jobs are often dangerous. They may involve working in dangerous conditions or being exposed to chemicals or bacteria that can cause illnesses. In Europe, for example, professional workers (like teachers or engineers) have significantly lower risks than unskilled workers (such as janitors or security guards) for a range of health conditions, including noncommunicable diseases such as heart disease, lung cancer, and stroke. Unskilled workers also have high rates of suicide.

Images retrieved from http://commons.wikimedia.org/wiki/File:Mumbai_Workers_Victor_Grigas_Random_Shots-4.jpg and http://commons.wikimedia.org/wiki/File:Rice_plantation_in_Java.jpg and reproduced here under the terms of the Creative Commons Attribution-Share Alike 3.0 Unported license (http://creativecommons.org/licenses/by-sa/3.0/deed.en). Images courtesy of Victor Grigas and Gunkarta Gunawan Kartapranata, respectively.

Presentation notes



Education, employment, and income are all interconnected. A person with a good education has an easier time finding good employment and earning a good income. That person has an easier time accessing health services and can afford to provide a good education for his or her children. However, a person with limited education may not find a good job, may not earn much money, and may struggle to access health services. This person’s children may not get a good education, and their lives may suffer as a result, just like their parent’s.

Many NGOs that work on global health issues have broadened their outlook to include working on poverty, education, and employment issues because they have realized that if this cycle is not broken, people will continue to suffer and die from easily curable and/or preventable diseases.

Presentation notes




Assessment Criteria: Health and Socioeconomic Development PSA

Student Names:______________________________________________________________

Date:_______________________________________________________________________


Met Partially Met

Didn’t Meet

Information about the geographic location of the country is accurate and easy to understand.

□ □ □

The PSA provides accurate data about the socioeconomic status and health status of the country.

□ □ □

The PSA includes at least one graph or table. □ □ □

The recommendations are logical, practical, and based on data.

□ □ □

The progression through the video is clear and easy to follow.

□ □ □

The PSA uses strong persuasive techniques, such as vivid, clear language, to convey the recommendations for the country.

□ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Key Vocabulary: Health and Socioeconomic Development

Term Definition

adult literacy rate Measurement based on the number of people age 15 and over who can read and write.

disparity A great difference; for example, a health disparity exists when poor people suffer more from infectious diseases than wealthy people do.

equity The absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically.

exacerbate To make a problem or situation worse.

functional literacy The ability to read and write well enough to function in everyday life.

gross domestic product (GDP)

The total value of goods produced and services provided in a country during one year; a way to measure a country’s wealth.

inequity Something that is unfair, unjust, or unequal.

population-based data Data that tracks a population’s health through broad measures, such as a census or birth certificate or death certificate records.

remedy In global health, to set right, or fix, inequity or social injustice.

school life expectancy How many years of education the average citizen of a country receives in a lifetime.

social justice The goal of a society in which everyone is expected to work together to achieve a common good, one that provides basic human rights and community resources to all members, regardless of their backgrounds.

socioeconomic status (SES) A way to measure a person’s position in society based on certain characteristics, including ownership, occupation, education level, or residential area.




Bibliography: Health and Socioeconomic Development





Online “About.” World Bank, http://www.worldbank.org/en/about (accessed October 22, 2015).

“About CDC 24-7.” CDC, http://www.cdc.gov/about/organization/mission.htm (accessed October 22, 2015).

“About UNICEF: Who We Are.” UNICEF, http://www.unicef.org/about/who/index_introduction.html (accessed October 22, 2015).

“About WHO: Leadership Priorities.” WHO, http://www.who.int/about/agenda/en/index.html (accessed October 22, 2015).

“American Indian and Alaska Native Populations.” CDC, http://www.cdc.gov/minorityhealth/populations/REMP/aian.html (accessed October 22, 2015).

“Asian American Populations.” CDC, http://www.cdc.gov/minorityhealth/populations/REMP/asian.html (accessed October 22, 2015).

“Black or African American Populations.” CDC, http://www.cdc.gov/minorityhealth/populations/REMP/black.html (accessed October 22, 2015).

“Commission on Social Determinants of Health Final Report: Closing the Gap in a Generation.” WHO, 2008, http://whqlibdoc.who.int/hq/2008/WHO_IER_CSDH_08.1_eng.pdf (accessed October 22, 2015).

“Diabetes and Hispanic Americans.” Office of Minority Health, http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=63 (accessed October 22, 2015).

“Drugs and Technology.” WHO, http://www.who.int/healthsystems/topics/technology/en/index.html (accessed October 22, 2015).

“Fact Sheet – CDC Health Disparities and Inequalities Report—U.S., 2011.” CDC, http://www.cdc.gov/minorityhealth/reports/CHDIR11/FactSheet.pdf (accessed October 22, 2015).

“Finland.” CIA World Factbook, https://www.cia.gov/library/publications/the-world-factbook/geos/fi.html (accessed October 22, 2015).

“Health Risks among Sexual Minority Youth.” CDC, http://www.cdc.gov/healthyyouth/disparities/smy.htm (accessed October 22, 2015).

“Highlights in Minority Health & Health Disparities: SIDS.” CDC, October 2006, http://www.cdc.gov/omhd/Highlights/2006/HOct06SIDSIF.htm (accessed October 22, 2015).



“Hispanic or Latino Populations.” CDC, http://www.cdc.gov/minorityhealth/populations/REMP/hispanic.html (accessed October 22, 2015).

“India.” CIA World Factbook, https://www.cia.gov/library/publications/the-world-factbook/geos/in.html (accessed October 22, 2015).

“Overview: A World of Development Experience.” UNDP, http://www.undp.org/content/undp/en/home/operations/about_us.html (accessed October 22, 2015).

“Qatar.” CIA World Factbook, https://www.cia.gov/library/publications/the-world-factbook/geos/qa.html (accessed October 22, 2015).

“Uganda.” CIA World Factbook, https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html (accessed October 22, 2015).


AOHS Global Health


Development

Student Resources


Student Resource 6.1 Predictions: Health and Socioeconomic Development

Student Resource 6.2 Note Taking: Health and Socioeconomic Development

Student Resource 6.3 Reading: Health and Socioeconomic Development

Student Resource 6.4 PSA Research: Health and Socioeconomic Development

Student Resource 6.5 Planning Guide: Producing a PSA

Student Resource 6.6 Reading: Equity and Social Justice in the United States

Student Resource 6.7 Note Taking: Equity and Social Justice in the United States

Student Resource 6.8 Stations: Organizations that Support Global Health




Predictions: Health and Socioeconomic Development


Directions: Make predictions based on what you already know about the relationship between a country’s health status and its socioeconomic development. First, read the new term you need to know to complete this resource. Then make predictions about the four unidentified countries using the information provided. The information about the countries is from the CIA World Factbook (updated in September 2015).

Term You Need to Know

School life expectancy – how many years of education the average citizen of a country receives in a lifetime

Country #1

1. Predict the life expectancy at birth in this country.

Under 50 years Between 50 and 75 years

Over 75 years

2. Predict the infant mortality rate in this country. Remember, it’s measured per 1,000 live births.

Fewer than 5 deaths per 1,000 live births

Between 5 and 25 deaths per 1,000 live births

Over 25 deaths per 1,000 live births

Country #2

School life expectancy 11 years

Unemployment rate 40%

GDP – per capita $3,100

1. Predict the life expectancy at birth in this country.

Under 50 years Between 50 and 75 years Over 75 years

2. Predict the infant mortality rate in this country. Remember, it’s measured per 1,000 live births.

Fewer than 5 deaths per 1,000 live births

Between 5 and 25 deaths per 1,000 live births

Over 25 deaths per 1,000 live births

School life expectancy 17 years

Unemployment rate 8.6%

GDP – per capita $40,300



Country #3

Life expectancy at birth 68.13 years

Infant mortality rate 41.81 deaths per 1,000 live births

1. Predict the school life expectancy for people in this country.

Less than 5 years Between 5 and 10 years More than 10 years

2. Predict the unemployment rate in this country.

Under 10% Between 10% and 25% Over 25%

3. Predict the GDP – per capita for this country.

$1,035 or less $1,036 to $4,085 $4,086 to $12,615 $12,616 or more

Country #4

Life expectancy at birth 78.59 years

Infant mortality rate 6.32 deaths per 1,000 live births

1. Predict the school life expectancy for people in this country.

Less than 5 years Between 5 and 10 years More than 10 years

2. Predict the unemployment rate in this country.

Under 10% Between 10% and 25% Over 25%

3. Predict the GDP – per capita for this country.

$1,035 or less $1,036 to $4,085 $4,086 to $12,615 $12,616 or more




Note Taking: Health and Socioeconomic Development


Directions: As you watch the presentation on health and socioeconomic development, write down words and phrases in the right column that explain the relationship between the concepts in the left column.

The relationship between:

My notes:

GDP and life expectancy

Socioeconomic status and health

Poverty and mortality

Literacy and education and health status

Education for women and the fertility rate

Employment and poverty and illness




Reading: Health and Socioeconomic Development

In this presentation, you will learn about the relationship between health and economic development, and how that affects global health.



This graph shows the relationship between a country’s gross domestic product (GDP) and the life expectancy in that country. The data is from 2010.

GDP per capita is the average total value of goods produced and services provided by each person within a country in one year. So, for example, in the United States in 2010, every person produced, on average, goods and services valued at $47,184. It’s one way to measure a country’s level of economic development.

Each dot on the graph represents a country. As you can see in the graph, if the GDP is low, the life expectancy is also likely to be low. The countries represented by dots on the left side, such as Congo, start with life expectancy below 50 and a GDP that is less than $1,000 per year. The graph curves upward, because as the GDP rises, so does the life expectancy. But economic development is only one factor in determining life expectancy. As you can see, some of the wealthiest countries are not necessarily highest in life expectancy.

The general trend corresponds with what you have already learned: that developed countries tend to have healthier populations. Developed countries are usually farther along in demographic and epidemiological transition. Their people have longer life expectancies and lower birth rates. They generally die from noncommunicable diseases rather than from infectious diseases.

The data used to compile this graph is available from the United Nations Development Program (UNDP) site at http://hdr.undp.org/en/data.



A person’s or a family’s socioeconomic status can have a significant impact on their health. There is no single way to determine someone’s SES; instead a range of different factors can be considered:

Ownership – What a person owns can tell us a lot about how much money that person has and how he or she chooses to spend it. SES can be evaluated based on whether someone owns a home, a car, a bicycle, a television, a radio, or livestock (cows, pigs, sheep, other farm animals).

Occupation – Different jobs require different levels of training, earn different salaries, and command different levels of respect. Occupation is often closely tied to education.

Education – If a person is literate, that person is much better equipped to make good health decisions than someone who cannot read and write. Typically, the more education someone has, the more likely he or she is to be able to access goods and services (such as health care).

Residential area – Where does someone live? In a rural environment? An urban environment? Is it a safe area? How much access does the person have to clean drinking water or healthy foods?



Income, education, and employment are all interconnected. If you have a good job, you will make a good income. If you have a good income, you can afford to educate your children. If your children are well educated, they have a better chance to get a good job for themselves.

All of these things together affect your health. On the next few slides, we will look at each of these factors more closely.



People who lack income live in poverty. More than 1 billion people, approximately 1 out of every 6 people in the world, try to survive on less than $1 per person per day. The 1995 World Health Report named extreme poverty “the world’s biggest killer and the greatest cause of ill-health and suffering across the globe.”

Poverty can have a major impact on health. It affects:

• The type of dwelling someone lives in (which might be unstable, made with dangerous materials, or unventilated—all health risks)

• How crowded a home is (which can cause the spread of infectious disease)

• Where a home is located (does it have access to clean drinking water, good sanitation, schools, or public transportation?)

Poor communities frequently suffer from unsafe drinking water, poor sanitation, or a lack of water for personal hygiene. Some communities may lack enough wood to boil water or cook food. Many poor people live without electricity, which means there is no way to safely store food or medicines. Plus, many poor people lack the money to buy medicine or pay for a doctor’s visit, or to pay for an education or the supplies needed to educate their children.

Images retrieved from http://commons.wikimedia.org/wiki/File:India_poverty.jpg and http://commons.wikimedia.org/wiki/File:Urban_Poverty.jpg, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Images courtesy of Steve Evans and Nikkul, respectively.



Literacy means functional literacy; that is, a person can read and write well enough to handle everyday tasks. The map above shows literacy rates worldwide. If you think about other maps you have seen in the course—maps that show levels of infection for illnesses like HIV, for example, or maps showing infant mortality rates—you may notice that the dark blue areas (the areas with the highest literacy rates) generally have better health indicators.

Education level refers to the amount of education a person has completed and the type of education the person received. Education level and literacy both have a significant impact on health. For one thing, people with a better education tend to have a higher income. This means they are less likely to experience the problems of poverty that you just learned about. They are also likely to work in less dangerous jobs, eat better-quality food, and be able to access medical care when they need it.

Literacy plays an important role in health care because literate people are better able to read and understand information about medical issues. They have an easier time understanding instructions from the doctor and are better equipped to learn about preventive measures they can take. Illiterate people not only struggle to understand medical information but also may be reluctant to seek medical care, not wanting to admit that they cannot read or write.

Map retrieved from http://commons.wikimedia.org/wiki/File:Literacy_rate_world.PNG and reproduced here under the terms of the GNU Free Documentation License (http://en.wikipedia.org/wiki/GNU_Free_Documentation_License).



You can probably recognize that the areas with the highest literacy rates generally have lower rates of under-5 mortality. Literacy rates, particularly for women, affect infant and under-5 mortality rates.



Educated and literate women improve the health of a country in many ways. As you can see in the graph above, more-educated women tend to have fewer children. Maternal education levels are also connected to decreased levels of under-5 child mortality, as you just saw, and to improved levels of childhood growth and nutrition. Educated women also tend to have an easier time obtaining help for their own health care needs.

Graph retrieved from the Population Reference Bureau at http://www.prb.org/Educators/TeachersGuides/HumanPopulation/Women.aspx on August 14, 2012, and reproduced here under fair-use guidelines of Title 17, US Code. Copyrights belong to respective owners.



Jobs are rated based on skill and education level. Low-skill jobs, such as manual labor, may be the only work available for people with limited education or people who are illiterate.

These photos show some types of manual labor jobs, including building a road and farming. Unfortunately, these jobs are often dangerous. They may involve working in dangerous conditions or being exposed to chemicals or bacteria that can cause illnesses. In Europe, for example, professional workers (like teachers or engineers) have significantly lower risks than unskilled workers (such as janitors or security guards) for a range of health conditions, including noncommunicable diseases such as heart disease, lung cancer, and stroke. Unskilled workers also have high rates of suicide.

Images retrieved from http://commons.wikimedia.org/wiki/File:Mumbai_Workers_Victor_Grigas_Random_Shots-4.jpg and http://commons.wikimedia.org/wiki/File:Rice_plantation_in_Java.jpg and reproduced here under the terms of the Creative Commons Attribution-Share Alike 3.0 Unported license (http://creativecommons.org/licenses/by-sa/3.0/deed.en). Images courtesy of Victor Grigas and Gunkarta Gunawan Kartapranata, respectively.



Education, employment, and income are all interconnected. A person with a good education has an easier time finding good employment and earning a good income. That person has an easier time accessing health services and can afford to provide a good education for his or her children. However, a person with limited education may not find a good job, may not earn much money, and may struggle to access health services. This person’s children may not get a good education, and their lives may suffer as a result, just like their parent’s.

Many NGOs that work on global health issues have broadened their outlook to include working on poverty, education, and employment issues because they have realized that if this cycle is not broken, people will continue to suffer and die from easily curable and/or preventable diseases.




PSA Research: Health and Socioeconomic Development


Directions: Imagine you are a citizen of one of the countries listed below. The WHO has recruited your team to create a public service announcement (PSA). The purpose of the PSA is to feature one or more recommendations for improving the socioeconomic status or health status in your country. Your PSA will be shown at an important WHO convention where the recommendations featured in your PSA will be taken under consideration for funding. Follow the instructions in this resource to create your PSA.

1. Choose your country Bahamas

Burkina Faso

China

El Salvador

Ireland

Italy

Lebanon

Malawi

Mexico

Mongolia

Panama

South Korea (or Republic of Korea)

Tajikistan

Tonga

Uzbekistan

Our country will be:

2. Research the following socioeconomic and health status data

Adult literacy rate (if available)

School life expectancy

Unemployment rate

GDP, per person

Life expectancy at birth

Infant mortality rate

Divide this list up among group members so that you work efficiently and don’t duplicate your efforts. Once you have all your data, pool it and decide as a team how best to illustrate it in the PSA. Some will fit well in a chart, but some data may be conveyed via voice-over, graphics, or close-ups of typed or written information.



3. Include the following elements in your PSA The name and geographic location of your country

A chart or other visuals with socioeconomic data and health status indicators for your country

One or more recommendations for improving the socioeconomic status or health status in your country. For ideas, review the essential services you learned about in Lesson 2. Note which essential service your recommendation addresses.

Resources CIA World Factbook: https://www.cia.gov/library/publications/the-world-factbook/

The World Bank Country and Lending Groups: http://data.worldbank.org/about/country-classifications/country-and-lending-groups

4. Make your recommendations Include at least one recommendation about how to improve your country’s socioeconomic status in order to improve its health status, or how to improve your country’s health status in order to improve its socioeconomic status. Your recommendation needs to link to the data you’ve found.

Here are some examples of recommendations:

In my country, 32% of children under 5 years old are underweight. I recommend focusing aid programs on providing food to children, which would improve child health. If the children are healthy, it will be easier for the parents to work and earn a steady income to take care of their family, because the children will be sick less often and won’t require a parent to stay with them at home.

In my country, only 52% of the population has access to clean sources of drinking water, and the youth unemployment rate is over 25%. I recommend creating a program to put young people to work building improved drinking water and sanitation facilities. This would improve both the socioeconomic status and health status.

Each team member should try writing several recommendations. Pick the best one(s) to put in your PSA.


Information about the geographic location of the country is accurate and easy to understand.

The PSA provides accurate data about the socioeconomic status and health status of the country.

The PSA includes at least one graph or table.

The recommendations are logical, practical, and based on data.

The progression through the video is clear and easy to follow.

The PSA uses strong persuasive techniques, such as vivid, clear language, to convey the recommendations for the country.




Planning Guide: Producing a PSA

Student Names:_____________________________________________ Date: ____________________

Use this planner to divide up responsibilities among your group members for producing the PSA. This resource also walks you through each step so that your PSA is interesting, persuasive, and factual.

Decide Which Mobile Device You Will Use If more than one person in your group has a mobile device that records video, decide whose device you will use for this assignment. Make sure that the mobile device will be available when you are ready to film. Work with your teacher if you need help finding a suitable mobile device.

Consider the following:

Is there enough memory to film a one- to two-minute video?

Does the device have apps that will allow you to edit the video or add music? (Editing the video or adding music is not a requirement for this assignment, but these are things you might like to try if you have the capability.)

Is the screen size large enough for classmates to view your video easily?

Will you be able to provide a copy of the PSA video to your teacher for assessment, according to your teacher’s instructions?

Choose Roles When creating your PSA, each of you needs to take on a specific job. Read over the roles described below and decide with your group which person should take on which role. You may also think of other roles and responsibilities that you need to allocate; add these to this list.

Visual designer: chooses graphics for the PSA; if using live actors, decides on location and background.

Videographer: manages the filming of the PSA; adds sound effects or music if appropriate.

Scriptwriter: writes the script for the PSA, using the research and the recommendations that the team put together. Makes sure that the PSA is between one and two minutes long.

Everyone should work together to decide on the sequence of information for the PSA. Information must flow logically so that the audience is led to understand why you are making specific recommendations and so that they are persuaded that your research is reliable and your recommendations are valuable.

My assigned role:



Gather Props and Materials Work on how you are going to present the information in your PSA. What props will you need? At a minimum, you will need a chart displaying socioeconomic data and health indicators. Will you show people, or just show props and text? Do you need background music? Think creatively about the most effective way to present your PSA and how to target your intended audience.

Film Your PSA Based on everything you know about your country and the recommendations you want to make, film your PSA. Before you begin, read “Tips for Filming a Video with a Mobile Device” below to prepare for filming your video.

Review the elements you need to include and check in with each group member to ensure that the script, props, and filming device are ready to go.

Practice going through your script and make sure it is under two minutes.

When you feel confident, film your PSA using the video camera on a mobile device. You may need to film your PSA a few times to get it right. If you have a video editing app such as iMovies, VidTrimPro, or AndroMedia and you know how to use it, you may want to do some minor editing to improve your video or add effects such as music. (If your class is not using mobile devices for this assignment, just practice your PSA several times so that you are ready to present it to the class.)

Review your video with your group and make sure it meets the assessment criteria.

Tips for Filming a Video with a Mobile Device

Make sure your battery is fully charged before filming. Taking video will quickly use up battery power.

Make sure you have plenty of free memory. Video files take up a lot of space on your device. You may wish to transfer old files to your computer before you begin filming your PSA.

Restart your phone before you begin filming. This will help prevent crashes and freezing.

Set your phone to Airplane Mode. In Airplane Mode, filming your video won’t be interrupted by calls or texts.

Clean your lens. Fingerprints on your lens will make your video blurry.

Shoot horizontally. If you shoot vertically, you will end up with a narrow image and black bars on the sides.




Reading: Equity and Social Justice in the United States

A community leader is speaking in Spanish to a group of female Latino farm workers in Florida. “We need to strive for equity,” the leader says. “The closest health clinic is 50 miles away and many of us don’t have cars. We are intimidated to go to the clinic because we don’t speak English. We don’t have insurance, and we don’t have money to pay for a doctor’s visit. But our health should not suffer because of these reasons. We demand social justice!”

The terms equity and social justice are often used when we talk about both health care in the United States and in the world. Let’s look at what the terms mean.

Equity and Inequity

Global health organizations are concerned about achieving equity. Equity means:

1. Eliminating differences in health care due to factors such as:

o A person’s gender

o A person’s religion

o Where a person lives and works

o A person’s ethnicity

2. Fixing, or remedying, the situation so that these health care differences no longer exist.

The factors mentioned above (gender, religion, location, and ethnicity) affect people’s health, even in the United States. They may affect a person’s:

o Health status

o Access to health services

o Coverage of health services

o Protection against financial risk from health care costs

Health inequity is a difference in health status that is unfair but that is also avoidable and fixable. Health inequity includes unfairness in mortality rates and the distribution of disease and illness across groups in the population. Here is an example of a health inequity: Latino farm workers have higher rates of cancer than other communities because they don’t have adequate health insurance and access to medical care, and they are exposed to toxic chemicals because of their work.

Social Justice

When the WHO and other organizations work to avoid and remedy, or fix, situations that are inequitable, we say they are working to achieve social justice.

Social justice means providing basic human rights and community resources to all members of a society, poor or rich, working or unemployed, uneducated or educated. Social justice is extremely important in the field of global health. As you have already seen, people who live in poverty often suffer from far greater health problems than people who have more money, stable work, or more education.

Health Inequities in the United States

Even though we live in a developed country, there are still inequities in our health system. They can also be called health disparities. A CDC report found that Americans with low socioeconomic status “are at

The WHO defines equity as “the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically.”



increased risk for mortality, morbidity, unhealthy behaviors, reduced access to health care, and inadequate quality of care.”

Here are some specific examples of inequities identified by the CDC:

Asian Americans are more prone to certain types of cancer, tuberculosis, and hepatitis B than other ethnic groups. These health conditions are exacerbated, or made worse, by language and cultural barriers, the stigma associated with certain conditions, and a lack of health insurance.

For example: A Vietnamese woman detects a lump in her breast. She worries that if she sees a doctor, he won’t speak her language. Since she has no health insurance, she can’t pay for the visit. Early detection and treatment are critical in treating breast cancer. But the woman’s tumor grows and her health situation worsens because she doesn’t go to the doctor.

In 2009, African Americans accounted for 14% of the US population, but they accounted for 44% of all new HIV infections. African Americans are the group that is most affected by HIV in the United States. African Americans may hide high-risk behavior such as having unprotected sex instead of getting tested. They do so because of the stigma of the disease, homophobia, and misperceptions about the disease and the test to diagnose the disease. Lack of knowledge of their HIV status can then lead to more infections.

For example: An African American man has a girlfriend, but he also has a secret relationship with a man. He doesn’t tell anyone because his friends and family look down on homosexual relationships. He doesn’t even tell his doctor. The man doesn’t use protection, and he contracts HIV. The man’s girlfriend has no idea that she is at risk of catching the disease from him.

Diabetes disproportionately affects Hispanic people in the United States. In 2008, they were almost twice as likely as non-Hispanic whites to be diagnosed with diabetes. Where they live, access to good-quality health care, and social and cultural factors may explain the prevalence of diabetes among Hispanic people.

American Indians and Alaska natives suffer from many health inequities. According to the Department of Health and Human Services report in August 2009, a baby born to an American Indian woman is more than nearly three times as likely to die from SIDS (sudden infant death syndrome) as a baby born to a white woman. American Indians and Alaska natives also suffer disproportionately from substance abuse issues. These health problems may be exacerbated by geographic isolation, economic limitations, and mistrust of outsiders.

For example: An American Indian teenager who lives on a reservation in New Mexico may have been raised to not trust, or even to fear, people who live outside the reservation. This teenager has limited access to health information about alcoholism and substance abuse. The adults in the local community don’t take seriously the information that is brought in by visiting nurses from the nearest city. Many close relatives are alcoholics, putting the teen at a greater risk for the disease, but there is no access to reliable information about the connection between alcoholism and genetics.

Young people who identify as lesbian, gay, bi-sexual, transgender (LGBT) may come from any ethnicity or socioeconomic background. However, because of family disapproval, social rejection, and discrimination or even violence from peers and their community, they face increased health risks. Adolescent lesbian and bisexual females are more likely to have been pregnant than heterosexual females of the same age range. Adolescent gay and bisexual males have significantly higher rates of HIV, syphilis, and other sexually transmitted diseases. They are also at greater risk for suicide.

Working in global health requires a high awareness of what equity and social justice mean in different parts of the world, including the United States. We live in an era when great strides are being made to bridge gaps in equity. As a young person today, you may have considerable opportunities to make a contribution in this area.




Note Taking: Equity and Social Justice in the United States

Student Name: Date:

Directions: As you read Student Resource 6.6, Reading: Equity and Social Justice in the United States, answer the questions below.

What are the characteristics of equity?

What are the characteristics of social justice?

List three examples of inequity you find in the reading. For each example, list one measure that you can think of that could be taken to reduce the inequity. An example is provided for you.

Inequity Measure to Reduce Inequity

Asian Americans suffer disproportionately from certain types of cancer, tuberculosis, and hepatitis because of language and cultural barriers, stigma associated with certain conditions, and lack of health insurance.

Health information could be provided to Asian Americans in their own languages. Also, clinics and hospitals could train their staff to interact with Asian Americans in ways that are culturally appropriate.




Stations: Organizations that Support Global Health

Student Name: Date:

Directions: Visit each information station and complete the questions below for each organization.

WHO What is this organization’s main purpose?

What are the three (or more) most important types of work that it does?

How does this organization play an important role in global health?

UNDP What is this organization’s main purpose?





UNICEF What is this organization’s main purpose?



CDC What is this organization’s main purpose?



World Bank What is this organization’s main purpose?




AOHS Global Health

Lesson 7 Introduction to Health

Determinants In this lesson, students learn about the determinants that influence the health of individuals and communities. They learn about the meanings and uses of the terms correlation and causation. Students learn about the role culture plays in determining health, and they examine how their own culture is a health determinant. Students conclude this lesson by writing an analysis of health determinants in their lives, their families, and their community.

Advance Preparation

In Class Period 1, you will need to access the website County Health Rankings and Roadmaps at http://www.countyhealthrankings.org/.


Lesson Framework


Define determinant and identify the different types of health determinants

Contrast the meanings and usage of the terms correlation and causation in relation to health issues

Explain how culture is a health determinant

Illustrate how each health determinant can impact the health of an individual and of the community*

Evaluate how determinants interact to affect a given health outcome


AOHS Global Health Lesson 7 Introduction to Health Determinants



Identify the differences between subjective and objective information (National Health Science Standards 2015, Standard 2.13)

Utilize proper elements of written and electronic communication (spelling, grammar, and formatting) (National Health Science Standards 2015, Standard 2.31)



Evaluate accepted ethical practices with respect to cultural, social, and ethnic differences within the healthcare workplace (Common Career Technical Core 2012, HL 6)

Assessment


Analysis of health determinants (Student Resource 7.6)

Assessment Criteria: Health Determinant Analysis (Teacher Resource 7.1)

Prerequisites Understanding of how socioeconomic status can impact health

Familiarity with basic concepts in epidemiology (e.g., how disease can be spread)


Teacher Resources Teacher Resource 7.1, Assessment Criteria: Health Determinant Analysis

Teacher Resource 7.2, Prompts: Learning Objective Reflection (separate PowerPoint slide)

Teacher Resource 7.3, Key Vocabulary: Introduction to Health Determinants

Teacher Resource 7.4, Bibliography: Introduction to Health Determinants

Student Resources Student Resource 7.1, Analysis: Causation and Correlation

Student Resource 7.2, Reading: Culture as a Health Determinant

Student Resource 7.3, Key Word Notes: Culture as a Health Determinant

Student Resource 7.4, Personal Analysis: Culture as a Health Determinant

Student Resource 7.5, Inventory: Personal Health Determinants



Student Resource 7.6, Analysis: Personal Health Determinants

Equipment and Supplies LCD projector and computer to show website data and PowerPoint slide

Blackboard, whiteboard, or flip chart

Chart paper (at least 11 sheets)

Markers (at least 11)

Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1

10 Health Determinants: Where Do We Rank?

This activity makes the abstract concept of health determinants more relevant and concrete as students explore their own community’s rankings on a range of health determinants.

Prior to class, go to the website County Health Rankings and Roadmaps at http://www.countyhealthrankings.org/. Click Health Rankings in the toolbar. Type the name of your county. Turn on the “Areas to Explore” option. It will highlight trends to look at in your county. Familiarize yourself with this data so that you can interpret it for your students. Set up your computer to project this page so that the whole class can see it.

Begin class by noting that students have learned a great deal about the factors that determine health. Ask volunteers to name some; they should easily be able to come up with suggestions such as age, diet, physical environment, and education level. Then ask them to consider this question by sharing their thoughts with a partner:

Do you think our own county is a place where people are pretty healthy on the whole? Why do you think so?

Elicit some thoughts from students. Then tell them that there is an organization that has ranked every county in the United States according to a range of factors that contribute to the health of the county’s residents. These factors are called “health determinants.”

Project the page of your county’s rankings. Note your county’s overall ranking and give an overview of what the data reveals. Instead of going through each data point in sequence, skip around to the factors that jump out about your county. For example, if you live in Erie County, New York, you would show your students the graphs indicating



Step Min. Activity

a rise in obesity and in sexually transmitted diseases. You would also show students the positive trends.

Click the data points that students want to know more about. Ask them to revisit their original thoughts on whether their county is a pretty healthy place to live. To conclude, point out that developing a thorough understanding of health determinants will be a focus throughout the lesson.

2 40 Analysis: Causation and Correlation

The purpose of this activity is to introduce students to the distinction between correlation and causation.

Write the following statement on the board:

High-fat foods cause heart disease.

Then ask students to share with a partner anything they think might be wrong with the statement. Have partners share their ideas with the class. Student responses may include: “There is more than one cause of heart disease” or “High-fat foods can contribute to heart problems, but they don’t cause them.”

Write the words correlation and causation on the board.

Explain that the statement “high-fat foods cause heart disease” is not accurate because we do not know that high-fat foods alone cause heart disease, but they may be correlated, or associated, with it. There is evidence suggesting a causal relationship. Further explain correlation by saying that there is a statistical relationship between high-fat foods and heart disease; high-fat foods are associated with, or related to, heart disease, but there is no proof that they are the only and direct cause of it.

Tell students that they are going to read about causation and correlation and then try for themselves to make the distinction between the two. Refer them to Student Resource 7.1, Analysis: Causation and Correlation. Note the section at the end of the resource, where students are to determine if the story is describing causation or correlation and then come up with an accompanying reason or task, depending on whether it’s causation or correlation. Answer any questions.

After students have completed the resource, ask them to compare their responses for accuracy with another student. Then ask pairs to share a hypothesis or a set of steps for improving health that they suggested for one of the stories. Finally, address any remaining questions or misunderstandings.

To conclude, remind students that correlations are often inaccurately portrayed as causations and that it is the role of scientists, researchers, and other health professionals to make sure the terms are used correctly. Tell students that they should use their understanding of the terms to think critically about health reports they read or hear about in the news.


CLASS PERIOD 2



Step Min. Activity

3 40 Summarizing: Culture as a Health Determinant

In this activity, students learn about culture as a health determinant as they practice noting key words and writing summaries. This activity focuses on the following college and career skills:

Demonstrating the ability to write effectively

Asking appropriate and effective questions

To begin, write the following prompt on the board:

Name one aspect of your culture that has either a positive or negative effect on your health. Explain.

Ask students to take a moment to think about their response. Ask them to share their response with a partner, and then ask partners to share their responses with the class. A sample response might be, “In my culture, music and dance are important. At family gatherings, there is a lot of singing and dancing, which relieves stress and is good for our health.”

Refer students to Student Resource 7.2, Reading: Culture as a Health Determinant, and Student Resource 7.3, Key Word Notes: Culture as a Health Determinant. Explain that writing down key terms about a reading is a good note-taking strategy that they can use throughout high school and college. It will help them to develop the skill of summarizing.

Ask students to read the first section (Introduction) of Student Resource 7.2. As they read, they should write down three or four key terms in the box labeled Introduction in Student Resource 7.3. Once students have written down words for the introduction, tell them to pair with a neighbor and share the words they wrote down. Ask volunteers to share their key words. Write these words on the board and hold a brief class discussion. Guide discussion with questions like these:

Who else picked those terms?

What other terms were chosen? How did you make your choices?

Which terms are the best for helping you remember key points?

If you were to summarize this introduction in two sentences, using key terms from the board, what would you say?

This is not an easy task and students will struggle. Acknowledge that effective summarizing takes a while to master, but it is a critical skill for health professionals to acquire. Use this discussion to guide students to understand how to use this note-taking strategy effectively.

Direct students to proceed through the rest of the reading, one section at a time, writing down key terms in Student Resource 7.3 as they go and comparing terms with their neighbor. Give students about 15 minutes for this part of the activity.

Finally, tell students to write a summary of the reading using their key words to guide them. Their summary can’t be longer than three sentences. While they do this, they should not refer to the reading itself; their goal is to remember the main points from the key words.

Ask volunteers to share their summaries. Generate brief discussions around the summaries, asking students if they can think of a way to make them more focused on key points. Use this time to help students recognize key points from details and answer



Step Min. Activity

questions.

4 10 Personal Analysis: Culture as a Health Determinant

The purpose of this activity is to have students examine how their own culture acts as a health determinant.

Refer students to Student Resource 7.4, Personal Analysis: Culture as a Health Determinant. Instruct students to read the instructions and then work individually to complete the resource.

If they don’t finish the resource in class, tell students to do so for homework. They will need it for the beginning of the next class.

CLASS PERIOD 3

5 10 Personal Analysis: Culture as a Health Determinant (Continued)

Students share the positive and negative influences of their culture that they identified.

Ask students to work with a partner to compare their answers on Student Resource 7.4, Personal Analysis: Culture as a Health Determinant. Then have partners share their responses with the class.

Point out that while some students may identify with the same culture, they may have different ideas about how culture acts as a health determinant. You may want to gauge student understanding by assessing Student Resource 7.4 on a credit/no-credit basis.

6 30 Inventory: Personal Health Determinants

Students consider how health determinants interact to affect their health and the health of their families and the broader community they live in.

Point out that students have learned about many different health determinants, and now they are going to consider how those health determinants interact to affect the health of an individual, a family, and a community.

Refer students to Student Resource 7.5, Inventory: Personal Health Determinants. Explain that this resource will help them figure out which health determinants are shaping their own lives. They will take a personal inventory of these health determinants that is as complete as possible. Tell students that they will be using this resource as the foundation for a writing assignment in the next class period.

Briefly review the questions to consider that follow each section of the resource and, if necessary, give an example of how one of the questions could help students figure out a health determinant that affects them. Encourage students to use these questions, along with their notes and other materials from this lesson, to complete the charts. Make sure that students know they don’t need to write answers to the questions; instead, the questions are there to help them get ideas for health determinants to write in the charts.



Step Min. Activity

7 10 Writing Assignment Preparation: Personal Health Determinants

Students compare their charts in preparation for writing a health determinant analysis.

Invite all students to share one determinant they identified and say if it affects them, their family, or their community. Encourage students to add to their own resource based on their classmates’ responses, when appropriate.

Point out to students that different health determinants interact, and often a health problem can be attributed to more than one health determinant. To illustrate the point, use an example such as the following:

Jared’s family eats deep-fried foods because it’s part of the cuisine typical in their culture. Jared’s family also lives in a community that has almost no open spaces for sports. This is one reason that Jared gets little exercise. Jared’s family has a history of cardiovascular disease.

Explain that the three determinants you just described—deep-fried foods, no space for sports, and a genetic predisposition for cardiovascular disease—are working together, and that they may lead to health problems for Jared.

Tell students that in the next class period, they will have a chance to figure out how the health determinants they listed in their chart interact in their own lives and in their community. If they don’t feel that their chart is filled in completely, tell them to work on it for homework.

CLASS PERIOD 4

8 50 Writing Assignment: Health Determinant Analysis

In this activity, students use their lists of health determinants that affect their lives as the basis for a written analysis of the factors that determine their health. This activity focuses on the following college and career skills:




Refer students to Student Resource 7.6, Analysis: Personal Health Determinants.

Explain that when health professionals do an analysis such as this, there are ethical guidelines they follow with respect to privacy and confidentiality. Point out to students that for their personal analysis, they won’t be required to share anything they don’t want to share with other students or the class.

Next, have students read the instructions. Review the assessment criteria and answer any questions. Ask students to read the example analysis and identify how it meets the assessment criteria. Answer any questions students have about the example analysis.

Point out that in order to write the analysis, students should use the inventory they just completed (Student Resource 7.5), but they also should think about how the different determinants they identified interact. If necessary, spend time going over the final paragraph of the example, which addresses how health determinants interact in the



Step Min. Activity

student’s life.

Instruct students to spend the rest of the class period working on their outline and writing their analysis. Remind students to use their outline as a guide to write their analysis. At the end of the class period, explain that they will be sharing their analysis with classmates before handing them in for assessment. If students don’t finish their analysis in class, tell them to do so for homework.

CLASS PERIOD 5

9 20 Peer Sharing: Health Determinant Analysis

In this activity, student volunteers share and respond to each other’s work.

Write the following question on the board, and ask students to think about the question as they listen to their peers share their health determinant analysis:

What health determinant did you learn about that you think is positive and healthy?

Ask student volunteers who want to read aloud their personal health determinant analysis to the class to do so. Make sure that students don’t feel pressure to share their work.

After each student reads his or her analysis, allow other students to share positive and negative health determinants they learned about.

Collect students’ work, and assess the assignments using Teacher Resource 7.1, Assessment Criteria: Health Determinant Analysis.

Conclude the activity by pointing out that now that they have written an analysis, they have a better sense about what important elements to look for when reading about health determinants.

10

30 Reflection: Key Learning Objective

Students reflect on whether they met a specific learning objective for this lesson.

Prior to class, prepare to project Teacher Resource 7.2, Prompts: Learning Objective Reflection (separate PowerPoint slide), during this activity.

Note: If your students need more practice and guidance with reflection, return to Teacher Resource 4.5 in Lesson 4.

Write the following learning objective on the board:

Contrast the meanings and usage of the terms correlation and causation in relation to health issues

Project Teacher Resource 7.2, Prompts: Learning Objective Reflection. Tell students to choose one of the prompts and think about it in connection with the learning objective on the board. They should then write their reflection in their notebook.

Give students a few minutes to write down their thoughts. Ask for a show of hands to see who chose the first prompt. Place these students in pairs or triads to compare their reflections. Do the same for each of the other prompts. Their task is to choose the



Step Min. Activity

reflection that is most complete, on topic, and thoughtful.

Ask a member of each group to share the reflection that the group feels best fits these criteria. Generate a brief class discussion to help students develop their metacognitive skills. Complete this activity by reminding students that this type of practice will help them when they have to complete professional self-evaluations in their internships or jobs. If your students are participating in NAFTrack Certification, it also prepares them for the reflection component of the culminating project.

Extensions

Content Enrichment Have students create a collage to illustrate the various health determinants that affect their health,

their family’s health, and the health of their community. Students should turn this in as an illustration to accompany their health determinant analysis.

Have students interview family members about their culture’s views on health-related topics, such as seeking therapy, organ and blood donation, prescription medicine, and diet and physical activity. Encourage students who want to, to share what they learn about their culture and family with the class. You may also wish to arrange for students to invite family members to come to the class and discuss these topics.

STEM Integration Technology: Play the game found at http://playspent.org/html/, either as a class or in small groups.

It underscores how difficult it is to make healthy decisions when you face serious hardship.

Science: Have students look at science experiments they have conducted recently. Ask them to examine if they found causation or correlation and explain why.

Technology: Students can use this website to learn about the degree of opportunity to improve life circumstances that exists in their communities: http://opportunitynation.org/. On the Research tab, tell students to choose the option “Opportunity Index.” Students can report their findings to the class after gathering information from this site.

Technology: Have students identify one or more health determinants that they think people in their community need to be more aware of. Assign students to groups and ask them to create a public service announcement about that determinant that could be aired on a local radio or television station.

Additional Cross-Curricular Ideas English Language Arts: Have students analyze the health determinants of the main character in a

novel they are reading. For example, how are socioeconomic and environmental determinants affecting the health of the Joad family in John Steinbeck’s The Grapes of Wrath? Have students work together to complete an analysis of the character’s health and use it to predict whether the character’s health will affect the plot of the novel.

Social Studies: Have students choose a culture during a historical era, such as the mining culture during the Gold Rush or the Protestant culture in colonial America. Then ask students to create presentations that examine how that culture acted as a health determinant during that era.


AOHS Global Health


Determinants

Teacher Resources


Teacher Resource 7.1 Assessment Criteria: Health Determinant Analysis

Teacher Resource 7.2 Prompts: Learning Objective Reflection (separate PowerPoint slide)

Teacher Resource 7.3 Key Vocabulary: Introduction to Health Determinants

Teacher Resource 7.4 Bibliography: Introduction to Health Determinants




Assessment Criteria: Health Determinant Analysis

Student Name:______________________________________________________________

Date:_______________________________________________________________________


Met Partially Met

Didn’t Meet

The introduction clearly describes who and what are being studied, and the conclusion clearly summarizes the effect of the determinants on the subject’s health.

□ □ □

The analysis accurately identifies socioeconomic, environmental, and geographic determinants that are impacting individual health, family health, and/or the health of the community.

□ □ □

The analysis accurately identifies social and cultural determinants that are impacting individual health, family health, and/or the health of the community.

□ □ □

The analysis accurately identifies behavioral, biological, and medical determinants that are impacting individual health, family health, and/or the health of the community.

□ □ □

The analysis accurately pinpoints how determinants can interact, or influence each other, to impact health.

□ □ □


□ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Key Vocabulary: Introduction to Health Determinants

Term Definition

case study A report that focuses on one instance, individual, or situation as an example of a broader concept.

causation Proof that a health determinant causes a health outcome.

correlation An association that has a statistical relationship between a health determinant and a health outcome.

health determinant Factor that affects or impacts health, such as genetics, culture, education, or income level.




Bibliography: Introduction to Health Determinants





Online “The Determinants of Health.” WHO, http://www.who.int/hia/evidence/doh/en/index.html (accessed October 23, 2015).

Gabrysch, Sabine, et al. “Cultural Adaptation of Birthing Services in Rural Ayacucho, Peru.” Bulletin of the World Health Organization, July 2009, http://www.who.int/bulletin/volumes/87/9/08-057794/en/ (accessed October 23, 2015).

“Social Determinants of Health.” CDC, http://www.cdc.gov/socialdeterminants/Definitions.html (accessed October 23, 2015).

“What Makes Canadians Healthy or Unhealthy?” Public Health Agency of Canada, http://www.phac-aspc.gc.ca/ph-sp/determinants/determinants-eng.php (accessed October 23, 2015).


AOHS Global Health


Determinants

Student Resources


Student Resource 7.1 Analysis: Causation and Correlation

Student Resource 7.2 Reading: Culture as a Health Determinant

Student Resource 7.3 Key Word Notes: Culture as a Health Determinant

Student Resource 7.4 Personal Analysis: Culture as a Health Determinant

Student Resource 7.5 Inventory: Personal Health Determinants

Student Resource 7.6 Analysis: Personal Health Determinants




Analysis: Causation and Correlation

Student Name: Date:

Directions: First, read about correlation and causation and be sure you understand the difference. Then check your understanding by answering the questions that follow the reading. If the story is describing correlation, give one hypothesis that could be tested to investigate the issue further. If the story is describing causation, think of one action public health officials could take to help people improve their health. Study the example below before you begin.

Imagine you read this headline on a news site: “Study shows strong link between fast food and obesity.” What exactly does this mean? Does fast food cause people to become obese? The headline doesn’t tell the whole story. The researchers may have found that fast food consumption over a period of time is correlated, or linked, to obesity, but this doesn’t mean that fast food causes the disease. Obesity is linked to many things, including diet, exercise, and genetics.

Correlation Sometimes when we talk about a health determinant that causes a health outcome, what we really mean is a correlation, or an association.

When we say that a health determinant and a health outcome are correlated, we are saying that they have a statistical relationship. In other words, when one thing increases or decreases, the other thing increases or decreases.

Let’s look at obesity as an example. Researchers found that over time when people increased their consumption of fast food, the likelihood of them becoming obese also increased. That is a direct correlation. If a different headline states that researchers have found that when people increased their physical activity, the likelihood of those people becoming obese decreased, that is an example of an indirect correlation.

Examples of Correlation Correlation Key Phrase

Relationship

There is a relationship between exercise and low stress levels.

“relationship between”

Indirect correlation: increase in exercise, decrease in stress

Pedestrian accidents are less likely to occur in intersections where there are crosswalks.

“less likely” Indirect correlation: increase in crosswalks, decrease in accidents

Eliminating saturated fat from the diet is associated with a lower risk for heart disease.

“associated with” Direct correlation: decrease in saturated fat, decrease in risk for heart disease

People who ate unwashed fruit were found to have an increased risk of bacterial infections.

“were found to have”

Direct correlation: increase in unwashed fruit, increase in risk for infection

People who have alcoholic relatives are more likely to develop a problem with alcohol.

“more likely” Direct correlation: increase in rate of alcoholism in family,



increase in risk for alcoholism in individual

Bullying is linked to teen suicide. “linked to” Direct correlation: increase in bullying, increase in risk for suicide

Causation Causation, or saying that something causes something else, is hard to determine. It requires particular types of rigorous research to prove causality.

For example, it may seem like common sense that the more fast food a person eats over time, the more likely it is that the person will struggle with weight issues, but researchers can’t say that fast food causes obesity. There are other things to consider. Were the people who ate fast food over a prolonged period of time exercising on a regular basis? Do they have a genetic predisposition to obesity? Did they have other physical problems? Did the work they do require them to be sedentary or active? Did they suffer from mental disorders that affect eating habits, such as depression? To prove causality, researchers must study two controlled groups of people that are similar in every way except for one variable, and that is very difficult to do. Even once causation has been determined, it still could be proven wrong.

Examples of Causation

Cigarette smoking can cause lung cancer.

Lyme disease is caused by a bacterium called spirochete and is spread by ticks.

Drunk driving causes an increase in fatal auto accidents.

The bacterium Chlamydia trachomatis causes chlamydia.

The mineral fiber asbestos found in some construction materials can cause lung cancer.

Global health researchers and public health workers make great efforts to distinguish between causation and correlation. In their work, they strive to provide people with information that is as accurate as possible.

Example A recent report released today shows that a group of researchers based in Germany have discovered an association between smoking cigarettes and alcoholism. They found that alcoholics are more likely to smoke than nonalcoholics.

Is the story describing causation or correlation? correlation

If it is correlation, write one hypothesis that could be tested to investigate the issue further. If it is causation, write one action that could be taken by public health officials to help people improve their health.

People who drink too much don’t care about their health, so they are more likely to smoke.



Story 1 The findings of a report conducted over a period of 10 years show that the risk for cardiovascular disease is partly genetic. The report emphasizes that heart disease is also caused by other factors, including lifestyle choices.

Is the story describing causation or correlation?


Story 2 According to a new study, people diagnosed with schizophrenia are at risk for using marijuana as a way to self-medicate. The study shows a link between the mental health disorder and marijuana use.



Story 3 Researchers have pinpointed a bacterium that causes pneumonia. It is called Streptococcus pneumoniae.






Reading: Culture as a Health Determinant

Introduction What do you eat when you feel sick? When do you know it’s time to call a doctor? What are your ideas about what made you sick? The answer to these questions is in large part determined by your culture.

But what exactly is culture? Culture is a difficult thing to pin down. In general, it is the behavior and beliefs that are shared and learned. Culture includes:

Customs, rituals, and traditions

Communication and language

Religion and spirituality

Art and music

Relationships

Food

Defining or understanding culture is difficult. What makes up American culture? A firm handshake? Hamburgers? Jazz?

The United States is a large country spanning several distinct geographical areas and inhabited by millions of people from all over the world. As is the case with most countries, defining American culture involves recognizing and understanding subcultures. There is the culture of the West Coast and the culture of the Deep South. There are religious cultures, such as Jewish American culture, which is very different from, say, the Jewish French culture. There are ethnic and racial cultures, such as African American culture. Of course, there are subcultures within that group, too; the difference between rural and urban African American culture is vast. There is American office culture. There is American sports culture. When you begin to compare colleges, campus culture is one thing you’ll consider.

Most of us are part of more than one cultural group. For example, if you are a Mexican American teen, you may identify with American culture, the culture of your high school, and Latino or Hispanic culture.

All of the cultural groups and values that you identify with act as health determinants in different ways. Some cultural values enhance health. For example, cultures that prioritize community often provide individuals with strong support networks. On the other hand, cultural values may not enhance health, such as a cultural practice of giving sugar water to newborns.

Health Behaviors There is a relationship between culture and health behaviors. One way to understand this relationship is to look at cultural attitudes about food and weight. In many Pacific Island cultures, larger women are perceived to have an ideal body weight. An excess of weight is seen as a sign of increased fertility. Some of these island nations have a high prevalence of obesity.

In other cultures, women who are underweight are seen as the ideal. Being underweight, like many Western celebrities and models, is seen as a sign of status and wealth. Young women in these cultures are at risk for eating disorders.

In these examples, culture affects health behaviors. In a culture that encourages over- or undereating, individuals’ behavior will be affected by these values.

Perception of Illness Culture affects people’s perception of illness. Different cultural groups have different ideas about what is normal and abnormal health. For example, a rare occurrence of malaria in North America would be



considered alarming. However, in sub-Saharan Africa, malaria is so common that it is considered normal, even though it claims lives.

Culture also affects people’s ideas about what causes disease. In India, many people believe that illness occurs when the body is out of balance, when the “hot” and “cold” elements of the body are off-kilter.

Some cultures believe that illness can be caused by an emotion, like envy or fear, or by something supernatural, like offending their deity or being possessed by spirits. In Canada, the First Nations people believe that illness is a sign from the creator that the sick person needs to reevaluate his or her life.

Health Services When people choose to use health services is linked to culture. In many cultures, people first turn to home remedies when faced with illness or injury. For example, if you feel a headache and chills, you may first take an aspirin, drink water, and then eat some chicken soup. If your symptoms don’t go away in a day or two, you might call the doctor.

In non-Western cultures, home remedies are often used extensively first. This might be due to lack of access to care or because of distrust of medical professionals. Next, a visit with a local healer might take place. A visit with a Western doctor won’t happen until the symptoms are severe or even life threatening. It is also common for a combination of modern and traditional medicine to be used at the same time.

Treatment Culture affects the choices people make when seeking treatment. People generally seek medical treatment from a provider who belongs to their culture. People want to be treated by someone who speaks their language and respects their customs and beliefs because it is easier to trust someone who understands your way of thinking and handling of health issues. In some cultures, people may avoid seeking treatment from a doctor whom they may need to pay with money. Instead, they may seek treatment from a provider they can barter with or give gifts.

The type of health services providers that people go to for diagnosis and treatment varies among cultures. Here are some examples:

Indigenous Health Service Providers

Western Health Service Providers

Chinese Medical System Health Service Providers

Uncertified midwives Physicians Acupuncturists

Shamans Nurse-midwives Herbalists

Priests Dentists Chemists

Herbalists Pharmacists

A Case Study: Childbirth Mortalities in Ayacucho, Peru A case study is a written document that describes an individual or a situation (the “case”) as an example of a broader topic or issue. They are very useful in global health as well as in all of the health sciences.

One significant challenge for global health workers is to find ways to respect people’s culture while implementing solutions that improve health outcomes. They work to resolve health issues without disrupting cultural norms. Below is a case study about childbirth and neonatal mortality in an impoverished region of Peru. In this case, an NGO worked with the local population to improve outcomes in childbirth. This case study illustrates an example of workers who respected the local culture while



resolving a major health issue. In this region of Peru called Ayacucho, the maternal mortality rate was 300 per 100,000 live births, compared with a rate of 50 per 100,000 live births in other parts of the country closer to the capital of Lima. In Ayacucho, poverty is extreme, educational levels are low, and illiteracy is widespread, especially among women. This region was populated mostly by indigenous peoples who generally did not trust Western health professionals. One NGO was determined to find a way to reduce the maternal mortality rate while still respecting local customs.

NGO workers invited tribal leaders, pregnant women, and traditional birth attendants to meet with health professionals. The challenge was to design a delivery room that would provide up-to-date medical care while also honoring Ayacucho tradition.

In the process of designing the delivery room, the health professionals and the traditional birth attendants trained each other. The health professionals taught the traditional attendants about newborn care and signs of danger during delivery, while the attendants taught the health professionals about their cultural birth practices and medications. The health professionals also studied the local dialect so that women giving birth could be addressed in their native language.

As a result of this work in Ayacucho, more women began to use the new delivery room. In 1999, only 3% of births took place in the health center. But by 2007, 83% of births took place there. Women who used the center reported that they felt more comfortable in the environment and would choose to use the center again for future births. The NGO had succeeded in respecting the local culture while achieving an improved health outcome for the women and their children.

Data retrieved March 2014 from: http://www.who.int/bulletin/volumes/87/9/08-057794/en/




Key Word Notes: Culture as a Health Determinant

Student Name: Date:

Directions: Read Student Resource 7.2, Reading: Culture as a Health Determinant. For each section of the reading, write down three or four terms that you think are key words, or words that can help you remember the most important point(s) of that section. When you have finished the reading, use your key words to write a summary of what you learned from the reading.

Introduction

Health Behaviors Perception of Illness

Health Services

Treatment A Case Study

Summary (two or three sentences):




Personal Analysis: Culture as a Health Determinant

Student Name: Date:

Directions: Complete this resource to look at the ways that your culture determines your health.

Cultures You Identify With Most people identify with more than one cultural group. List two to four cultural groups that you identify with. Then underline the cultural group that you would like to focus on.

1.

2.

3.

4.

Elements That Make Up Your Culture Think about some of the elements that make up the culture you underlined. Fill in the chart with your ideas.

What customs and rituals are parts of the culture?

What recreational activities are parts of the culture?

Are religious beliefs a part of the culture? Explain.

What language(s) do people in the culture speak?



How are art and music a part of the culture?

What are the cultural beliefs about relationships, family, and community?

What distinguishing types of food are eaten in the culture?

Examples of Your Culture as a Health Determinant Give two examples of how the culture affects your health behaviors. First give one example about how the culture enhances your health behavior, and then give one example about how the culture does not. Next, explain one way that you could address the negative health behavior while still respecting your culture. Examples are shown.

Positive Health Behavior Example

Negative Health Behavior Example

One Way to Address Negative Behavior

In my culture, there is an emphasis on team sports, so I’ve been athletic from a young age. I get plenty of physical activity.

People in my culture encourage overeating. They push seconds—or even thirds—on the young people. I worry that I’m going to be overweight like my relatives when I get older.

I can still enjoy the wonderful, festive family meals with people from my culture but politely refuse more food. I can explain that I’m full and that I’ll eat more later if I feel hungry.




Inventory: Personal Health Determinants

Student Name: Date:

Directions: Use this resource to identify health determinants that apply to your community, your family, and yourself. It is divided into three sections:

1. Socioeconomic, Environmental, and Geographic Health Determinants

2. Social and Cultural Health Determinants

3. Behavioral, Biological, and Medical Health Determinants

Each section has some questions to help you determine which health determinants affect your community, your family, and you. Use this information to fill in the chart that follows each set of questions. An example of a health determinant is given in each chart. You don’t need to write answers to the questions; they are designed to help you think carefully about health determinants. Remember too that you learned about health determinants in your community in the beginning of this lesson.

Socioeconomic, Environmental, and Geographic Health Determinants Education and Employment

o Is there a high level of unemployment in your community? Do the adults in your family have stable and fulfilling work?

o Do young people in your community need to work to make a family financial contribution?

o Are work-related issues a source of stress?

o Do people typically receive health insurance through their work?

o How has the level of education affected the employment opportunities for people in your family and community? Has a lack of education prevented people from obtaining employment?

o What workplace dangers do people face? Do people do sedentary work, like office jobs? Do they do work that is physically taxing, like farm work? Are they exposed to dangerous chemicals or conditions at work?

Health Services

o Do you, your family, and people in your community have access to quality health services? Is there anything holding people back from accessing health services?

o Are there specific types of health services, such as dental care, that aren’t accessible or affordable?

o Do people seek preventive care or do they typically wait until a problem develops before seeking care?

Physical Environment

o Is there violence in your home or community? How does the violence affect people?

o Do people in your family and community have safe housing?

o Is there clean drinking water and excellent sanitation?

o Are there places to get healthy, affordable food?



o Are there clean and safe places to exercise and play?

o Do people use public transportation? Is it affordable, reliable, and safe?

Geography

o Is there air, water, or soil pollution where people live and work?

o Do you live in an area that has extreme climates, either really cold or really hot, that put people at risk for conditions like frostbite, hypothermia, or heat exhaustion?

o Do certain insects thrive in the area where you live, putting people at risk for diseases like malaria or West Nile virus?

Health Determinants Common to Most People in My Community

Health Determinants Common to Most People in My Family

Health Determinants that Affect Me Specifically

Most people in my community have a relative who has a chronic respiratory condition from working in the paint factory.



Social and Cultural Health Determinants Support Networks

o Are there strong support networks, such as community centers, clubs, or church groups, that help people develop healthy coping skills and encourage people to make healthy choices?

o Are elderly people looked after in your community?

o Are there good infant and day-care options in your community?

o Are there good afterschool programs for school-aged children and teens?

Cultural Beliefs

o Does your culture enhance people’s health behavior?

o Is healthy eating and physical activity part of your culture?

o What is your culture’s perception of illness?

Discrimination

o Are people discriminated against because of their sexual orientation? Do gay people feel safe in your community?

o Is racism a problem in your community? Are certain racial groups discriminated against? Is there racial violence?




Most people in my family believe that you should keep your problems to yourself.



Behavioral, Biological, and Medical Health Determinants Personal Behavior

o Do you make healthy food and drink choices?

o Are you physically active?

o Do you make healthy choices about smoking, drinking, and using drugs?

o Do you feel informed about how to protect yourself from sexually transmitted diseases and unwanted pregnancy?

Genetics

o Do people in your family typically have a long life span? What is the general level of health for people in your family?

o Are you at risk for developing certain diseases or conditions that have a genetic correlation, like alcoholism or heart disease? Are you knowledgeable about your family’s medical history?

o What is your general health like? Do you have any chronic illness?

Gender

o Are there some conditions or health-related issues that are more common to your gender? Do you feel informed about those issues?




I am a vegetarian and carefully plan my diet to be healthy and balanced.




Analysis: Personal Health Determinants


Directions: Use Student Resource 7.5, Inventory: Personal Health Determinants, to help you write an analysis of the health determinants that affect you, your family, and your community. An example is provided. Before you begin, read through all of the instructions on this sheet, and read the assessment criteria at the end to make sure you understand how your work will be assessed.

Remember that health determinants don’t need to be bad or things that cause health to suffer. For example, perhaps you live in a place that has safe drinking water, and there is little or no pollution in the air and soil. This geographic health determinant is going to have a positive health outcome on you and people in your community.

Your analysis should include information on the following topics:

Introduction (Give a brief explanation of who you are and where you live.)

One paragraph about socioeconomic, environmental, and geographic determinants

One paragraph about social and cultural determinants

One paragraph about behavioral, biological, and medical determinants

Conclusion (Summarize what effect the determinants have on your health.)

Before you begin writing, create an outline, using the model below. Include in the outline the information that you are going to use in each section of your analysis. When you have completed the outline, begin writing. Remember to make sure that your analysis meets or exceeds the assessment criteria.

I. Introduction

II. Socioeconomic, Environmental, and Geographic Determinants

III. Social and Cultural Determinants

IV. Behavioral, Biological, and Medical Health Determinants



V. Conclusion


The introduction clearly describes who and what are being studied, and the conclusion clearly summarizes the effect of the determinants on the subject’s health.

The analysis accurately identifies socioeconomic, environmental, and geographic determinants that are impacting individual health, family health, and/or the health of the community.

The analysis accurately identifies social and cultural determinants that are impacting individual health, family health, and/or the health of the community.

The analysis accurately identifies behavioral, biological, and medical determinants that are impacting individual health, family health, and/or the health of the community.

The analysis accurately pinpoints how determinants can interact, or influence each other, to impact health.


Example Analysis I am a 14-year-old boy living in a Texas suburb. Many people in my community work for a nearby university, so the economy in our town is stable and the quality of life is pretty good. I live with my mother, my older sister, and my baby niece.

My father died of a heart attack when I was young. Since then, my mother has worked very hard as a housecleaner to provide for our family. Many families in our town need housecleaners, so my mother always has plenty of work. Because of her work, her back hurts a lot. The doctor calls it “chronic back pain.” Another problem is that we don’t have health insurance. When we need to see a doctor, we go to a clinic, but we only go if we’re really sick. Until she had a baby, my older sister also worked. Now she stays home. I’ve wanted to work, but my mother wants me to focus on school. I feel pressure to succeed.

We live in a community with clean air and clean drinking water. The climate is the geographical determinant that has the greatest impact on us. Summers are blistering hot. When my sister was pregnant, she had heat stroke and had to go to the hospital.

We belong to an active church. After my father died, members gave us a lot of support. They brought food and offered to do repairs around the house. They were very supportive. However, one of the church’s beliefs is that young people should not be taught about birth control. My sister was uneducated when she had an unplanned pregnancy. Her pregnancy gave my family a lot of stress. But the church stepped in again and helped my sister learn how to take care of the baby while my mom worked.

Some kids at my high school drink beer and smoke cigarettes and pot. My friends and I don’t hang out with them. We play softball, go fishing, and listen to new bands that we find on the Internet. Some people at my church smoke. My father was a smoker. But now no one in my family drinks, smokes, or uses drugs. Smoking might be one factor that caused my father’s heart attack, so I am not going to smoke.

Overall, I am in good health. My mother and sister are overweight and that’s bad for their health. I am going to watch my weight. I don’t drink a lot of soda. I know that being active and not eating junk food will help keep me healthy in the long run. Having no health insurance could have a bad impact if my mother’s back pain gets worse or my sister or niece gets really sick. Sometimes my life is stressful, but I have my family and friends to help me deal with things.


AOHS Global Health

Lesson 8 Environmental Risk Factors

In this lesson, students learn about the main environmental risk factors and diseases related to sanitation, water, hygiene, indoor air pollution, and outdoor air pollution. They draw diagrams to illustrate how health determinants are linked to environmental risk factors and analyze charts and diagrams to retrieve risk factor information. They read case studies about environmental risk factors that affect health. During a guest speaker visit, they interact with a professional who specializes in environmental global health. Students also learn about the culminating project for this course. Their first project-related task is to consider environmental health issues that they think may need immediate attention.

Advance Preparation

Determine how you want students to keep culminating project portfolios. The portfolio can be a separate section of their binder, a separate folder that they use just for project materials, or, if you have a paperless classroom, a computer folder.

In Class Period 2, you will need access to the YouTube video “Clean Hands Help Prevent the Flu” at https://www.youtube.com/watch?v=XHISh559oho. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see www.keepvid.com) or a similar program.

Before Class Period 4, arrange for a professional who works in environmental health, such as an NGO worker or an academic researcher, to visit the class. See Teacher Resource 8.2, Guide: Guest Speaker, for ideas on how to find a speaker and how to prepare him or her for the visit with your students.

In Class Period 2, each student will need access to a computer for Internet research, and in Class Period 5, pairs of students will need a computer for Internet research.

Prior to Class Period 5, check the links provided in Student Resource 8.10, Research Sources: Environmental Diseases, to make sure that they are at an appropriate reading level for your students.


Lesson Framework


AOHS Global Health Lesson 8 Environmental Risk Factors


Identify the main environmental risk factors that affect health*

Compare and contrast the impact of environmental risk factors based on health determinants

Describe the relationship between environmental risk factors and a major disease*

Deduce the relative impacts of diseases related to environmental factors from data charts and graphs



Describe common diseases and disorders of each body system (such as: cancer, diabetes, dementia, stroke, heart disease, tuberculosis, hepatitis, COPD, kidney disease, arthritis, ulcers) (National Health Science Standards 2015, Standard 1.21)



Differentiate methods of controlling the spread and growth of microorganisms (National Health Science Standards 2015, Standard 7.12)



Assessment


Observations on environmental health issues (Student Resource 8.9)

Assessment Criteria: Environmental Health Issues (Teacher Resource 8.3)

Prerequisites Knowledge about the chain of infection

Knowledge of scope of health determinants and how they can interact


Teacher Resources Teacher Resource 8.1, Presentation and Notes: Environmental Risk Factors Related to Sanitation,

Water, and Hygiene (includes separate PowerPoint file)



Teacher Resource 8.2, Guide: Guest Speaker

Teacher Resource 8.3, Assessment Criteria: Environmental Health Issues

Teacher Resource 8.4, Key Vocabulary: Environmental Risk Factors

Teacher Resource 8.5, Bibliography: Environmental Risk Factors

Student Resources Student Resource 8.1, Note Taking: Environmental Risk Factors Related to Sanitation, Water, and

Hygiene

Student Resource 8.2, Reading: Environmental Risk Factors Related to Sanitation, Water, and Hygiene

Student Resource 8.3, Reading: Air Pollution

Student Resource 8.4, Note Taking: Air Pollution

Student Resource 8.5, Diagrams: Health Determinants and Environmental Risk Factors

Student Resource 8.6, Global Health Detective: Environmental Statistics

Student Resource 8.7, Launch Letter: Global Health Summit

Student Resource 8.8, Project Overview: Global Health Summit Proposal

Student Resource 8.9, Observations: Environmental Health Issues

Student Resource 8.10, Research Sources: Environmental Diseases


Computers with Internet access (one for each student in Class Period 2 and one for each pair of students in Class Period 5)


Chart paper with sticky backing to affix to the classroom wall

Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1 10 Discussion: Environmental Risk Factors and Disease



Step Min. Activity

The purpose of this activity is to have students use what they already know to become familiar with important environmental risk factors and the diseases that are associated with them.

To begin, read aloud the following description of a situation:

A woman in a rural area of Nigeria builds a fire inside her home to cook dinner. She uses dry wood that she has collected. The low fire lets off smoke. Because there is little ventilation, the smoke stays inside her home. While the woman cooks, two children sleep nearby on a simple cot.

Tell students that in this situation, there is an environmental risk factor. Explain that there is something in the woman’s environment that is putting her health and the health of her children at risk. Ask students to tell a partner what they think the environmental risk factor is. Then ask them to tell their partner a disease or condition they think could be associated with the risk factor. Ask students to share their responses with the class.

Explain that the environmental risk factor is indoor air pollution that is caused by burning wood inside an unventilated area. In global health, the wood would be called biomass, which is any organic matter used as fuel. People burn dried cow dung patties for fuel as well in some countries. Point out that there are many serious conditions related to this risk factor, including chronic respiratory conditions.

Write the following risk factors on the board:

Poor hygiene

Indoor smoke pollution

Unsafe water

Smog

Poor sanitation

Exposure to vehicle emissions

Tell students to decide which risk factor or factors are involved in the following scenario:

There are no toilets at a school in a rural community in Sri Lanka. The children relieve themselves among the trees behind the school. There is a tap with running water to wash their hands, but the school cannot afford soap.

Once students have offered their guesses, which should include poor hygiene and poor sanitation, ask them what diseases the children are in danger of contracting because of these risk factors. They should remember that diarrhoea is a common disease in this situation. Children may also become infected with intestinal worms.

Tell students that this lesson is about environmental risk factors. Point out that in many situations, there is more than one risk factor and more than one disease related to each risk factor. Throughout the lesson, students should be alert to ways that environmental risk factors are linked, or connected, to each other.

2

35 Presentation: Environmental Risk Factors Related to Sanitation, Water, and Hygiene

This activity gives students a more in-depth understanding of the risk factors and diseases related to sanitation, water, and hygiene. It also develops students’ listening and note-taking skills.

To prepare, make notes to guide class discussion using Teacher Resource 8.1,



Step Min. Activity

Presentation Notes: Environmental Risk Factors Related to Sanitation, Water, and Hygiene. Have Teacher Resource 8.1, Presentation: Environmental Risk Factors Related to Sanitation, Water, and Hygiene (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Also before class begins, prepare to project the video “Clean Hands Help Prevent the Flu” (https://www.youtube.com/watch?v=XHISh559oho ), which you will show after Slide 7 of the PowerPoint presentation. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

Refer students to Student Resource 8.1, Note Taking: Environmental Risk Factors Related to Sanitation, Water, and Hygiene. Explain that they will use this chart to take notes during the presentation.


Stop the PowerPoint after you have discussed Slide 7 about hand washing. Ask students the following question:

How long do you need to wash your hands in order to get rid of germs that carry disease?

Take some suggestions before telling them that most people don’t really know how to wash their hands properly. It takes 15‒20 seconds of washing wet hands with soap to get rid of most germs.

Using an LCD projector, show the video on the proper way to wash your hands (https://www.youtube.com/watch?v=XHISh559oho ).

Answer any questions before continuing with the presentation.

This presentation is duplicated as Student Resource 8.2, Reading: Environmental Risk Factors Related to Sanitation, Water, and Hygiene. If an LCD projector is unavailable, students can read the presentation, answer the discussion questions in their notebook, and discuss their answers as a class. This student resource is also useful for review.

After the presentation, divide the class into pairs and have them compare their notes for completeness and accuracy. Invite each pair to share their thoughts and questions so that you can answer any outstanding questions and address any misunderstandings. Ask one or two volunteers to summarize how water, sanitation, and hygiene issues are connected.

3 5 Reading: Risk Factors Related to Air Pollution

This activity introduces students to the sources of air pollution and the health outcomes that result from air pollution.

Refer students to Student Resource 8.3, Reading: Air Pollution, and Student Resource 8.4, Note Taking: Air Pollution. Explain that students should complete the resource as they go through the reading. Have them review the instructions, and then answer any questions.

Instruct students to complete the reading and note-taking resource for homework. They will need them in the next class period.



Step Min. Activity

CLASS PERIOD 2

4 10 Homework Review: Air Pollution Reading

In this activity, students consolidate their understanding of air pollution as a major environmental risk factor.

Instruct students to review their homework, Student Resource 8.4, for accuracy and completeness with a partner. When they have completed the review, answer any questions and then check their understanding by asking pairs to report the main reasons why air pollution is an environmental risk factor.

Point out that awareness of the pollutants in their own environment is important knowledge that is meaningful in the context of global health.

5 30 Diagrams: Health Determinants and Environmental Risk Factors

This activity helps students understand how health determinants are linked to environmental risk factors.

Point out that health determinants are at the root of health issues. In this activity, they will learn how health determinants relate to environmental risk factors. To begin, ask students to share with a partner how a health determinant is linked to an environmental risk factor they have learned about. If necessary, remind them that a health determinant is a factor that affects health. You may wish to have students review their notes on health determinants from Lesson 7 as they discuss their response with their partner. Then have partners share their responses with the class. A sample student response might be:

Poverty is a health determinant linked to indoor air pollution. Poor people often don’t have access to gas or electric stoves, so they might cook with coal or biomass fuels.

Refer students to Student Resource 8.5, Diagrams: Health Determinants and Environmental Risk Factors. Ask a volunteer to read the example scenario on the first page aloud while students follow along. Then ask students to identify the health determinants in the scenario, and list them on the board. Next, list the environmental risk factors, and finally the diseases and conditions. Then explain that the diagram shows one way that the three elements are related:

The family’s work (one determinant) affects where the child lives (another determinant). These determinants are the reason that the child has been exposed to lead (the environmental risk factor), and the exposure to lead is associated with the child’s health problems.

Place students in pairs and ask them to read the instructions on Student Resource 8.5. Answer questions and then set students to work.

When students are finished, ask pairs to show each other their diagrams and compare them.

To conclude, point out that there is often more than one way to graphically depict information accurately. Making diagrams that illustrate connections is a useful skill in health professions.



Step Min. Activity


6

10 Interpreting Charts and Graphs: Environmental Statistics

Students practice reading charts and graphs and use them to find environmental risk factor statistics. This activity focuses on the following college and career skill:


Explain that graphs and charts, which are often interactive online, are tools used by global health organizations, governments, and researchers to communicate information about environmental risk factors and other information related to global health. Being able to read graphs and charts accurately is another important skill to develop.

Refer students to Student Resource 8.6, Global Health Detective: Environmental Statistics. Ask students to read the instructions, and then answer any questions.

Assign students to computers. Make sure students understand that they should use the resources listed in the Where to Look for Information section to find the information they need. Emphasize that as students use the online charts and graphs to look for information to complete their resource, they should notice the different ways charts and graphs display information, as well as the type of information they convey. They will need to make their own charts and graphs later in the course.

Tell them to complete this resource for homework and bring it to the next class.

CLASS PERIOD 3

7 15 Homework Review: Environmental Statistics

Students go over their homework to make sure they understand how to locate and interpret information in charts and graphs.

Ask students to work with a partner to compare responses on Student Resource 8.6, Global Health Detective: Environmental Statistics. Then have pairs share their answers with the class, and answer any questions students have about the information they found. You may want to gauge student understanding by assessing this assignment on a credit/no-credit basis.

Give students a few minutes to add information they learned to the regional reference maps at the beginning of their notebook.

8 25 Culminating Project Work: Project Launch

The purpose of this activity is to introduce students to the culminating project.

Announce that it’s time for the students to find out what they will be doing for their culminating project. Refer students to Student Resource 8.7, Launch Letter: Global Health Summit, and ask students to read the letter from the expert panel. When students have finished reading the letter, ask them to tell a partner their first impressions of the challenge by saying which parts of the project they think they will



Step Min. Activity

enjoy and which ones seem most challenging.

Then introduce the driving question for the culminating project by writing it on the board and reading it aloud:

How can we develop a call to action to address a global health threat for an international summit?

Tell students that during the rest of the course, they will address this driving question. Point out that they will be examining environmental health issues in this lesson and then nutritional and behavioral health issues in the next lessons. Then they will pick three issues that they think are worthy of being a focus at an international summit. At this point, they will form project groups and agree on one issue for their project focus. Explain that they will make their case for this issue in front of the expert panel at the end of the course.

Ask students to read Student Resource 8.8, Project Overview: Global Health Summit Proposal. When students have finished reading, give them a few minutes to formulate their general questions about the project, and then address each question. Tell students to take notes in the margins of their project overview to help them remember details and answers to questions.

Refer students to Student Resource 8.9, Observations: Environmental Health Issues, and ask them to read the instructions. Then ask them to read the assessment criteria at the end of the resource. Answer any questions. Explain that this is the first project-related step that they will complete.

9 10 Composing Questions: Preparation for the Guest Speaker

Students prepare for a guest speaker in the next class period by thinking of questions they want to ask.

Draw students’ attention to Section 1 of Student Resource 8.9, Observations: Environmental Health Issues. Explain that a guest speaker will be coming to the next class period to discuss environmental health issues that the speaker is working on or that affect his or her work. The speaker will also talk about his or her career, how the speaker chose it and prepared for it, and what the speaker’s job is like.

Note that this is a golden opportunity for students to ask questions that could help them in their quest to figure out which environmental health issues might be appropriate to focus on for their culminating project. Tell students to write down three questions in the space provided. Tell them that they can always ask other questions as they think of them, but that it is important to be prepared to make the most of the guest speaker’s visit.

Ask volunteers to share their questions. If any are inappropriate, explain why and steer students toward better questions. Tell students that they need to pay close attention to the speaker and their classmates’ questions, because each question should be asked only once.

Review any other instructions you want to share with students (about being polite, thanking the guest speaker, and so forth).

Instruct students to keep Student Resource 8.9, Observations: Environmental Health Issues, in a project portfolio. The portfolio can be a separate section of their binder, a separate folder that they use just for project materials, or an electronic folder if you



Step Min. Activity

have a paperless classroom. They will need to have Student Resource 8.9 on hand to start filling it in with notes on the guest speaker’s presentation in the next class period.

CLASS PERIOD 4

10 35 Guest Speaker: Environmental Risk Factors and Health Issues

The purpose of this activity is to introduce students to a global health professional and give students a greater understanding of the professional’s work. This activity focuses on the following college and career skills:

Asking appropriate and effective questions

Understanding the opportunities and requirements in this industry or field

Prior to this activity, arrange for a professional who works in environmental health to visit the class. If it isn’t possible for the professional to visit in person, arrange for a teleconference using Google video chat, Skype, or other similar technology. Refer to Teacher Resource 8.2, Guide: Guest Speaker, to help the speaker prepare for the visit.

Introduce the speaker. Tell students that the professional will first speak for 20 minutes about his or her work, and then students will have an opportunity to ask questions. Instruct students to take notes in Section 1 on Student Resource 8.9, Observations: Environmental Health Issues. Write the following topics on the board and tell students that they should listen for them and write down what they learn as the guest speaker discusses them:

The speaker’s professional responsibilities and tasks

Education and training

Populations and regions the speaker focuses on

Environmental risk factors

Diseases

After the speaker has presented, allow students time to ask questions. Remind them to fill in the first section of Student Resource 8.9, Observations: Environmental Health Issues, as they listen.

When the speaker’s visit has concluded, have students thank the speaker and shake his or her hand.

11 15 Review: Environmental Risk Factors

Students have a chance to take notes on the environmental risk factors they have learned about so far in this lesson, now with their culminating project in mind.

Turn students’ attention to Section 2 of Student Resource 8.9. This is where they take notes on what they have learned in the lesson up to this point that is relevant to the culminating project.

For homework, tell students to finish filling out this section. They should also review the notes they took during the guest speaker’s visit and make sure that both of these sections meet the assessment criteria.



Step Min. Activity

CLASS PERIOD 5

12 10 Peer Review: Environmental Risk Factors

Students compare the notes they have taken so far on environmental risk factors.

Organize students into pairs. Ask them to swap Student Resource 8.9, Observations: Environmental Health Issues, with their partner and read the first two sections. If they think something is missing, they should tell their partner. If they see something they want to include on their own resource based on their partner’s, they should make revisions accordingly. Circulate among the students, clearing up misunderstandings and listening for potential project topics that seem to incite interest.

13

40 Charting: Linking Disease to Environmental Risk Factors

The purpose of this activity is to provide students with a more in-depth understanding of a disease that is attributed to environmental risk factors.

Prior to class, check the suggested links in Student Resource 8.10, Research Sources: Environmental Diseases. These resources are for students to use in their research, so make sure they are at an appropriate reading level. If you have other websites in mind, add them to the list.

To begin, have volunteers name diseases that they have learned about so far that are connected to environmental risk factors, and create a list on the board. They can look at Student Resource 8.9 to jog their memory.

Tell students that they will expand on their knowledge of environmental diseases by conducting online research with a partner. They will share the information they find about a particular disease with their classmates.

Place students in pairs. Refer students to Student Resource 8.10, Research Sources: Environmental Diseases. Students will look at one or more of these websites and choose a disease that they want to research.

Emphasize that if an article is about the impact of a disease in the United States, students should conduct a search for information on how that disease affects people in developing countries. These are the countries that the summit wants to help, because they are most in need.

Explain that they will be making a chart about their disease, and the class will use the charts as reference materials as they continue their work on global health.

Pass out chart paper, and write the following topics on the board. Instruct pairs to divide their chart paper into four sections and address one topic in each section:

A brief description of the disease

The environmental factors linked to the disease

The groups of people who are most at risk for the disease

Steps that can be taken to reduce the environmental risk

Ask students to title their chart with the name of their disease. Explain that students should use information from the websites along with what they have already learned to



Step Min. Activity

complete their charts. Tell them that they may refer to their notes from any lesson in the course. Assign each pair of students to a computer.

When students have completed their work, ask them to post the charts around the room. Instruct each pair to share one important fact they learned about their disease with the class. Also, remind students to add information to Section 2 of Student Resource 8.9, Observations: Environmental Health Issues, if they learn something that they want to consider for their culminating project.

Point out to students that having a basic understanding of the diseases related to environmental risk factors is an important asset for a global health worker. Encourage students to look at each other’s charts when they need information about a disease.

CLASS PERIOD 6

14 20 Summarizing: Environmental Health Issues

In this activity, students summarize their reasons for choosing several environmental health issues to consider for their culminating project.

Tell students to retrieve Student Resource 8.9, Observations: Environmental Health Issues, from their project portfolio. Ask them to read the instructions for Section 3 of this resource, in which they review all of the information they have gathered and choose three issues to summarize. Answer any questions, and give students about 15 minutes to work. Remind them to keep the assessment criteria at the end of the resource in mind as they write.

When 15 minutes are up, tell students to swap drafts with a partner. Their job is to tell the partner if anything seems to be missing or is unclear. Once students have received feedback, tell them to make any necessary revisions. They may need to write their final draft for homework.

15 30 Diagramming: Environmental Health Issues

This activity gives students more practice in diagramming the relationship between a disease, an environmental risk factor, and a health determinant.

Direct students to Section 4 of Student Resource 8.9, in which they choose one of the topics they summarized in Section 3 to create a diagram. Remind students that they created similar diagrams when they completed Student Resource 8.5, Diagrams: Health Determinants and Environmental Risk Factors. Answer any questions and give students the rest of this class period to complete Student Resource 8.9. If students don’t finish their work by the end of the class period, give them a due date for handing this resource in for assessment.

Assess Student Resource 8.9 using Teacher Resource 8.3, Assessment Criteria: Environmental Health Issues. Remind students to keep their work in their project portfolio after you return it.

Point out that what students have learned about environmental health issues in this lesson is a vital part of the big picture of global health concerns. The potential to resolve many of the issues they learned about in their lifetime is very real, and caring for the



Step Min. Activity

environment in order to create a healthy place to live is a responsibility we all share.

Extensions

Content Enrichment Each year the WHO hosts World Water Day to raise awareness about water issues across the

globe. Have students participate in an event taking place in an area near them, or have them download campaign materials to use to launch a public awareness campaign at their school. Information can be found at www.unwater.org/.

Tell students that in times of crisis and emergency, such as a natural disaster or war, issues related to water, sanitation, and hygiene often intensify. Have students work in pairs to choose a disaster in recent history, such as the earthquake in Haiti or Typhoon Haiyan (2013), and then research issues related to water, sanitation, and hygiene that arose because of the disaster. Have pairs report on what the issues were, what the response of the global health community was, and if the response was successful.

STEM Integration Science: Have students conduct an experiment in which they calculate the volume of air in their

classroom and examine the importance of indoor air quality. Instruct students to follow experiment instructions for the section called Breathing Room at http://www2.epa.gov/students/lesson-plans-teacher-guides-and-online-resources-educators.

Science: The major components of particulate matter are sulfate, nitrates, ammonia, sodium chloride, carbon, mineral dust, and water. Ask students to investigate the properties of these chemicals and report back on why they might be harmful when they are in the air we breathe.

Technology: Ask students to make a list of all the environmental pollutants they can think of that might exist in their community. Then have them see how many they captured by visiting the website ToxTown at http://toxtown.nlm.nih.gov/index.php. Tell them to choose the type of community that best represents their own (border town, city, port, farm, and so forth) and explore the many areas where environmental hazards exist. Students will discover that there are many more toxins in their environment than they realized.

Technology: Ask students to study the Air Quality Index forecast map at www.airnow.gov. Ask them to identify the areas of the United States that have the poorest air quality on a particular day, and then ask students to do research to identify the determinants.

Technology: Have students use this site to calculate their water footprint: http://www.gracelinks.org/1408/water-footprint-calculator. Then have students work in groups to come up with detailed plans for reducing water usage at home, at school, and in their communities.

Additional Cross-Curricular Ideas English Language Arts: Organize a screening of the documentary Flow, which examines the

issues of water rights and privatization (http://www.flowthefilm.com/). Then ask students to take on the role of a film critic and write a review of the movie.



History: Explain to students that although malaria is not a concern for most Americans, until the 20th century malaria was a problem in the United States. Then ask students to research and create a timeline that explains the history of malaria, including the discovery of how malaria is transmitted and the connection between malaria eradication and the Panama Canal. You might wish to have students begin their research at http://www.cdc.gov/malaria/about/history/.

Social Studies: Explore the paradigm shift that is starting to take hold in parts of Africa, where Africans are coming up with solutions to pressing issues rather than needing the help to come from other countries. Tell students to read this article or watch the Ted Talk noted in it: http://www.theroot.com/articles/culture/2014/03/the_root_recommends_dayo_olopade_s_new_book_the_bright_continent_breaking.html. Hold a class discussion on the ramifications of this shift for the people of Africa. Are there ideas here that could make a difference in the United States? In other parts of the world?


AOHS Global Health


Teacher Resources


Teacher Resource 8.1 Presentation and Notes: Environmental Risk Factors Related to Sanitation, Water, and Hygiene (includes separate PowerPoint file)

Teacher Resource 8.2 Guide: Guest Speaker

Teacher Resource 8.3 Assessment Criteria: Environmental Health Issues

Teacher Resource 8.4 Key Vocabulary: Environmental Risk Factors

Teacher Resource 8.5 Bibliography: Environmental Risk Factors




Presentation Notes: Environmental Risk Factors Related to Sanitation, Water, and Hygiene


Urban air pollution, indoor air pollution from burning solid fuels, unsafe water, hygiene, and sanitation are the most important environmental issues affecting health. You will learn about outdoor and indoor air pollution later in this lesson. In this presentation, we focus on sanitation, water, and hygiene.

Presentation notes



According to the WHO, 2.6 billion people lack improved sanitation facilities, and over 1.1 billion people use unsafe drinking water sources. Many of these people also lack knowledge about effective hygiene practices. All three of these issues—lack of improved sanitation, inadequate access to safe water, and poor hygiene practices—are linked. They are issues that mostly affect the poorer people of the world. As a result, 1.6 million people die every year from diarrhoeal diseases.

Data from: http://www.who.int/water_sanitation_health/mdg1/en/

Presentation notes



This map of sub-Saharan Africa and Oceania shows various areas with poor access to drinking water. Oceania is the regional name for the islands scattered throughout most of the Pacific Ocean.

As of 2011, much of the world’s population has access to improved drinking water sources. But still it was estimated in 2011 that 768 million people were without improved drinking water sources, and many of them were children. The majority of the deaths due to diarrhoeal disease, which is related to water, sanitation, and hygiene, are among children. Children are particularly vulnerable because their bodies are still developing; they may not have the immunity necessary to fight off diseases related to water, sanitation, and hygiene.

Image retrieved from WHO/UNICEF report “Progress on Sanitation and Drinking-Water, 2013 Update” at http://apps.who.int/iris/bitstream/10665/81245/1/9789241505390_eng.pdf and included here under fair-use guidelines of Title 17, US Code. Copyrights belong to respective owners. Data from http://www.who.int/mediacentre/news/notes/2013/sanitation_mdg_20130513/en/index.html.

Presentation notes



Without water, there is no life. Water is an essential resource, but more than 1 billion people lack access to water from sources that are within a reasonable distance from their homes. They live in areas where water is physically scarce. Most of these people live in low- and middle-income countries. A 2004 study found that access to water ranged from 56% of people in sub-Saharan Africa to universal access, or access for everyone, in high-income countries like the United States, Japan, and Germany.

Water scarcity doesn’t just occur in areas where there is no water. In areas where there is plenty of rainfall or freshwater, water scarcity can still be a problem. It may not be distributed to everyone or stored properly, for example. To meet the demands of households, farms, and industry, water needs to be conserved and used and distributed properly in communities. The water scarcity situation on the planet is worsening. As the global population grows and the world becomes more urbanized—meaning that more and more people live in cities—there is an increased need for water.

In addition to access, safety is another concern. When water is scarce, people are forced to rely on unsafe drinking water. The water may contain pathogens (remember that these are bacteria, microorganisms, or viruses) that can cause numerous waterborne diseases. Water scarcity also creates situations where people cannot bathe or keep their clothes and homes clean. When water is scarce, people might be forced to store water in dangerous ways. They may store water in their homes, which increases the risk for contamination. It also provides a breeding ground for mosquitoes that carry diseases like malaria.

Presentation notes



Currently, 2.6 billion people don’t have access to basic sanitation, and the number is growing. This means that they have no toilets—not even basic outdoor latrines. There are large cities in Africa that have no modern sanitation system. In some areas of Asia, women wait until nightfall and then defecate in groups on the side of the road or in open fields because they have no access to sanitary disposal of human waste, not even a simple pit latrine. Sanitation is a serious health concern. Lack of sanitation is also an issue that affects basic human dignity. The regions that are most affected are sub-Saharan Africa, southern Asia, and Oceania. Countries that have weak infrastructures, like poor sewage systems, and scarce resources, like water, are at a greater disadvantage to offer adequate sanitation facilities.

Without adequate sanitation facilities, people are forced to defecate in the open. This may mean that they do so in rivers that are used as a water source, in fields where food is grown, or even near areas where children play and food is prepared. This greatly increases the risk of diseases.

Image retrieved from http://commons.wikimedia.org/wiki/File:Arborloo_in_Haiti.jpg on April 23, 2012, and reproduced here under the terms of the Creative Commons Attribution-Share Alike 3.0 Unported license (http://creativecommons.org/licenses/by-sa/3.0/deed.en). Image courtesy of Rémi Kaupp.

Presentation notes



Without proper sanitation, people are forced to defecate and get rid of their waste in areas that have a direct effect on their health. For example, the Ganges River in India is used to collect drinking water, bathe, and wash clothes and dishes. It’s used by millions of people every day, but over a million liters of raw sewage are dumped into it every minute. People defecate near the river; the remains of cremated bodies are also put into the river. The result is that it is one of the most polluted rivers in the world, and the toxic levels near the ancient city of Varanasi are more than one hundred times the level that the Indian government says is safe. The state of the river is a major health threat to the people who use it, along with the animal and fish species that live in the river or depend on it.

Image retrieved from http://commons.wikimedia.org/wiki/File:Ganges_river_at_Varanasi_2008.jpeg on April 23, 2012, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Image courtesy of JM Suarez.

Presentation notes



Improved sanitation facilities and improved water access and safety do not necessarily lead to improved health. Understanding and using hygienic practices, hand washing in particular, is critical to improving health outcomes.

For effective hand washing, people need access to both soap and water. They also need knowledge about the most important times to wash their hands: after defecating or urinating, before eating, and before and after preparing food. Studies have shown that hand washing with soap at these times can reduce the number of diarrhoeal bouts by almost half. Hand washing can also lower people’s risk for other diseases, including skin and eye infections and Avian influenza, or bird flu. In fact, the risk for most bacterial or viral infections can be reduced by hand washing.

Presentation notes



Diarrhoea is the most important global health issue related to water, sanitation, and hygiene. It is caused by a variety of microorganisms, including viruses, bacteria, and protozoans. When these microorganisms enter a person’s system through food, water, or bodily contact, they can make a person very sick. When a person has diarrhoea, that person loses both water and electrolytes, which include sodium, chloride, potassium, and bicarbonate. The balance of electrolytes in the body is necessary for the cells and organs to function properly. Diarrhoea can lead to dehydration. In severe cases, it can lead to death.

Dehydration occurs when a person loses more fluids than he or she consumes. These fluids must be replaced. A person who is mildly dehydrated can often replace the fluids by drinking water, but with severe dehydration, medical attention is often required. When people are severely dehydrated, they may have a difficult time keeping fluids down. They may need to receive fluids intravenously. They may also need rehydration salts mixed into clean water. The rehydration salts will help them replace the electrolytes that they lost. Dehydration can become a serious issue for people who live in areas where there is limited clean water and limited access to medical clinics and rehydration salts.

Globally, 1.6 million people die from diarrheal disease each year. Over 90% of the deaths are among children under 5 years old. Children who have repeated episodes of diarrhoeal disease become more vulnerable to other diseases and malnutrition.

Source of data: http://www.who.int/water_sanitation_health/mdg1/en/

Presentation notes



Whereas diarrhoeal disease is the most important health problem related to water, sanitation, and hygiene, there are many other serious related health diseases and conditions. Let’s look at five of them.

Arsenicosis is caused by long-term exposure to low concentrations of arsenic from natural sources in drinking water. It causes painful skin lesions and can result in cancers of the skin, lungs, bladder, and kidney.

Cholera is a bacterial infection in the intestinal tract. It causes severe attacks of diarrhoea. Without treatment, it quickly can lead to dehydration and death.

Intestinal parasitic worms are caused by contact with soil that has been contaminated with human waste from an infected person or by eating contaminated food. The severity of the infection can vary, but it can lead to malnutrition when the body doesn’t have enough healthy red blood cells (anemia), or to retarded growth. Children are particularly vulnerable to worms. There are different kinds of worms. A quarter of the world’s population is believed to be infected with roundworm and whipworm.

Areas of inadequate water supply and unsafe sanitation are breeding grounds for trachoma, an eye infection spread by poor hygiene.

Typhoid fever is a bacterial infection caused by contaminated food or water. About 12 million people are affected by it each year. Symptoms include headaches, nausea, severe diarrhoea, dehydration, and fever.

Presentation notes



Poor sanitation, water, and hygiene have many other serious repercussions in addition to disease. In areas where water is scarce, women are often forced to spend large parts of their day retrieving water. Not only does this activity take up a lot of time, but the physical work can cause damage to their back and neck. They are also at risk for assault when they retrieve water from areas that are unsafe.

When wage earners are less productive due to illness caused by poor sanitation, water, and hygiene, the economy of a community, or even a nation, can suffer. In addition, health systems are overwhelmed diagnosing and treating people.

The education of children may also suffer because of poor sanitation, water, and hygiene. Children, girls especially, may drop out of school early because their schools lack decent sanitation facilities. Their schools may not have toilets. If they do, the conditions may be extremely unsanitary, or the facilities may not offer any privacy. The schools may lack a clean source of drinking water and facilities for hand washing. If hygiene practices at the school are poor, children who attend the school may be at risk of contracting serious illness. Once girls begin menstruating, they may be less likely to attend a school that doesn’t have private, adequate toilets. These girls may drop out of school instead.

Presentation notes



The most successful attempts to eliminate the risks caused by poor sanitation, water, and hygiene address the link between all three issues. The attempts to improve access to a safe water supply include the increase of basic sanitation information about hygienic practices in order to decrease the risk for diarrhoeal disease and other dangerous conditions that affect much of the world’s population.

For example, in the mountainous northern region of Vietnam, safe water and proper sanitation can be difficult to find. Basic knowledge about hand washing in rural areas is poor. One study found that fewer than 10% of existing latrines meet national hygienic standards.

One NGO teamed up with the Vietnamese government to address the needs of these remote communities on multiple levels. They educated the community, changed the environment, and worked with families. They built white concrete latrines and sanitation systems in schools. They worked with local teachers to develop a regular, ongoing program to teach children about hand washing. They organized parents to pitch in to cover the costs of soap.

In the community, women often had to retrieve water from wells down the road three or four times a day. The organization constructed a facility that takes water from a natural spring, purifies it, and then pumps it directly into the homes of people in the village. Now women have more time to spend with their children and devote to other responsibilities.

Presentation notes



As the world population expands, issues related to sanitation, water, and hygiene will likely become more and more serious. Global health workers who focus on these issues understand that they are linked. People need improved access to safe water sources in order to establish improved sanitation facilities and hygienic practices. Tackling all three issues can reduce the number of children who die as a result of diarrhoeal diseases and other preventable conditions.

Presentation notes




Guide: Guest Speaker

Use the suggestions below to find a guest speaker and prepare the speaker for a successful classroom visit. The speaker must be able to talk about environmental health with the students. An NGO worker, a researcher, or someone in government would be appropriate.

Find a Guest Speaker There are several sources you may consider consulting to find guest speakers.

Start with your advisory board. Members of the advisory board are exemplary guest speakers.

Advisory board members can connect you with other professionals.

Your school career counselor may have ideas.

Talk to personal connections.

See if anyone in the class has a parent, family member, or family friend who might work in environmental health and be willing to come talk to the class.

Finally, if it is not possible for the professional to visit the class, you can arrange for a teleconference using Google video chat, Skype, or other similar technology.

Prepare the Guest Speaker First, describe the format: the speaker will have 20 minutes to talk, and then students will have about 10 minutes to ask questions that they have prepared beforehand.

Explain that the students will have just learned what their culminating project entails, which is to research and present the global health issue that they think is most critical for global health workers to address. They will present their work at a summit of global health professionals. Environmental health issues are the first category that the students are exploring, so many of their questions will be about pressing current issues that the speaker is familiar with.

Finally, give the guest speaker the following list of topics to touch on in the presentation:

Important roles and responsibilities of people in his or her profession

Tasks that are involved in the speaker’s daily work

Regions or populations in the world that the speaker focuses on

Education and training necessary to do his or her work

Environmental risk factors related to health that the speaker thinks are the most important

Diseases that the speaker thinks are most important to address




Assessment Criteria: Environmental Health Issues

Student Name:______________________________________________________________

Date:_______________________________________________________________________


Met Partially Met

Didn’t Meet

The observations on the guest speaker’s presentation show evidence of paying close attention; they are thoughtful and include ideas for potential culminating project steps.

□ □ □

The notes on environmental issues explored in this lesson are clear and complete.

□ □ □

The summary of three potential issues to focus on for the culminating project demonstrates an ability to compare a range of environmental issues and evaluate their relative need to be addressed by the global health community.

□ □ □

The diagram of a specific issue makes the connection between health determinant(s), environmental risk factor(s), and disease easy to understand.

□ □ □


□ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Key Vocabulary: Environmental Risk Factors

Term Definition

biomass An energy source that includes wood, animal dung, and crop waste.

dehydration Excessive water loss in the body, marked by thirst and dark urine and caused by vomiting and diarrhoea.

dignity The quality of being and feeling respected.

electrolyte Substances present in the human body, including sodium, potassium, and chloride. The balance of electrolytes is necessary for the normal function of the body’s cells and organs.

infrastructure A society’s basic physical and organizational structures, including roads and sewage systems.

particulate matter (PM) The mixture of solid particles and liquid droplets found in the air; a dangerous pollutant.

scarce resource A resource that there is not enough of to meet the demand.




Bibliography: Environmental Risk Factors





Online Ana, G. R., M. K. Sridhar, and E. A. Bamgboye. “Environmental Risk Factors and Health Outcomes in Selected Communities of the Niger Delta Area, Nigeria.” Perspectives in Public Health, July 2009, http://rsh.sagepub.com/content/129/4/183.short (accessed October 25, 2015).

Baumgartner, Jill, et al. “Indoor Air Pollution and Blood Pressure in Adult Women Living in Rural China.” Environmental Health Perspectives, July 2011, http://ehp03.niehs.nih.gov/article/info%3Adoi%2F10.1289%2Fehp.1003371 (accessed October 25, 2015).

“Case Studies in Environmental Medicine: Lead Toxicity.” CDC, http://wonder.cdc.gov/wonder/prevguid/p0000017/p0000017.asp (accessed October 25, 2015).

“Children’s Environmental Health: Air Pollution.” WHO, http://www.who.int/ceh/risks/cehair/en/index.html# (accessed October 25, 2015).

“Gender Aspects of Water and Sanitation.” Water Aid, http://www.wateraid.org/~/media/Publications/gender-aspects-water-sanitation.pdf (accessed October 25, 2015).

Nettleton, Steve. “Water and Hygiene Facilities Change Lives for Families in Rural Viet Nam.” UNICEF, http://www.unicef.org/infobycountry/vietnam_38064.html (accessed October 25, 2015).

“Progress on Sanitation and Drinking-Water, 2013 Update.” WHO/UNICEF, http://www.unicef.org/wash/files/JMP2013final_en.pdf (accessed October 25, 2015).

“Reducing Indoor Air Pollution: A Serious Public Health Problem.” California Environmental Protection Agency, May 2, 2001 (updated January 2006), http://www.arb.ca.gov/research/indoor/rediap.htm (accessed October 25, 2015).

“2.4 Billion People Will Lack Improved Sanitation in 2015.” WHO Media Centre, http://www.who.int/mediacentre/news/notes/2013/sanitation_mdg_20130513/en/index.html (accessed October 25, 2015).

“Water, Sanitation and Hygiene: The Importance of Hygiene.” UNICEF, http://www.unicef.org/wash/index_hygiene.html (accessed October 25, 2015).

“Water, Sanitation and Hygiene: Introduction.” UNICEF, http://www.unicef.org/wash/index_3951.html (accessed October 25, 2015).


AOHS Global Health


Student Resources


Student Resource 8.1 Note Taking: Environmental Risk Factors Related to Sanitation, Water, and Hygiene

Student Resource 8.2 Reading: Environmental Risk Factors Related to Sanitation, Water, and Hygiene

Student Resource 8.3 Reading: Air Pollution

Student Resource 8.4 Note Taking: Air Pollution

Student Resource 8.5 Diagrams: Health Determinants and Environmental Risk Factors

Student Resource 8.6 Global Health Detective: Environmental Statistics

Student Resource 8.7 Launch Letter: Global Health Summit

Student Resource 8.8 Project Overview: Global Health Summit Proposal

Student Resource 8.9 Observations: Environmental Health Issues

Student Resource 8.10 Research Sources: Environmental Diseases




Note Taking: Environmental Risk Factors Related to Sanitation, Water, and Hygiene


Directions: As you watch the presentation on environmental risk factors related to sanitation, water, and hygiene, take notes using the chart below.

Topic Important Points

Causes of global health issues related to water

Reasons inadequate sanitation is a health concern

Reasons hand washing is important



Topic Important Points

Causes and effects of diarrhoea

Repercussions of poor sanitation, water, and hygiene

Solutions to the problems of poor sanitation, water, and hygiene




Reading: Environmental Risk Factors Related to Sanitation, Water, and Hygiene

Urban air pollution, indoor air pollution from burning solid fuels, unsafe water, hygiene, and sanitation are the most important environmental issues affecting health. You will learn about outdoor and indoor air pollution later in this lesson. In this presentation, we focus on sanitation, water, and hygiene.



According to the WHO, 2.6 billion people lack improved sanitation facilities, and over 1.1 billion people use unsafe drinking water sources. Many of these people also lack knowledge about effective hygiene practices. All three of these issues—lack of improved sanitation, inadequate access to safe water, and poor hygiene practices—are linked. They are issues that mostly affect the poorer people of the world. As a result, 1.6 million people die every year from diarrhoeal diseases.

Data from: http://www.who.int/water_sanitation_health/mdg1/en/



This map of sub-Saharan Africa and Oceania shows various areas with poor access to drinking water. Oceania is the regional name for the islands scattered throughout most of the Pacific Ocean.

As of 2011, much of the world’s population has access to improved drinking water sources. But still it was estimated in 2011 that 768 million people were without improved drinking water sources, and many of them were children. The majority of the deaths due to diarrhoeal disease, which is related to water, sanitation, and hygiene, are among children. Children are particularly vulnerable because their bodies are still developing; they may not have the immunity necessary to fight off diseases related to water, sanitation, and hygiene.

Image retrieved from WHO/UNICEF report “Progress on Sanitation and Drinking-Water, 2013 Update” at http://apps.who.int/iris/bitstream/10665/81245/1/9789241505390_eng.pdf and included here under fair-use guidelines of Title 17, US Code. Copyrights belong to respective owners. Data from http://www.who.int/mediacentre/news/notes/2013/sanitation_mdg_20130513/en/index.html.



Without water, there is no life. Water is an essential resource, but more than 1 billion people lack access to water from sources that are within a reasonable distance from their homes. They live in areas where water is physically scarce. Most of these people live in low- and middle-income countries. A 2004 study found that access to water ranged from 56% of people in sub-Saharan Africa to universal access, or access for everyone, in high-income countries like the United States, Japan, and Germany.

Water scarcity doesn’t just occur in areas where there is no water. In areas where there is plenty of rainfall or freshwater, water scarcity can still be a problem. It may not be distributed to everyone or stored properly, for example. To meet the demands of households, farms, and industry, water needs to be conserved and used and distributed properly in communities. The water scarcity situation on the planet is worsening. As the global population grows and the world becomes more urbanized—meaning that more and more people live in cities—there is an increased need for water.

In addition to access, safety is another concern. When water is scarce, people are forced to rely on unsafe drinking water. The water may contain pathogens (remember that these are bacteria, microorganisms, or viruses) that can cause numerous waterborne diseases. Water scarcity also creates situations where people cannot bathe or keep their clothes and homes clean. When water is scarce, people might be forced to store water in dangerous ways. They may store water in their homes, which increases the risk for contamination. It also provides a breeding ground for mosquitoes that carry diseases like malaria.



Currently, 2.6 billion people don’t have access to basic sanitation, and the number is growing. This means that they have no toilets—not even basic outdoor latrines. There are large cities in Africa that have no modern sanitation system. In some areas of Asia, women wait until nightfall and then defecate in groups on the side of the road or in open fields because they have no access to sanitary disposal of human waste, not even a simple pit latrine. Sanitation is a serious health concern. Lack of sanitation is also an issue that affects basic human dignity. The regions that are most affected are sub-Saharan Africa, southern Asia, and Oceania. Countries that have weak infrastructures, like poor sewage systems, and scarce resources, like water, are at a greater disadvantage to offer adequate sanitation facilities.

Without adequate sanitation facilities, people are forced to defecate in the open. This may mean that they do so in rivers that are used as a water source, in fields where food is grown, or even near areas where children play and food is prepared. This greatly increases the risk of diseases.

Image retrieved from http://commons.wikimedia.org/wiki/File:Arborloo_in_Haiti.jpg on April 23, 2012, and reproduced here under the terms of the Creative Commons Attribution-Share Alike 3.0 Unported license (http://creativecommons.org/licenses/by-sa/3.0/deed.en). Image courtesy of Rémi Kaupp.



Without proper sanitation, people are forced to defecate and get rid of their waste in areas that have a direct effect on their health. For example, the Ganges River in India is used to collect drinking water, bathe, and wash clothes and dishes. It’s used by millions of people every day, but over a million liters of raw sewage are dumped into it every minute. People defecate near the river; the remains of cremated bodies are also put into the river. The result is that it is one of the most polluted rivers in the world, and the toxic levels near the ancient city of Varanasi are more than one hundred times the level that the Indian government says is safe. The state of the river is a major health threat to the people who use it, along with the animal and fish species that live in the river or depend on it.

Image retrieved from http://commons.wikimedia.org/wiki/File:Ganges_river_at_Varanasi_2008.jpeg on April 23, 2012, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). Image courtesy of JM Suarez.



Improved sanitation facilities and improved water access and safety do not necessarily lead to improved health. Understanding and using hygienic practices, hand washing in particular, is critical to improving health outcomes.

For effective hand washing, people need access to both soap and water. They also need knowledge about the most important times to wash their hands: after defecating or urinating, before eating, and before and after preparing food. Studies have shown that hand washing with soap at these times can reduce the number of diarrhoeal bouts by almost half. Hand washing can also lower people’s risk for other diseases, including skin and eye infections and Avian influenza, or bird flu. In fact, the risk for most bacterial or viral infections can be reduced by hand washing.



Diarrhoea is the most important global health issue related to water, sanitation, and hygiene. It is caused by a variety of microorganisms, including viruses, bacteria, and protozoans. When these microorganisms enter a person’s system through food, water, or bodily contact, they can make a person very sick. When a person has diarrhoea, that person loses both water and electrolytes, which include sodium, chloride, potassium, and bicarbonate. The balance of electrolytes in the body is necessary for the cells and organs to function properly. Diarrhoea can lead to dehydration. In severe cases, it can lead to death.

Dehydration occurs when a person loses more fluids than he or she consumes. These fluids must be replaced. A person who is mildly dehydrated can often replace the fluids by drinking water, but with severe dehydration, medical attention is often required. When people are severely dehydrated, they may have a difficult time keeping fluids down. They may need to receive fluids intravenously. They may also need rehydration salts mixed into clean water. The rehydration salts will help them replace the electrolytes that they lost. Dehydration can become a serious issue for people who live in areas where there is limited clean water and limited access to medical clinics and rehydration salts.

Globally, 1.6 million people die from diarrheal disease each year. Over 90% of the deaths are among children under 5 years old. Children who have repeated episodes of diarrhoeal disease become more vulnerable to other diseases and malnutrition.

Source of data: http://www.who.int/water_sanitation_health/mdg1/en/



Whereas diarrhoeal disease is the most important health problem related to water, sanitation, and hygiene, there are many other serious related health diseases and conditions. Let’s look at five of them.

Arsenicosis is caused by long-term exposure to low concentrations of arsenic from natural sources in drinking water. It causes painful skin lesions and can result in cancers of the skin, lungs, bladder, and kidney.

Cholera is a bacterial infection in the intestinal tract. It causes severe attacks of diarrhoea. Without treatment, it quickly can lead to dehydration and death.

Intestinal parasitic worms are caused by contact with soil that has been contaminated with human waste from an infected person or by eating contaminated food. The severity of the infection can vary, but it can lead to malnutrition when the body doesn’t have enough healthy red blood cells (anemia), or to retarded growth. Children are particularly vulnerable to worms. There are different kinds of worms. A quarter of the world’s population is believed to be infected with roundworm and whipworm.

Areas of inadequate water supply and unsafe sanitation are breeding grounds for trachoma, an eye infection spread by poor hygiene.

Typhoid fever is a bacterial infection caused by contaminated food or water. About 12 million people are affected by it each year. Symptoms include headaches, nausea, severe diarrhoea, dehydration, and fever.



Poor sanitation, water, and hygiene have many other serious repercussions in addition to disease. In areas where water is scarce, women are often forced to spend large parts of their day retrieving water. Not only does this activity take up a lot of time, but the physical work can cause damage to their back and neck. They are also at risk for assault when they retrieve water from areas that are unsafe.

When wage earners are less productive due to illness caused by poor sanitation, water, and hygiene, the economy of a community, or even a nation, can suffer. In addition, health systems are overwhelmed diagnosing and treating people.

The education of children may also suffer because of poor sanitation, water, and hygiene. Children, girls especially, may drop out of school early because their schools lack decent sanitation facilities. Their schools may not have toilets. If they do, the conditions may be extremely unsanitary, or the facilities may not offer any privacy. The schools may lack a clean source of drinking water and facilities for hand washing. If hygiene practices at the school are poor, children who attend the school may be at risk of contracting serious illness. Once girls begin menstruating, they may be less likely to attend a school that doesn’t have private, adequate toilets. These girls may drop out of school instead.



The most successful attempts to eliminate the risks caused by poor sanitation, water, and hygiene address the link between all three issues. The attempts to improve access to a safe water supply include the increase of basic sanitation information about hygienic practices in order to decrease the risk for diarrhoeal disease and other dangerous conditions that affect much of the world’s population.

For example, in the mountainous northern region of Vietnam, safe water and proper sanitation can be difficult to find. Basic knowledge about hand washing in rural areas is poor. One study found that fewer than 10% of existing latrines meet national hygienic standards.

One NGO teamed up with the Vietnamese government to address the needs of these remote communities on multiple levels. They educated the community, changed the environment, and worked with families. They built white concrete latrines and sanitation systems in schools. They worked with local teachers to develop a regular, ongoing program to teach children about hand washing. They organized parents to pitch in to cover the costs of soap.

In the community, women often had to retrieve water from wells down the road three or four times a day. The organization constructed a facility that takes water from a natural spring, purifies it, and then pumps it directly into the homes of people in the village. Now women have more time to spend with their children and devote to other responsibilities.



As the world population expands, issues related to sanitation, water, and hygiene will likely become more and more serious. Global health workers who focus on these issues understand that they are linked. People need improved access to safe water sources in order to establish improved sanitation facilities and hygienic practices. Tackling all three issues can reduce the number of children who die as a result of diarrhoeal diseases and other preventable conditions.




Reading: Air Pollution

As Shreya weaves her way home through a dense maze of rickshaws, taxis, buses, and cars on the streets of Mumbai, India, she pulls fabric over her mouth. The air is thick with heat, dust, and smog. Her eyes and lungs burn as she walks. Once home, she begins to prepare dinner. She burns wood inside of her one-room home located in a slum that is larger than many cities in the world. The inside of her home fills with smoke. She stifles a violent cough and continues to cook.

Like many of the poor people in the world, Shreya is exposed to many types of air pollution, a major environmental health risk. Outdoor air pollution in the city where she lives is unavoidable. At home she’s exposed to indoor air pollution produced by burning biomass in an unventilated space.

Indoor Air Pollution In the United States, most families cook with modern stoves using gas, electricity, or kerosene. In 2011, Shreya was just one of around 3 billion people in the world who cooked and heated their homes using solid fuels in open fires. This is the main source of indoor air pollution around the world. Solid fuels include coal and biomass, like wood, animal dung, logging wastes, and crop waste. A biomass is an energy source. People use the energy from burning biomass to cook and heat their homes. Most of the people who cook with solid fuels are poor and live in developing countries.

Cooking and heating with these materials inside a home produces high levels of indoor air pollution. Many of these homes are not vented to the outside, so the pollutants stay inside the homes and penetrate deep into the inhabitants’ lungs.

At left, a boy in India wheels a supply of cow dung patties. The patties are a common source of energy for cooking in many poor communities around the world.

Image retrieved from

http://commons.wikimedia.org/wiki/File:Cow

_dung_transport_in_India.jpg

and reproduced here under the terms of the

Creative Commons Attribution 2.0 license

(http://creativecommons.org/licenses/by/2.0

/deed.en). Image courtesy of Flickr user

lazyoldsun.

Women and children are especially vulnerable. In poor societies, women are often responsible for cooking food for the family, and young children spend most of their time in the home. Consequently, women and children are more exposed to the effects of indoor cooking with biomass than men.

According to the World Health Organization (WHO) in 2014, indoor air pollution was estimated to cause approximately 4 million premature deaths per year. More than half of the deaths were due to pneumonia in children under 5. Indoor air pollution is associated with serious diseases that include respiratory infections, chronic obstructive pulmonary disease (COPD), and lung cancer. There are also new reports indicating that indoor air pollution increases the risk of asthma, low birth weight, tuberculosis, cardiovascular disease, and blindness.



Other Sources of Indoor Air Pollution

Pollutant Indoor Sources Potential Effect

Tobacco smoke Cigarettes, cigars, pipes Bronchitis and pneumonia, emphysema, lung cancer, heart disease

Radon Soil under buildings, ground water

Lung cancer

Asbestos Damaged or deteriorating insulation

Lung cancer; asbestosis

Bacteria, viruses, animal dander, mites, fungi

House dust, pets, poorly maintained air conditioners, wet or moist structures

Asthma; allergic reactions; eye, nose, and throat irritation; influenza

Organic chemicals

Aerosol sprays, glues, cleaning agents, pesticides, paints

Headaches; damage to liver, kidneys, and brain; eye, nose, and throat irritation

Nitrogen oxides Unvented or malfunctioning gas appliances

Eye, nose, and throat irritation; respiratory infections in children

Outdoor Air Pollution There are many sources of outdoor air pollution. Power plants, industries, households, and vehicles, like cars, trucks, and buses, emit mixtures of air pollutants. Many of these pollutants are harmful to our health. According to the WHO in 2012, outdoor air pollution was estimated to cause 3.7 million deaths worldwide per year. (Source: http://www.who.int/mediacentre/factsheets/fs313/en/)

Smog dominates the skyline at sunset in Shanghai. Smog is a mixture of pollutants.

Image retrieved

from http://commons.wikimedia.org/wiki/File:Shan

ghaiairpollutionsunset.jpg and reproduced here

under the terms of the Creative Commons

Attribution-Share Alike 3.0 Unported license

(http://creativecommons.org/licenses/by-

sa/3.0/deed.en). Image courtesy of Suicup.

The most dangerous pollutant to human health produced by these sources is fine particulate matter, or PM, which comes from burning fuel for energy. PM is estimated to cause about 9% of lung cancer cases



in the world. Diesel smoke from trucks, cars, and buses is an example of particulate matter. The major components of PM are sulfate, nitrates, ammonia, sodium chloride, carbon, mineral dust, and water.

There are many common air pollutants in an urban environment. Carbon monoxide and lead are two examples. The combustion of gasoline and fossil fuels in cars is a source of carbon monoxide. The health effects include a reduction in the capacity the blood has to carry oxygen. Lead is found in paint and batteries, and it is also found in leaded gasoline. Leaded gasoline is no longer commonly used in the United States, but it is used in other countries. Health effects of exposure to lead over time can include brain damage and digestive problems.

Older and younger people are susceptible to illnesses related to outdoor air pollution. People with preexisting conditions, such as lung or heart disease, are also at a greater risk. Outdoor air pollution affects people worldwide, but some of the areas most greatly affected are urban areas in China, India, and Eastern Europe.

Short-Term Effects of Outdoor Air Pollution

Long-Term Effects of Outdoor Air Pollution

Irritation to eyes, nose, and throat Chronic respiratory disease

Upper respiratory infections, like bronchitis and pneumonia

Lung cancer

Headaches and nausea Heart disease

Aggravation of conditions like asthma and emphysema

Damage to brain, nerves, liver, or kidneys

Most people around the world are exposed to some type of air pollution. The type of air pollution depends on where they live. Some people, like Shreya in Mumbai, are exposed to both indoor and outdoor air pollution. However, all air pollution, both indoor and outdoor, can pose serious health risks.




Note Taking: Air Pollution


Directions: Complete this chart with information you learn while reading Student Resource 8.3, Reading: Air Pollution.

Indoor Air Pollution Outdoor Air Pollution

What are the sources of it?

Who is affected by it?

What effect does it have on health?




Diagrams: Health Determinants and Environmental Risk Factors


Directions: The scenarios in this resource describe links between health determinants, environmental risk factors, and diseases. For each scenario, fill in the chart describing what health determinants are linked to the environmental risk factor, and what diseases or conditions are associated with them. Next, draw a diagram that shows how the determinants, environmental risk factors, and diseases are connected.

To begin, go over the example to get some ideas about how the different parts of the scenario might be linked. Your diagram may look similar to the example, but each diagram will likely be different. There are a number of ways to create the diagram to show the links. Use arrows to show how the elements in the scenario connect to each other. If you need to, refer to your notes from Lesson 7 about health determinants.

Example

A couple in Colorado Springs owns an auto repair shop located on a frontage road by the side of a highway. The family lives in a small old house behind the shop. The couple has a 7-year-old son. He hangs around the shop while his parents work or he plays outside in the dirt with his dog. The child has shown serious attention problems at school. His IQ is also much lower than average, and he has problems with his hearing. Doctors believe that his problems are related to his exposure to lead. The primary sources of environmental exposure to lead are leaded paint, auto emissions, and drinking water. Living on the side of the highway, the child inhales the lead from auto emissions and is exposed to contaminated soil. He has also been exposed to lead because of his parents’ work. Auto repairers, along with printers, plumbers, and steel welders, are at a greater risk for lead exposure. In addition, the boy lives in a deteriorating house that was built before 1970 and contains lead-painted surfaces.

Determinant:

Parents' occupations

Determinant:

Location where child lives and

plays

Environmental Risk Factor: Exposure to

lead

Diseases and Conditions:

Attention problems, low

IQ,

hearing problems



Scenario 1

In Eleme, an oil-rich area of Nigeria, there is a lot of industry. Petroleum companies excavate oil. The oil industrial work takes place close to the area where people live. Researchers wanted to study the health outcomes associated with industrial pollution in Eleme. They used lab experiments, community health surveys, and hospital records. They took air, soil, and water samples, and they found that various toxins in the air were much higher than the guideline limit. They found that the contaminants were associated with respiratory health problems among community members. They also found that the air pollution was associated with painful skin disorders. The hospital records showed that people who lived in the community had much higher proportions of respiratory disorders and skin disorders than other communities in the region.

Determinant(s)

Environmental Risk Factor(s)

Diseases and Condition(s)

My diagram:



Scenario 2

Almost half of the world’s population uses coal and biomass fuels for domestic energy, to warm their homes and to cook food. Researchers went to six villages in Yunnan, a rural area of China, to study the effect of this type of indoor air pollution on blood pressure. They focused on 280 women from 235 households who ranged in age from 25 to 92 years old. Fifty-two percent of the women had a primary education. None of the women were current or former smokers and none were pregnant.

The researchers found that there was a connection between exposure to air pollutants from indoor biomass combustion and elevated blood pressure. They also found that the average exposure to the pollutants was higher in the winter than in the summer, presumably because during the winter the women spent more time indoors cooking. The researchers found that seasonal weather was related to the exposure women had to indoor air pollutants.

Determinant(s)

Environmental Risk Factor(s)

Diseases and Condition(s)

My diagram:




Global Health Detective: Environmental Statistics


Directions: Look at the information listed in the What to Find column of the chart below. You will search through charts and graphs online to find this information. This is the type of research that a global health worker might do.

First, make sure that you understand what information you are being asked to find. Then look for the information, using the web pages listed on the next page in the Where to Look for Information section of this resource. Write your response in the Answer column. Then describe how you know your answer is correct in the last column, and include the name of the chart or graph where you found your answer.

Notice that for some of the charts and graphs, information is revealed when you roll your mouse over certain areas. Also notice that the important information is often given in the legend of a chart or graph. You can often use this information to understand abbreviations. Study the example before you begin work.

What to Find Answer Where I Found the Answer and How I Know

Example: The proportion of the population in Cambodia that is using improved water sources

67% “Water and Sanitation: Proportion of Population Using Improved Drinking-Water Sources”

I scrolled over Cambodia on the map to see the percentage.

Region of the world in 2008 that had the most deaths attributed to outdoor air pollution

Continent that had most reported cholera outbreaks in 2010–2011

Death rate in Brazil attributed to outdoor air pollution in 2008



What to Find Answer Where I Found the Answer and How I Know

If the proportion of the population with improved water sources is higher in Angola or Paraguay

Where to Look for Information Burden of Disease Associated with Urban Outdoor Air Pollution for 2008

http://www.who.int/phe/health_topics/outdoorair/databases/burden_disease/en/index.html

Cholera Cases Reported to WHO by Year and by Continent 1989–2013 http://www.who.int/gho/epidemic_diseases/cholera/cholera_005.jpg?ua=1

Deaths Attributable to Outdoor Air Pollution, 2008 http://gamapserver.who.int/mapLibrary/Files/Maps/Global_oap_death_2008.png

Proportion of Population Using Improved Drinking-Water Sources (%), 2012 http://gamapserver.who.int/gho/interactive_charts/mdg7/atlas.html




Launch Letter: Global Health Summit

From: International Health Summit Expert Panel

To: AOHS, Global Health Students

Subject: Call for Proposals

Dear Students,

As representatives of major global health organizations, we are writing with a special invitation. We are organizing an international summit to address the most pressing health issues the people on our planet face today. The summit will be attended by leading medical doctors, public health strategists, politicians and government officials, academic researchers, funders, and NGO directors.

At the summit, we will hone in on a few of the global health issues that are most in need of our attention and work over the next five years. Here’s where you come in. We would like you to tell us which global health issue you think is worthy of being a focus of our summit. This task will not be simple. As we all know, there are many important issues that affect millions of people around the globe. We have confidence that your thoughtful, well-researched choice will help us make a decision that leads to significant improvements in the future of global health.

Here is what we will need from you. We would like you to choose an issue and create a persuasive presentation that you will deliver to both our expert panel and people from your own community. The presentation gives us an in-depth description of the issue that you choose. We would also like you to identify a geographic region that is particularly affected by the issue and describe the determinants and impacts of the issue from both individual and societal perspectives. We would also be interested in learning about interventions that have been, or could be, successful at addressing the issue. Most importantly, we want you to convince us that the issue you choose is worthy of being a focus of our summit.

Your teacher will provide you with a project overview that outlines the details of the project and explains what you should expect. Thank you for participating in this process, and we look forward to seeing your work.

Best regards,

Expert Panel at the International Health Summit




Project Overview: Global Health Summit Proposal

As you learned, a group of health organizations is holding an international health summit. The summit will focus on a few key global health issues that are most in need of attention over the next five years. An expert panel will hear proposals from several groups about which issues to feature at the summit.

Your group will choose, research, and propose an issue to the expert panel. The driving question of the project is:

How can we develop a call to action to address a global health threat for an international summit?

Your group is responsible for making a strong case to the panel about why your issue should be one of the key issues that the summit focuses on.

You will need to draw on all that you already know about global health. You will also use information that you learn in the remaining lessons of the course. As you know, in the work world, teams of health professionals work together. In this project, you will also work as part of a team.

The work you do on this project should be something that you are proud of. It will help you in your internship, college classes, and beyond. You can add this project to your resume and think of it as an important step on the road to career success!

Important Steps in the Project As you study different risk factors related to global health, you will examine health issues to consider for the issue you want to propose at the summit. This will be a difficult decision to make. Most of the issues you will learn about have a serious effect on people’s lives around the world, and the various issues will all seem important. However, you will have to narrow in on one issue. These are the steps you will take to reach your decision:

1. Learn about environmental risk factors and the diseases attributed to them.

2. Learn about nutritional risk factors and the diseases attributed to them.

3. Learn about behavioral risk factors and the diseases attributed to them.

4. Make a final decision about the issue you want to propose at the summit. At this point, you will form project groups.

5. Learn about community, government, and NGO interventions that are designed to reduce risk factors or alleviate the disease attributed to the risk factors. You will consider how interventions could alleviate the impact of the health issue you have chosen.

6. Your group will create a self-running slideshow about the issue to present at the summit.

Project Deliverables Over the course of this project, you and/or you and your group will produce the following pieces:

A portfolio where you keep all of your notes and other materials you collect to use as resources for your project

Observations on environmental health issues



An examination of nutrition issues in global health

Notes on behavioral risk factors that affect global health

A brief argument that presents three health issues related to an environmental, nutritional, or behavioral risk factor

A chart about types of interventions relevant to your project topic

A self-running slideshow that makes a case for the health issue you have chosen

Assessment The brief argument will be assessed using assessment criteria.

The self-running slideshow will be assessed using a rubric.

For the slideshow, your whole group will receive the same assessment, so please do your best to be a reliable, effective, and contributing group member!

Presenting Your Work You will participate in a mock International Health Summit proposal review where you make a case before a public audience for the health issue you have chosen. At that time, you will have a chance to see what your classmates have done in their groups and to share your work with friends, family, and your NAF academy advisory board. Your teacher will handle the details of organizing the event and let you know more specifics closer to the date of the summit.




Observations: Environmental Health Issues


Directions: Use this resource to make observations and gather information about the environmental health issues you learn about in this lesson. You will also summarize your findings and develop a strong sense of which issues are worthy of consideration for the International Health Summit proposal. Read the assessment criteria at the end of this resource. They describe how your work will be assessed.

1. Observations on the Guest Speaker’s Presentation A global health professional with knowledge of environmental health issues will come to class as a guest speaker. Think of three questions you would like to ask this person. Keep your culminating project in mind, because the speaker is likely to have current knowledge of the most pressing issues in the field of environmental health. You may wind up asking different questions once you’ve heard the speaker’s presentation, but thinking of questions ahead of time is a great way to be prepared to take full advantage of this opportunity.

Write the speaker’s answers to each question in the space below the question. There is also room to record other observations that might be valuable as you make your decisions about potential culminating project topics.

My question:

The speaker’s response:

My question:




My question:


Other observations on the speaker’s presentation:



2. Notes on Environmental Issues Explored in this Lesson Use this section to record what you learn in this lesson that could help you choose project topics. Review all of your resources for ideas, and keep adding to this chart as you complete the activities in this lesson. An example is provided.

Health Issue and Related Risk Factor

Related Diseases / Conditions

Two or Three Compelling Reasons to Consider the Issue

Where I Learned about the Issue

No clean and private sanitation facilities in schools in South Asia

Diarrhoeal diseases

1. School children are unnecessarily exposed to harmful pathogens. 2. It’s a preventable problem. 3. Children, girls especially, drop out of school because of lack of private facilities.

Student Resource 8.2, Reading: Environmental Risk Factors Related to Sanitation, Water, and Hygiene







3. Summarize Which Three Issues You Might Focus On Write a paragraph summarizing which three environmental health issues are worthy of consideration as a topic for your culminating project. For each issue, cover the following points:

What the issue is

How it is connected to one or more environmental factors

Health determinants for this issue

How it affects people

Why you think it’s a good candidate for your culminating project

Write a draft of your summary on a separate sheet of paper. Show it to a classmate to get suggestions for how to improve it. Then write the final draft in the space below.

Write the final draft of your summary here:



4. Create a Diagram for One of the Health Issues You’re Considering Choose one of the three issues you summarized in Section 3. Create a diagram that shows the connection between:

Health determinant(s)

Environmental risk factor(s)

Associated diseases

Refer to Student Resource 8.5, Diagrams: Health Determinants and Environmental Risk Factors, to refresh your memory on how to create this kind of diagram.

Make a draft of your diagram on a separate sheet of paper. Use the space on the next page for the final draft of your diagram.



Create the final draft of your diagram here:


Your observations on the guest speaker’s presentation show that you paid close attention; they are thoughtful and include ideas for potential culminating project topics.

Your notes on environmental issues explored in this lesson are clear and complete.

Your summary of three potential issues to focus on for your culminating project demonstrates an ability to compare a range of environmental issues and evaluate their relative need to be addressed by the global health community.

Your diagram of a specific issue makes the connection between health determinant(s), environmental risk factor(s), and disease easy to understand.

Your assignment is neat and uses proper spelling and grammar.




Research Sources: Environmental Diseases

Directions: Use the websites below to choose an environmental disease to research. Make a chart of your findings according to your teacher’s instructions. The first section has websites that describe a number of diseases and their connection to the environment. The second section has links for specific diseases.

If the website focuses on how a disease affects people in the United States, research its impact in developing countries. The International Health Summit wants proposals that address global health issues in the places that need help the most urgently, so be sure to focus on developing countries.

Research Sources that Cover a Range of Environmental Diseases http://www.ehso.com/environmentaldiseases.htm

http://www.uniteforsight.org/environmental-health/module3

http://www.niehs.nih.gov/health/topics/conditions/index.cfm

http://www.humanillnesses.com/original/E-Ga/Environmental-Diseases.html#b

http://www.cdc.gov/DiseasesConditions/az/a.html

Research Sources for Specific Diseases Chagas disease

http://www.who.int/mediacentre/factsheets/fs340/en/index.html

Radon and cancer


Malaria


http://www.gatesfoundation.org/What-We-Do/Global-Health/Malaria

West Nile virus


Cholera


Asbestos-related illness


Asthma


Chikungunya


Dengue


http://www.gatesfoundation.org/What-We-Do/Global-Health/Neglected-Infectious-Diseases



Dracunculiasis (guinea-worm disease)


http://www.gatesfoundation.org/What-We-Do/Global-Health/Neglected-Infectious-Diseases


AOHS Global Health

Lesson 9 Nutritional Risk Factors

In this lesson, students learn about the causes and effects of different types of malnutrition, including undernutrition and obesity. They learn about specific terminology related to malnutrition and about the health determinants linked to malnutrition. They also learn to analyze information about malnutrition and display it in charts and graphs. Students explore the cycle of malnutrition, from infancy to old age. For their culminating project, they take notes on compelling health issues related to nutritional risk factors.

Advance Preparation

In Class Period 2, every pair of students will need access to computers for Internet research. In Class Period 3, pairs of students will need computers with Microsoft Excel or other spreadsheet software.

If you are using spreadsheet software other than Excel, you may need to modify the instructions for the activity in Lesson Step 6.

In Class Period 4, you will need access to the YouTube video about the cycle of malnutrition at http://www.youtube.com/watch?v=6f0AMQQszQU. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see www.keepvid.com) or a similar program.

In Class Period 4, each student will need a copy of the article “The Life Cycle of Malnutrition,” available at http://www.ifpri.org/publication/life-cycle-malnutrition (click the PDF link at the end of the page). Print the article in color if possible.


Lesson Framework


Describe the different types of malnutrition and give examples of the diseases and conditions associated with each

Identify the health determinants that most frequently come into play in malnutrition*

Characterize the life course of an undernourished child

AOHS Global Health Lesson 9 Nutritional Risk Factors


Identify the main factors leading to obesity and characterize the populations that are most at risk for this condition

Deduce the relative global impacts of nutritional factors from data charts and graphs




Demonstrate competency in basic math skills and mathematical conversions as they relate to healthcare (National Health Science Standards 2015, Standard 1.31)




Assessment


An examination of nutrition in global health (Student Resource 9.7)

Assessment Criteria: Nutrition in Global Health (Teacher Resource 9.2)

Prerequisites Basic understanding of what makes a healthy diet and the nutrients needed to be healthy

Knowledge of the scope of health determinants and how they can interact

Understanding of correlation and causation

Understanding of environmental risk factors, including water, sanitation, hygiene, indoor air pollution, and outdoor air pollution

Ability to create charts and graphs using Excel or other spreadsheet software


Teacher Resources Teacher Resource 9.1, Presentation and Notes: Causes and Effects of Malnutrition (separate

PowerPoint file)



Teacher Resource 9.2, CDC Obesity Trends: 1985–2010 (separate PowerPoint file)

Teacher Resource 9.3, Assessment Criteria: Nutrition in Global Health

Teacher Resource 9.4, Key Vocabulary: Nutritional Risk Factors

Teacher Resource 9.5, Bibliography: Nutritional Risk Factors

Student Resources Student Resource 9.1, Matching: Malnutrition

Student Resource 9.2, Reading: Causes and Effects of Malnutrition

Student Resource 9.3, Correlations: Health Determinants and Malnutrition

Student Resource 9.4, Reading: Health Determinants and Malnutrition

Student Resource 9.5, Stations: Online Obesity

Student Resource 9.6, Graphing: Creating a Visual Picture of Malnutrition

Student Resource 9.7, Examination: Nutrition in Global Health


Computers with Internet access and Excel or similar spreadsheet software for students (one for each pair of students)


Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1 10 Terminology Matching: Malnutrition

The purpose of this activity is to introduce students to terms related to malnutrition.

To begin, make sure everyone has the same notion of what nutrition is. Ask students to suggest some definitions. Then say that the World Health Organization (WHO) defines nutrition like this:

Nutrition is the intake of food, considered in relation to the body’s dietary needs. Good nutrition—an adequate, well-balanced diet combined with regular physical activity—is a cornerstone of good health.



Step Min. Activity

In other words, nutrition is not the same as having enough food to not be hungry. What we eat also needs to meet the body’s needs, which means that it has to include many different kinds of nutrients. Ask students to name some examples of foods that are nutritious—they should be able to come up with fruits, vegetables, whole grains, and protein in the form of lean meats, poultry, seafood, low-fat dairy products like yogurt, milk, and cheese, beans, and eggs.

Given the complexity of good nutrition, students can imagine that malnutrition is a complex topic that encompasses more than just not getting enough food.

Tell students that it is important to understand the terminology related to malnutrition in order to grasp the bigger concepts. Refer students to Student Resource 9.1, Matching: Malnutrition. Explain that many of the words related to malnutrition are words that they already know something about, and in this activity they will match the words to the description of how the term is used in the field of malnutrition. Have students work in pairs. Ask them to read the instructions, and then answer any questions. Remind students that they will fill out the last column of the chart during the next activity and find out if their matches are correct.

2

25 Presentation: How Nutrition Impacts Health Status

This activity provides students with a more in-depth understanding of what causes malnutrition, what the effects of malnutrition are, and how global health workers are fighting malnutrition. It also develops their listening and note-taking skills.

To prepare, make notes to guide class discussion using Teacher Resource 9.1, Presentation Notes: Causes and Effects of Malnutrition. Have Teacher Resource 9.1, Presentation: Causes and Effects of Malnutrition (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Advise students that as they watch the presentation, they should take notes by completing the third column of the chart in Student Resource 9.1, Matching: Malnutrition. Instruct them to also make any necessary changes to the first column of their resource while they watch. You may also want to ask students to keep in mind ways that issues related to nutrition are linked to the issues related to water, sanitation, and hygiene that they learned about in the previous lesson.


This presentation is duplicated as Student Resource 9.2, Reading: Causes and Effects of Malnutrition. If an LCD projector is unavailable, students can read the presentation, answer the discussion questions in their notebook, and discuss their answers as a class. This student resource is also useful for review.

Have students compare their matches and final answers in pairs. Then have the pairs report out as a class to answer any outstanding questions or misunderstandings.

3 15 Reading: Health Determinants and Malnutrition

In this activity, students learn about health determinants that are major factors in malnutrition.

To begin this activity, ask students to open their notebook and write down two or three of



Step Min. Activity

the health determinants they have learned about that they think might be factors in malnutrition. A sample student response could be, “Socioeconomic status is a health determinant. People living in poverty do not have money to buy nutritional food.” After students have had time to write down their ideas, ask them to share with a partner what they wrote down, and then ask partners to share their ideas with the class.

Advise students that they are going to read about health determinants and malnutrition, and as they do so, they will look for correlations between the two. Refer students to Student Resource 9.3, Correlations: Health Determinants and Malnutrition, and Student Resource 9.4, Reading: Health Determinants and Malnutrition.

Ask student volunteers to explain what a correlation is, which they learned about earlier in this course, and then ask students to read the instructions on Student Resource 9.3. Explain that as students read about health determinants and malnutrition, they will complete the statements that describe correlations. Remind students that correlation does not mean the same thing as cause and effect. Answer any questions that students have.

If necessary, ask students to complete the reading and resource for homework. Tell them that they should come to class prepared to share their answers. Also, remind students to add any relevant information they learn to their regional reference maps.

CLASS PERIOD 2

4 10 Homework Review: Health Determinants and Malnutrition Reading

In this activity, students check their correlations statements for accuracy and completeness.

Ask students to review their work on Student Resource 9.3 with a partner for accuracy and completeness, reminding them that their responses will likely vary. Then ask several pairs to choose one correlation statement that they would like to share with the class, and have students read their statements aloud. Answer any questions students have about these correlations, and remind them that uncovering correlations between health determinants and health issues such as malnutrition is a skill that global health workers use as a way to think about improving health for a population.


5

40 Online Stations: Obesity

In this activity, students calculate body mass index (BMI) and learn about obesity trends. This activity focuses on the following college and career skill:


This activity requires one computer for every two students for two of the three stations. Before class begins, divide the classroom into three sections, and have the computers in each section set to access one of the following sites:

Section 1, Calculating BMI Station: http://nccd.cdc.gov/dnpabmi/Calculator.aspx

Section 2, Tracking Obesity Station: print at least one copy of Teacher Resource 9.2,



Step Min. Activity

CDC Obesity Trends: 1985–2010 (separate PowerPoint file)

Section 3, Obesity around the Globe Station: http://tiny.cc/Global_WHO_Obesity

To begin this activity, ask students to think about what they already know about obesity, and have volunteers share their ideas.

Explain to students that in this activity, they will be using information about obesity on CDC and WHO sites to calculate BMI and track trends in obesity in both their own state and in the world.

Pair students up and explain that they will be visiting three stations during the activity. Show students where the computers are located for two of the stations, and where Station 2 is located with a copy of Teacher Resource 9.2. Assign each pair an order in which they should visit the stations so that one-third of the students begin at each of the three stations. Tell students they will have 12 minutes at each station, and then they will need to move on to the next station. Point out that they will need to stay focused to complete the activity at each station in time.

Refer students to Student Resource 9.5, Stations: Online Obesity. Go over the instructions as a class, and answer any questions. Instruct students to have one partner serve as recorder to record their answers on the resource and the other partner serve as timekeeper to make sure they are on track to complete the station in 12 minutes.

As students work, circulate and answer questions. You will also need to act as timekeeper: every 12 minutes, ask students to move on to the next station. (You may want to give them a 2-minute warning before they have to move on.)

When students have completed all three stations, go over Student Resource 9.5 as a class and have pairs check for completeness and accuracy. To gauge student understanding, you may want to assess this resource on a credit/no-credit basis.

To conclude the discussion, write the following questions on the board:

What is one important discovery you have made about obesity?

What is one solution that you think would be effective in curbing the rise of obesity?

Ask students to discuss their responses with their partner, and then have volunteers share their responses with the class.

Remind students that because obesity is so prevalent in the United States, the information that they are learning about it will be useful as they make personal decisions about diet, physical activity, and lifestyle.

CLASS PERIOD 3

6

35 Graphing: Creating a Visual Picture of Malnutrition

The purpose of this activity is for students to analyze information about malnutrition and display it in a meaningful way in bar graphs and pie charts. This activity focuses on the following college and career skill:

Effectively using technology relevant to a profession

To begin this activity, ask students to recall the types of graphs and charts they have used so far in this course. (Their answers should include column and bar charts, line



Step Min. Activity

graphs, and pie charts.) Advise students that in this activity, they will be creating graphs that paint a picture of malnutrition in different areas of the world, and they will be expected to draw on what they already know about creating graphs in Excel. (You may wish to refer students to the work they did in Lesson 2, to help them recall how to create graphs.) Their job will be to choose the type of graph that is most appropriate to represent the data, and then use Excel or similar spreadsheet software to create the graph.

Divide students into pairs and refer them to Student Resource 9.6, Graphing: Creating a Visual Picture of Malnutrition. Ask students to read the instructions for the graphs, and then answer any questions. Provide students with instructions for saving their graphs. For example, you may wish to have them save the file into their personal work folder or on a flash drive.

Circulate as students work, answering their questions. When students have completed the first graph, ask them to check their work for accuracy with another pair.

To conclude the activity, point out that being able to convey the essence of global health statistics in a graph is an important professional skill.


7 15 Examination, Part I: Nutrition in Global Health

The first part of this assignment helps students assimilate what they have learned about nutrition and global health.

Refer students to Student Resource 9.7, Examination: Nutrition in Global Health. As they did for their assignment in Lesson 8, students will complete different sections of this assignment in stages. Ask students to look at the directions for each section and answer their questions. Draw their attention to the assessment criteria at the end of the resource, and make sure students understand how their work will be assessed.

Give students the remainder of the class period to start filling in the first section. Tell them to complete their review of everything they have learned in this lesson for homework and be prepared to discuss their work.

CLASS PERIOD 4

8

10 Examination, Part 1: Nutrition in Global Health (Continued)

Students compare the information they gleaned for homework.

Prior to class, prepare to show the YouTube video “Cycle of Malnutrition” at http://www.youtube.com/watch?v=6f0AMQQszQU, or prepare to show a similar video on the cycle of malnutrition. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

Also, each student will need a copy of the article “The Life Cycle of Malnutrition,” available at http://www.ifpri.org/publication/life-cycle-malnutrition (click the PDF link toward the top of the page). If possible, print the copies of the article in color. If it’s not



Step Min. Activity

possible to print the article for each student, prepare for students to read the article online, or download the article and provide students access to it.

Place students in groups of four. Tell each group to share what they filled in on the first section of Student Resource 9.7, Examination: Nutrition in Global Health. Tell students to make additions to their own resources if they hear something that they agree they want to consider for their culminating project. Circulate among the groups, listening to the students’ ideas.

9

30 Examination, Part 2: The Malnutrition Cycle

The second part of this assignment deepens students’ understanding of how malnutrition affects all stages of the human life cycle.

Explain that students are going to view a short video about the cycle of malnutrition. Explain that the video focuses on girls and women in South Asia. Ask students to listen for the major stages of the human life cycle. Then have students view the video (http://www.youtube.com/watch?v=6f0AMQQszQU) using an LCD projector.

After students have watched the video, ask volunteers to name the major stages of human life, often referred to as lifespan, and create a list on the board. The list should include these stages:

Birth and Infancy

Childhood

Adolescence

Adulthood

Old Age

Refer students to the article “The Life Cycle of Malnutrition.” Also ask them to review Section 2 of Student Resource 9.7, Examination: Nutrition in Global Health. Tell students to work independently to complete the following steps:

Read the article

Answer the questions about the article

Add project ideas to Section 1

Circulate as students work, helping students who are struggling to understand any part of the article or who have questions.

10 10 Examination, Part 3: Potential Project Topics

The final part of the assignment for this lesson gives students a chance to pull what they have learned together and make some choices about which issues related to nutrition might be good topics for their culminating projects.

Direct students’ attention to Section 3 of Student Resource 9.7. This is where they write a summary of which issues they’d like to consider as topics for their culminating projects, and why. They wrote a similar summary for Lesson 8 on environmental issues. Give students time to discuss which issues they’re going to focus on with their classmates.

Tell them to complete this assignment for homework. Give them a due date for handing it



Step Min. Activity

in. Assess the assignment using Teacher Resource 9.3, Assessment Criteria: Nutrition in Global Health. When you return it, remind students to keep it in their project portfolio.

Conclude the class period by letting students know that the next area of global health that they will learn about is how behavior affects health around the world.

Extensions

Content Enrichment Explain to students that the World Food Program uses five products to enhance the nutritional

status of undernourished people. In groups of four, have students look at the products featured here: http://www.wfp.org/nutrition/special-nutritional-products. Then have students choose one that they would like to research and create a presentation about. In their presentation, students should explain when the product is used and why it is effective, and they should provide details about the specific nutrients contained in the product. Also, ask students to include information about a specific population that received the product they chose.

Have students research and create a classroom map that depicts areas that are experiencing severe food shortages, such as the Sahel. Ask students to use Google News keyword searches for terms like food shortage or food crisis to start compiling the list.

Have the class cook a World Meal, which is the average meal for the average person on the planet. It consists of a limited amount of white rice and beans. The purpose of this activity is to bring awareness of the incredible abundance of foods that we experience in Western society compared to most of the rest of the world.

Ask students to read articles about obesity, such as those listed below. Then have students use the information in the articles to write down possible solutions to the obesity epidemic. Engage students in a discussion about which solutions they believe to be the most effective.

o “A Simpler Way to Slow the Obesity Crisis,” http://tiny.cc/Global_TIME_Simpler

o “Pharmageddon: Can a New Weight Loss Drug Really Save Us?” www.huffingtonpost.com/dr-mark-hyman/qnexa_b_1303050.html

o “Solutions: Dealing with America’s Obesity Problem,” http://tiny.cc/Global_WT_Solutions

STEM Integration Math: Ask students to research the origins of the formula used to calculate BMI and explain why

this formula works. What is the effect of squaring the person’s height? And why is the factor 703 used? Have students share their findings with the class.

Technology: Send students to the US Department of Agriculture’s website that shows where America’s food deserts are: http://www.ers.usda.gov/data/fooddesert. First ask students to research what a food desert is; then they can experiment with finding food deserts near their community as well as other statistics that provide information about access to healthy foods for different segments of the population.



Additional Cross-Curricular Ideas English Language Arts: Ask students to imagine what the world would be like if the patterns of

malnourishment that they have learned about continue. Invite them to imagine a future in which developed nations suffered even more from an overweight and obese population and undeveloped nations suffered gravely from undernourishment. Then ask them to write a science fiction story that takes place 150 years in the future. Tell them that the plot of the story should focus on an issue related to malnourishment and that they should use everything they know about the topic to make the story believable and compelling.

History: Have students work in groups to research one of the following periods of famine in history:

o Pol Pot era in Cambodia

o Russian famine of 1601–1603

o Great Leap Forward famine in China

o Famine in the Aztec empire in Mexico

o Highland potato famine in Scotland

o 1984–1985 famine in Ethiopia

o Bengal famine of 1943–1944

Ask students to find information about what caused the famine, who was affected, how the famine ended, and what lessons can be learned. Have students create presentations about their findings.


AOHS Global Health


Teacher Resources


Teacher Resource 9.1 Presentation and Notes: Causes and Effects of Malnutrition (separate PowerPoint file)

Teacher Resource 9.2 CDC Obesity Trends: 1985–2010 (separate PowerPoint file)

Teacher Resource 9.3 Assessment Criteria: Nutrition in Global Health

Teacher Resource 9.4 Key Vocabulary: Nutritional Risk Factors

Teacher Resource 9.5 Bibliography: Nutritional Risk Factors




Presentation Notes: Causes and Effects of Malnutrition


In this presentation, you will learn what malnourishment is, what causes it, what effects malnourishment has on people, and some ways that global health workers are successfully fighting malnourishment.

Presentation notes



In global health, nutrition is very important. Nutritional status has a major impact on health status. Undernourished women are at an increased risk of delivering premature babies or babies with a dangerously low birth weight. These babies are at risk for not developing properly.

Nutrition is directly linked to the physical and mental development of children, and therefore it affects how healthy children will be as adults. Nutrition plays a role in determining whether children attend school, how well they do at school, and if they complete their schooling. Since it is linked to education, it is also linked to how productive people are as adults and what their prospects are for earning income.

Presentation notes



The number of undernourished people in the world is humbling. The United Nations Food and Agriculture Organization (FAO) estimated that in 2010–2012 one in eight people in the world suffered from chronic undernourishment. Almost all of them lived in developing countries.

Data from World Hunger Education Service’s “2013 World Hunger and Poverty Facts and Statistics”: http://www.worldhunger.org/articles/Learn/world%20hunger%20facts%202002.htm#Number_of_hungry_people_in_the_world.

Image retrieved from https://commons.wikimedia.org/wiki/File:Percentage_population_undernourished_world_map.PNG, on October 5, 2015, and reproduced here under the terms of the Creative Commons Attribution Unported 3.0 license (http://creativecommons.org/licenses/by/3.0/).

Presentation notes



When we talk about malnutrition in global health, we are talking about a subject that is more complex than people not getting enough to eat. We are talking about people who do not get the proper nutrition. This may mean that they get too little nutrition, too much, or the wrong kind. Undernourished people lack sufficient energy and nutrients. People who have a low weight for their age are underweight. The term stunted refers to people who are too short for their age. People who are dangerously thin for their height are defined as wasted, and people who are too heavy for their height are defined as either overweight or obese, depending on the severity of their problem. You will learn more about obesity later in this lesson.

Presentation notes



Most people arriving at Dolo Ado refugee camp in Ethiopia have little or no possessions or food. Children are especially at risk. Almost 50% of them are acutely malnourished. More aid is starting to get through.

Image retrieved from https://www.flickr.com/photos/dfid/5977576537/in/set-72157627161283625 on March 25, 2014, and reproduced here under the terms of the Creative Commons Attribution Unported 3.0 license (http://creativecommons.org/licenses/by/3.0/), in accordance with the Open Government license (http://www.nationalarchives.gov.uk/doc/open-government-licence/). Photo courtesy of Cate Turton/UK Department for International Development (DFID).

Presentation notes



Malnutrition refers to getting too much or not enough food and the wrong types of food. But it is also about the body’s responses to infections and illness that result in the body not being able to use nutrients from food properly. When a person is malnourished, the person’s body isn’t able to fully utilize, or get the most out of, the food he or she eats. This may be the case if the person suffers from diarrhoea. That person won’t be able to adequately absorb the nutrients that he or she consumes.

Whatever form it takes, malnutrition increases a person’s risk for both disease and early death.

Presentation notes



Malnourished children may exhibit many different types of symptoms. They may be short for their age or they may be thin. They may be bloated or listless. They often have weakened immune systems that make them vulnerable to other diseases. Malnutrition can affect their skin, which may be pale, thick, and dry. Their skin also may change color or bruise easily, or they may get rashes. Their hair may come out easily. Their bones may be more tender, and their gums may bleed easily. They may have an increased sensitivity to light or glare. Malnutrition can affect the way the organs function. Malnourished children may experience dizziness and fatigue.

Image retrieved from http://commons.wikimedia.org/wiki/File:A_child_is_checked_for_signs_of_malnutrition_in_Katsina_State,_Nigeria,_March_2011_(8406367308).jpg on September 11, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by-sa/2.0/deed.en). Image courtesy of Jane Miller/DFID.

Presentation notes



Nutrients that provide the protein and energy we need to survive are called macronutrients. The macronutrients are:

• Protein, which provides energy and also serves to build and repair the body

• Carbohydrates, which provide energy

• Fat, which provides energy

We need all three types of macronutrients. People who don’t get enough macronutrients have energy and protein malnutrition. Energy and protein malnutrition is associated with low birth weight, being underweight, failing to grow properly, and a weakening of immunity.

Image retrieved from http://commons.wikimedia.org/wiki/File:Getting_treatment_for_malnutrition_in_northern_Kenya_(6220164120).jpg on September 11, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by-sa/2.0/deed.en). Image courtesy of Marisol Grandon/DFID.

Presentation notes



People who don’t get enough vitamins and minerals have micronutrient malnutrition.

Vitamin A is found in plants, particularly leafy green vegetables, like kale and chard, and in yellow and orange fruits that are not citrus, and carrots. Lack of vitamin A is associated with a condition that can lead to blindness. Vitamin A is also important for the health of the body’s immune system and for a child’s capacity to grow properly. Children who lack vitamin A may have a harder time surviving serious conditions like malaria and diarrhoeal disease.

Iodine is found in some seafood and in plants grown in soil that naturally contains iodine. Lack of iodine is associated with goiters, which are growths on the thyroid. It is also associated with intellectual disabilities, hearing impairment, and stillbirths. Many developed nations fortify their salt with iodine, but many countries don’t. In those countries, most people don’t naturally get the iodine that they need.

Fish, meat, and poultry provide iron. Lack of iron is linked to anemia, a blood disease that causes weakness and fatigue. It is also associated with poor mental development. Iron is a critical nutrient for children to develop motor skills and cognitive functions.

The best source of zinc is red and white meat and shellfish. A severe deficiency is associated with growth retardation, impaired immunity, skin disorders, and an increased susceptibility to infection.

Presentation notes



A woman’s health before she becomes pregnant has a major impact on her pregnancy, the health of her baby, and her own health as a new mother. Preconception health—how healthy a woman is before she conceives—involves having a healthy lifestyle: eating nutritious foods, exercising regularly, getting enough sleep, having healthy relationships, and not engaging in risky behaviors such as smoking, doing drugs, or abusing alcohol.

Preconception health also refers to the health of the father. Smoking, drinking, and doing drugs lower the quality of a man’s sperm. So do having a poor diet, exposure to too much stress, and unhealthy relationships. A father’s overall lifestyle leaves biological traces on his children in a complicated interplay of genetics and environment that scientists are just beginning to understand.

Presentation notes



Good maternal nutrition is essential for good outcomes in pregnancy. For the health of both mother and child, pregnant women must stay well nourished. They need sufficient amounts of energy and protein. It is recommended that a pregnant woman consume about 300 more calories each day than she would consume when she’s not pregnant. Maternal nutrition is linked to healthy birth weight. Babies that don’t receive sufficient nutrients from their mothers in utero can suffer from mental impairment, birth defects, and a failure to grow properly in general.

Presentation notes



Breast milk is the ideal food for infants. It provides them with all the nutrients that they need to grow. It is safe and it contains antibodies that help protect infants from common childhood diseases, like pneumonia and diarrhoea. Breast-feeding women need a healthy diet and plenty of liquids in order to produce a good supply of breast milk.

Even after babies are born, their health is still directly linked to the health of their mother. It is recommended that mothers exclusively breast-feed for the first six months of an infant’s life. This means that the infant should consume only breast milk and no water, food, or juice.

While there can be challenges, most women can breast-feed successfully. They need accurate information about breast-feeding and support from the people close to them, their health care system, and, in general, the society that they live in. Women may run into obstacles if they live in a culture that doesn’t support breast-feeding.

Infant formula is a good substitute for mothers who cannot breast-feed. However, formula doesn’t contain the important antibodies that breast milk does. There is also a risk that the water used to prepare the formula will be unsafe or the equipment used will be contaminated. Malnutrition can also result from overdiluting formula to prolong supplies.

Presentation notes



After the first six months of a child’s life, it is recommended that mothers continue to breast-feed while introducing appropriate complementary foods. This is considered to be a vulnerable time for babies and when many infants become malnourished. The foods given to babies should provide sufficient energy, protein, and micronutrients. They should also be prepared in a safe way that limits the risk of contamination. The foods should be prepared hygienically, and the water given to children or used to prepare the food should be clean and safe.

The time from when a child is conceived until that child is 2 years old, or about the first 1,000 days, is critical. This is considered to be a window of opportunity. It’s been found that nutritional deficits in fetuses and children under 2 can produce growth and development problems that can never be undone. For example, stunted children have very little chance to catch up in their growth.

Presentation notes



Global health workers believe that there are cost-effective solutions to address many of the world’s most serious nutritional concerns. These include the following:

• Promoting proper hand-washing, which reduces infections that take a toll on nutritional status

• Promoting exclusive breast-feeding to infants for the first six months of life

• Providing food supplements to people who don’t get enough protein or energy

• Providing nutritional supplements to people who lack vitamin A and iron

• Fortifying salt with iodine, as is done in the United States and other developed countries

• Providing zinc with oral rehydration to reduce the severity of diarrhoeal disease

• Promoting educational campaigns that help families improve what they eat

• Promoting healthy choices prior to conceiving a child

• Ensuring that pregnant and nursing women are well nourished

Presentation notes



Fortifying food is one way to improve the health status of malnourished children and adults. Take this case study for an example. Health care professionals found that a significant number of children in a Delhi slum were anemic because of inadequate intake of foods with iron, a lack of diversity in their diet, and a high prevalence of infection. So, for 90 days the children were given biscuits fortified with iron. Biscuits were chosen because they are ready to eat, convenient, hygienic, and low cost. After the intervention, those conducting the study found a significant improvement in the children’s iron storage capability.

Data from Navjyoti India Foundation / Britannia Nutrition Foundation study “Pilot Study to Assess the Impact of Intervention with Iron Fortified Biscuits on Anemic Children”: http://www.britannia-biscuits.com/bnf/ps.html.

Presentation notes



Malnutrition is a serious problem in global health, but because of global health programs, interventions, and campaigns, there is evidence that progress is being made. Households around the world that used iodized salt increased from about 20% in 1990 to 70% in 2011. The rate of children younger than 5 years old in developing countries who are underweight fell from 31% to 26% from 1990 to 2008. There has also been an increase in children who receive vitamin A supplements. In 2004, it was estimated that 72% of children received them.

Still, in spite of the progress, it was estimated in 2013 that over 800 million people were undernourished. The nutritional status of women and children in South Asia and sub-Saharan Africa continues to be a pressing challenge in global health.

Presentation notes




Assessment Criteria: Nutrition in Global Health

Student Name: _____________________________________________ Date: _______________


Met Partially Met

Didn’t Meet

The notes on nutrition issues explored in this lesson are clear and complete.

□ □ □

The answers to questions about the cycle of malnutrition are thorough and demonstrate a close reading of the article they are based on.

□ □ □

The summary of three potential issues to focus on for the culminating project demonstrates an ability to compare a range of nutritional issues and evaluate their relative need to be addressed by the global health community.

□ □ □


□ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Key Vocabulary: Nutritional Risk Factors

Term Definition

body mass index (BMI) The medical standard used to determine if a person is obese.

complementary food Food given to a baby while the baby continues to breast-feed.

fortify Strengthen or enrich. For example, salt is often fortified with iodine.

malnutrition A state of not getting proper nutrition, which may mean either too little, too much, or the wrong kind.

micronutrient deficiency A health condition that can occur when a person doesn’t consume or absorb enough of the micronutrients vitamin A, iodine, iron, and zinc.

obese Too heavy for a certain height; a form of malnutrition.

preconception The period of time before a couple conceives a child

premature baby A baby who is born at a gestational age of less than 37 weeks.

protein-energy malnutrition A health condition that occurs when a person doesn’t get enough macronutrients. It can result in low birth weight, being underweight, and weakened immunity.

stunted Being too short for a certain age.

undernourished Lacking sufficient energy and nutrients.

underweight Having a low weight for a certain age.

wasted Being too thin for a certain height.




Bibliography: Nutritional Risk Factors


Print Skolnik, Richard. Global Health 101. Burlington, MA: Jones and Bartlett Learning, 2012.

Online “About BMI for Adults.” CDC, http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html (accessed October 25, 2015).

“BMI Percentile Calculator for Child and Teen.” CDC, http://nccd.cdc.gov/dnpabmi/Calculator.aspx (accessed October 5, 2015).

Britannia Nutrition Foundation. “Pilot Study to Assess the Impact of Intervention with Iron Fortified Biscuits on Anemic Children.” http://www.britannia-biscuits.com/bnf/ps.html (accessed October 25, 2015).

“Dynamics of Change: The Dividends of Food Security.” FAO, http://www.fao.org/docrep/X8200E/x8200e05.htm (accessed October 25, 2015).

“Fact File: 10 Facts on Breastfeeding.” WHO, http://www.who.int/features/factfiles/breastfeeding/facts/en/index.html (accessed October 25, 2015).

“Fact Sheet 342: Infant and Young Child Feeding.” WHO, http://www.who.int/mediacentre/factsheets/fs342/en/ (accessed October 25, 2015).

“Higher and Volatile Food Prices and Poor Rural People.” International Fund for Agriculture Development (IFAD), http://www.ifad.org/operations/food/ (accessed October 25, 2015).

“High Food Prices: 10 Questions Answered.” World Food Program (WFP), August 8, 2012, http://www.wfp.org/stories/rising-food-prices-10-questions-answered (accessed October 25, 2015).

The Hunger Project. “Cycle of Malnutrition.” YouTube video, 1:14. December 22, 2007. http://www.youtube.com/watch?v=6f0AMQQszQU (accessed October 25, 2015).

International Food Policy Research Institute (IFPRI). “The Life Cycle of Malnutrition.” IFPRI 1999–2000 Annual Report Essay, http://www.ifpri.org/publication/life-cycle-malnutrition (accessed October 25, 2015).

Neill, James, “World Meal,” http://www.wilderdom.com/games/descriptions/WorldMeal.html (accessed October 25, 2015).

“Nutrition,” World Health Organization, http://www.who.int/topics/nutrition/en/ (accessed October 25, 2015).

“Nutritional Status and Vulnerability: The Spectrum of Malnutrition.” Food and Agriculture Organization (FAO), http://www.fao.org/docrep/X8200E/x8200e04.htm (accessed October 25, 2015).

“Overweight and Obesity: Adult Obesity Facts.” CDC, http://www.cdc.gov/obesity/data/adult.html (accessed October 25, 2015).

“Prevalence of Child Malnutrition (Percent Underweight Under Age Five).” Kaiser Family Foundation, http://kff.org/global-indicator/child-malnutrition/ (accessed October 25, 2015).

“Recommendations to Improve Preconception Health and Care—United States,” CDC, http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm (accessed October 25, 2015).



“Scaling Up Nutrition.” UN, http://www.unscn.org/en/sun-scaling-up/ (accessed October 25, 2015).

“South Asia: Data and Statistics.” The World Bank, http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,menuPK:158851~pagePK:146732~piPK:146813~theSitePK:223547,00.html (accessed October 25, 2015).

“Top 10 Protein Foods,” WebMD, http://www.webmd.com/diet/top-10-protein-foods (accessed October 25, 2015).

“Why Fathers Really Matter,” New York Times, September 8, 2012, http://www.nytimes.com/2012/09/09/opinion/sunday/why-fathers-really-matter.html?_r=0 (accessed October 25, 2015).

World Hunger Education Service. “2015 World Hunger Poverty Facts and Statistics.” Hunger Notes, http://www.worldhunger.org/articles/Learn/world%20hunger%20facts%202002.htm (accessed October 25, 2015).


AOHS Global Health


Student Resources


Student Resource 9.1 Matching: Malnutrition

Student Resource 9.2 Reading: Causes and Effects of Malnutrition

Student Resource 9.3 Correlations: Health Determinants and Malnutrition

Student Resource 9.4 Reading: Health Determinants and Malnutrition

Student Resource 9.5 Stations: Online Obesity

Student Resource 9.6 Graphing: Creating a Visual Picture of Malnutrition

Student Resource 9.7 Examination: Nutrition in Global Health




Matching: Malnutrition


Directions: With your partner, read the list of terms below and talk about what you think they mean. Then use what you already know to match each of the following terms with the appropriate description in the table below by filling in the first column. You will complete the third column of the table with important information you learn about the topics when your teacher presents “Causes and Effects of Malnutrition.”

malnutrition

micronutrient malnutrition

stunted

complementary foods

wasted

underweight

macronutrients

undernourished

premature baby

obese/overweight

breast milk

Term Description Important Information I Learned about the Topic

Being too short for a certain age

Not getting proper nutrition, meaning either too little, too much, or the wrong kind

Not getting enough vitamins or minerals

Having a low weight for a certain age



Term Description Important Information I Learned about the Topic

Lacking sufficient energy and nutrients

Being too heavy for a certain height

Being too thin for a certain height

Ideal food for newborns and babies

Protein, carbohydrates, and fat

Foods given to a baby while he or she continues to breast-feed

Baby born at less than 37 weeks gestational age




Reading: Causes and Effects of Malnutrition

In this presentation, you will learn what malnourishment is, what causes it, what effects malnourishment has on people, and some ways that global health workers are successfully fighting malnourishment.



In global health, nutrition is very important. Nutritional status has a major impact on health status. Undernourished women are at an increased risk of delivering premature babies or babies with a dangerously low birth weight. These babies are at risk for not developing properly.

Nutrition is directly linked to the physical and mental development of children, and therefore it affects how healthy children will be as adults. Nutrition plays a role in determining whether children attend school, how well they do at school, and if they complete their schooling. Since it is linked to education, it is also linked to how productive people are as adults and what their prospects are for earning income.



The number of undernourished people in the world is humbling. The United Nations Food and Agriculture Organization (FAO) estimated that in 2010–2012 one in eight people in the world suffered from chronic undernourishment. Almost all of them lived in developing countries.

Data from World Hunger Education Service’s “2013 World Hunger and Poverty Facts and Statistics”: http://www.worldhunger.org/articles/Learn/world%20hunger%20facts%202002.htm#Number_of_hungry_people_in_the_world.

Image retrieved from https://commons.wikimedia.org/wiki/File:Percentage_population_undernourished_world_map.PNG, on October 5, 2015, and reproduced here under the terms of the Creative Commons Attribution Unported 3.0 license (http://creativecommons.org/licenses/by/3.0/).



When we talk about malnutrition in global health, we are talking about a subject that is more complex than people not getting enough to eat. We are talking about people who do not get the proper nutrition. This may mean that they get too little nutrition, too much, or the wrong kind. Undernourished people lack sufficient energy and nutrients. People who have a low weight for their age are underweight. The term stunted refers to people who are too short for their age. People who are dangerously thin for their height are defined as wasted, and people who are too heavy for their height are defined as either overweight or obese, depending on the severity of their problem. You will learn more about obesity later in this lesson.



Most people arriving at Dolo Ado refugee camp in Ethiopia have little or no possessions or food. Children are especially at risk. Almost 50% of them are acutely malnourished. More aid is starting to get through.

Image retrieved from https://www.flickr.com/photos/dfid/5977576537/in/set-72157627161283625 on March 25, 2014, and reproduced here under the terms of the Creative Commons Attribution Unported 3.0 license (http://creativecommons.org/licenses/by/3.0/), in accordance with the Open Government license (http://www.nationalarchives.gov.uk/doc/open-government-licence/). Photo courtesy of Cate Turton/UK Department for International Development (DFID).



Malnutrition refers to getting too much or not enough food and the wrong types of food. But it is also about the body’s responses to infections and illness that result in the body not being able to use nutrients from food properly. When a person is malnourished, the person’s body isn’t able to fully utilize, or get the most out of, the food he or she eats. This may be the case if the person suffers from diarrhoea. That person won’t be able to adequately absorb the nutrients that he or she consumes.

Whatever form it takes, malnutrition increases a person’s risk for both disease and early death.



Malnourished children may exhibit many different types of symptoms. They may be short for their age or they may be thin. They may be bloated or listless. They often have weakened immune systems that make them vulnerable to other diseases. Malnutrition can affect their skin, which may be pale, thick, and dry. Their skin also may change color or bruise easily, or they may get rashes. Their hair may come out easily. Their bones may be more tender, and their gums may bleed easily. They may have an increased sensitivity to light or glare. Malnutrition can affect the way the organs function. Malnourished children may experience dizziness and fatigue.

Image retrieved from http://commons.wikimedia.org/wiki/File:A_child_is_checked_for_signs_of_malnutrition_in_Katsina_State,_Nigeria,_March_2011_(8406367308).jpg on September 11, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by-sa/2.0/deed.en). Image courtesy of Jane Miller/DFID.



Nutrients that provide the protein and energy we need to survive are called macronutrients. The macronutrients are:

• Protein, which provides energy and also serves to build and repair the body

• Carbohydrates, which provide energy

• Fat, which provides energy

We need all three types of macronutrients. People who don’t get enough macronutrients have energy and protein malnutrition. Energy and protein malnutrition is associated with low birth weight, being underweight, failing to grow properly, and a weakening of immunity.

Image retrieved from http://commons.wikimedia.org/wiki/File:Getting_treatment_for_malnutrition_in_northern_Kenya_(6220164120).jpg on September 11, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by-sa/2.0/deed.en). Image courtesy of Marisol Grandon/DFID.



People who don’t get enough vitamins and minerals have micronutrient malnutrition.

Vitamin A is found in plants, particularly leafy green vegetables, like kale and chard, and in yellow and orange fruits that are not citrus, and carrots. Lack of vitamin A is associated with a condition that can lead to blindness. Vitamin A is also important for the health of the body’s immune system and for a child’s capacity to grow properly. Children who lack vitamin A may have a harder time surviving serious conditions like malaria and diarrhoeal disease.

Iodine is found in some seafood and in plants grown in soil that naturally contains iodine. Lack of iodine is associated with goiters, which are growths on the thyroid. It is also associated with intellectual disabilities, hearing impairment, and stillbirths. Many developed nations fortify their salt with iodine, but many countries don’t. In those countries, most people don’t naturally get the iodine that they need.

Fish, meat, and poultry provide iron. Lack of iron is linked to anemia, a blood disease that causes weakness and fatigue. It is also associated with poor mental development. Iron is a critical nutrient for children to develop motor skills and cognitive functions.

The best source of zinc is red and white meat and shellfish. A severe deficiency is associated with growth retardation, impaired immunity, skin disorders, and an increased susceptibility to infection.



A woman’s health before she becomes pregnant has a major impact on her pregnancy, the health of her baby, and her own health as a new mother. Preconception health—how healthy a woman is before she conceives—involves having a healthy lifestyle: eating nutritious foods, exercising regularly, getting enough sleep, having healthy relationships, and not engaging in risky behaviors such as smoking, doing drugs, or abusing alcohol.

Preconception health also refers to the health of the father. Smoking, drinking, and doing drugs lower the quality of a man’s sperm. So do having a poor diet, exposure to too much stress, and unhealthy relationships. A father’s overall lifestyle leaves biological traces on his children in a complicated interplay of genetics and environment that scientists are just beginning to understand.



Good maternal nutrition is essential for good outcomes in pregnancy. For the health of both mother and child, pregnant women must stay well nourished. They need sufficient amounts of energy and protein. It is recommended that a pregnant woman consume about 300 more calories each day than she would consume when she’s not pregnant. Maternal nutrition is linked to healthy birth weight. Babies that don’t receive sufficient nutrients from their mothers in utero can suffer from mental impairment, birth defects, and a failure to grow properly in general.



Breast milk is the ideal food for infants. It provides them with all the nutrients that they need to grow. It is safe and it contains antibodies that help protect infants from common childhood diseases, like pneumonia and diarrhoea. Breast-feeding women need a healthy diet and plenty of liquids in order to produce a good supply of breast milk.

Even after babies are born, their health is still directly linked to the health of their mother. It is recommended that mothers exclusively breast-feed for the first six months of an infant’s life. This means that the infant should consume only breast milk and no water, food, or juice.

While there can be challenges, most women can breast-feed successfully. They need accurate information about breast-feeding and support from the people close to them, their health care system, and, in general, the society that they live in. Women may run into obstacles if they live in a culture that doesn’t support breast-feeding.

Infant formula is a good substitute for mothers who cannot breast-feed. However, formula doesn’t contain the important antibodies that breast milk does. There is also a risk that the water used to prepare the formula will be unsafe or the equipment used will be contaminated. Malnutrition can also result from overdiluting formula to prolong supplies.



After the first six months of a child’s life, it is recommended that mothers continue to breast-feed while introducing appropriate complementary foods. This is considered to be a vulnerable time for babies and when many infants become malnourished. The foods given to babies should provide sufficient energy, protein, and micronutrients. They should also be prepared in a safe way that limits the risk of contamination. The foods should be prepared hygienically, and the water given to children or used to prepare the food should be clean and safe.

The time from when a child is conceived until that child is 2 years old, or about the first 1,000 days, is critical. This is considered to be a window of opportunity. It’s been found that nutritional deficits in fetuses and children under 2 can produce growth and development problems that can never be undone. For example, stunted children have very little chance to catch up in their growth.



Global health workers believe that there are cost-effective solutions to address many of the world’s most serious nutritional concerns. These include the following:

• Promoting proper hand-washing, which reduces infections that take a toll on nutritional status

• Promoting exclusive breast-feeding to infants for the first six months of life

• Providing food supplements to people who don’t get enough protein or energy

• Providing nutritional supplements to people who lack vitamin A and iron

• Fortifying salt with iodine, as is done in the United States and other developed countries

• Providing zinc with oral rehydration to reduce the severity of diarrhoeal disease

• Promoting educational campaigns that help families improve what they eat

• Promoting healthy choices prior to conceiving a child

• Ensuring that pregnant and nursing women are well nourished



Fortifying food is one way to improve the health status of malnourished children and adults. Take this case study for an example. Health care professionals found that a significant number of children in a Delhi slum were anemic because of inadequate intake of foods with iron, a lack of diversity in their diet, and a high prevalence of infection. So, for 90 days the children were given biscuits fortified with iron. Biscuits were chosen because they are ready to eat, convenient, hygienic, and low cost. After the intervention, those conducting the study found a significant improvement in the children’s iron storage capability.

Data from Navjyoti India Foundation / Britannia Nutrition Foundation study “Pilot Study to Assess the Impact of Intervention with Iron Fortified Biscuits on Anemic Children”: http://www.britannia-biscuits.com/bnf/ps.html.



Malnutrition is a serious problem in global health, but because of global health programs, interventions, and campaigns, there is evidence that progress is being made. Households around the world that used iodized salt increased from about 20% in 1990 to 70% in 2011. The rate of children younger than 5 years old in developing countries who are underweight fell from 31% to 26% from 1990 to 2008. There has also been an increase in children who receive vitamin A supplements. In 2004, it was estimated that 72% of children received them.

Still, in spite of the progress, it was estimated in 2013 that over 800 million people were undernourished. The nutritional status of women and children in South Asia and sub-Saharan Africa continues to be a pressing challenge in global health.




Correlations: Health Determinants and Malnutrition


Directions: The statements below describe correlations. As you read Student Resource 9.4, Reading: Health Determinants and Malnutrition, use what you know about determinants, malnutrition, the Millennium Development Goals, and correlations to complete the statements as full sentences. The first one has been done for you.

There is a relationship between rising food prices and

the number of poor people who are malnourished.

Girls who live in societies where their nutritional needs are put second to those of men and boys are more likely to

There is a relationship between the number of babies who are born with low birth weight and women who

Poor women who don’t receive support and education about breast-feeding are more likely to have babies who

There is an association between people who live in communities without health clinics and

People who suffer from seasonal hunger are more likely to

Poverty is a determinant of nutritional status. So, improving income will

Improving nutritional status can help combat HIV/AIDS, malaria, and other diseases because people with poor nutritional status are

Improving nutritional status can help children’s performance at school because undernourished children




Reading: Health Determinants and Malnutrition

There are many health determinants that affect nutritional status. In this reading, we are going to look at some of the major determinants that affect malnutrition in individuals and communities.

Poverty and Rising Food Prices

Poverty is a major determinant that affects the nutritional status of people around the globe, especially people living in rural areas of sub-Saharan Africa and South Asia. The amount of food and the type of food available to families in these places is dependent on the family’s access to land, their ability to produce food on the land, and the amount of money they have to purchase food.

In recent years, the price of food has spiked around the globe. This has put a strain on the poor people of the world, who were already struggling to eat. One major spike in prices occurred during 2007 to 2008 and another occurred during 2010 to 2011. During these periods, the prices of common food commodities, like cereal, rose significantly. For example, in Somalia the price of red sorghum, a type of grain that is a staple food there, increased up to 240%.

Governmental and global polices affect agricultural production and the distribution of food. These determinants are often beyond the control of the people who are most affected by them.

Many of the world’s poorest people spend half of their money on food.

Social Position and Cultural Practices

Social status can be a determinant of nutritional status. In some parts of the world, like rural Pakistan, the girls and women in a family eat less food, or less nutritious food, than the men and boys.

A 16-year-old girl named Amina lives in an isolated community in Pakistan. Amina was recently married. In the morning, it’s her responsibility to get water for chai, or tea. She drinks the chai with milk and sugar. Then she and her mother-in-law make breakfast for the family. The men eat. When they leave to work in the fields, Amina and the other women eat the food that is left. Amina’s share is one paratha, a whole-wheat bread fried in butter. Over the course of the day, she eats chapatti, a light bread, and vegetables from their garden cooked in ghee, or butter. With each meal, she waits until the men and boys have finished eating before she eats.

Cultural practices can be another determinant of nutritional status. In some cultures, it is expected that women will eat different foods when they are pregnant. Unfortunately, some of the foods that are excluded from their diet during pregnancy are critical to their health and the health of their developing babies. For example, before the 1980s, poverty and malnutrition were major problems throughout rural Thailand. Many women in these areas were undernourished when they entered their reproductive years, but their nutritional status suffered even more because of traditional customs. Some of these customs prohibited them from eating nutritious foods like eggs and other important animal proteins while they were pregnant. As a result, pregnant women gained about half the weight that was normal, and their babies were often born underweight.



Childcare Practices

A 17-year-old woman in Bangladesh gave birth to her first baby at home. Both the baby and the mother were underweight. The woman tried to breast-feed the baby, but she found the experience painful and difficult. She didn’t know who to ask for help. She lived with her husband and his family. Her mother-in-law told her that formula was better for the baby than breast milk. The woman stopped breast-feeding and began using formula, but the water she used to mix the formula was contaminated. The baby suffered from terrible bouts of diarrhoea. She tried to breast-feed him again, but by this point her body was no longer making enough milk to feed her child. The child was severely malnourished and at risk of dying.

Childcare practices affect nutritional status. Breast-feeding, like in the story above, is one example. In 2013, fewer than 40% of infants under six months of age were exclusively breast-fed. According to the WHO, adequate breast-feeding support for mothers and families could save many lives, but because of misinformation and lack of support, many women don’t breast-feed.

Access to Appropriate Health Services

Illness and infection affect a person’s ability to properly absorb the nutrients that they need, so having access to medical services that help people fight illness and infection is important in maintaining healthy nutritional status.

Children who have access to health services like immunizations are better protected from illness and infection. Supplements of Vitamin A, an important micronutrient missing from the diet of many children, are often provided by health services. Intestinal worms, which can compromise a child’s ability to absorb nutrients, are treated by medication that is available through health services.

Many poor and rural communities around the world don’t have access to an adequate health clinic such as

this one in Zambia.

Seasonal Hunger

In low-income countries, especially in rural areas where people live primarily by means of subsistence farming, communities may experience a “hunger season.” This can occur when a family has exhausted the food from the last harvest before more food can be harvested. If they don’t have income to buy food, they are forced to eat less or simply go without.

In these situations, climate is often a determinant. An agricultural area that receives too little rain, or too much rain, will produce fewer crops, which will affect both what community members earn and what they have to eat.

Even in years with normal rainfall, seasonal hunger can affect people whose work changes with the season. Take for example a family in northern Zambia. The family lives near a lake, and the father works by fishing in the lake. The mother grows vegetables, like sweet potatoes and pumpkins. During the dry season, the father has steady work. The family has enough to eat with meals like boiled sweet potatoes with roasted nuts and a thick porridge with boiled fish, but the wet season is difficult for the family. The lake is closed to fishing, so the father doesn’t have work. The family eats just one meal, at midday. At this time of year, the family does not get the energy they need for daily activities, health, and growth.



Millennium Development Goals

The determinants you have read about are just some of the factors that affect the malnourished around the globe. The determinants often interact, creating serious situations in which nutritional status is severely compromised.

In fact, addressing people’s nutritional needs and the determinants related to them are a critical part in meeting the United Nations Millennium Development Goals. These are eight goals that all of the member states of the United Nations have agreed to try to achieve by 2015. The first six of the Millennium Development Goals are closely tied to nutrition, as described below.

Goal 1: Eradicate poverty and hunger

Poverty is a determinant of nutritional status. Improving income will improve nutritional status.

Goal 2: Achieve universal primary education

Undernourished children enroll in school at lower rates. They also attend school for fewer years and don’t perform as well as properly nourished children. Improving nutritional status will improve children’s attendance and performance at school.

Goal 3: Promote gender equality and empower women

Women are often undernourished in part because of cultural and social determinants. Improving their nutritional status will cut down on conditions like anemia that interfere with their income-earning potential.

Goal 4: Reduce child mortality

In 2013, undernutrition was associated with 45% of child deaths. It’s impossible to reduce child mortality without improving children’s nutritional status.

Goal 5: Improve maternal health

Undernourished women are more likely to give birth prematurely or to have underweight babies. Improving maternal nutrition is directly linked to improving maternal health.

Goal 6: Combat HIV/AIDS, malaria, and other diseases

People with poor nutritional status are more vulnerable to illness and infection. Improving nutritional status is important to fighting serious diseases like AIDS and malaria.




Stations: Online Obesity


Directions: Follow the directions on this resource to complete the activities for each station your teacher has set up.

Station 1: Calculating BMI The medical standard for determining if a person is obese is to measure the person’s body mass index (BMI). It’s a measurement of body fat based on height and weight. The criteria used to measure obesity in children and teens is different from the criteria used for adults. In this exercise, you will first learn to measure the BMI of adults and then you will use an online calculator to measure the BMI of teens.

BMI Categories for Adults

Underweight: less than 18.5

Normal weight: 18.5–24.9

Overweight: 25–29.9

Obese: 30 or greater

How to Measure BMI for Adults

1. Divide weight in pounds (lbs.) by height in inches squared.

2. Multiply by a conversion factor of 703.

Here’s an example:

Weight = 150 lbs.

Height = 5'5" (65")

Calculation: [150 / 652] x 703 = 24.96

With a BMI of 24.96, this person has normal weight.

Calculate the BMI for the following adults. You may use a calculator. Record your answers in the space provided below.

A woman who weighs 125 lbs. and is 5'2"

BMI:

Is the woman underweight, normal weight, overweight, or obese?

A man who weighs 296 lbs. and is 5'11"

BMI:

Is the man underweight, normal weight, overweight, or obese?



Calculating BMI for Teens

Go to the BMI percentile calculator for teens and children on this page: http://nccd.cdc.gov/dnpabmi/Calculator.aspx. Use the information below to determine if this teen is overweight or obese. Use today’s date for the date of measurement. One measurement the calculator will give you is a percentile. The percentile shows how the teen’s weight compares with other teens of the same age and sex. For example, if the percentile is 23%, that means that the teen’s weight is greater than 23% of other teens of the same age and sex. Record your answers in the space provided below.

Sex: Female

Date of birth: May 2, 1998

Height: 5'4"

Weight: 140 lbs.

BMI:

Percentile:

Is the teen underweight, normal weight, overweight, or obese?



Station 2: Tracking Obesity Is it true that the prevalence of obesity has skyrocketed over the past 25 years? Follow the instructions below to create graphs that track obesity and give you a visual answer to this question.

1. Look through the printed PowerPoint from the CDC showing obesity trends from 1985–2010. The maps show how the percentage of obese adults has changed between 1985 and 2010 in each state.

2. Find your state on the map. Then look at what the percentage of obese adults in your state was for the following years: 1985, 1990, 1995, 2000, 2005, and 2010. Take note of the percentages below:

1985:

1990:

1995:

2000:

2005:

2010:

3. Choose another state, and repeat the exercise you did in Step 2.

1985:

1990:

1995:

2000:

2005:

2010:

4. Now fill in the bar graph below to show how the percentage of obese adults in your state and the other state you collected data for has changed between 1985 and 2010. Use different colors of ink to distinguish between the two states, and fill in the legend with the color you use for each state.

0

10

20

30

40

50

60

70

80

90

1985 1990 1995 2000 2005 2010

Percentage

of Obese Adults

Year

Increase in Obesity by State

My state

Other state



Station 3: Obesity around the Globe Obesity is not a problem in the United States alone. Mexico and the United Kingdom have obesity rates that are also dangerously high. Study the map on this web page to get an idea of obesity around the world: http://tiny.cc/Global_WHO_Obesity. The map shows the estimated overweight and obesity prevalence in males aged 15 and older in 2010. Use the map to answer the questions below.

1. Which continent has the highest prevalence of obesity?

2. What is the prevalence for India?

3. What is the prevalence for the United States?

4. Name two countries where the prevalence is less than 20%.

5. Name one where the prevalence is equal to or greater than 80%.




Graphing: Creating a Visual Picture of Malnutrition


Directions: Follow the instructions below to create graphs in Excel that give a visual picture of malnutrition. Your graphs should help the reader quickly understand what the major issues are and which regions are most at risk. You may wish to refer to your Lesson 2 notes on creating graphs using Excel.

Graph 1: Prevalence of Child Malnutrition (Percent Underweight under the Age of 5)

The chart below provides information from 2005–2012 from the Kaiser Family Foundation about underweight children in countries where malnutrition is a major issue.

Timor-Leste Niger Pakistan India Bangladesh Somalia

Percent of underweight children

45.3% 39.9% 30.9% 43.5% 41.3% 32.8%

1. Decide what type of chart or graph (such as a pie chart, bar graph, or line graph) is the best choice to display the information.

2. Use Excel to create the graph. Remember to give your graph a title and labels.

3. When you have finished creating your chart or graph, compare the information in your graph with the data given above. Make sure that the information is correct and that your graph is easy to interpret.

4. Follow your teacher’s instructions to save your work.

Graph 2: Malnourished Children

The purpose of this graph is to show where the majority of malnourished children live.

Read the statement below, and then follow the instructions to construct your graph:

In 2010, 70% of malnourished children lived in Asia, 26% in Africa, and 4% in Latin America and the Caribbean.

1. Decide what type of chart or graph is the best choice to depict the information given in the statement.

2. Use Excel to create the graph. Remember to give your graph a title, and make sure all of the information is clear.

3. When you have finished creating your chart or graph, compare the information in it to the information given in the statement above. Make sure that the information is correct and that your graph is easy to interpret.




Graph 3: Deaths Related to Vitamin A Deficiency (Children under Age 5)

The purpose of this graph is to compare by region the deaths related to vitamin A deficiency in 2001 in children under 5 years of age.

East Asia and Pacific

Europe and Central Asia

Latin America and the Caribbean

Middle East and North Africa

South Asia

Sub-Saharan Africa

Deaths related to vitamin A deficiency in children under 5 years of age

11,000 0 5,000 70,000 157,000 383,000

1. Decide what type of chart or graph (such as a pie chart, bar graph, or line graph) is the best choice to display the information. Look at the numbers in this data, and determine what would be the best scale to use.

2. Use Excel to create the graph. Remember to give your graph a title and labels.

3. When you have finished creating your chart or graph, compare the information in your graph to the data given above. Make sure that the information is correct and that your graph is easy to interpret.





Examination: Nutrition in Global Health

Student name________________________________________ Date_____________________

Directions: Fill in each section of this resource according to the directions for that section.

1. Notes on Nutrition in Global Health That I Learned from This Lesson As you complete the activities in this lesson, you will learn about pressing nutritional issues that affect people around the globe and that may be worthy of being the focus of your culminating project. Use this chart to keep track of any topics or ideas that you may want to use in your project.







2. The Malnutrition Cycle You will read an article titled “The Cycle of Malnutrition” that describes the way malnutrition affects every stage of human life. As you read, take notes by answering the questions below. They may give you more ideas for culminating project topics to consider. Add these ideas to Section 1 of this resource.

The Life Course of an Undernourished Person

When can malnutrition start?

What are important health concerns for a pregnant woman and her fetus?

What are some of the consequences of not getting proper nutrition when pregnant?

How does malnourishment affect children?

What are some of the consequences of malnourishment in adolescence?

How does malnourishment affect adults?

Why is proper nutrition in old age important?

What interventions can break the life cycle of malnutrition?



3. Summarize Which Three Issues You Might Focus on Write a paragraph summarizing three issues related to nutrition that are worthy of consideration as a topic for your culminating project. For each issue, cover the following points:

What the issue is

How it is connected to one or more nutritional factors

Health determinants for this issue

How it affects people

Why you think it’s a good candidate for your culminating project

Discuss your ideas with a classmate. For homework, write a draft of your summary on a separate sheet of paper. Then write the final draft in the space below.



Make sure your assignment meets or exceeds the following criteria: Your notes on nutrition issues explored in this lesson are clear and complete.

Your answers to questions about the cycle of malnutrition are thorough and demonstrate a close reading of the article they are based on.

Your summary of three potential issues to focus on for your culminating project demonstrates an ability to compare a range of nutritional issues and evaluate their relative need to be addressed by the global health community.



AOHS Global Health

Lesson 10 Behavioral Risk Factors

In this lesson, students learn about high-risk behaviors and associated health outcomes. They learn about health determinants that are linked to risky behaviors. By developing concept maps, they analyze the links between high-risk behaviors and injury and disease. In preparation for their culminating project, they write an argument about pressing health issues related to nutritional, environmental, or behavioral risk factors.

Advance Preparation

In Class Period 4, each student will need access to a computer for Internet research. In Class Period 5, each student will also need word processing software.

In this lesson, students are placed in groups of four to begin work on their culminating project. Put some thought into grouping students according to their skills and work styles as well as to the topics they’ve chosen, so that all groups are likely to succeed with their project.


Lesson Framework


Identify the high-risk behaviors that have the biggest impact on global health

Describe the general relationship between risky behavior and disease, and explain how a risky behavior can impact an entire population*

Evaluate how health determinants can influence individual high-risk behaviors

Explain the ways that risky behaviors increase risk for a particular disease and identify the health determinants that come into play

Evaluate all aspects of global health issues that merit attention and determine which issue deserves resources to be the next global initiative


AOHS Global Health Lesson 10 Behavioral Risk Factors



Practice speaking and active listening skills (National Health Science Standards 2015, Standard 2.15)




Assessment


Concept map that shows links between a risky behavior and injuries and diseases (Student Resource 10.4)

Assessment Criteria: Concept Map (Teacher Resource 10.3)

Notes on behavioral risk factors (Student Resource 10.5)

Assessment Criteria: Behavioral Risk Factors in Global Health (Teacher Resource 10.4)

Brief argument about an important issue related to environmental, nutritional, or behavioral risk factors (Student Resource 10.6)

Assessment Criteria: Pressing Health Issue Argument (Teacher Resource 10.5)

Prerequisites Knowledge about nutritional and environmental risk factors

Knowledge of scope of health determinants

Knowledge about substance abuse


Teacher Resources Teacher Resource 10.1, Presentation and Notes: Risky Behaviors and Health Outcomes (includes

separate PowerPoint file)

Teacher Resource 10.2, Answer Key: Vignettes on Health Determinants and Risky Behaviors

Teacher Resource 10.3, Assessment Criteria: Concept Map

Teacher Resource 10.4, Assessment Criteria: Behavioral Risk Factors in Global Health



Teacher Resource 10.5, Assessment Criteria: Pressing Health Issue Argument

Teacher Resource 10.6, Key Vocabulary: Behavioral Risk Factors

Teacher Resource 10.7, Bibliography: Behavioral Risk Factors

Student Resources Student Resource 10.1, Note Taking: Risky Behaviors and Health Outcomes

Student Resource 10.2, Reading: Risky Behaviors and Health Outcomes

Student Resource 10.3, Vignettes: Health Determinants and Risky Behaviors

Student Resource 10.4, Assignment: Concept Map

Student Resource 10.5, Notes: Behavioral Risk Factors

Student Resource 10.6, Writing Assignment: Pressing Health Issue Argument


Computers with Internet access and word processing software (one for each student)


Sticky notes (about 10 per student)

Basic art supplies to make a concept map, such as markers, scissors, glue, rulers, and recycled magazines

Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1 10 Correlations: Risky Behavior and Health Outcomes

This activity introduces students to the concept of risky behaviors and activates students’ prior knowledge to identify health outcomes of risky behaviors.

To begin, write the following list on the board:

Sitting around too much (being sedentary)

Not wearing a seat belt

Having unprotected sex



Step Min. Activity

Ask students to tell a partner what they think the items have in common, and then have students share their responses with the class.

Explain that this list describes risky behaviors. Tell students that high-risk behaviors potentially threaten the health of the person who manifests the behavior, and they can threaten the health of others.

Then refer students to Student Resource 10.1, Note Taking: Risky Behaviors and Health Outcomes. Have students work in pairs to complete the second column, where they write down what they know about how a behavior affects health outcomes. Ask students to read the directions, and then answer their questions. Explain that as they watch a presentation in the next activity, they will complete the What I Learned column of the chart.

After pairs complete their work, ask them to share different examples they wrote as health outcomes. Take a minute to reinforce the difference between a health behavior and a health outcome. Make sure students understand that bad eating habits, for example, should always be classified as a behavior and not as an outcome. Obesity, on the other hand, is always an outcome and never a behavior.

2

30 Presentation: Risky Behaviors and Health Outcomes

This activity provides students with a more in-depth understanding of diseases and injuries that can be attributed to high-risk behaviors. It also develops students’ listening and note-taking skills.

To prepare, make notes to guide class discussion using Teacher Resource 10.1, Presentation Notes: Risky Behaviors and Health Outcomes. Have Teacher Resource 10.1, Presentation: Risky Behaviors and Health Outcomes (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Refer students to Student Resource 10.1, Note Taking: Risky Behaviors and Health Outcomes. Remind them that as they watch the presentation, they should take notes by filling in the third column of their chart.


This presentation is duplicated as Student Resource 10.2, Reading: Risky Behaviors and Health Outcomes. If an LCD projector is unavailable, students can read the presentation, answer the discussion questions in their notebook, and discuss their answers as a class. This student resource is also useful for review.

After the presentation, divide the class into pairs and have them compare their notes for completeness and accuracy. Then have the pairs report out as a class to answer any outstanding questions or misunderstandings. If time allows, ask students to add information about India and sub-Saharan Africa to their regional reference maps. If time is running short, tell students to add information to their regional reference maps for homework.

To conclude, summarize that finding solutions to problems associated with risky behavior involves helping people change their behavior.



Step Min. Activity

3 10 Vignettes: Health Determinants and Risky Behaviors

This activity helps students activate prior knowledge about health determinants that are linked to risky behaviors.

To begin, ask student volunteers to recall what a health determinant is. If students struggle to remember, offer this way of putting it: a health determinant is one of many things that determine your health—it’s a factor that affects how healthy you are. Then refer students to Student Resource 10.3, Vignettes: Health Determinants and Risky Behaviors. Tell students to use what they know about health determinants to complete the resource. Ask students to read the instructions, and then answer their questions.

Explain that students should complete the resource for homework and come to class prepared to review it.

CLASS PERIOD 2

4 15 Homework Review: Health Determinants and Risky Behavior Vignettes

Students solidify their understanding of the relationship between health determinants and risky behaviors as they review their homework.

Call on different volunteers to offer their answers for each vignette. Encourage students with different answers to explain their reasoning. Take this opportunity to clear up misunderstandings and to point out that a range of answers can be accurate. Use Teacher Resource 10.2, Answer Key: Vignettes on Health Determinants and Risky Behaviors, to help guide the discussion.

You may wish to gauge student understanding by assessing this assignment on a credit/no-credit basis.

Explain that you’ve been talking about risky behaviors; but the other side of the coin is behaviors that protect a person from engaging in risky behavior. Ask students to call out some ideas on what these might be. Flesh out their suggestions with some of the following:

Positive relationship with parents

Positive relationships with other adults

Community service or volunteering for an hour a week

Solid boundaries for behavior at home and school, with realistic consequences

Doing something creative every week

Being on a team or doing something physically active regularly

Reading for pleasure

Feeling good about the future

Professionals call these protective factors. Teens who have these in their lives are less likely to engage in risky behaviors and more likely to grow up into caring, healthy, responsible adults.



Step Min. Activity

5 35 Concept Map: Risky Behaviors

Students discover that concept maps are a means of showing how a risky behavior can lead to injury or disease. The activity also focuses on the following college and career skill:


Assign students to groups of three. Then refer them to Student Resource 10.4, Assignment: Concept Map. Direct their attention to the sample concept map on the second page. Explain that a concept map is used to communicate ideas about a complex subject. Ask the groups to spend a few moments studying the example.

Write the questions listed below on the board. Use the questions to help students understand the purpose of a concept map. Ask students to discuss their responses as a group, and then have groups share their responses with the class:

What is the broad topic of the concept map?

Why do you think the creator of the map put some information in boxes with dotted borders and some information in boxes with broken line borders?

What do the dotted lines between boxes show?

What is the most interesting or creative aspect of the map?

Once students have a general understanding of the purpose and function of a concept map, tell them that they will be creating a concept map that shows how a risky behavior can lead to injury or disease. Ask students to read the instructions and assessment criteria, and then answer any questions. Emphasize that students should let their creativity be their guide but that they should also focus on making sure that the relationship between the elements on their map is clear and accurate. Also, tell them that they can let their classmates’ work serve as inspiration, but their work should be original and unique. Then provide students with various materials that they can use to create their maps, such as chart paper, markers, recycled magazines, scissors, and rulers.

Consider having students create concept maps using an online brainstorming tool like SpiderScribe (www.spiderscribe.net) or MindMeister (www.mindmeister.com).

At the end of the activity, tell students that they will have 20 minutes in the next class period to complete their concept maps.

CLASS PERIOD 3

6 20 Concept Map: Risky Behaviors (Continued)

In this activity, students complete their concept maps.

Have students assemble in their groups and get right to work completing their concept maps. Remind them to make sure that their map meets or exceeds the assessment criteria. Circulate to answer questions as students work.

When students complete their maps, have them post them around the room in preparation for a gallery walk.



Step Min. Activity

7 10 Gallery Walk: Concept Maps

Students provide each other with feedback on their concept maps.

Point out that the ability to recognize how different parts of a broad concept fit together is an important professional skill that is especially useful for problem solving. Explain that in this gallery walk, they will study their peers’ concept maps and look for elements or relationships that might help to solve a problem.

Pass out sticky notes, about 9 or 10 per student, and instruct students to view at least three of the maps in the room. Write the following questions on the board, and ask students to respond to the questions on sticky notes for each map they view:

What relationship or element do you see that gives a new clue about a way to decrease this risky behavior? Try to find something you haven’t thought about before.

How could the relationship between the elements on the map be even clearer?

Tell students they can turn their map in for assessment, or they can make improvements to their map based on their peers’ feedback and turn it in at the beginning of the next class period. Use Teacher Resource 10.3, Assessment Criteria: Concept Map, to assess students’ work.

You may wish to have students vote on three maps that will be displayed in a public area at school, such as the library, media center, or cafeteria.

8 15 Note Taking: Behavioral Risk Factors

This activity allows students to review what they’ve learned in this lesson and evaluate which behavioral health issues are the most pressing.

Ask students to look at Student Resource 10.5, Notes: Behavioral Risk Factors. Its format will be familiar by now, since they have filled out a similar chart on environmental and nutritional issues. Remind students that the objective is to look through all of their resources from this lesson and fill in the chart with behavioral issues that they feel are worthy of consideration for their culminating project. Ask students to take note of the assessment criteria at the end of the resource, and answer any questions.

Tell students to complete their chart for homework. They will need to use it in the next class period.

9 5 Homework: Narrowing the Project Choices

Students look at the project options they have accumulated and narrow them down in preparation for choosing one.

For homework, tell students to look at the environmental, nutritional, and behavioral issues they have written down as possibilities for their culminating project. Tell them to narrow their choices down to three, and to write these down on a piece of paper. Explain that you will use their choices to help you form project groups in the next class period.



Step Min. Activity

CLASS PERIOD 4

10 10 Notes Review: Behavioral Risk Factors

Students compare the notes they took on behavioral risk factors.

Prior to class, decide which factors (in addition to an interest in the same or similar global health issues) are most important for choosing project groups in which students will work well together. Also decide if it matters whether more than one group winds up choosing the same issue or if you want each group to work on a different one.

As students come into class, collect their papers with their top three project choices. Make sure their names are on the papers.

Place students in groups of four. Ask them to share which issues they chose for Student Resource 10.5, Notes: Behavioral Risk Factors. Then tell them to discuss the following prompts:

In our community, I think the risky behaviors that are a problem are….

If I were a health professional in our community, interventions I’d try in order to decrease these risky behaviors are….

As students are talking in their groups, look through their project choices. Combine these with the other factors you have considered and choose project groups.

Collect and assess Student Resource 10.5, Notes: Behavioral Risk Factors using Teacher Resource 10.4, Assessment Criteria: Behavioral Risk Factors in Global Health. Return Student Resource 10.5 to the students as soon as possible, so that they can refer to it as they work on their culminating project as needed.

11 15 Culminating Project Work: Choosing an Issue

Students learn who their project group mates are and work together to finalize their choice of issue for their culminating project. This activity focuses on the following college and career skills:


Demonstrating adaptability and flexibility

Organize students into their project groups. Note that one factor in choosing these groups is the similarity of their top three project choices. Their first task as a group is to choose one issue to work on together for their culminating project. Explain that professionals are often required to relinquish their top choices in order to move forward with group consensus, and many students today will need to be flexible and agree on a topic that was not their favorite. The ability to adapt to a new priority and work just as hard on it as if it were their top choice is a great experience that will serve them well.

Tell students to follow this procedure to make their choices:

Group members pitch their favorite issue to the group.

Group members ask questions and carefully consider each suggestion.

Group members take a vote.



Step Min. Activity

Circulate among groups as they work through the process of making a choice, guiding and encouraging students to be open and willing to go with the majority. If there is a tie, students can undergo the procedure again or ask you for guidance on making the final decision.

Once groups have made their choices (which should take about 5–10 minutes), ask each group to tell you their decision and write these on the board. Decide whether you want to ensure that each group works on a different issue or if some overlap is acceptable.

12

25 Culminating Project Work: Pressing Health Issue Written Argument

Students produce a written argument about a pressing health issue attributed to an environmental, nutritional, or behavioral risk factor. This activity also focuses on the following college and career skill:

Thinking critically and systemically to solve difficult problems


Refer students to Student Resource 10.6, Writing Assignment: Pressing Health Issue Argument. Ask students to read the instructions, including the assessment criteria, and then answer any questions.

Have students read the example argument in their project group and write down their ideas about whether the argument meets each of the assessment criteria. Then assign one of the assessment criteria to each group, and ask them to share with the class why they think the example argument does or does not meet the assessment criterion assigned to them. Make sure they give specific examples of how the argument measures up to the assessment criterion.

Before students begin, emphasize that their argument should be persuasive—meaning that they are expressing a belief or a point of view that they want others to share.

If students have Internet access, another option is to have them use a cloud-based application like Google Docs to upload, edit, and review documents as a group. This will be especially useful when students are working on their argument for homework.

Then have students get to work. Circulate as students work and answer any questions they have about their argument.

At the end of the class period, let students know that they will have 40 minutes in the next class period to finish writing their argument. Tell them that they should complete any remaining research they need to bolster their argument for homework.

CLASS PERIOD 5

13

40 Culminating Project Work: Pressing Health Issue Written Argument (Continued)

In this activity, students write the rough and final draft of their argument.

Assemble students in their project groups. Have each group designate one person to collect everyone’s research into one document and then share this complete set of research with the group members (if the research hasn’t already been collected via



Step Min. Activity

Google docs or a similar application).

Next, groups should decide which member is responsible for writing the rough draft of different sections of the argument. Circulate around the room, ensuring that each group has divided up responsibilities and written down who is in charge of writing each section.

Assign each student to a computer with word processing software. Then students should use their research to write the rough draft of their section of the argument. When they have completed their drafts, one member of the group acts as the editor and puts each section into one complete draft. All group members read this draft, noting areas that need revision. Remind students to keep an eye out for issues as noted in Student Resource 10.6. The editor should make revisions with input from the group, and all group members should review the final draft of their argument before submitting it. Assess the arguments using Teacher Resource 10.5, Assessment Criteria: Pressing Health Issue Argument. When you return them, remind students to keep their assessed argument in their project portfolio.

To conclude, remind students that the work they have done on their argument prepares them for working on their culminating project slideshow.

14 10 Final Reflection: High-Risk Behavior and Health Outcomes

The purpose of this activity is for students to reflect on risky behavior and health outcomes in their own lives.

Write the following prompts on the board:

One potentially risky behavior I have is….

Based on what I now know about risky behavior, I might consider changing….

Ask students to complete the statements in their notebook. Tell them that they will not be required to share what they wrote.

After students have finished writing, ask volunteers to share their statements, if they feel comfortable doing so.

Then conclude by pointing out that students can use what they know about risky behavior to help them make healthy lifestyle choices now and in the future.

Extensions

Content Enrichment Have students assess what risky behaviors are most prevalent in their communities. Instruct

students to design surveys that they will use to collect data about risky behavior in their communities. Students should cover a range of risky behaviors—from texting while driving to unsafe sex—on their surveys. Then work with students to develop a plan to have community members fill out surveys anonymously. Once students have collected data, work with them to use charts and graphs to organize and then draw conclusions from their data.

Remind students that experts believe that there are certain measures that can be taken to curb high-risk drinking, such as prohibiting the sale of alcohol at certain times of day or prohibiting



drinking in public places, like sports events. Explain that some people feel, though, that measures like these infringe on people’s personal freedom and rights. Have students participate in an organized debate about the issue.

Explain that since the AIDS epidemic began, public awareness about the consequences of risky sexual behavior has risen dramatically in the United States and elsewhere. Have students conduct and film interviews with their parents, grandparents, or other older adults whom they are close to about what life was like before AIDS. They may wish to ask them questions about how they first learned about the disease, if the epidemic changed the behavior of people they knew, and the difference they see in the awareness of young people compared with people’s awareness in their generation. Then instruct students to edit the interviews into five- to eight-minute videos to share with the class.

Expand the Final Reflection activity into a longer journal assignment. Ask students to journal how they do with their own risky behaviors every day for a week. At the end of the week, ask students to reread their previous entries and respond to the following questions:

o What about the behavior was risky?

o Why did I participate in the risky behavior?

o How could I change my behavior?

o Why would changing my behavior be hard?

STEM Integration Math: Have students examine a few case studies that illustrate how statistics show or don’t show

correlation. Help students understand the basic statistical math that establishes correlation.

Technology: Create and use an online discussion forum on the topic of risky behavior at your school. Alternatively, start an online discussion forum where students contribute to a descriptive list of protective assets. The forum can be hosted on your class or school website using an application like Moodle, or use a host service such as Boardhost.

Additional Cross-Curricular Ideas English Language Arts: Have students write persuasive essays that argue in support of a certain

solution to obesity. Students may choose to write solutions such as restricting the sale of high-fat food, mandatory physical activity during the work day, or increased use of medications that help control weight. Students can choose a solution that they have learned about or a solution that is their own idea.

History: Have students research and develop either a physical or online exhibition that explains the history of traffic laws in their state. Their exhibit should also include information about current, or persistent, road-safety problems that still need to be addressed. You may wish for students to view this online exhibit about the history of traffic laws in Indiana to get ideas for their project: http://www.in.gov/judiciary/citc/museum/traffic/index.html.


AOHS Global Health


Teacher Resources


Teacher Resource 10.1 Presentation and Notes: Risky Behaviors and Health Outcomes (includes separate PowerPoint file)

Teacher Resource 10.2 Answer Key: Vignettes on Health Determinants and Risky Behaviors

Teacher Resource 10.3 Assessment Criteria: Concept Map

Teacher Resource 10.4 Assessment Criteria: Behavioral Risk Factors in Global Health

Teacher Resource 10.5 Assessment Criteria: Pressing Health Issue Argument

Teacher Resource 10.6 Key Vocabulary: Behavioral Risk Factors

Teacher Resource 10.7 Bibliography: Behavioral Risk Factors




Presentation Notes: Risky Behaviors and Health Outcomes


In this presentation, we will focus on high-risk behaviors and the health outcomes related to them. We will look at some of the reasons why people engage in risky behaviors and the methods that are used to help people change their behaviors.

Presentation notes



A risky behavior is an action that can threaten the health of the person who performs the behavior or the health of others. For example, drinking and driving is a risky behavior. People who drink and drive risk not only getting into an accident and injuring or killing themselves, but also injuring or killing other drivers or pedestrians. The range of risky behaviors that affect global health in the world is wide. It spans personal choices about exercise to choices about contraception.

A behavior is different from an outcome. The outcome is the result of the behavior. For example, texting while driving is a behavior. A possible outcome is an accident-related injury.

Presentation notes



A risky behavior is linked to personal choice. Finding solutions to risky behaviors is usually about helping people change their choices and, therefore, change their behavior. For example, a person may choose not to exercise. This behavior can be modified, and the person can choose to begin exercising. But changing personal behavior is not easy. It’s a lifestyle change.

Changing a behavior can be difficult if it goes against what family and friends are doing or what is considered normal in a society or community. For example, if a person is a member of a family where no one exercises, changing this behavior may be especially hard. On the other hand, if the entire family decides to be more physically active, the person may feel more positive and capable about making the change in his or her behavior.

Many forces influence a person’s behavior. These include family, friends, and societal norms. They also include personal knowledge about health outcomes related to the behavior, attitudes, beliefs, and religion. For example, the health outcomes of smoking cigarettes are widely known in the United States, but other countries lack public health campaigns to educate people about the risks of smoking. Without this knowledge, people might choose to smoke, not fully understanding the dangers.

Forces that influence behavior also include the rules and laws in a society that regulate or support healthy actions (e.g., whether or not underage smoking is illegal). Financial status is another force that can influence a person’s behavior. For example, someone might feel that healthy food is not affordable.

Presentation notes



There are many serious health outcomes related to teens having sex before the time is right. One of those outcomes is unplanned pregnancy. In the United States in 2013, a total of 273,105 babies were born to women aged 15–19 years. An unplanned pregnancy can cause emotional and financial stress on anyone, let alone a young person. An unintended pregnancy will affect the rest of a teen’s life. Teen mothers are less likely to finish high school or go to college, and the babies born to teen mothers face greater health risks. Teen fathers face the responsibility of supporting their children.

Painful and harmful sexually transmitted diseases (STDs) and sexually transmitted infections (STIs) are another potential health outcome. There are 20 million new cases of STDs every year, almost half of which are among young people between 15 and 24 years old. There are some sexually transmitted infections (STIs) that never really go away, even with treatment.

Trends in rates of active teenage sexual activity show an overall decrease. Teen pregnancy is also in decline. This may be attributed to improved access to sex education and contraception, and an increased understanding of the consequences of unprotected sex.

Data from: http://www.cdc.gov/teenpregnancy/about/index.htm; and

http://www.cdc.gov/nchhstp/newsroom/docs/std-trends-508.pdf

Presentation notes



Another potential health outcome of having sex is getting HIV/AIDS. HIV/AIDS can be transmitted through unprotected sexual activity.

HIV/AIDS is one of the most pressing global health concerns facing the planet. In 2013, 35 million people worldwide were living with HIV. In that same year, 1.5 million people died of AIDS.

In the United States in 2010, about 12,200 new HIV infections were diagnosed among youths aged 13 to 24. Most of these new infections were among black youths (7,000 new cases). Teens account for about 26% of new HIV diagnoses.

Abstinence is the best way to protect against HIV/AIDS. Condoms limit the risk of contracting HIV through sex, but many sexually active people around the world don’t use condoms. Why do people engage in this high-risk behavior? Some people, like commercial sex workers, may be forced into having sex without condoms. But what about people who are not forced?

There are many reasons why people engage in this risky behavior. Cultural norms in some societies or communities may make talking about contraception embarrassing. A person’s religion might forbid the use of contraception. A person’s partner may be opposed to using contraception, or a person may feel scared about his or her partner’s reaction to a request to use condoms. Married women may feel social pressure to have children, so they don’t use condoms. People may believe myths and perceptions about the side effects of contraception, such as the perception that condoms decrease pleasure or intimacy. Some people may think that they are not at risk for HIV or AIDS and don’t use condoms for that reason.

Data from: http://www.who.int/gho/hiv/en/; and http://www.cdc.gov/hiv/group/age/youth/

Presentation notes



Not having access to condoms is one reason that people around the world have unsafe sex. For example, South Africa has the world’s highest number of people living with HIV/AIDS at 6.3 million, and AIDS is the leading cause of death. The South African government responded to the crisis with a program that distributes free condoms. However, in 2012 the government had to recall 1.35 million condoms that were given away. The condoms were defective and breaking, which did not protect the users from exposure to HIV/AIDS. The event made many people mistrust the government-issued condoms, and they don’t want to use them. Many people don’t have the money to buy condoms or are worried about being seen buying them. If these people choose to have sex without a condom, they are at risk for contracting HIV/AIDS.

Image retrieved from http://commons.wikimedia.org/wiki/File:KwaZulu-Natal_(South_Africa)_004_(5329410146).jpg on September 18, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by-sa/2.0/deed.en). Image courtesy of Steve Evans.

Presentation notes



Injuries that result from accidents on the road are a serious global health problem. Nearly 3,400 people die on the roads each day and many more are injured or disabled around the world. Many of these injuries are the outcome of risky behavior.

These injuries can be prevented by controlling speeds, requiring helmet use, and mandating infant car seats. Worldwide, 59 countries have implemented speed limits, 90 countries have helmet laws that apply to all riders and all road types, and half of all countries require child-restraint use in cars.

Texting or talking on the phone is increasingly becoming a problem around the world. Some places, like California, have passed laws about these issues, but many places have not.

Data from: Source: http://www.who.int/violence_injury_prevention/road_traffic/en/; and http://www.who.int/features/factfiles/roadsafety/en/ Image retrieved from http://commons.wikimedia.org/wiki/File:Delhi_India_traffic_1997.jpg on May 10, 2012, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by-sa/2.0/deed.en). Image courtesy of David Bleasdale.

Presentation notes



Rwanda once faced a severe road-safety problem. It had one of the worst road safety records in the world, and thousands of people were hurt each year because of risky behavior on the road. Beginning in 2001, the country started a comprehensive road-safety initiative by offering its population many aspects of road safety. The program has been successful in changing people’s behavior in part because of the enforcement of traffic laws.

The country initiated a national speed limit of 60 kilometers per hour on open roads and 40 kilometers per hour in villages and towns. Drivers are fined if they speed and if they don’t wear seat belts. Speed bumps have been constructed. A number of studies have shown that speed bumps are one of the most cost-effective methods to reduce road injuries and death in developing countries like Rwanda. Police also now give breath tests to measure alcohol levels. Drivers are fined if the test shows that their alcohol level is over the legal limit. Drivers of minibuses are now required to allow only a certain number of passengers in their vehicle. If they carry more passengers, they can be fined. Police also supervise school crossings and teach children about road safety.

Presentation notes



Many serious health outcomes are related to being overweight, obese, and physically inactive. These include high blood pressure, high cholesterol, coronary heart disease, and some cancers.

Type 2 diabetes is generally caused by poor diet and lack of exercise. Evidence shows that often diabetes can be prevented through a healthy diet that is free from foods high in sugar, salt, and fat, and through physical activity. But around the world, including in developing countries, poor diet and physical inactivity are on the rise. The result is more cases of diabetes. In 2014, more than 9% of adults worldwide had diabetes, approximately 90% of these cases are type 2. More than 80% of all diabetes deaths occur in low- and middle-income countries. Diabetes is considered to be an emerging global epidemic.

Researchers have found that as a country becomes wealthier, the lifestyle of its people can change for the worse. Their diet can change, resulting in unhealthy weight gain, and they can become less physically active. China is one example. The diet in China is changing to include more saturated fat than it used to, and people are less inclined to walk or ride bikes as their primary mode of transportation. In China, Type 2 diabetes grew 30% in seven years. Researchers consider this an alarming increase. In one study in China, rural residents had a 60% increase in the same time period.

Data from: http://www.who.int/mediacentre/factsheets/fs312/en/

Image retrieved from http://commons.wikimedia.org/wiki/File:Dongmen.JPG on April 12, 2012, and reproduced here under the terms of the Creative Commons Attribution-ShareAlike 3.0 Unported license (http://creativecommons.org/licenses/by-sa/3.0/deed.en). Image courtesy of Chintunglee.

Presentation notes



In 2012, 3.3 million deaths worldwide were attributed to alcohol consumption. Between the ages of 20 and 39, 25% of deaths are from alcohol-related causes. The health outcomes of harmful alcohol use are serious. They include esophageal cancer, liver disease, motor vehicle accidents, homicide, and other intentional injuries. Babies born to mothers who drink while they are pregnant are at risk for serious health conditions such as fetal alcohol syndrome. Alcohol is associated with many serious social issues, including violence, child neglect and abuse, and absenteeism in the workplace.


Presentation notes



Alcohol use is considered a risky behavior around the globe, but the problem is worse in certain areas. According to a study cited in the medical journal the Lancet, one in four men in Russia die before they are 55, and most of those deaths are due to alcohol.

Data from http://www.who.int/mediacentre/news/releases/2011/alcohol_20110211/en/index.html and http://www.who.int/mediacentre/factsheets/fs349/en/index.html and http://gamapserver.who.int/mapLibrary/Files/Maps/Global_patterns_drinking_score_2005.png.

Presentation notes



Risky drinking around the world can lead to death. Compare this map to the previous one and consider whether or not countries with the riskiest drinking have high levels of deaths attributable to alcohol.

Image from: http://gamapserver.who.int/mapLibrary/Files/Maps/Global_deaths_2012.png

Presentation notes



In spite of the problems related to alcohol, few countries have taken a strong stance on reducing alcohol consumption. However, researchers believe that there are various actions that could make a difference. One action is to increase the taxation of alcohol. A higher tax on alcoholic beverages would likely lead to a decrease in the purchase of alcohol. This has been the result in instances where taxation on cigarettes was increased.

Another action would be to reduce the number of hours in a day that alcohol can be sold. Restrictions on both the sale of alcohol and drinking in public places, like parks or sports stadiums, is another action. Banning alcohol advertising or limiting the type of advertising used can affect alcohol consumption and may reduce its use. Studies have also shown that providing alcohol counseling in health care settings can have a positive effect on decreasing consumption.

Presentation notes



Tobacco product use is one of the most serious public health issues affecting global health. Tobacco is responsible for the death of 5.4 million people per year. It’s believed that by 2030, smoking will be related to the deaths of 6 in 10 people. The possible health outcomes of smoking include cancer, cardiovascular disease, and low birth weight. Although the consumption of tobacco products is decreasing in some countries, it is steadily increasing globally.

Image retrieved from http://www.who.int/tobacco/mpower/tobacco_facts/en/.

Presentation notes



In the 1980s, Poland faced what seemed to be an insurmountable problem. It had the highest smoking rate in the world. Almost three-quarters of Polish men smoked every day, and the result was that middle-aged Polish men had one of the highest rates of lung cancer in the world.

In 1995, the Polish government took action. They passed legislation aimed at reducing the number of smokers in their country. The new laws required a large health warning on cigarette packs. In fact, the warning on the package was one of the largest of its kind in the world. They banned smoking in health centers and enclosed workspaces. They also banned tobacco-related electronic media advertisements, and they banned selling tobacco products to minors. In addition, they launched a health education campaign.

The efforts to reduce smoking were effective. In an eight-year period, cigarette consumption dropped 10%. The reduction in smoking led to 10,000 fewer deaths per year and a decline in both lung cancer and cardiovascular disease.

Presentation notes



Risky behaviors are actions that threaten the health of the people who engage in them and the health of others around them. High-risk behaviors are associated with dangerous health outcomes ranging from injury to HIV to death. The control of risky behaviors involves helping people to change their behavior through regulations, education, and community participation.

Presentation notes



As you saw in the Rwanda example, rules and regulations can make a big difference in affecting people’s behaviors. Here are some other methods that are widely used:

• Community mobilization – engages an entire community in making a healthy change in behavior. It utilizes community leaders or representatives to mobilize their communities.

• Mass media – uses media, like radio or television, to both entertain and educate people about risky behavior. For example, in Myanmar there is a popular soap opera featuring a famous actress who educates people about leprosy.

• Marketing – uses the tools of commercial marketing to make a healthy product attractive. For example, designing condoms so that they appeal to a certain population, selling them at an affordable price, and selling them in convenient places.

• Health education – provides education through classrooms, the news media, or the Internet.

• Conditional cash-transfer programs – uses economic incentives to help people change their behavior. For example, some Latin America countries have paid families to send their female children to school on a regular basis.

Presentation notes




Answer Key: Vignettes on Health Determinants and Risky Behaviors

lack of education poverty access to health services unemployment

safe housing community violence reliable public transportation poor infrastructure

climate genetics gender expectations health insurance

rules, laws, regulations culture depression social norms

Vignette One Raj lives in Bangalore, India. He works for a large telecommunications company on the outskirts of the city. Raj’s job is to call Americans and try to sell them discounted cell phone plans. Because he needs to reach the Americans during the day, Raj must work at night. There is no bus that operates at night, so Raj drives his motorbike. Raj takes his two good friends to work. They all ride on his motorbike. Raj drives and his friends sit tightly behind him. Raj wears a helmet, but his friends don’t.

A new road was built linking the city with the area where the telecommunications companies are. The government designated a speed limit on the road, but it is never enforced. There is no lighting on the road, and the light on Raj’s bike is very dim. He can’t afford to fix it. When the road was built, it divided a neighborhood in half, so it’s common to see people running across the road at night to visit friends who live on the other side. Recently, one of Raj’s coworkers hit a young boy who was crossing the street. The boy had serious head injuries and the coworker broke his arm. The coworker’s bike was badly damaged and now he has no way to get to work. Raj worries that something similar will happen to him.

Sample response:

Risky behaviors: unsafe driving (riding with too many people on the motorbike, passengers riding without helmets, broken light on motorbike)

Health determinants: rules, laws, regulations; poverty; reliable public transportation; poor infrastructure; social norms

Vignette Two Abeje lives in a village in Nigeria. She has two children. Abeje has never left the village. She did not go to school and she was married when she was 16. Abeje’s husband works in a factory in a city hundreds of miles from the village. He comes home once every three months to visit and bring money. Abeje has heard rumors from other women in the village that the men who work in the factory see prostitutes in the city. Abeje has never asked her husband if he has been with other women, but she suspects that he has. Abeje has known several women who died of AIDS. The thought of her children losing their mother before they are grown breaks her heart, but when Abeje asked her husband if they should use condoms, he laughed. He told her that they will have more children, so there was no reason to use condoms. “God intends for us to have a big family, Abeje!” he said.

Sample response:



Risky behaviors: unsafe sex (Abeje suspects her husband may be having sex with other women)

Health determinants: culture, gender expectations, social norms

Vignette Three The plant that Shane’s father worked at in Michigan closed two years ago. Since then, Shane’s father hasn’t been able to find work. The family moved in with Shane’s uncle. Shane’s uncle starts drinking every day around 4 p.m., and he doesn’t stop until he falls asleep on the couch around 11 p.m. At first Shane’s father would drink a beer or two with his brother, but now he drinks all the time, too. Shane’s father and his uncle told Shane that even though he’s only 14, he can drink whenever he wants. “You’re practically a man now,” his father said.

Sample response:

Risky behaviors: underage drinking

Health determinants: poverty, culture, depression, unemployment, social norms

Vignette Four Marta has been a marketing executive for 10 years. She lives in Atlanta, Georgia. Socializing is a big part of Marta’s job. She takes clients out for long, expensive dinners on the company’s tab. Drinks usually follow the dinners. Inevitably, Marta is offered a cigarette. Marta never particularly enjoyed smoking, but it was a social ritual that went hand in hand with her work. It felt rude and unprofessional to decline to participate in an activity that her coworkers and clients were doing. Marta never felt like she was going to develop a habit, but soon she found herself smoking after lunch, too. Then she started buying packs and smoking during her breaks in the courtyard.

Sample response:

Risky behaviors: smoking

Health determinants: culture, social norms

Vignette Five Everyone in Tara’s family is overweight. At 13, Tara worries that she, too, will struggle with her weight and, like her mother, have body image issues and high blood pressure. For dinner, Tara’s mother typically will heat up a frozen pizza or pick up hamburgers and fries after work. Tara has asked her mother if they can try to eat healthier foods; she’s even offered to learn how to cook. But her mother says fresh produce is too expensive and that there’s nothing wrong with the way they eat. She says that if Tara doesn’t like it, she can just eat less. She makes Tara feel unappreciative.

Sample response:

Risky behaviors: unhealthy eating

Health determinants: lack of education; genetics; culture




Assessment Criteria: Concept Map

Student Names:______________________________________________________________

Date:_______________________________________________________________________


Met Partially Met

Didn’t Meet

The concept map includes important topics, subtopics, and information about the risky behavior.

□ □ □

Items are identified in a way that is easy to follow. □ □ □ The concept map clearly shows connections, patterns, and relationships, and it uses symbols and drawings to illustrate details effectively.

□ □ □

The concept map shows creativity and flexible thinking, and expands on ideas in new and unique ways.

□ □ □

The concept map is neat and easy to read. □ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Assessment Criteria: Behavioral Risk Factors in Global Health

Student Name:______________________________________________________________

Date:_______________________________________________________________________


Met Partially Met

Didn’t Meet

The notes on behavioral health issues explored in this lesson are clear and complete.

□ □ □

The notes demonstrate an understanding of the relationship between behavior, diseases, and conditions.

□ □ □

The choice of three potential issues to focus on for the culminating project demonstrates an ability to compare a range of behavioral issues and evaluate their relative need to be addressed by the global health community.

□ □ □


□ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Assessment Criteria: Pressing Health Issue Argument

Student Names:______________________________________________________________

Date:_______________________________________________________________________

Using the following criteria, assess whether the students met each one.

Met Partially Met

Didn’t Meet

The argument demonstrates a clear understanding of the health issue, including the risk factors, diseases, and populations involved.

□ □ □

The argument presents convincing reasons about the importance of the health issue and why it needs immediate attention.

□ □ □

The information in the argument is clearly organized with evidence to support each position, including facts and statistics that are attributed correctly.

□ □ □

The transitions between paragraphs and ideas are smooth.

□ □ □

The argument is neat and uses proper spelling and grammar.

□ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Key Vocabulary: Behavioral Risk Factors

Term Definition

commercial sex worker A person who exchanges sex for money.

conditional cash-transfer program

A program in which money is exchanged for participating in a public health behavior.

emphysema A chronic respiratory disease where there is over-inflation of the air sacs in the lungs, causing a decrease in lung function and often breathlessness; usually caused by smoking.

protective assets Qualities or behaviors that protect or prevent a person from engaging in risky behaviors.

risky behavior An action that threatens the health of the person performing the behavior or the health of others.

sexually transmitted infection (STI)

An infection contracted through sexual activity. Examples include herpes, pubic lice, and hepatitis B.




Bibliography: Behavioral Risk Factors



Online “Alcohol.” WHO, http://www.who.int/topics/alcohol_drinking/en/ (accessed October 26, 2015).

“Case 14: Curbing Tobacco Use in Poland.” Center for Global Development, http://www.cgdev.org/section/initiatives/_archive/millionssaved/studies/case_14 (accessed October 26, 2015).

“Case 2: Preventing HIV and Sexually Transmitted Infections in Thailand.” Center for Global Development, http://www.cgdev.org/section/initiatives/_archive/millionssaved/studies/case_2 (accessed October 26, 2015).

“Fact File: 10 Facts about Diabetes.” WHO, http://www.who.int/features/factfiles/diabetes/facts/en/index9.html (accessed October 26, 2015).

“Fact File: 10 Facts on Global Road Safety.” WHO, http://www.who.int/features/factfiles/roadsafety/facts/en/index9.html (accessed October 26, 2015).

“40 Developmental Assets for Adolescents.” Search Institute, http://www.search-institute.org/content/40-developmental-assets-adolescents-ages-12-18 (accessed October 26, 2015).

“HIV among Youth,” CDC, http://www.cdc.gov/hiv/risk/age/youth/index.html?s_cid=tw_std0141316 (accessed October 26, 2015).

Kanani, Bazi. “Condom Recall in South Africa Concerns AIDS Activists.” ABC News, January 31, 2012, http://abcnews.go.com/blogs/headlines/2012/01/condom-recall-in-south-africa-concerns-aids-activists/ (accessed October 26, 2015).

“Making Roads Safer in Rwanda.” WHO, http://www.who.int/features/2007/road_safety/photo_story/en/index.html (accessed October 26, 2015).

Mazumdar, Tulip, “Vodka Blamed for High Death Rates in Russia,” BBC News, 31 January 2014, http://www.bbc.com/news/health-25961063 (accessed October 26, 2015).

“Reproductive Health: Teen Pregnancy,” CDC, http://www.cdc.gov/teenpregnancy/about/index.htm (accessed October 26, 2015).


AOHS Global Health


Student Resources


Student Resource 10.1 Note Taking: Risky Behaviors and Health Outcomes

Student Resource 10.2 Reading: Risky Behaviors and Health Outcomes

Student Resource 10.3 Vignettes: Health Determinants and Risky Behaviors

Student Resource 10.4 Assignment: Concept Map

Student Resource 10.5 Notes: Behavioral Risk Factors

Student Resource 10.6 Writing Assignment: Pressing Health Issue Argument




Note Taking: Risky Behaviors and Health Outcomes


Directions: In the left column of the chart below is a list of risky behaviors. With your partner, decide what health outcomes (injury or disease) you believe could result from the behavior. An example is given for you. You will fill in the third column as you watch the presentation Risky Behaviors and Health Outcomes.

Risky Behavior Health Outcomes I Know About What I Learned

Driving without seat belts; driving motorcycles without helmets; speeding in urban areas

Paralysis

Unsafe sexual behavior

Eating foods high in fat, sugar, and salt; physical inactivity

Alcohol abuse

Smoking tobacco




Reading: Risky Behaviors and Health Outcomes

In this presentation, we will focus on high-risk behaviors and the health outcomes related to them. We will look at some of the reasons why people engage in risky behaviors and the methods that are used to help people change their behaviors.



A risky behavior is an action that can threaten the health of the person who performs the behavior or the health of others. For example, drinking and driving is a risky behavior. People who drink and drive risk not only getting into an accident and injuring or killing themselves, but also injuring or killing other drivers or pedestrians. The range of risky behaviors that affect global health in the world is wide. It spans personal choices about exercise to choices about contraception.

A behavior is different from an outcome. The outcome is the result of the behavior. For example, texting while driving is a behavior. A possible outcome is an accident-related injury.



A risky behavior is linked to personal choice. Finding solutions to risky behaviors is usually about helping people change their choices and, therefore, change their behavior. For example, a person may choose not to exercise. This behavior can be modified, and the person can choose to begin exercising. But changing personal behavior is not easy. It’s a lifestyle change.

Changing a behavior can be difficult if it goes against what family and friends are doing or what is considered normal in a society or community. For example, if a person is a member of a family where no one exercises, changing this behavior may be especially hard. On the other hand, if the entire family decides to be more physically active, the person may feel more positive and capable about making the change in his or her behavior.

Many forces influence a person’s behavior. These include family, friends, and societal norms. They also include personal knowledge about health outcomes related to the behavior, attitudes, beliefs, and religion. For example, the health outcomes of smoking cigarettes are widely known in the United States, but other countries lack public health campaigns to educate people about the risks of smoking. Without this knowledge, people might choose to smoke, not fully understanding the dangers.

Forces that influence behavior also include the rules and laws in a society that regulate or support healthy actions (e.g., whether or not underage smoking is illegal). Financial status is another force that can influence a person’s behavior. For example, someone might feel that healthy food is not affordable.



There are many serious health outcomes related to teens having sex before the time is right. One of those outcomes is unplanned pregnancy. In the United States in 2013, a total of 273,105 babies were born to women aged 15–19 years. An unplanned pregnancy can cause emotional and financial stress on anyone, let alone a young person. An unintended pregnancy will affect the rest of a teen’s life. Teen mothers are less likely to finish high school or go to college, and the babies born to teen mothers face greater health risks. Teen fathers face the responsibility of supporting their children.

Painful and harmful sexually transmitted diseases (STDs) and sexually transmitted infections (STIs) are another potential health outcome. There are 20 million new cases of STDs every year, almost half of which are among young people between 15 and 24 years old. There are some sexually transmitted infections (STIs) that never really go away, even with treatment.

Trends in rates of active teenage sexual activity show an overall decrease. Teen pregnancy is also in decline. This may be attributed to improved access to sex education and contraception, and an increased understanding of the consequences of unprotected sex.

Data from: http://www.cdc.gov/teenpregnancy/about/index.htm; and

http://www.cdc.gov/nchhstp/newsroom/docs/std-trends-508.pdf



Another potential health outcome of having sex is getting HIV/AIDS. HIV/AIDS can be transmitted through unprotected sexual activity.

HIV/AIDS is one of the most pressing global health concerns facing the planet. In 2013, 35 million people worldwide were living with HIV. In that same year, 1.5 million people died of AIDS.

In the United States in 2010, about 12,200 new HIV infections were diagnosed among youths aged 13 to 24. Most of these new infections were among black youths (7,000 new cases). Teens account for about 26% of new HIV diagnoses.

Abstinence is the best way to protect against HIV/AIDS. Condoms limit the risk of contracting HIV through sex, but many sexually active people around the world don’t use condoms. Why do people engage in this high-risk behavior? Some people, like commercial sex workers, may be forced into having sex without condoms. But what about people who are not forced?

There are many reasons why people engage in this risky behavior. Cultural norms in some societies or communities may make talking about contraception embarrassing. A person’s religion might forbid the use of contraception. A person’s partner may be opposed to using contraception, or a person may feel scared about his or her partner’s reaction to a request to use condoms. Married women may feel social pressure to have children, so they don’t use condoms. People may believe myths and perceptions about the side effects of contraception, such as the perception that condoms decrease pleasure or intimacy. Some people may think that they are not at risk for HIV or AIDS and don’t use condoms for that reason.

Data from: http://www.who.int/gho/hiv/en/; and http://www.cdc.gov/hiv/group/age/youth/



Not having access to condoms is one reason that people around the world have unsafe sex. For example, South Africa has the world’s highest number of people living with HIV/AIDS at 6.3 million, and AIDS is the leading cause of death. The South African government responded to the crisis with a program that distributes free condoms. However, in 2012 the government had to recall 1.35 million condoms that were given away. The condoms were defective and breaking, which did not protect the users from exposure to HIV/AIDS. The event made many people mistrust the government-issued condoms, and they don’t want to use them. Many people don’t have the money to buy condoms or are worried about being seen buying them. If these people choose to have sex without a condom, they are at risk for contracting HIV/AIDS.

Image retrieved from http://commons.wikimedia.org/wiki/File:KwaZulu-Natal_(South_Africa)_004_(5329410146).jpg on September 18, 2013, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by-sa/2.0/deed.en). Image courtesy of Steve Evans.



Injuries that result from accidents on the road are a serious global health problem. Nearly 3,400 people die on the roads each day and many more are injured or disabled around the world. Many of these injuries are the outcome of risky behavior.

These injuries can be prevented by controlling speeds, requiring helmet use, and mandating infant car seats. Worldwide, 59 countries have implemented speed limits, 90 countries have helmet laws that apply to all riders and all road types, and half of all countries require child-restraint use in cars.

Texting or talking on the phone is increasingly becoming a problem around the world. Some places, like California, have passed laws about these issues, but many places have not.

Data from: Source: http://www.who.int/violence_injury_prevention/road_traffic/en/; and http://www.who.int/features/factfiles/roadsafety/en/ Image retrieved from http://commons.wikimedia.org/wiki/File:Delhi_India_traffic_1997.jpg on May 10, 2012, and reproduced here under the terms of the Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by-sa/2.0/deed.en). Image courtesy of David Bleasdale.



Rwanda once faced a severe road-safety problem. It had one of the worst road safety records in the world, and thousands of people were hurt each year because of risky behavior on the road. Beginning in 2001, the country started a comprehensive road-safety initiative by offering its population many aspects of road safety. The program has been successful in changing people’s behavior in part because of the enforcement of traffic laws.

The country initiated a national speed limit of 60 kilometers per hour on open roads and 40 kilometers per hour in villages and towns. Drivers are fined if they speed and if they don’t wear seat belts. Speed bumps have been constructed. A number of studies have shown that speed bumps are one of the most cost-effective methods to reduce road injuries and death in developing countries like Rwanda. Police also now give breath tests to measure alcohol levels. Drivers are fined if the test shows that their alcohol level is over the legal limit. Drivers of minibuses are now required to allow only a certain number of passengers in their vehicle. If they carry more passengers, they can be fined. Police also supervise school crossings and teach children about road safety.



Many serious health outcomes are related to being overweight, obese, and physically inactive. These include high blood pressure, high cholesterol, coronary heart disease, and some cancers.

Type 2 diabetes is generally caused by poor diet and lack of exercise. Evidence shows that often diabetes can be prevented through a healthy diet that is free from foods high in sugar, salt, and fat, and through physical activity. But around the world, including in developing countries, poor diet and physical inactivity are on the rise. The result is more cases of diabetes. In 2014, more than 9% of adults worldwide had diabetes, approximately 90% of these cases are type 2. More than 80% of all diabetes deaths occur in low- and middle-income countries. Diabetes is considered to be an emerging global epidemic.

Researchers have found that as a country becomes wealthier, the lifestyle of its people can change for the worse. Their diet can change, resulting in unhealthy weight gain, and they can become less physically active. China is one example. The diet in China is changing to include more saturated fat than it used to, and people are less inclined to walk or ride bikes as their primary mode of transportation. In China, Type 2 diabetes grew 30% in seven years. Researchers consider this an alarming increase. In one study in China, rural residents had a 60% increase in the same time period.


Image retrieved from http://commons.wikimedia.org/wiki/File:Dongmen.JPG on April 12, 2012, and reproduced here under the terms of the Creative Commons Attribution-ShareAlike 3.0 Unported license (http://creativecommons.org/licenses/by-sa/3.0/deed.en). Image courtesy of Chintunglee.



In 2012, 3.3 million deaths worldwide were attributed to alcohol consumption. Between the ages of 20 and 39, 25% of deaths are from alcohol-related causes. The health outcomes of harmful alcohol use are serious. They include esophageal cancer, liver disease, motor vehicle accidents, homicide, and other intentional injuries. Babies born to mothers who drink while they are pregnant are at risk for serious health conditions such as fetal alcohol syndrome. Alcohol is associated with many serious social issues, including violence, child neglect and abuse, and absenteeism in the workplace.




Alcohol use is considered a risky behavior around the globe, but the problem is worse in certain areas. According to a study cited in the medical journal the Lancet, one in four men in Russia die before they are 55, and most of those deaths are due to alcohol.

Data from http://www.who.int/mediacentre/news/releases/2011/alcohol_20110211/en/index.html and http://www.who.int/mediacentre/factsheets/fs349/en/index.html and http://gamapserver.who.int/mapLibrary/Files/Maps/Global_patterns_drinking_score_2005.png.



Risky drinking around the world can lead to death. Compare this map to the previous one and consider whether or not countries with the riskiest drinking have high levels of deaths attributable to alcohol.

Image from: http://gamapserver.who.int/mapLibrary/Files/Maps/Global_deaths_2012.png



In spite of the problems related to alcohol, few countries have taken a strong stance on reducing alcohol consumption. However, researchers believe that there are various actions that could make a difference. One action is to increase the taxation of alcohol. A higher tax on alcoholic beverages would likely lead to a decrease in the purchase of alcohol. This has been the result in instances where taxation on cigarettes was increased.

Another action would be to reduce the number of hours in a day that alcohol can be sold. Restrictions on both the sale of alcohol and drinking in public places, like parks or sports stadiums, is another action. Banning alcohol advertising or limiting the type of advertising used can affect alcohol consumption and may reduce its use. Studies have also shown that providing alcohol counseling in health care settings can have a positive effect on decreasing consumption.



Tobacco product use is one of the most serious public health issues affecting global health. Tobacco is responsible for the death of 5.4 million people per year. It’s believed that by 2030, smoking will be related to the deaths of 6 in 10 people. The possible health outcomes of smoking include cancer, cardiovascular disease, and low birth weight. Although the consumption of tobacco products is decreasing in some countries, it is steadily increasing globally.

Image retrieved from http://www.who.int/tobacco/mpower/tobacco_facts/en/.



In the 1980s, Poland faced what seemed to be an insurmountable problem. It had the highest smoking rate in the world. Almost three-quarters of Polish men smoked every day, and the result was that middle-aged Polish men had one of the highest rates of lung cancer in the world.

In 1995, the Polish government took action. They passed legislation aimed at reducing the number of smokers in their country. The new laws required a large health warning on cigarette packs. In fact, the warning on the package was one of the largest of its kind in the world. They banned smoking in health centers and enclosed workspaces. They also banned tobacco-related electronic media advertisements, and they banned selling tobacco products to minors. In addition, they launched a health education campaign.

The efforts to reduce smoking were effective. In an eight-year period, cigarette consumption dropped 10%. The reduction in smoking led to 10,000 fewer deaths per year and a decline in both lung cancer and cardiovascular disease.



Risky behaviors are actions that threaten the health of the people who engage in them and the health of others around them. High-risk behaviors are associated with dangerous health outcomes ranging from injury to HIV to death. The control of risky behaviors involves helping people to change their behavior through regulations, education, and community participation.



As you saw in the Rwanda example, rules and regulations can make a big difference in affecting people’s behaviors. Here are some other methods that are widely used:

• Community mobilization – engages an entire community in making a healthy change in behavior. It utilizes community leaders or representatives to mobilize their communities.

• Mass media – uses media, like radio or television, to both entertain and educate people about risky behavior. For example, in Myanmar there is a popular soap opera featuring a famous actress who educates people about leprosy.

• Marketing – uses the tools of commercial marketing to make a healthy product attractive. For example, designing condoms so that they appeal to a certain population, selling them at an affordable price, and selling them in convenient places.

• Health education – provides education through classrooms, the news media, or the Internet.

• Conditional cash-transfer programs – uses economic incentives to help people change their behavior. For example, some Latin America countries have paid families to send their female children to school on a regular basis.




Vignettes: Health Determinants and Risky Behaviors


Directions: In the box below is a list of health determinants. Read each vignette describing a risky behavior. Name the risky behavior and then decide which determinants are linked to the behavior. You may also include determinants that you know about that are not in the box.

lack of education poverty access to health services unemployment

safe housing community violence reliable public transportation poor infrastructure

climate genetics gender expectations health insurance

rules, laws, regulations culture depression social norms

Vignette One Raj lives in Bangalore, India. He works for a large telecommunications company on the outskirts of the city. Raj’s job is to call Americans and try to sell them discounted cell phone plans. Because he needs to reach the Americans during the day, Raj must work at night. There is no bus that operates at night, so Raj drives his motorbike. Raj takes his two good friends to work. They all ride on his motorbike. Raj drives and his friends sit tightly behind him. Raj wears a helmet, but his friends don’t.

A new road was built linking the city with the area where the telecommunications companies are. The government designated a speed limit on the road, but it is never enforced. There is no lighting on the road, and the light on Raj’s bike is very dim. He can’t afford to fix it. When the road was built, it divided a neighborhood in half, so it’s common to see people running across the road at night to visit friends who live on the other side. Recently, one of Raj’s coworkers hit a young boy who was crossing the street. The boy had serious head injuries and the coworker broke his arm. The coworker’s bike was badly damaged and now he has no way to get to work. Raj worries that something similar will happen to him.

Risky behaviors:

Health determinants:

Vignette Two Abeje lives in a village in Nigeria. She has two children. Abeje has never left the village. She did not go to school and she was married when she was 16. Abeje’s husband works in a factory in a city hundreds of miles from the village. He comes home once every three months to visit and bring money. Abeje has heard rumors from other women in the village that the men who work in the factory see prostitutes in the city. Abeje has never asked her husband if he has been with other women, but she suspects that he has. Abeje has known several women who died of AIDS. The thought of her children losing their mother before they are grown breaks her heart, but when Abeje asked her husband if they should use condoms, he laughed. He told her that they will have more children, so there was no reason to use condoms. “God intends for us to have a big family, Abeje!” he said.



Risky behaviors:


Vignette Three The plant that Shane’s father worked at in Michigan closed two years ago. Since then, Shane’s father hasn’t been able to find work. The family moved in with Shane’s uncle. Shane’s uncle starts drinking every day around 4 p.m., and he doesn’t stop until he falls asleep on the couch around 11 p.m. At first Shane’s father would drink a beer or two with his brother, but now he drinks all the time, too. Shane’s father and his uncle told Shane that even though he’s only 14, he can drink whenever he wants. “You’re practically a man now,” his father said.

Risky behaviors:


Vignette Four Marta has been a marketing executive for 10 years. She lives in Atlanta, Georgia. Socializing is a big part of Marta’s job. She takes clients out for long, expensive dinners on the company’s tab. Drinks usually follow the dinners. Inevitably, Marta is offered a cigarette. Marta never particularly enjoyed smoking, but it was a social ritual that went hand in hand with her work. It felt rude and unprofessional to decline to participate in an activity that her coworkers and clients were doing. Marta never felt like she was going to develop a habit, but soon she found herself smoking after lunch, too. Then she started buying packs and smoking during her breaks in the courtyard.

Risky behaviors:


Vignette Five Everyone in Tara’s family is overweight. At 13, Tara worries that she, too, will struggle with her weight and, like her mother, have body image issues and high blood pressure. For dinner, Tara’s mother typically will heat up a frozen pizza or pick up hamburgers and fries after work. Tara has asked her mother if they can try to eat healthier foods; she’s even offered to learn how to cook. But her mother says fresh produce is too expensive and that there’s nothing wrong with the way they eat. She says that if Tara doesn’t like it, she can just eat less. She makes Tara feel unappreciative.

Risky behaviors:





Assignment: Concept Map


Directions: A concept map is used to give a visual picture of how the different aspects of a concept are interconnected. In this assignment, you will create a concept map to show what you have learned about how a risky behavior can impact health. Follow the instructions below to create a concept map that shows the various ways that the risky behavior can lead to injury and/or disease. Before you start working on this assignment, look at the example concept map on the second page, and read this resource. Make sure you understand how your work will be assessed.

1. Choose a risky behavior to create a concept map about: unsafe sex, unsafe road behavior, smoking, drinking, drugs, unhealthy diet, or physical inactivity.

2. Use what you’ve learned in this lesson and what you already know to create your concept map. For your additional research, use sources that you already know are reliable, or verify the websites you use with your teacher. You may wish to print out images or graphics to use on your map in addition to drawing your own illustrations.

3. Place the risky behavior at the center of your concept map, and add subtopics around the risky behavior. To come up with subtopics, ask yourself who, what, where, when, and how questions. Think about specific places in the world where the risky behavior poses serious problems.

4. Use elements such as color to differentiate subtopics. Use words, symbols, and drawings to show what you know. Be creative!

5. Use lines, colors, arrows, branches, or some other way of showing connections between the elements on your concept map. Identify the relationships clearly. Label lines as needed.

Tips for Creating Your Concept Map Use single words, simple phrases, or simple drawings for information.

A concept map is a summary; include only the content that is most important.

The structure of your map will likely evolve of its own accord.

Use color and shapes to separate different ideas and relationships. Each color or shape should be assigned some particular meaning and not just be used to make the concept map look colorful.


The concept map includes important topics, subtopics, and information about the risky behavior.

Items are identified in a way that is easy to follow.

The concept map clearly shows connections, patterns, and relationships, and it uses symbols and drawings to illustrate details effectively.

The concept map shows creativity and flexible thinking, and expands on ideas in new and unique ways.

The concept map is neat and easy to read.



Example: Occupational Risk Factors Concept Map




Notes: Behavioral Risk Factors

Student Name______________________________________ Date_____________________

Directions: Look through all of the resources and notes from this lesson. Fill out the chart with three or more behavioral health issues that you think are compelling and pressing enough to consider for your culminating project. Note the assessment criteria listed at the end of this resource.





.


Your notes on behavioral health issues explored in this lesson are clear and complete.



Your notes demonstrate an understanding of the relationship between behavior, diseases, and conditions.

Your choice of three potential issues to focus on for your culminating project demonstrates an ability to compare a range of behavioral issues and evaluate their relative need to be addressed by the global health community.





Writing Assignment: Pressing Health Issue Argument


Directions: Follow the instructions below to write a brief argument that makes a case for the issue your group has decided on as the one that deserves immediate attention from the global health community. Read through all of the instructions, including the assessment criteria and the example, before you begin work. Make sure you understand how your work will be assessed.

The Health Issue We Chose Write down the health issue your group chose to work on for your culminating project:

List Compelling Reasons to Focus on the Issue Work with your group to come up with reasons why this issue deserves immediate attention from the global health community. Refer to your notes to help you think of good reasons. Each group member should contribute at least one reason. Once you have a list, circle or highlight the top three reasons that your group agrees upon as the most compelling to present to the global health community. .

Reasons Why This Issue Is Critical and Urgent:

1.

2.

3.

4.

5.



6.

Remember to circle or highlight the top three reasons from this list. These are the ones that you will discuss in your argument.

Research Now research your issue to prepare to write your argument. Each member of the group must help with this step. In your notebook, create a chart like the one below and use it to take notes as you research.

The third column of the chart below is important. If you use a student resource, write the name of it. If you use an online source, note the name of the website and the URL. If you use a book or an article, include the title, page number, and author name. As you write, attribute facts and statistics to your sources.

You may decide to divide up the work so that each group member is using different sources to conduct research. For example, one group member should look at the relevant student resources to gather information. You can also do a search, see what websites come up, and divide them up so that each group member investigates three or four.

Next, share your research with your group mates. You can make copies of your research for your group mates or email your notes to each other.

Research Item My Responses Where I Found the Information

Which diseases or conditions are related to this issue? What information about the diseases (such as symptoms and treatment) is important to include in my argument?

What health determinants are the most important when considering this risk factor and disease? What information about the health determinant should I include in my argument?



What regions, countries, communities, or populations are most at risk? Why?

Write a Rough Draft When you have completed your research and shared it with your group mates, write your part of the argument. Remember that your argument should be persuasive: it should express a belief or a point of view that you want others to share. Each member of the group is responsible for writing the rough draft of one section of the argument. One person will have to write two sections if you have four people in your group. Write down who will be in charge of which section in the spaces provided:

Introductory Paragraph

The introductory paragraph should say what the health issue is that you are focusing on and why you are focusing on it. It should explain the impact of the issue and summarize why you think that it is an issue that deserves immediate attention. You should use strong persuasive language in the introductory paragraph.

Group member who will draft this section:

Second Paragraph

In this paragraph, explain what diseases or conditions are related to the issue. You may wish to explain how the disease is acquired, what the symptoms are, and how it affects people physically and mentally. You may wish to say how the disease can affect a person’s societal status.


Third Paragraph

In this paragraph, explain the health determinants associated with the issue. Name the main health determinants and briefly describe them. For instance, the example essay shows how poverty and poor sanitation and hygiene contribute to the spread of the disease.


Fourth Paragraph

In this paragraph, describe the location and population that is most at risk and give reasons why. For instance, the example essay focuses on how tropical areas are most at risk and explains why.


Conclusion

In your conclusion, summarize the main points in your argument and emphasize why you think your chosen issue is an issue that deserves immediate attention. Use strong persuasive language to make your point.




Create a Final Draft Choose one group member to put each of the draft paragraphs into one complete argument.

Review the argument independently and mark it up with ideas for improvement and revision. Be careful to note the following:

Any parts that are repetitive (if you find that the same fact or idea is stated in more than one place, note where you think it should stay and where it should be deleted)

Any parts that are contradictory or that contain facts or information that is at odds with facts or information in a different section

Anything that is missing, such as transition sentences from one idea to another so that the argument flows smoothly

Choose a different group member to act as the editor. This person reviews all of the suggestions for changes and creates a final draft that incorporates ideas for improvement.

Everyone should read the final version and make sure that the argument meets or exceeds the assessment criteria.

Make sure your argument meets or exceeds the following assessment criteria:

The argument demonstrates a clear understanding of the health issue, including the risk factors, diseases, and populations involved.

The argument presents convincing reasons about the importance of the health issue and why it needs immediate attention.

The information in the argument is clearly organized with evidence to support each position, including facts and statistics that are attributed correctly.

The transitions between paragraphs and ideas are smooth.

The argument is neat and uses proper spelling and grammar.



Example Argument: Lymphatic Filariasis Lymphatic filariasis, also known as elephantiasis, is a painful, disfiguring, and disabling disease. Spread by mosquitoes, it has incapacitated 40 million people, according to the WHO. There is no cure for the disease, but it can be prevented. In fact, the WHO considers this infectious disease eradicable, which means that it is possible to completely eliminate it. Since 2000, the WHO has been implementing a mass drug administration program in which 900 million people have received treatments that will prevent them from getting the disease. We are at a critical moment in the disease’s history. We should seize the opportunity to continue this work and destroy this disease.

Lymphatic filariasis is caused by a small parasitic worm, transmitted through mosquitoes, that lives in the blood. People can carry the disease and not know it. They can feel healthy, but eventually they will begin to experience a fever and painful swollen limbs, especially in their legs. Their skin will smell bad. There are symptoms that can’t be seen, too. The disease affects the lymphatic system and the kidneys. Walking and working become difficult. People who have the disease are shunned by society because of the way they look. They experience financial hardship because of increased medical expenses and a loss of income.

There are several health determinants linked to the disease. These include poverty, sanitation and hygiene, and education. Mosquitoes spread the disease. Mosquitoes often breed in stagnating, polluted areas of water, like blocked drains and sewers. These areas are often found in impoverished areas where there is poor sanitation and hygiene. People without health education about how to protect themselves from the disease may not use, or have access to, mosquito netting, repellents, and insecticides.

Filariasis is a tropical disease. According to the WHO, 120 million people have filariasis, and 1.3 billion people in 72 countries are at risk for getting the disease. These countries have tropical areas where mosquitoes thrive. According to the WHO, 65% of those infected live in the South-East Asia region and 30% of those infected live in the Africa region. The rest of the people infected live in tropical areas around the globe.

The WHO believes that it is possible to eliminate filariasis, which would save millions of people from a life of pain, disability, and stigmatization. Both the knowledge about how to protect people against the disease and the medication to prevent the disease exists. In other words, the resources to stop this preventable disease in its tracks are available to us, and we should continue to do everything in our power to eliminate filariasis.


AOHS Global Health

Lesson 11 Community and Policy Health

Interventions In this lesson, students learn about the different types and levels of health interventions. They learn about the criteria for a community-based intervention, the different levels of prevention, and different ways for evaluating an intervention. They also identify the characteristics of policy health interventions and learn what makes policy health interventions successful and effective. They compare and contrast community and policy health interventions, and they develop an understanding of how community and policy health interventions support each other.

Advance Preparation

Prior to Class Period 5, review the flash cards students create in Class Period 2 for accuracy. Add in questions of your own to cover any important material that the students have missed.


Lesson Framework


Identify the different types and levels of intervention

Categorize types of community intervention in health care

Identify and describe criteria for judging the effectiveness of an intervention*

Explain how health education, promotion, and communication can be used effectively in community intervention programs*

Explain how community interventions can be used to bring about behavioral or environmental modifications

Display understanding of how government policy can create effective health change

Describe a successful government intervention program

Compare and contrast a community intervention and a policy intervention

AOHS Global Health Lesson 11 Community and Policy Health Interventions










Explain the healthcare worker’s role within their department, their organization, and the overall healthcare system (Common Career Technical Core 2012, HL-2)

Evaluate accepted ethical practices with respect to cultural, social, and ethnic differences within the healthcare workplace (Common Career Technical Core 2012, HL-6)

Assessment


Quiz on community and policy health interventions (Teacher Resource 11.4)

Answer Key: Community and Policy Health Interventions Quiz (Teacher Resource 11.5)

Prerequisites Knowledge of environmental, nutritional, and behavioral risk factors

Knowledge of health determinants

Basic understanding of roles and responsibilities of health care professionals


Teacher Resources Teacher Resource 11.1, Scenarios: Public Health Interventions (separate Word file)



Teacher Resource 11.2, Presentation and Notes: Types and Levels of Global Health Interventions (includes separate PowerPoint file)

Teacher Resource 11.3, Vignettes: Community and Policy Interventions

Teacher Resource 11.4, Quiz: Community and Policy Health Interventions

Teacher Resource 11.5, Answer Key: Community and Policy Health Interventions Quiz

Teacher Resource 11.6, Key Vocabulary: Community and Policy Health Interventions

Teacher Resource 11.7, Bibliography: Community and Policy Health Interventions

Student Resources Student Resource 11.1, Note Taking: Types and Levels of Global Health Interventions

Student Resource 11.2, Reading: Types and Levels of Global Health Interventions

Student Resource 11.3, Reading: Community-Based Interventions

Student Resource 11.4, Investigative Questions: Motorcycle Helmet Laws

Student Resource 11.5, Compare and Contrast: Community-Based and Policy-Based Interventions

Equipment and Supplies Blank name tags or paper and tape for students to make their own professional identification

badges

LCD projector and computer for PowerPoint presentation

Index cards for students to create flash cards (5 to 10 per student); pens or pencils


Sticky notes

Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1 25 Professional Roles: Public Health Interventions

In this activity, students use what they know about public health to predict which professionals are involved in different types of interventions.

Before the activity begins, print out Teacher Resource 11.1, Scenarios: Public Health



Step Min. Activity

Interventions (separate Word file). The first part of this resource contains different professional roles accompanied by a brief description of each role. Cut these apart, fold them, and place them in a container for students to pick from. Print enough sets of these roles so that there is one for each student. The second part of this resource contains scenarios. Post the scenarios around the room.

Remind students that in the previous unit of this course, they learned about the environmental, nutritional, and behavioral risk factors that impact global health. In this unit, they will be learning about the different ways that global health workers and governments intervene to address these risk factors.

Write the following list of professionals on the board and tell students that all of these professionals might be involved in public health interventions.

Doctor

Dentist

Public health nurse

Health educator

Community organizer

Nutritionist

Government official

Researcher

Grant writer

Fundraising manager

Politician (such as state representative)

Tell students to pick one folded slip of paper from the container to find out which profession they are assigned.

Ask students to read the brief description of their responsibilities, and answer their questions; some of these professions may be unfamiliar. Pass out blank name tags or paper and tape. Instruct students to write the name of their profession on their tag and stick it to their shirt so that everyone can easily identify each other’s profession.

Next, point out the intervention scenarios posted around the room. Explain that each scenario briefly describes a public health problem in need of an intervention. Tell students that all of the scenarios take place in the United States.

Write the following instructions on the board and make sure students understand them:

1. Read each scenario.

2. Stand by the scenario where you think you would be most effective in your professional role.

After all students have chosen a spot to stand, go around the room asking students to give the reason why they chose their scenario and explain what they think someone in their profession would contribute to the intervention. You may also want to ask students to identify other scenarios in which someone in their profession might be useful, and make sure they understand that there are some overlaps.

To conclude, point out that carrying out effective health interventions requires a vast array of resources and professionals. In this unit, students will learn what makes an



Step Min. Activity

effective intervention and how interventions can address the risk factors that they have learned about.

2

25 Presentation: Types and Levels of Global Health Interventions

This activity gives students an understanding of the different types and levels of global health interventions, including an understanding of population-based interventions and examples of specific interventions. It also develops students’ listening and note-taking skills.

To prepare, make notes to guide class discussion using Teacher Resource 11.2, Presentation Notes: Types and Levels of Global Health Interventions. Have Teacher Resource 11.2, Presentation: Types and Levels of Global Health Interventions (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

Refer students to Student Resource 11.1, Note Taking: Types and Levels of Global Health Interventions. Ask students to examine the graphic on the note-taking sheet. Tell them to read the instructions, and then answer any questions.


This presentation is duplicated as Student Resource 11.2, Reading: Types and Levels of Global Health Interventions. If an LCD projector is unavailable, students can read the presentation, answer the discussion questions in their notebook, and discuss their answers as a class. This student resource is also useful for review.

After the presentation, divide the class into pairs and have them compare their graphics and notes for completeness and accuracy. Invite each pair to share their thoughts and questions, and address any misunderstandings.

To conclude, remind students that writing about possible interventions will be part of the work they do for their culminating project, so as they work on the activities in this lesson, they should keep in mind ideas that they have for their culminating project.

CLASS PERIOD 2

3 35 Reading: Community-Based Interventions

The purpose of this activity is to give students a more in-depth understanding about what community-based interventions are, including levels of prevention and ways to evaluate interventions.

Explain to students that they are going to read about community-based interventions, and that to understand what makes an intervention community based, it is important to understand what a community is. Ask students to share with a partner what the term community means to them as it relates to global health, and then have them share their responses with the class.

Refer students to Student Resource 11.3, Reading: Community-Based Interventions. Tell students to complete the reading individually and to do the following as they read:



Step Min. Activity

Circle any words that are confusing

Write questions in the margin

After about 15 minutes, or when students have completed the reading, put them in pairs and ask them to see if they can define terms and answer questions that their partner wrote down. Circulate among students, listening in for terms that come up repeatedly.

Next, give pairs an opportunity to ask for definitions of terms that neither of them knew, and to ask questions that neither could answer. Use this time to clear up misunderstandings.

Point out that community-based interventions have many important aspects, and students can refine their ideas about what is most important in a community intervention later in the lesson, when they will study some examples of community intervention.

4 15 Vocabulary Building: Making Flash Cards

Students strengthen their grasp of new vocabulary by making flash cards with terms on one side and definitions on the other.

Acknowledge to students that the reading they just finished included a lot of new vocabulary. To help them remember new terms, they will create flash cards.

Hand out 5 to 10 index cards to each student. Tell the students to write a term that was new or confusing to them on one side of the index card, and to write down the definition on the other side. After about 10 minutes, tell them to share their terms and definitions with a partner. The partner should make sure that the definition is accurate. Tell students to make changes to their flash cards (or write revised versions on new index cards) as necessary.

Collect the flash cards before the end of the class period. Review them to make sure the definitions are all correct. Keep the flash cards on hand; students will use them to prepare for the quiz later in the lesson.

CLASS PERIOD 3

5 50 Analysis: Effectiveness of Policy Interventions

Students think about what a policy intervention is and the types of effort that go into developing a policy intervention.

Orient students to this activity by asking them to volunteer answers to the following prompt:

What are the three types of interventions used in global health?

If students draw a blank, offer hints until they come up with community-focused, systems-focused, and individual-focused as the answers. Then ask: which type of intervention would a policy intervention be? Students should recognize that it is a systems-focused intervention, but if there is confusion, now is the time to clear it up.

Then explain that in this activity, they will learn about some of the factors that go into



Step Min. Activity

designing a policy intervention. Assign students to groups of three, and refer them to Student Resource 11.4, Investigative Questions: Motorcycle Helmet Laws. Have groups read the directions, and point out that developing a policy intervention requires lawmakers to exercise the kind of inquisitive thinking that students will use in this activity. Answer questions and then instruct groups to get to work reading the letters and writing their questions.

When students have completed writing their questions, first discuss with them which letter they thought made a stronger case and why. Then ask each group to share their best questions with the class and to briefly explain how the question is designed to get the types of factual information and statistics lawmakers will need.

Then work with students to create a list on the board of defining characteristics of policy interventions, making sure that it includes:

Change organizations, laws, rules, regulations, ordinances, policies, and power structures

Use local, state, and national government agencies to bring about change

Remind students that citizens often disagree about whether a policy intervention is the best way to respond to a health problem and that policymakers strive to consider all viewpoints.

If time allows, ask students if they know what the law is in your state regarding wearing a helmet when riding a motorcycle. The answer is on this Consumer Reports web page:

http://www.consumerreports.org/cro/news/2011/06/state-by-state-guide-to-motorcycle-helmet-laws/index.htm

Engage students in a discussion based on these prompts:

If you were a motorcyclist, would you want to wear a helmet? Why or why not?

What interventions would be effective to get you to wear one?

Do you think being a policymaker would be a good career for you? Why or why not?

Tell students that in the next class period, they will have a chance to apply what they have been learning to global health interventions.

CLASS PERIOD 4

6 35 Vignettes: Evaluating Interventions

Students apply what they have learned about effective community and policy interventions to analyzing examples of global health interventions.

Before class begins, print out the vignettes featured in Teacher Resource 11.3, Vignettes: Community and Policy Interventions, and post them around the room. Depending on the size of your class, you may wish to print two or three sets.

Next, pair students up and tell them they will use what they have learned to look in depth at five interventions.

Pass out sticky notes, and point out the vignettes posted around the classroom. Tell



Step Min. Activity

students that each vignette describes an intervention. Explain that pairs should read each vignette and then use sticky notes to respond to the questions about the effectiveness and characteristics of the intervention at the bottom of the vignette. Instruct them to spend no more than five minutes at each vignette.

When students have finished posting their sticky notes, give them a few minutes to look at each other’s responses. Discuss any of the questions that don’t have clear answers, and make sure students understand the most important features of the interventions.

To conclude, ask students to share with the class which of the interventions they found most impressive and why.

Tell students that they will need to propose interventions for their culminating project, so they should take note of the interventions that they found most effective in this activity.

7 15 Compare and Contrast: Community and Policy Interventions

Students compare and contrast the characteristics of community and policy interventions to develop a more thorough understanding of these categories.

To begin, ask students to explain what they know about policy interventions that have been enacted in their state to address texting while driving. You may wish to refer them to the following site to see if there is a driving and texting ban in your state:

http://www.ghsa.org/html/stateinfo/laws/cellphone_laws.html

Alternatively, you can bring up the site on your computer and project it so that you visit the site as a class. Then refer students to Student Resource 11.5, Compare and Contrast: Community-Based and Policy-Based Interventions. Tell students to work independently. Ask them to read the instructions, and then answer any questions. As students work, circulate and answer questions that come up about the differences between the types of interventions.

If students don’t finish their Venn diagram in class, tell them to do so for homework.

CLASS PERIOD 5

8 15 Compare and Contrast: Community and Policy Interventions (Continued)

Students share their comparisons of community and policy intervention characteristics with classmates.

Place students in groups of four and have them compare their responses to the questions and the Venn diagrams in Student Resource 11.5. Tell them to add anything they might have overlooked to their own diagrams or responses. Ask each group to share one or more characteristics that they had questions about. Use this time to clear up misunderstanding.

You may wish to gauge student understanding by assessing Student Resource 11.5 on a credit/no-credit basis.

9 20 Quiz Preparation: Flash Cards



Step Min. Activity

This activity helps students prepare for the quiz on what they have learned in this lesson. It focuses on the following college and career skill:


Prior to this activity, review the flash cards students created at the end of Class Period 2 for accuracy. Consider adding more flash cards for words that you think students should review but that aren’t included in the collection.

Tell students that in the next class period, they will be taking a quiz on what they have learned in this lesson. They will spend the rest of this class period preparing for the quiz.

Line students up in two rows that face each other, so that each student is directly across from another student. Distribute the flash cards that students created at the end of Class Period 2.

Instruct the students as follows: each student in one row shows the person across from him or her either the term or the definition on one of the flash cards. The other student says the answer; if it’s incorrect, the student with the flash card provides the correct answer. Once this student has quizzed the partner on all of his or her flash cards, the other student does the quizzing with his or her own set of flash cards.

Signal when it’s time to switch partners by ringing a bell, blowing a whistle, or making some other sound. One row of students always stands still, and the other row moves down one student. The student at the end of the row who is now without a partner comes around to the beginning of the row.

This activity is over when students are standing in front of their original partner, but you can always decide to do another round.

10 15 Quiz Preparation: Review Resources

Students continue to prepare for the quiz by reviewing their resources.

Give students the rest of this class period to look through their student resources. They can work independently, in pairs, or in small groups to review material. Circulate during this time, answering questions and keeping students on task.

For homework, tell students to study for the quiz.

CLASS PERIOD 6

11 35 Quiz: Community and Policy Health Interventions

In this activity, students take a quiz to demonstrate what they have learned in this lesson.

Distribute Teacher Resource 11.4, Quiz: Community and Policy Health Interventions. Give students about 20 minutes to complete it. Collect the quizzes and assess them using Teacher Resource 11.5, Answer Key: Community and Policy Health Interventions Quiz.

After you have collected the quizzes, review the correct answers with the class.



Step Min. Activity

12 15 Final Reflection: Community Intervention on a Global Scale

Students consider a health issue that affects them personally and the interventions that could be most effective in mitigating it.

Ask students to think about a health issue that affects them personally. Examples might include a behavioral risk factor in their family such as smoking, an environmental issue in their neighborhood such as pollution from a nearby highway, or a nutritional issue that they believe is affecting students at their school. Then tell students to answer the following prompt:

Which interventions might work to resolve this issue or lessen its effects? Explain your reasoning.

Ask students to respond by writing a four- to six-sentence paragraph in their notebook.

If time remains, allow student volunteers to read their paragraphs aloud.

To conclude, summarize by saying that targeting an intervention to a specific population is an important means of ensuring that the community’s needs are met. Remind students that they will need to consider effective interventions for their culminating project as well.

Extensions

Content Enrichment Arrange for a visit from a representative of a local public health agency. Have the professional

speak to the class, focusing on how interventions are designed and evaluated. Ask the professional to come prepared to share several examples of interventions that have been evaluated and what the organization learned from the evaluations.

Work with students to assemble a focus group to further explore their idea for a community health intervention. The group should consist of members of the population that the intervention is targeting, such as teens, senior citizens, or cancer survivors. Have students present their idea to the group. Have students prepare questions in advance to ask group members. The questions should focus on reasons why the group members think the intervention might or might not be effective. After meeting with the group, ask students to use the information they gathered to make improvements to their idea.

Provide students with a list of health interventions in your community. Then ask students to research and categorize the interventions by their level of prevention: primary, secondary, or tertiary.

Explain to students that according to one study, only 40% of health care workers in the United States receive a seasonal flu shot. Pose the following question: Should it be mandatory for health care workers to receive a flu shot? Divide students into groups to research and debate the issue.

Tell students that the surgeon general plays an important role in US health policies. Have students work in pairs to research one of the following topics: the surgeon general’s roles and responsibilities, a profile of the current or a past surgeon general, or changes to the surgeon general’s initiatives over time. You may wish for students to begin their research at this site: http://www.surgeongeneral.gov/.



Assign students to work in small groups, and display the following topics: drinking and driving, and cigarette sales to minors. Then have students select one of the following pairs of countries:

o Mexico and Canada

o China and the United States

o India and France

o South Africa and Israel

o Argentina and Australia

o Russia and Japan

o South Korea and Uruguay

Instruct students to research the policies on their topic for the pair of countries they selected. Then have them create a poster comparing and contrasting the policies in the two countries. Have students analyze the findings of their research by considering questions such as: How do you think the culture of both countries affects the policies on the issues? What effect do you think the policies have on the health and well-being of the people who live in the country? If the policies are similar, why do you think they are? If they’re different, why do you think that is so?

STEM Integration Math: To give students a real-world sense of what resources are required to implement a

successful intervention, work with a local nonprofit health agency to acquire a basic budget for a program. Help students understand how the budget works, and then have them create budgets for their community health intervention using the budget as a model.

Math: Distribute copies of the article “Distracted Driving in California: Number of Youth Using a Phone behind the Wheel Has Doubled” (http://www.huffingtonpost.com/2012/05/10/distracted-driving-in-california_n_1506772.html). Instruct students to create graphs depicting the information given in the article about young people using cell phones while driving.

Technology: Have students design some informational web pages for your class website or for the school website on a topic from this course that has resonated with your students.

Additional Cross-Curricular Ideas English Language Arts: Arrange for students in small groups to shadow a public health

professional such as a nutritionist, legislative policy advisor, or epidemiologist during his or her workday. Then have them write day-in-the-life essays in which they describe the typical responsibilities, challenges, and tasks for that person.

History: Ask students to research and create an illustrated timeline of significant events related to cigarette advertising policy in the United States. The timeline should show important dates and also feature images showing how cigarette advertising has changed over time due to policy. You may wish for students to begin their research by reading the article “Cigarette Advertising”: http://www.time.com/time/magazine/article/0,9171,1905530,00.html.

Social Studies: Instruct students to choose a health issue affecting people in their state that they think should be addressed by a policy intervention. Then have them write letters to a state senator persuading the senator to consider the issue. Encourage students to research the issue and use facts and figures to support the argument they make in their letters.


AOHS Global Health


Interventions

Teacher Resources


Teacher Resource 11.1 Scenarios: Public Health Interventions (separate Word file)

Teacher Resource 11.2 Presentation and Notes: Types and Levels of Global Health Interventions (includes separate PowerPoint file)

Teacher Resource 11.3 Vignettes: Community and Policy Interventions

Teacher Resource 11.4 Quiz: Community and Policy Health Interventions

Teacher Resource 11.5 Answer Key: Community and Policy Health Interventions Quiz

Teacher Resource 11.6 Key Vocabulary: Community and Policy Health Interventions

Teacher Resource 11.7 Bibliography: Community and Policy Health Interventions




Presentation Notes: Types and Levels of Global Health Interventions


In this presentation, you will learn about the different types and levels of global health interventions.

Presentation notes



The purpose of global health interventions is to bring about change. You’ve learned about various interventions so far in this course. For example, you learned about policy changes in Rwanda to make the roads safer. These policy changes were interventions.

An intervention is an organized effort made by health professionals to address a health-related problem. Interventions are often programs, such as a cancer-screening program or a program that teaches mothers about the benefits of breast-feeding.

Presentation notes



This graphic shows one way of understanding the scope of public health interventions.

There are three categories of public health interventions:

• Systems-focused interventions, which use government agencies, organizational structures, policies, and laws to bring about change.

• Community-focused interventions, which change the way communities think and act.

• Individual-focused interventions, which change the way individuals think and act. These interventions focus on changing unhealthy behaviors into healthier ones.

The right-hand column in the graphic gives examples of specific types of interventions. For example, school-based health education focuses on a community of students.

Presentation notes



Interventions focus on entire populations. A population is a collection of individuals who have at least one characteristic in common. For example, you are part of a population of American high school students. While there are many things that set you apart from a high school student in another state, or even from the student sitting next to you, what you have in common is that you go to high school in the same country. That makes you part of the same population.

Another characteristic of interventions is that they consider the health determinants, such as education and health services, that are linked to a health problem. For example, an intervention addressing obesity would consider a population’s ability to access healthy foods.

Interventions also focus on different levels of prevention. This means that some interventions focus on keeping problems from occurring (primary prevention). Other interventions might focus on detecting and treating problems early (secondary prevention), or they might try to keep problems from getting worse once they have occurred (tertiary prevention).

Presentation notes



A systems-focused practice does not focus directly on individuals and communities. Rather, it looks at the systems that affect health. These interventions change organizations, policies, laws, and power structures. For example, an intervention that implemented traffic laws, such as a speed limit or a requirement about motorcycle helmets, would be a systems-focused intervention.

A community-focused intervention is directed at an entire population in a community. For example, there might be a community-focused intervention in your community that aims to vaccinate children for whooping cough. These interventions change community attitudes, awareness, practice, norms, and behaviors. It is important to note that this community-focused intervention supports the individual-level intervention in which any given person receives his or her vaccination.

Individual-focused interventions are directed at individuals and families. These interventions change the knowledge, attitudes, beliefs, practices, and behaviors of individuals. For example, a nurse advising an individual with a family history of high blood pressure on diet and lifestyle changes is an example of an individual-focused intervention.

Presentation notes



There are many specific types of interventions. In this presentation, we are going to focus on four types and look at examples of each. The types are screening, health education, social marketing, and policy development.

Presentation notes



Screening is a type of intervention in which members of a population are tested for a specific disease known to be a major health issue. Members of a population who are showing symptoms of the disease will be screened. The screening is also meant to identify individuals who may have the disease but are not experiencing symptoms. With many diseases, early detection of a disease is key to effectively treating and managing it.

Public health screening is an intervention that is used in Australia and other countries to address breast cancer. Breast cancer is the second most common cause of cancer-related death in Australian women. Government officials and other health workers believed that well-organized mammograms would substantially reduce the number of deaths from breast cancer, so in 1990 a new intervention program called BreastScreen Australia began. The program targeted a specific population: well women without symptoms between the ages of 50 and 69. Since the program began, there has been a reduction in breast cancer mortality of about 25%.

Presentation notes



Health education is a type of intervention in which communicating facts, ideas, and skills about health helps to change health knowledge, attitudes, values, beliefs, behaviors, and practices.

The Asthma Care Training (ACT) for Kids is an example of a health education intervention. In three educational sessions in pediatric clinics across the United States, children ages 7–12 and their families learn asthma self-management skills. The program is based on the idea that children should be active participants in the prevention and control of their symptoms. This means that they should be able to recognize asthma symptoms and know what actions to take. Parents participate too, learning about things like how to control environmental pollutants and irritants. The result of the program was that the frequency and severity of asthma episodes was reduced.

Presentation notes



Social marketing is another type of intervention. In this type of intervention, commercial marketing principles and technologies are used to influence the health knowledge, attitudes, values, beliefs, and behaviors of population members.

In the United States, the CDC launched a social marketing intervention called the VERB. For four years this intervention used print, radio, and television ads to encourage increased physical activity in the tween population. Commercials were aired on stations like MTV, the Cartoon Network, and Nickelodeon, and advertisements were placed in national magazines like Teen People, Family Circle, and YM. The campaign was geared toward both parents and kids. One ad showed a basketball. It encouraged parents to be physically active with their kids, saying that kids who are physically active aren’t just healthier but feel better about themselves. On the basketball were the words “Inflate your child’s self esteem.”

Image courtesy of Centers for Disease Control; retrieved from http://www.cdc.gov/youthcampaign/ on April 23, 2012, and reproduced under fair-use guidelines of Title 17, US Code. Copyrights belong to respective owners.

Presentation notes



Policy development is another type of health intervention. Policy development results in laws, rules, regulations, ordinances, and policies about issues related to health. Policy development is a type of intervention that is aimed at systems as well as individuals and communities.

South Africa is a country that has used policy development as a form of health intervention. Like many countries, South Africa has passed into law a number of measures aimed at creating smoke-free environments and reducing the number of tobacco-related health issues in the population. For example, smoking is only allowed in designated areas in work places, public places, and public transportation. Tobacco advertising is mostly banned. All tobacco products, like cigarette boxes, contain warnings.

Presentation notes



When tackling a health issue, it is often the case that more than one intervention is used. For example, while policy development is helping to change smoking behavior in South Africa, there are also programs that use health education as an intervention to educate communities and individuals about the effects of smoking.

Comprehensive interventions often use multiple techniques. They also often require global cooperation from multiple governments and health organizations and agencies, like the WHO, the Red Cross, or the Bill and Melinda Gates Foundation. Health issues that require global cooperation include diseases that spread around the globe, like avian flu, malnutrition related to changing climate patterns and global warming, and diseases linked to war and conflict. You will learn more about global cooperation later in this course.

Presentation notes



Interventions are about making change. They focus on individuals, communities, and systems. There are many types of successful interventions, including screenings, health education, social marketing, and policy development. Governments and global health organizations use interventions to tackle pressing global health concerns around the world.

Presentation notes




Vignettes: Community and Policy Interventions

Print out the following four vignettes and post them in different parts of the classroom. You might wish to print two versions of each, depending on the size of your class. Ask students to read each vignette and then respond to the questions at the bottom of the vignette using sticky notes.



Malaria in the Democratic Republic of Congo (DRC)

Almost 10,000 employees worked at a remote mining and drilling site in the DRC. About 70% of the workers were Congolese. Many of them had traveled great distances from other parts of the country to work at the site. The other workers were expatriates from other countries. They had come to work in the mines to support their families in their home countries. They came from India, Bangladesh, Pakistan, and the Philippines.

Malaria is a leading cause of death and illness in the DRC. The mining company was concerned that if they didn’t do something to stop the spread of malaria at the site, many people could get sick and die. The company teamed up with a health organization that specialized in malaria control and prevention. First, the health organization surveyed the people who worked at the company. They wanted a better understanding of the workers’ knowledge about how malaria is spread as well as their attitudes toward the disease and practices used to prevent it. The survey revealed that the separate national groups within the community had varied levels of understanding about the disease—about its severity and how to prevent it.

Based on the results of the survey, the team created educational health awareness programs for each nationality. The programs were geared specifically toward each target audience, taking into consideration cultural practices and beliefs. Along with the educational programs, they began a program to spray insecticide inside homes and facilities. They passed out durable bed nets and provided medication to those who needed it. Local health staff workers in the area were trained about how to detect and treat malaria. After two years, the team evaluated the program and found that malaria had been reduced by 60% of what it was when the program started.

What was particularly challenging about creating this intervention?

The evaluation of the program looked at the reduction in malaria cases. What is another way that the program could have been evaluated?



Hepatitis B in Cambodia

One way that the disease hepatitis B can be contracted is when mothers who are infected transmit it to their babies during delivery. However, it is possible to prevent mother-to-child transmission. Infants must be given a vaccine within three days of being born. In Cambodia, 90% of infants are born at home, and this makes vaccinating infants against dangerous diseases like hepatitis B very difficult.

A nonprofit agency wanted to create an intervention that would increase the number of children who were vaccinated. They decided to first focus on one province. The agency identified local health workers in the province who could give them more information about families in the area. Then they worked together to create a specific plan for targeting infants in this province.

The local workers set up an informal system whereby people in communities in the province would communicate via word-of-mouth when a mother was about to give birth. This pass-the-word system worked. The information would soon reach the health workers, who would then prepare to make a home visit and deliver the vaccine. However, transportation to homes could be difficult. Often there weren’t direct roads, so arrangements were made for health workers to travel first by rail and then by motorbike to reach out-of-the-way homes. Only nine months after starting the program, over 1,000 newborns were vaccinated, or 40% of the children being born.

What made the community that was the focus of this intervention unique?

What were some of the challenges of executing this intervention?



Diarrhoeal Disease in Egypt

Oral rehydration therapy (ORT) was developed in the 1960s. ORT is a simple solution of water, sugar, and salt that was found to be effective in stopping dehydration caused by diarrhoeal disease.

In the 1970s, infant mortality was very high in Egypt. Diarrhoeal disease caused at least half of all infant deaths. When ORT first reached pharmacy shelves in Egypt, it wasn’t being used, but the government soon realized how powerful ORT could be in curbing the number of deaths due to diarrhoeal disease. It decided to target a community that could make a difference: mothers of young children.

The ORT packages were designed and branded in a way to appeal to mothers. They were created in a size Egyptian mothers would think was appropriate for a child’s drink. They were distributed in places that would be accessible to mothers, such as the private homes of community leaders. Thousands of health workers were trained to teach mothers how to use ORT, and there were educational ads about ORT on TV.

Between 1982 and 1987, infant mortality dropped 36% and child mortality dropped 42%. In addition, the cost per child treated with ORT was estimated at only $6, a small price to save a life.

What part of this intervention do you think could work in other parts of the world?

How could the program be evaluated to see if the beliefs or attitudes of the target population had changed?



Iron Deficiency in Venezuela

After an economic crisis, the nutritional status of the Venezuelan population deteriorated. People could not afford the food needed to provide them with valuable nutrients like iron.

For more than 50 years, countries around the world have used iron fortification to increase the iron intake of their populations. When a food is fortified, a nutrient is added to it. So, in 1993 the Venezuelan government began a mandatory iron fortification program. Precooked corn flour is a staple in the Venezuelan diet. The program required manufacturers by law to enrich precooked corn flour with iron.

Soon after the program began, surveys showed a sharp drop in iron deficiency in children.

What are the characteristics that made this intervention successful?

Why do you think a policy intervention was needed in this situation?




Quiz: Community and Policy Health Interventions

Name:___________________________________________ Date:______________________

Directions: Answer each question accurately and thoroughly in the space below the question.

1. What is a global health intervention and what is its purpose?

2. Describe the differences between community-focused, systems-focused, and individual-focused interventions.

3. Read the following description of a community-based intervention. Then identify the resources, activities, products, and outcome:

An intervention targets the parents of middle-school girls in a rural community in Kansas. The program, run by a group of public health nurses, provides health education about the physical and mental health risks of eating disorders. The nurses have developed brochures that explain warning signs parents should be aware of. They also host events at a community center where parents can ask questions and share personal stories.

Since the program was launched, health care providers in the community have tracked an increase in parents bringing their daughters in for medical attention in the early stages of an eating disorder. Since early detection and intervention is important in treating the illness, the intervention is considered to be a success.

a. Resources (what is needed to make the intervention happen):

b. Activities (what the program does with the resources to fulfill its mission):

c. Products (the goods that result from the program):



d. Outcome (the benefits):

4. A program has been launched of physical activity for overweight adult males with a family history of cardiovascular disease. Is this an example of a primary, secondary, or tertiary level of prevention? Explain your reasoning.

5. Which of these do policy interventions target? Explain your reasoning.

Individual

Communities

Systems

6. You are in charge of evaluating a new program designed to support orphaned refugee children who have been taken in by a nonprofit organization in Basel, Switzerland. Which of these methods of evaluation would you use, and why?

a. Interview the children to see how they are responding to support.

b. Interview the caregivers of the children to see if they think the children are benefiting.

c. Analyze the students’ performance on IQ tests.

d. Analyze medical data about their physical condition over the time they have been in Switzerland.




Answer Key: Community and Policy Health Interventions Quiz

1. What is a global health intervention and what is its purpose?

A global health intervention is an organized effort made by health professionals to address a health-related problem. The purpose of this type of intervention is to bring about positive change.

2. Describe the differences between community-focused, systems-focused, and individual-focused interventions.

Community-focused interventions change the way communities think and act.

Systems-focused interventions use government agencies, policies, and laws to bring about change.

Individual-focused interventions change the way individuals think and act. These interventions focus on changing unhealthy behaviors into healthier ones.

3. Read the following description of a community-based intervention. Then identify the resources, activities, products, and outcome:

An intervention targets the parents of middle-school girls in a rural community in Kansas. The program, run by a group of public health nurses, provides health education about the physical and mental health risks of eating disorders. The nurses have developed brochures that explain warning signs parents should be aware of. They also host events at a community center where parents can ask questions and share personal stories.

Since the program was launched, health care providers in the community have tracked an increase in parents bringing their daughters in for medical attention in the early stages of an eating disorder. Since early detection and intervention is important in treating the illness, the intervention is considered to be a success.

a. Resources (what is needed to make the intervention happen):

Staff—specifically, public health nurses

b. Activities (what the program does with the resources to fulfill its mission):

Events at the community center for parents

c. Products (the goods that result from the program):

Brochures for parents

d. Outcome (the benefits):

More parents bring their daughters in for medical attention when they recognize early stages of an eating disorder.

4. A program has been launched of physical activity for overweight adult males with a family history of cardiovascular disease. Is this an example of a primary, secondary, or tertiary level of prevention? Explain your reasoning.



This is a tertiary level of prevention because it focuses on preventing disease progression after a disease or a risk factor for that disease has been identified. In this case, the identified risk factor is a family history of cardiovascular disease.

5. Which of these do policy interventions target? Explain your reasoning.

Individual

Communities

Systems

Policy interventions target all three, because laws and regulations affect individuals, whole communities, and systems such as governments, education, and health.

6. You are in charge of evaluating a new program designed to support orphaned refugee children who have been taken in by a nonprofit organization in Basel, Switzerland. Which of these methods of evaluation would you use, and why?

a. Interview the children to see how they are responding to support.

b. Interview the caregivers of the children to see if they think the children are benefiting.

c. Analyze the students’ performance on IQ tests.

d. Analyze medical data about their physical condition over the time they have been in Switzerland.

A case could be made for a, b, and d; all of these would provide information about how the children’s psychological, emotional, and physical health have improved (or not) over time while the children were in the program. The IQ of the children is irrelevant to whether the program supports their healing and well-being. Option d, analyzing medical data, would be useful only in conjunction with evaluating students’ psychological and emotional states.




Key Vocabulary: Community and Policy Health Interventions

Term Definition

community-based intervention

A health intervention that aims to reduce the impact of disease and other health-related risk factors in a supportive environment; targets a specific community and takes place in a variety of settings.

comply To act in accordance with a law or rule.

evaluation An analysis of a health intervention in order to determine its effectiveness.

legislation A law or laws passed by the government.

mandate To be instructed or given the authority to do something, such as carry out a policy.

policy intervention A health intervention that aims to reduce the impact of disease and other health-related risk factors by changing organizations, laws, rules, and regulations; focuses on systems that affect health rather than individuals or communities; uses local, state, and national government agencies to bring about change.

population A collection of individuals who have at least one characteristic in common.

primary prevention A level of intervention that focuses on preventing disease before it begins.

repeal To officially end a law so that it is no longer valid.

secondary prevention A level of intervention that focuses on screening and early detection of disease and conditions.

social marketing A type of intervention that uses commercial marketing principles and technologies to increase the health knowledge, attitudes, values, beliefs, and behaviors of population members.

tertiary prevention A level of intervention that focuses on preventing disease progression after a disease or risk factor has been identified.




Bibliography: Community and Policy Health Interventions


Print Guttmacher, Sally. Community-Based Health Interventions. San Francisco: Jossey-Bass, 2010.


Online “Asthma: Interventions.” CDC, http://www.cdc.gov/asthma/interventions.htm (accessed October 26, 2015).

“Ban on Texting While Driving in Arkansas Starts Oct. 1.” Insurance Journal, September 29, 2009, http://www.insurancejournal.com/news/southcentral/2009/09/29/104151.htm (accessed October 26, 2015).

“The California’s Motorcycle Helmet Law Has NOT Caused Lower Fatality and Injury Rates, But It HAS Resulted in Drastically Lower Motorcycle Ridership, Ownership and Usage.” Bikers Rights, http://www.bikersrights.com/statistics/hlfaq.html (accessed October 26, 2015).

“Cambodia Achieves Significant Boost in Immunization.” PATH, http://www.path.org/news/press-room/586/ (accessed October 26, 2015).

“Case 14: Curbing Tobacco Use in Poland.” Center for Global Development, http://www.cgdev.org/section/initiatives/_archive/millionssaved/studies/case_14/ (accessed October 26, 2015).

“Case Studies: Leading a Successful Malaria Programme.” International SOS, https://www.internationalsos.com/case-studies/case-study-folder/leading-a-successful-malaria-programme (accessed October 26, 2015).

“Country Details for South Africa.” Tobacco Control Laws, http://www.tobaccocontrollaws.org/legislation/country/south-africa (accessed October 26, 2015).

“Distracted Driving.” Governors Highway Safety Association, http://www.ghsa.org/html/issues/distraction/index.html (accessed October 26, 2015).

“Distracted Driving Laws.” Governors Highway Safety Association, http://www.ghsa.org/html/stateinfo/laws/cellphone_laws.html (accessed October 26, 2015).

“It Can Wait.” AT&T, http://www.att.com/gen/press-room?pid=2964 (accessed October 26, 2015).

Mannar, Venkatesh, and Erick Boy Gallego. “Iron Fortification: Country Level Experiences and Lessons Learned.” The Journal of Nutrition, April 1, 2002, http://jn.nutrition.org/content/132/4/856S.full (accessed October 26, 2015).

“Nepal: A Whiff of Sobriety.” Economist, July 28, 2012, http://www.economist.com/node/21559665 (accessed October 26, 2015).

Parker, Elisbeth. “Campaign to Discourage Texting While Driving Visits Tampa Prep.” Tampa Bay Times, May 16, 2012, http://www.tampabay.com/news/education/k12/campaign-to-discourage-texting-while-driving-visits-tampa-prep/1230444 (accessed October 26, 2015).



“Public Health Interventions.” Minnesota Department of Health, http://www.health.state.mn.us/divs/opi/cd/phn/docs/0301wheel_manual.pdf (accessed October 26, 2015).

“Q & A: Motorcycles—Helmets.” Insurance Institute for Highway Safety, http://www.iihs.org/iihs/topics/t/motorcycles/qanda#motorcycles--helmets (accessed October 26, 2015).

Stoto, Michael A., and Leon E. Cosler. “Chapter 18: Evaluation of Public Health Interventions.” Jones & Bartlett Learning, http://www.jblearning.com/samples/0763738425/38425_CH18_495_544.pdf (accessed October 26, 2015).

“Youth Media Campaign.” CDC, http://www.cdc.gov/youthcampaign/ (accessed October 26, 2015).


AOHS Global Health


Interventions

Student Resources


Student Resource 11.1 Note Taking: Types and Levels of Global Health Interventions

Student Resource 11.2 Reading: Types and Levels of Global Health Interventions

Student Resource 11.3 Reading: Community-Based Interventions

Student Resource 11.4 Investigative Questions: Motorcycle Helmet Laws

Student Resource 11.5 Compare and Contrast: Community-Based and Policy-Based Interventions




Note Taking: Types and Levels of Global Interventions


Directions: Below is a graphic showing different levels of health interventions. You will learn more about the topics in the graphic as you watch the presentation Types and Levels of Global Health Interventions. Write important things that you learn about each topic in the corresponding box.

Public Health Intervention

Systems‐Focused Policy

Development

Community‐Focused

Health Education

Social Marketing

Individual‐Focused Screening




Reading: Types and Levels of Global Health Interventions

In this presentation, you will learn about the different types and levels of global health interventions.



The purpose of global health interventions is to bring about change. You’ve learned about various interventions so far in this course. For example, you learned about policy changes in Rwanda to make the roads safer. These policy changes were interventions.

An intervention is an organized effort made by health professionals to address a health-related problem. Interventions are often programs, such as a cancer-screening program or a program that teaches mothers about the benefits of breast-feeding.



This graphic shows one way of understanding the scope of public health interventions.

There are three categories of public health interventions:

• Systems-focused interventions, which use government agencies, organizational structures, policies, and laws to bring about change.

• Community-focused interventions, which change the way communities think and act.

• Individual-focused interventions, which change the way individuals think and act. These interventions focus on changing unhealthy behaviors into healthier ones.

The right-hand column in the graphic gives examples of specific types of interventions. For example, school-based health education focuses on a community of students.



Interventions focus on entire populations. A population is a collection of individuals who have at least one characteristic in common. For example, you are part of a population of American high school students. While there are many things that set you apart from a high school student in another state, or even from the student sitting next to you, what you have in common is that you go to high school in the same country. That makes you part of the same population.

Another characteristic of interventions is that they consider the health determinants, such as education and health services, that are linked to a health problem. For example, an intervention addressing obesity would consider a population’s ability to access healthy foods.

Interventions also focus on different levels of prevention. This means that some interventions focus on keeping problems from occurring (primary prevention). Other interventions might focus on detecting and treating problems early (secondary prevention), or they might try to keep problems from getting worse once they have occurred (tertiary prevention).



A systems-focused practice does not focus directly on individuals and communities. Rather, it looks at the systems that affect health. These interventions change organizations, policies, laws, and power structures. For example, an intervention that implemented traffic laws, such as a speed limit or a requirement about motorcycle helmets, would be a systems-focused intervention.

A community-focused intervention is directed at an entire population in a community. For example, there might be a community-focused intervention in your community that aims to vaccinate children for whooping cough. These interventions change community attitudes, awareness, practice, norms, and behaviors. It is important to note that this community-focused intervention supports the individual-level intervention in which any given person receives his or her vaccination.

Individual-focused interventions are directed at individuals and families. These interventions change the knowledge, attitudes, beliefs, practices, and behaviors of individuals. For example, a nurse advising an individual with a family history of high blood pressure on diet and lifestyle changes is an example of an individual-focused intervention.



There are many specific types of interventions. In this presentation, we are going to focus on four types and look at examples of each. The types are screening, health education, social marketing, and policy development.



Screening is a type of intervention in which members of a population are tested for a specific disease known to be a major health issue. Members of a population who are showing symptoms of the disease will be screened. The screening is also meant to identify individuals who may have the disease but are not experiencing symptoms. With many diseases, early detection of a disease is key to effectively treating and managing it.

Public health screening is an intervention that is used in Australia and other countries to address breast cancer. Breast cancer is the second most common cause of cancer-related death in Australian women. Government officials and other health workers believed that well-organized mammograms would substantially reduce the number of deaths from breast cancer, so in 1990 a new intervention program called BreastScreen Australia began. The program targeted a specific population: well women without symptoms between the ages of 50 and 69. Since the program began, there has been a reduction in breast cancer mortality of about 25%.



Health education is a type of intervention in which communicating facts, ideas, and skills about health helps to change health knowledge, attitudes, values, beliefs, behaviors, and practices.

The Asthma Care Training (ACT) for Kids is an example of a health education intervention. In three educational sessions in pediatric clinics across the United States, children ages 7–12 and their families learn asthma self-management skills. The program is based on the idea that children should be active participants in the prevention and control of their symptoms. This means that they should be able to recognize asthma symptoms and know what actions to take. Parents participate too, learning about things like how to control environmental pollutants and irritants. The result of the program was that the frequency and severity of asthma episodes was reduced.



Social marketing is another type of intervention. In this type of intervention, commercial marketing principles and technologies are used to influence the health knowledge, attitudes, values, beliefs, and behaviors of population members.

In the United States, the CDC launched a social marketing intervention called the VERB. For four years this intervention used print, radio, and television ads to encourage increased physical activity in the tween population. Commercials were aired on stations like MTV, the Cartoon Network, and Nickelodeon, and advertisements were placed in national magazines like Teen People, Family Circle, and YM. The campaign was geared toward both parents and kids. One ad showed a basketball. It encouraged parents to be physically active with their kids, saying that kids who are physically active aren’t just healthier but feel better about themselves. On the basketball were the words “Inflate your child’s self esteem.”

Image courtesy of Centers for Disease Control; retrieved from http://www.cdc.gov/youthcampaign/ on April 23, 2012, and reproduced under fair-use guidelines of Title 17, US Code. Copyrights belong to respective owners.



Policy development is another type of health intervention. Policy development results in laws, rules, regulations, ordinances, and policies about issues related to health. Policy development is a type of intervention that is aimed at systems as well as individuals and communities.

South Africa is a country that has used policy development as a form of health intervention. Like many countries, South Africa has passed into law a number of measures aimed at creating smoke-free environments and reducing the number of tobacco-related health issues in the population. For example, smoking is only allowed in designated areas in work places, public places, and public transportation. Tobacco advertising is mostly banned. All tobacco products, like cigarette boxes, contain warnings.



When tackling a health issue, it is often the case that more than one intervention is used. For example, while policy development is helping to change smoking behavior in South Africa, there are also programs that use health education as an intervention to educate communities and individuals about the effects of smoking.

Comprehensive interventions often use multiple techniques. They also often require global cooperation from multiple governments and health organizations and agencies, like the WHO, the Red Cross, or the Bill and Melinda Gates Foundation. Health issues that require global cooperation include diseases that spread around the globe, like avian flu, malnutrition related to changing climate patterns and global warming, and diseases linked to war and conflict. You will learn more about global cooperation later in this course.



Interventions are about making change. They focus on individuals, communities, and systems. There are many types of successful interventions, including screenings, health education, social marketing, and policy development. Governments and global health organizations use interventions to tackle pressing global health concerns around the world.




Reading: Community-Based Interventions

Directions: Follow your teacher’s instructions for circling difficult terms and writing down questions as you go through this reading.

Community-based interventions are one of the most important tools available to global health workers. To understand how and why community interventions work, it’s important to grasp the underlying concept of community.

How do you define community? By religion? Age? Place? Health condition? There are many ways that global health workers define community.

Place, or geography, is often the way we define community. For example, you could refer to a community by a general area, such as the community on the other side of the river or the community south of the railroad tracks. A community could also be defined by a physical feature, such as the community near Grant Park or the Peralta Elementary School community. Political boundaries or municipal lines can also make up a geographic community, such as the Jacksonville community or the Clark County community.

A community can also be defined by a shared interest, behavior, or characteristic. For example, people who are active in cleaning up a neighborhood park could be considered a community. They have a shared interest. Drug users who use needles are a community defined by a risky behavior. Hearing-impaired adults form a different type of community. They have a shared health condition.

What Does a Community Intervention Look Like?

Community-based interventions are about making positive change. What community-based interventions have in common is that they aim to reduce the impact of disease and other health-related risk factors in a supportive environment.

All community interventions have four main components: resources, activities, products, and outcomes. The following table explains each of these components:

Targeting a Community

Community-based health interventions target a particular community. They might target a community that is defined by a place. They might also target a community that is defined by a shared interest, behavior,

Component What It Is Examples

Resources Elements needed to make the intervention happen

Staff, time, money, facilities, equipment

Activities What the program does with the resources to fulfill its mission

Educating people about a health issue, like safe driving and distributing vaccines

Products The goods that result from the program activities

Number of brochures handed out, doses of vaccine delivered

Outcomes The benefit during and after program activity

Changed attitudes about a health issue, children vaccinated



or characteristic. A community can be broad, such as young athletes, or specific, such as young athletes who have had concussions.

Television ads that carry a public health message are one type of community-based intervention. These ads may target a broad community, such as young athletes. For example, an ad campaign targeting young athletes might show professional athletes talking about the importance of wearing safety gear.

The ads could also target a specific community, such as young athletes who have had concussions. These ads might also feature professional athletes, but in these ads the athletes could be discussing the dangers of returning to sports too soon after a concussion. They might share their personal experience, making the ad more effective.

Ethical Issues

As you have learned, ethics are moral beliefs and rules about right and wrong. Ethical issues are a major part of community-based interventions. People who plan interventions want to make ethical decisions that are right, moral, fair, and just for the community they are working with.

Public health workers who plan community-based interventions respect the rights of the individuals in the group they are targeting. As outsiders they want to make sure that they are not assuming that they know what a community needs or what is best for a community. Instead, they try to discover what the real needs of a community are. They often do that by first assessing what the needs are before planning an intervention. This type of assessment is a critical part of an effective intervention.

For example, a German development organization is planning an intervention in a rural area of Uganda. Before assessing the needs of the community, the organization expected that the intervention would be a campaign to raise awareness about the importance of children attending school. Then organizers spoke to community members. They learned that parents wanted to send children to school but that the school lacked sanitation facilities. For this reason, parents were discouraged from sending their children to school, so the group changed its strategy. Instead of a campaign, they began constructing sanitation facilities at the school. The focus of their intervention shifted after assessing the needs of the community.

Respecting and acknowledging diverse values, cultures, and beliefs is another ethical issue that is an important part of community-based interventions. For example, a nonprofit agency planned an intervention to promote the benefits of breast-feeding in a Muslim community in northern India. The agency wanted to respect the values and beliefs of the community. In the community, it was unacceptable for women to meet with men who were not relatives, so the agency arranged for only female educators to visit the communities and lead the workshops.

Levels of Prevention

Interventions typically focus on at least one, but sometimes all three, of the following levels of prevention: primary, secondary, and tertiary. The chart shows how each level of prevention is defined and gives an example of an activity for each.

Level of Prevention What It Means Example

Primary prevention Intervention that focuses on preventing a disease or condition before it begins

A program that vaccinates children for whooping cough

Secondary prevention Intervention that focuses on screening and the early diagnosis of a disease or condition

A skin cancer screening program for women over 55



Level of Prevention What It Means Example

Tertiary prevention Intervention that focuses on preventing disease progression after a disease or a risk factor has been identified

A physical activity program for overweight adult males with a family history of cardiovascular disease

Evaluating Community-Based Interventions

Evaluation is an important part of community-based interventions. When interventions are evaluated, their processes as well as their effectiveness and the level of benefit the programs provide participants are measured. Programs are evaluated to figure out how to improve them.

There are many methods to evaluate an intervention. Here are three:

An evaluation might assess the impact that program activities and products have on the outcome. For example, it might be determined that educating people about safe driving by means of brochures results in fewer accidents over time.

An evaluation might assess a program from an economic perspective. For example, an evaluation might find that online ads are more cost-effective than brochures in changing people’s driving behavior. Revising the program so that more resources are spent on online ads than brochures would be a better use of resources.

An evaluation might consist of holding focus groups or interviewing community members to see how effective a program is. For example, interviews might reveal that community members would be likely to read an email about texting and driving and forward it to a friend, but they wouldn’t be likely to read or share a brochure they received in the mail. This information can be used to improve the program.

Putting It All Together

The following chart shows specific types of interventions, which community was targeted, the level of prevention that was the focus of the intervention, how the intervention was evaluated, and what was learned during the evaluation.

Community-Based Intervention

Level of Prevention

Evaluation

Support group for HIV-positive women in Tanzania

Tertiary A survey was conducted to see how women responded to the support group.

The evaluation found that the intervention was effective in decreasing stress and improving coping and overall mental health.

Advertisements in a Spanish-speaking community in Miami about preventing sudden infant death syndrome (SIDS)

Primary Data was compiled to see if there had been a change in the incidence of SIDS cases.

The evaluation found a reduced incidence of SIDS by 45% over the course of 10 years.

Community-based interventions target specific communities. They focus on at least one level of prevention. Effective interventions evaluate progress periodically and use what they learn from the evaluation to improve their program.




Investigative Questions: Motorcycle Helmet Laws

Directions: As you complete this reading, follow the instructions that accompany each letter.

Introduction A US Senate committee is considering enacting a federal law that would require all motorcycle drivers and passengers to wear helmets. The committee has received letters from two powerful organizations. One organization supports the law and the other is against it. The committee will meet soon with representatives from both organizations. As Senate committee aides, your group has been asked to read the letters and prepare a list of investigative questions that committee members can ask the organizations’ representatives. Your questions should force the organizations to defend their position with factual information and reasoned arguments. The senators need to acquire facts and figures that will enable them to develop policy that is in the best interest of all Americans.

Letter Against the Law As you read the letter below, circle any section that gives you an idea for a question the committee could ask. Write the question in the margin next to the pertinent section. Try to think of at least two questions.

August 17, 2015

Dear Committee Members,

Americans Against Federal Helmet Laws strongly urges you to not enact a law that would require all motorcycle riders to wear helmets. We represent tens of thousands of Americans who believe that wearing a helmet is a personal choice, which should not be legislated.

Our opponents say that in states where strict helmet laws have been passed, accidents have decreased. But these decreases are not related to the laws. They are related to training and education programs, which we wholly support. Laws do not change people’s behavior, but education does.

Our opponents also say that if there is an accident, helmets protect riders from head and neck injuries. But do they really?

The best way to protect riders is training and responsible riding.

We don’t believe that enough research has been conducted to draw conclusions on this point. In fact, we believe that helmets may even cause head and neck injuries in the case of an accident and that they impair riders’ vision and hearing.

Finally, when states have passed laws requiring helmets, motorcycle sales have immediately dropped. Imagine the effect a national helmet law would have on the motorcycle industry. Imagine how many people’s jobs would be at stake!

Thank you for considering our position. We look forward to discussing this important issue.

Sincerely,

Marissa Santiago and John Nell, Presidents of Americans against Federal Helmet Laws



Letter in Support of the Law As you read the letter below, circle any section that gives you an idea for a question the committee could ask. Write the question in the margin next to the pertinent section. Try to think of at least two questions.

August 3, 2015

To Senate Committee Members,

We are writing on behalf of all Americans who have lost loved ones in cases where a fatality could have been prevented by the wearing of a motorcycle helmet. Please consider moving forward with a law requiring all motorcycle riders to wear helmets.

For over 30 years, it’s been found that when states enact strict helmet laws, deaths and injuries decrease. And when states repeal such laws, deaths and injuries go up. Here are just two examples:

In 1992, California adopted an excellent law requiring helmets for all riders. The result was that the number of fatalities decreased by 37%.

In 1977, Texas weakened its helmet laws. The new law said that only people under the age of 18 were required to wear helmets. Fatalities spiked by 35%.

Motorcyclists and their families are not the only ones who pay in the absence of a national all-rider helmet law. Society pays big time. One study estimated that in 2002, $853 million in costs would have been saved if all motorcyclists had worn helmets. These costs include medical care, rehab, lost productivity, and legal and insurance costs.

We are facing a national epidemic that we believe requires swift action. Thank you for your support.

Best regards,

Helmet laws save lives and protect less skilled riders.

Bob Martin and Gregory Wang

Board members of Helmets Now!




Compare and Contrast: Community-Based and Policy-Based Interventions


Directions: An issue like driving and texting can be addressed by both policy interventions and community interventions. Read the sections below and answer the questions about each intervention. Then use the Venn diagram to compare and contrast community-based health interventions and policy interventions.

Introduction to Driving and Texting

Driving and texting, a type of distracted driving, is a leading cause of accidents in the United States. This issue especially affects teens. According to one survey, almost half of teens admit to driving and texting. People who drive and text are 23% more likely to be in a crash than those who don’t.

By 2015, 46 states had implemented a policy intervention to address this serious issue. These states have laws banning texting while driving. Community health interventions are also used to fight driving and texting.

Community Interventions Address Texting While Driving

The It Can Wait program alerts teens to the dangers of texting while driving. Health educators visit high schools in communities in several states, such as Arkansas and Florida. They show a documentary that features the families of teens who died in texting and driving accidents. They also bring an experiment. Teens take turns “driving” in a special car. They put on headgear that shows an active roadway with pedestrians and stoplights. Hooked up to a simulator, the teens steer and press gas and brake pedals while texting. Their peers watch on a screen as the teen drivers try to navigate the objects in the road.

Who is the target audience of the It Can Wait program?

Who runs the program?

What are some of the resources that the program needs in order to run?

What consequences do students face if they disregard the program?

What outcome do you think program organizers are hoping for?



Policy Interventions Also Address Texting While Driving

In 2007–2008, electronic communication devices were the cause of 1,336 wrecks in Arkansas. In response to the problem, a law went into effect in 2009 prohibiting Arkansas drivers from texting while driving. The ban is referred to as Paul’s Law, named after a father who was killed in a head-on crash with a driver who was typing a text. The law prohibits reading, writing, or sending text messages while driving. Drivers will be fined if they are caught texting while driving.

Who does the Paul’s Law intervention affect?

Who is involved in enforcing the intervention?

What are some of the resources that the program needs in order to run?

What consequence do drivers face if they don’t follow the law?

What outcome do you think lawmakers are hoping for?



Community Interventions

Policy Interventions

Comparing the Community Intervention and Policy Intervention Approaches

List characteristics of policy interventions in the left oval, characteristics of community interventions in the right oval, and characteristics that are common to both in the overlapping area. Consider factors such as outcomes, target audience, activities, and other characteristics of interventions you have learned about.


AOHS Global Health

Lesson 12 Cooperative Efforts to Improve

Global Health In this lesson, students learn about cooperative efforts to address natural disasters and complex humanitarian emergencies. They compare and contrast different characteristics of natural disasters and complex humanitarian emergencies. They also view a video on polio eradication in India and analyze the role of innovation in the eradication. They learn about different real-life scenarios that required multinational cooperative efforts and analyze the reasons that cooperation is necessary. Students use PowerPoint slides to create graphic narratives that focus on a specific emergency and illustrate the need for global cooperation. For their culminating project, they identify types of interventions that could be used to address the health issue they have chosen to focus on.

Advance Preparation

In Class Periods 1, 3, and 4, each student will need access to a computer for Internet research. In Class Periods 3 and 4, each student will also need PowerPoint or similar presentation software. Students will also need access to a color printer in Class Period 4.

In Class Period 2, you will need access to the YouTube video Innovations in Polio Eradication at http://www.youtube.com/watch?v=V_BxUwFLkMM. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

During the lesson, students create graphic narratives that focus on a specific emergency and illustrate the need for global cooperation. You may wish to arrange in advance for students to display their completed narratives in a public space, such as the school library, media center, or cafeteria, or in a public library or city hall.


Lesson Framework


Explain why and how natural disasters and complex humanitarian emergencies are addressed through international cooperation

AOHS Global Health Lesson 12 Cooperative Efforts to Improve Global Health


Explain the importance of creating and sharing innovations in public health

Describe a global intervention that encourages innovative approaches and information sharing, and explain why it is effective


Model verbal and nonverbal communication (National Health Science Standards 2015, Standard 2.11)


Identify ethical issues and their implications related to healthcare (National Health Science Standards 2015, Standard 6.12)


Evaluate roles and responsibilities of team members (National Health Science Standards 2015, Standard 8.11)

Identify characteristics of effective teams (National Health Science Standards 2015, Standard 8.12)



Evaluate accepted ethical practices with respect to cultural, social and ethnic differences within the healthcare workplace (Common Career Technical Core 2012, HL 6)

Assessment


Graphic narrative on successful cooperative action for global health (Student Resource 12.4)

Assessment Criteria: Graphic Narrative on Successful Cooperative Action for Global Health (Teacher Resource 12.1)

Prerequisites Knowledge of environmental, nutritional, and behavioral risk factors

Knowledge about the scope of health determinants

Knowledge of the characteristics of community and policy interventions




Teacher Resources Teacher Resource 12.1, Assessment Criteria: Graphic Narrative on Successful Cooperative

Action for Global Health

Teacher Resource 12.2, Key Vocabulary: Cooperative Efforts to Improve Global Health

Teacher Resource 12.3, Bibliography: Cooperative Efforts to Improve Global Health

Student Resources Student Resource 12.1, Reading: Natural Disasters and Complex Humanitarian Emergencies

Student Resource 12.2, Note Taking: Natural Disasters and Complex Humanitarian Emergencies

Student Resource 12.3, Vignettes: Reasons for Cooperation in Global Health

Student Resource 12.4, Graphic Narrative: Successful Cooperative Action for Global Health

Student Resource 12.5, Culminating Project Work: Intervention Strategies

Equipment and Supplies LCD projector and computer to show a video

Computers with Internet access and PowerPoint (or similar software), one per student

A color printer for students to print PowerPoint slides


Pushpins or sticky notes to mark locations on classroom map

Poster board, scissors, tape, and other supplies for creating graphic narratives

Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1

25 Discussion: Natural Disasters and Complex Humanitarian Emergencies

The purpose of this activity is to activate students’ prior knowledge about contemporary natural disasters and complex humanitarian emergencies and to generate ideas about



Step Min. Activity

why a global effort is required to address these situations.

Before class begins, make sure the classroom world map is hanging in a prominent place where students can reach it.

Ask student volunteers to name a natural disaster or complex humanitarian emergency that they know about, such as Hurricane Sandy in 2012 or the earthquake, typhoon, and flooding that afflicted the Philippines in 2013 and 2014.

If students are having difficulty selecting a disaster, or if they are all generating the same response, have students visit the following sites for ideas:

Natural Disasters and Extreme Weather: http://www.guardian.co.uk/world/natural-disasters

ReliefWeb: http://reliefweb.int/

The UN Refugee Agency: http://www.unhcr.org/pages/49c3646c23f.html

Create a three-column chart on the board. As students share their responses, list the specific disasters and emergencies that they name in the first column.

Next, ask student volunteers to come up to the classroom map and locate where the disasters or emergencies occurred by marking them with pushpins or sticky notes. Then ask students to identify the countries on their regional reference maps. Tell students that throughout the lesson, they will learn about natural disasters and complex humanitarian emergencies that have occurred across the globe. Remind students that as they learn about them, they should add the information to their regional reference maps.

Then work with the class to create a list of consequences resulting from the disasters and emergencies. Record student responses in the second column of the chart. Responses might include loss of life, deterioration of health and human services, ecological destruction, economic loss, infrastructure damage, government upheaval, displacement of people, disease, or discrimination.

Next, ask students to work with a partner to choose one of the disasters or emergencies and discuss the question:

What kind of assistance do you think was needed to alleviate victims’ suffering?

Have pairs share their responses and record them in the third column of the chart. Sample responses might include help from other countries, clean water, food, and shelter, or a fast response from the government.

Then write the following question on the board, and have students share their responses with the class:

Why do you think many disasters and emergencies require some type of global intervention?

When considering their response, encourage students to think about which people and countries they consider most vulnerable to the consequences of disasters and emergencies.

To conclude, point out that disasters have been increasing in frequency and impact, and there is a growing need for worldwide response to related health crises.

2 25 Reading: Natural Disasters and Complex Humanitarian Emergencies



Step Min. Activity

The purpose of this activity is for students to characterize the following:

Natural disasters and complex humanitarian emergencies

Refugees and internally displaced people

Vulnerabilities of men, women, and children

To begin, ask student volunteers to explain what they think the difference is between a natural disaster and a complex humanitarian emergency, based on the discussion from the first activity. Then explain that the reading will help them to clarify their definitions of these terms.

Refer students to Student Resource 12.1, Reading: Natural Disasters and Complex Humanitarian Emergencies, and Student Resource 12.2, Note Taking: Natural Disasters and Complex Humanitarian Emergencies. Tell students that they will take notes using Student Resource 12.2 as they work through the reading. Ask students to read the directions on Student Resource 12.2, and answer any questions. If necessary, have a student volunteer recall the function of a Defining Format chart. Then have students get to work.

At the end of the class period, tell students that they should complete the reading and resource for homework and come to the next class prepared to discuss their responses.

CLASS PERIOD 2

3 10 Homework Review

In this activity, students review the reading and resource about natural disasters and complex humanitarian emergencies that they completed for homework.

Refer students to Student Resource 12.2, which they completed for homework. Then create a Defining Format chart and Venn diagrams on the board like the ones on the resource. Fill in the chart and diagrams on the board as students share their responses with the class. Use this time to clear up any misunderstandings. You may want to gauge student understanding by assessing Student Resource 12.2 on a credit/no-credit basis.

4

20 Video: Innovations in Polio Eradication in India

Students consider innovation as another important topic related to global health.

To prepare, make sure you can access UNICEF India’s YouTube video on polio eradication at http://www.youtube.com/watch?v=V_BxUwFLkMM. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

Introduce the activity by explaining that innovation is another important topic related to global cooperation for health. Ask students what they think innovation means. Take some suggestions and explain that it means coming up with something new, something that hasn’t been tried before. The problems confronting global health definitely require new ideas for solutions.

Explain to students that innovations can take different forms. They can be partnerships with organizations such as United Nations agencies like the WHO, development banks



Step Min. Activity

like the World Bank, and foundations like The Rockefeller Foundation, as well as think tanks, human rights organizations, and advocacy organizations. Explain that innovations can also be strategies, such as ways to communicate with people who live in hard-to-reach rural areas, and technologies, such as diagnostic tests, vaccines, and medicines.

Ask student volunteers to recall and explain what polio is. Then tell students that the video they will be watching shows how innovations have been used successfully to eradicate polio in India.

Then write the following categories on the board:

Innovations in Partnerships

Innovations in Strategies

Innovations in Technologies

Instruct students to write these categories in their notebook, with space to write examples below each one. As they watch the video, tell them to create a list in their notebook of the different innovations that they learn about, placing each one in the appropriate category.

Using an LCD projector, show students the video Innovations in Polio Eradication at http://www.youtube.com/watch?v=V_BxUwFLkMM.

Call on students to name innovations that they identified, and work as a class to categorize them into the three categories on the board. Explain that an innovation may fall into more than one category. The following are examples of an innovation in each category:

Innovations in Partnerships: partnership with UNICEF

Innovations in Strategies: house-to-house vaccinations

Innovations in Technologies: rapid stool-sample test

After the initial round of categorizations, you may wish for students to watch the video again, looking for innovations that they missed during the first viewing.

To conclude, use the following questions to guide a discussion about the importance of global cooperation and innovation to eradicate polio:

What do you think are the reasons that complete eradication in India might not occur?

Do you think the innovations used in India might work in other countries? Why or why not?

Is there one innovation that seems like the most important?

Think about what you know about the cell phone, Internet, and social media that could be the basis for innovation in communication. How might an innovation in communication be used to help eradicate polio in other countries?

Point out to students that one of the key challenges in public health interventions, whether on a community level or a global level, is developing innovative technologies and strategies that will maximize the effectiveness of the intervention.

5 20 Vignettes: Reasons for Cooperation in Global Health

This activity exposes students to examples of cooperation in global health to help them assess why cooperation in global health is needed.



Step Min. Activity

To begin, ask volunteers to state reasons why they think that cooperation is needed in global health emergencies. Create a list of responses on the board. These may include:

The emergency affects more than one country.

Disease or contamination is likely to spread to multiple countries.

The emergency requires more technical or managerial resources than the affected country can provide.

The resources needed to alleviate the emergency are expensive.

Explain that in this activity, students are going to think about the particular reasons why cooperation is needed in various global health emergencies. Assign students to pairs and refer them to Student Resource 12.3, Vignettes: Reasons for Cooperation in Global Health. Remind students to update their regional reference maps as they work.

Instruct students to read each vignette and then discuss with their partner the reasons why global cooperation was needed. Ask pairs to write their responses to the questions in the space provided following each vignette.

After students have completed their work, write the following question on the board and have students discuss their responses as a class:

Based on the scenarios you read about, what is one reason that individuals and organizations might not work together during an emergency or disaster?

To conclude, point out that in general, the quicker and more organized the global response is to an emergency, the less loss of life and damage there is.

CLASS PERIOD 3

6

50 Graphic Narrative Assignment: Successful Cooperative Action for Global Health

The purpose of this activity is for students to research a successful cooperative action in the realm of global health and create a graphic narrative that demonstrates the effectiveness of cooperation for improving global health. It also focuses on the following college and career skills:



Before this activity, you may wish to arrange for students to display their completed graphic narratives in a public space, such as the school library, media center, or cafeteria, or in a public library or city hall.

Assign students to groups of three, and explain that they will be creating a graphic narrative that features a successful cooperative action in the realm of global health. The purpose is to demonstrate the effectiveness of cooperation for improving global health. Explain that students will create a set of PowerPoint slides, with visuals in the slide and text in the notes section that accompanies each slide. They will print out and organize this material into an easy-to-follow, visually appealing graphic narrative.

If you have arranged for students to display their work, explain that their narratives will be displayed (tell them where) to raise awareness of global cooperation for public health.



Step Min. Activity

Refer students to Student Resource 12.4, Graphic Narrative: Successful Cooperative Action for Global Health. Instruct them to read the directions and the assessment criteria. Answer any questions.

Have students choose their issue and begin their research. Tell them that by the end of the class period, they should have a solid draft of their slides. Explain that they will have 20 minutes in the next class period to put it all together, but if they think they will need more time, they should work on their slides for homework.

CLASS PERIOD 4

7

20 Graphic Narrative Assignment: Successful Cooperative Action for Global Health (Continued)

In this activity, students complete their graphic narratives.

Instruct students to use the next 20 minutes to complete their graphic narratives. Tell them they should look at their slides as a group to make sure that they are all accurate and that they complement each other, telling a story that their audience will find persuasive. Advise the students to check that their slide set meets the assessment criteria and to make any final changes to their slides.

Finally, have students print out their slides and arrange them on their poster board in a storyboard format. If necessary, give them instructions for printing out their slides. Remind students that they can either leave the notes below each slide or snip them apart and arrange them in a way that makes their story flow for the audience.

Collect the graphic narratives and assess them using Teacher Resource 12.1, Assessment Criteria: Graphic Narrative on Successful Cooperative Action for Global Health. If you have arranged for displaying the narratives, remind students of where they will be on display. Encourage them to bring their friends and family to see their narratives and to see the work of their classmates.

To conclude, summarize the following points about effective cooperation:

Countries with limited resources would be unable to respond to emergencies if it weren’t for cooperation.

Global cooperation allows use of multiple innovations in responding to an emergency.

Emergencies or disasters that extend across national boundaries require the participation of multiple nations and groups.

8

30 Culminating Project Work: Evaluating Intervention Strategies

The purpose of this activity is for students to use what they have learned about intervention strategies to decide what types of strategies may be effective for the health issue that they have chosen for their culminating project.

Have students meet in their culminating project groups. Explain that they are going to use what they have learned about intervention strategies to decide what types of strategies may be effective for the health issue that they have chosen for their culminating project.

Refer students to the argument that they wrote in Lesson 10 to refresh their memory.



Step Min. Activity

Next, refer students to Student Resource 12.5, Culminating Project Work: Intervention Strategies. Have students read the directions and look at the example. Answer questions. Emphasize that students should include as many interventions as they can think of, and that they can narrow down the options later. Tell them to conduct research online to gather more ideas and to try to be as specific as possible. For example, instead of saying “pass laws banning cigarette sales in certain places,” they might say “pass laws banning cigarette sales from vending machines and grocery stores.” Also tell them that if they don’t think a type of intervention would be appropriate for their issue, they should explain why in the chart.

Circulate as students work, allowing them to share their ideas with you.

When students have completed their work, ask each group to share two interventions that they think would be effective, encouraging them to explain their reasons.

To conclude, point out that for most major global health issues, more than one type of intervention is needed to tackle the problem.

Extensions

Content Enrichment Have students read the UNHCR booklet “Refugee Teenagers: Escape and Protection from

Persecution and War” (http://www.unhcr.org/4534f1e713.html). Then have them write letters or emails to their local or national elected officials, urging them to support refugees in general or to find solutions for a specific refugee crisis.

Show students the film Trouble the Water, which is about Hurricane Katrina (http://www.troublethewaterfilm.com/). Then have students respond to the documentary by considering the role that racial issues can play in natural disasters.

Have students use color or graphics to create a map depicting the refugees from and in countries in the Middle East. Encourage students to be creative, yet clear and accurate, with their maps. Facts about refugees in the Middle East can be found at the UN Refugee Agency’s Middle East page (http://www.unhcr.org/pages/49e45ade6.html).

STEM Integration Science: Have students work in groups to research the science behind the occurrence of natural

disasters, such as a hurricane, earthquake, or tsunami. Students should also focus on what effect, if any, experts think climate change is having on the frequency and severity of the disaster. Have students create presentations about their findings.

Technology: Ask students to consider what disasters might befall their own community and how they could best prepare themselves, their families, and their neighborhoods by visiting the website Ready at http://www.ready.gov/youth-preparedness. Students can work together to develop a disaster preparedness plan and present it at a school assembly.



Additional Cross-Curricular Ideas English Language Arts: Provide students with a list of books related to the topic of child soldiers,

using the following list as a guide. Have students choose a book to read and then write a book review in which they discuss the weaknesses and strengths of the book and describe the book’s approach to the topic. Encourage students to use what they know about complex humanitarian emergencies as they put together their ideas.

o A Long Way Gone: Memoirs of a Boy Soldier, by Ishmael Beah

o What Is the What, by Dave Eggers

o War Child: A Child Soldier’s Story, by Emmanuel Jal and Megan Lloyd Davies

History or English Language Arts: Have students choose one of the following natural disasters:

o 1815 Mount Tambora volcanic eruption in Indonesia

o 1906 San Francisco earthquake

o 1931 China floods

o 1988 United States heat wave

o 2004 Indian Ocean tsunami

o 2005 Kashmir earthquake

Tell students that they are going to research and write a historical fiction story that takes place either during or right after their chosen disaster. Explain that the story should be based on historical facts and that the setting and characters should be believable and true to the event.


AOHS Global Health


Global Health

Teacher Resources


Teacher Resource 12.1 Assessment Criteria: Graphic Narrative on Successful Cooperative Action for Global Health

Teacher Resource 12.2 Key Vocabulary: Cooperative Efforts to Improve Global Health

Teacher Resource 12.3 Bibliography: Cooperative Efforts to Improve Global Health




Assessment Criteria: Graphic Narrative on Successful Cooperative Action for Global Health

Student Names:______________________________________________________________

Date:_______________________________________________________________________


Met Partially Met

Didn’t Meet

The graphic narrative demonstrates an understanding of the health issue it presents and the cooperative effort undertaken to address the issue.

□ □ □

The text of the graphic narrative enriches understanding of the visual it accompanies and tells the story of the cooperative global health effort in an engaging way.

□ □ □

The graphic narrative clearly explains why cooperation was needed and what key factors and innovations led to success.

□ □ □

Visuals are used effectively to convey information. □ □ □

The slides are presented in a way that holds the viewer’s attention and walks the viewer through the narrative in a compelling and logical order.

□ □ □

The graphic narrative is neat and uses proper spelling and grammar.

□ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Key Vocabulary: Cooperative Efforts to Improve Global Health

Term Definition

adverse Harmful; unfavorable.

cholera An infection of the small intestine that causes profuse diarrhoea and can be fatal if untreated.

complex humanitarian emergency (CHE)

A disaster caused by a human conflict or political situation that threatens the security of a region and is linked to death, illness, injury, and destruction.

creed A statement of belief.

famine A widespread scarcity of food.

graphic narrative A story accompanied by visual elements; a genre that includes comic books, graphic novels, and sequential art.

innovation Something new; in global health, a new way to solve a problem or a new way of thinking about an issue that leads to a new solution.

internally displaced person or people (IDP)

A type of refugee who is forced to flee home but stays in his or her country.

natural disaster A disaster related to weather or a natural occurrence that causes damage, ecological destruction, death, and the deterioration of health.

quarantine A mandatory isolation of people or animals often used to prevent the spread of disease.

refugee A person who is forced to flee his or her country to escape danger or because of a fear of persecution.

severe acute respiratory syndrome (SARS)

A previously unknown severe form of pneumonia that spread quickly around the globe in 2003 and required cooperative action; no known cases of SARS have been reported since 2004.




Bibliography: Cooperative Efforts to Improve Global Health



Online Deasy, Kristin. “UN: World Refugee Population Skyrockets in 2011, Highest This Century.” Global Post, June 17, 2012, http://www.globalpost.com/dispatch/news/regions/americas/united-states/120617/un-world-refugee-population-skyrockets-2011-high (accessed October 27, 2015).

“Fact Sheet: Child Soldiers,” UNICEF, http://www.unicef.org/emerg/files/childsoldiers.pdf (accessed October 27, 2015).

“Facts and Figures about Refugees,” UNHCR, http://www.unhcr.org.uk/about-us/key-facts-and-figures.html (accessed October 27, 2015).

“Global Trends Report: 800,000 New Refugees in 2011, Highest This Century.” UNHCR, June 18, 2012, http://www.unhcr.org/print/4fd9e6266.html (accessed October 27, 2015).

“Haiti.” New York Times, http://topics.nytimes.com/top/news/international/countriesandterritories/haiti/index.html (accessed October 27, 2015).

“Internally Displaced People Figures.” UNHCR, http://www.unhcr.org/pages/49c3646c23.html (accessed October 27, 2015).

“The Operational Response to SARS.” WHO, April 16, 2003, http://www.who.int/csr/sars/goarn2003_4_16/en/ (accessed October 27, 2015).

“Over 435,000 Malians Displaced As Country Faces Complex Emergency—UN.” UN News Centre, August 16, 2012, http://www.un.org/apps/news/story.asp?NewsID=42693&Cr=+mali+&Cr1 (accessed October 27, 2015).

“Refugee Figures.” UNHCR, http://www.unhcr.org/pages/49c3646c1d.html (accessed October 27, 2015).

“SARS Basics Fact Sheet.” CDC, http://www.cdc.gov/sars/about/fs-SARS.html (accessed October 27, 2015).

“Severe Acute Respiratory Syndrome (SARS).” PubMed Health, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004460/ (accessed October 27, 2015).

“Turkey’s Border Porosity Problem with PKK.” Small Wars Journal, June 18, 2009, http://smallwarsjournal.com/jrnl/art/turkeys-border-porosity-problem-with-pkk (accessed October 27, 2015).

“2011 Tōhoku Earthquake and Tsunami.” Wikipedia, http://en.wikipedia.org/wiki/2011_T%C5%8Dhoku_earthquake_and_tsunami (accessed October 27, 2015).

“2015 UNHCR Country Operations Profile—Mali,” UNHCR, http://www.unhcr.org/pages/49e484e66.html (accessed October 27, 2015).



UNICEF India. “Innovations in Polio Eradication.” YouTube video, 7:00. May 23, 2012. http://www.youtube.com/watch?v=V_BxUwFLkMM (accessed October 27, 2015).

“Who We Help.” UNHCR, http://www.unhcr.org/pages/49c3646c11c.html (accessed October 27, 2015).


AOHS Global Health


Global Health

Student Resources


Student Resource 12.1 Reading: Natural Disasters and Complex Humanitarian Emergencies

Student Resource 12.2 Note Taking: Natural Disasters and Complex Humanitarian Emergencies

Student Resource 12.3 Vignettes: Reasons for Cooperation in Global Health

Student Resource 12.4 Graphic Narrative: Successful Cooperative Action for Global Health

Student Resource 12.5 Culminating Project Work: Intervention Strategies




Reading: Natural Disasters and Complex Humanitarian Emergencies

The people of Sierra Leone suffered greatly during a civil war from 1991–2002. The fighting left more than 50,000 people dead. During the war, women were raped, people were tortured and enslaved, and children were forced to be soldiers. Many people were displaced from their homes, and families were torn apart.

Haiti is one of the poorest countries in the world. In January 2010, a 7.0 magnitude earthquake violently shook the capital city. Major devastation followed. Over half of the existing health facilities were destroyed. The estimated death toll ranged from 200,000 to as high as 316,000. Even more people were injured. The earthquake damaged the country’s already burdened infrastructure (basic services and facilities like roads and water supply) and many people lost their homes. A cholera epidemic followed the earthquake, sickening about half a million people. Years after the catastrophe, people were still living in inadequate tent camps and broken buildings.

Port-au-Prince was in rubble after the earthquake.

The earthquake in Haiti was a natural disaster. The civil war in Sierra Leone was a complex humanitarian emergency (CHE). Both situations have a significant effect on global health. Earthquakes and armed conflict both lead to death, illness, disabilities, and severe economic consequences. Both natural disasters and CHEs require a cooperative effort of multiple countries, organizations, and agencies to alleviate the suffering of the victims.

Natural Disasters

A natural disaster causes damage, ecological destruction, and death. Global health is concerned with natural disasters that cause large-scale destruction that can only be addressed by global cooperation. In a natural disaster like the Haiti earthquake, the suffering of the people is so great that assistance from outside the country is vital. People and organizations from all over the world gave aid to Haiti.

A natural disaster can be related to weather, such as a drought, hurricane, typhoon, cyclone, or heavy rain. It can also be a natural occurrence like a tsunami, volcano, or earthquake. Earthquakes are the natural disasters that kill the most people. More than 90% of deaths caused by earthquakes occur in low- and middle-income countries.

Examples of Natural Disasters

In 2007, a cyclone in Bangladesh killed 3,500 people.

In 2008, a 7.9 magnitude earthquake in western China killed 67,000 people.

In 2009, a typhoon caused mudslides that buried at least 600 people in southern Taiwan.



Natural disasters often have a bigger impact on people in low-income countries. There are several reasons for this. Housing in poor areas is not built to standards needed to withstand the damage caused by a natural disaster. For example, buildings in Los Angeles or Tokyo are constructed to withstand the effects of a moderate earthquake. That is not the case in Haiti. Also, in poor areas a natural disaster often damages elements of the infrastructure. Reservoirs used for clean water can become polluted. Roads that are used to transport sick or hurt people are often damaged, as are hospitals and health clinics.

People can die as a direct result of a natural disaster. For example, they can get buried in the rubble after an earthquake or they can drown during a flood.

The flooding of the Kosi River in India in 2008 killed at least 75 people and displaced over 2 million.1

But many people also become ill or die from indirect events related to the natural disaster. For example, if an earthquake damages a sewage system, people could develop sanitation-related health problems. Other long-term risks for natural disaster survivors include physical disabilities, mental health problems, diarrhoeal diseases, respiratory infections, and skin diseases.

Complex Humanitarian Emergencies (CHEs)

Complex Humanitarian Emergencies, or CHEs, like the civil war in Sierra Leone, account for more deaths each year than all natural disasters combined. Conflicts, wars, or political situations that threaten regional or international security are CHEs. During a CHE, institutions, like banks, schools, or even governments, often collapse. Law and order break down. In a CHE, people are unable to pursue normal activities. Portions of the population are often forced to migrate in an effort to seek safety. Food, water, and safe shelter become limited or unavailable. CHEs are linked to death, illness, and injury that would not have occurred if the conflict hadn’t happened. Conflicts often last for long periods of time, compromising the health of people over years or even decades. Like a natural disaster, a CHE can require the response of outside groups.

CHEs affect health in many ways. Often the groups involved in the conflict will not allow humanitarian assistance provided by global organizations to reach opposing groups, so people who are sick or injured do not get the medical treatment or food or water that they need. Combatants intentionally harm or kill civilians. Torture and rape are used as weapons of war. People suffer from nutritional issues and mental health issues, like depression and post-traumatic stress disorder (PTSD).

Refugees and Internally Displaced People (IDP)

CHEs create refugees. Refugees are people who flee their country because they fear persecution based on their race, religion, nationality, or membership in a social or political group. These people are unable or unwilling to return to their country.

People who flee for safety during a CHE often end up in refugee camps, which are crowded and may not have appropriate sanitation systems. Disease can spread quickly in these conditions. For example, in 1994 there was genocide, or mass murder, in Rwanda. Almost a million people were killed during a short period of time. Because of the violence, tens of thousands of Rwandan refugees fled to the border town

1 Image retrieved from http://commons.wikimedia.org/wiki/File:NDRF_in_Bihar_Flood.jpg on August 22, 2012, and reproduced here under the terms of the Creative Commons Attribution Share Alike 3.0 Unported (http://creativecommons.org/licenses/by-sa/3.0/deed.en). Image courtesy of Kumarrakajee.



of Goma in the Democratic Republic of Congo. In one month in 1994, many refugees died in Goma, and almost all of the deaths were from cholera spread by contamination of the lake where the refugees were getting their water.

An internally displaced person, or IDP, is a type of refugee. IDPs also flee their homes, but they stay in another region of their country. For example, the worsening conflict in the Syrian Arab Republic displaced 6.5 million people in 2015 within the country's borders (this is in addition to the nearly 4.2 million people who have fled the country). These people were forced to leave their homes because of violence or the threat of violence, but they remained in the country. They mostly lived in refugee-type camps or informal camps set up around urban areas.

In 2013, there were 16.7 million refugees and 33.3 million IDPs around the world. Pakistan was the country with the largest number of refugees. These are the highest numbers since 1994.

In 2011, a family that fled from the civil war in Somalia inside the Dadaab refugee camp in Kenya.

Vulnerable People

All refugees and internally displaced people are vulnerable, but people are vulnerable in different ways. Female refugees often face discrimination, harassment, and sexual abuse, even after reaching refugee camps. Pregnant and nursing women are at risk for maternal and reproductive health problems.

Being forcibly displaced, and possibly separated from their families, increases children’s exposure to violence, abuse, and neglect. They have nutritional needs that must be met to ensure normal growth and development. When food is scarce, they face health issues related to growth and development.

Men and boys are often most directly affected by armed conflicts. They are at risk of being forced to participate in armies and militia groups. If they are refugees in countries that ban them from being a part of the workforce, they face not being able to provide for themselves and family.

Military Recruitment of Children

The UN outlaws children from participating in military activities. But today it is estimated that over 300,000 children and teens are fighting in over 30 conflicts around the world.

Sometimes children and teens are forced to become soldiers. Armies and rebel groups have been known to take children from their schools or villages. Some children decide to fight because they need food, clothing, and shelter. They may think that participating in the conflict will help protect their families.

Child soldiers face serious health risks. They can be wounded, disabled, or killed. They suffer severe psychological damage. Many find that it is impossible to lead a normal life after the fighting has stopped.

Natural disasters and CHEs have a profound impact on the state of people’s health around the globe. Hurricanes, droughts, and earthquakes, as well as wars, genocide, and tribal conflict, can lead to death and illness. Understanding how global health professionals from different nations and different relief organizations work cooperatively to address such catastrophes is a vital part of global health.




Note Taking: Natural Disasters and Complex Humanitarian Emergencies


Directions: Complete this resource as you read Student Resource 12.1, Reading: Natural Disasters and Complex Humanitarian Emergencies. First, use the Defining Format chart below to define the terms natural disaster and complex humanitarian emergency. The first category is filled in for you.

Then use a Venn diagram to compare and contrast the characteristics of refugees and internally displaced persons (IDPs). Finally, use a Venn diagram to explain the differences in the risks faced by displaced women, men, and children.


A natural disaster is a catastrophe caused by nature

that

1.

2.

3.

4.

A complex humanitarian emergency

is a _______________________

that

1.

2.

3.

4.



Refugee and IDP Venn Diagram In the left part of the Venn diagram, list characteristics that apply only to refugees. In the right part, list characteristics that apply only to IDPs. In the overlapping part, list characteristics common to both.

Refugees IDPs



Risks Faced by Men, Women, and Children Venn Diagram Think about the risks brought on by natural disasters and CHEs. In the left part of the red circle, list risks faced only by men. In the right of the blue circle, list risks faced only by women. In the bottom part of the orange circle, list risks faced only by children. In the overlapping areas, list risks that are common to the groups whose circles are overlapping.

Risks men face

Risks children face

Risks women face




Vignettes: Reasons for Cooperation in Global Health


Directions: Read the following four vignettes with your partner and respond to the questions.

Vignette #1: Severe Acute Respiratory Syndrome (SARS)

SARS is a serious form of pneumonia that is spread by close person-to-person contact. This chest X-ray was taken of a patient with SARS.2

Before 2003, SARS was an unknown disease, but in February of that year a WHO physician diagnosed a businessman with the new disease. The businessman had traveled from China to Hong Kong to Vietnam. Both the businessman and the doctor eventually died. Over the next few months, the disease spread quickly to more than two dozen countries.

It became clear to experts that global cooperation was going to be necessary to control the potentially fatal disease.

The WHO issued a rare travel advisory for people going to countries where the disease was present. Screening measures at airports were set up for travelers coming from infected areas. Quarantines were established for people who were infected or were believed to have been in contact with infected people.

Modern communication technology allowed the WHO to quickly alert both medical professionals and travelers about the serious situation. However, it was also technology—the ability for people to easily move from one country to the next—that allowed the disease to quickly spread.

Specialists from dozens of nations were flown to countries that needed assistance. A lab network in nine countries was set up. Researchers worked in these labs around the clock to figure out what was causing the disease.

Over 8,000 people became sick with SARS during the 2003 outbreak and 774 died. Since 2004, there have been no known cases of SARS anywhere in the world. The fast and efficient global response likely saved many lives.

Questions:

Why was global cooperation needed to respond to the SARS outbreak?

What made the cooperative effort effective?

2 Image retrieved from http://commons.wikimedia.org/wiki/File:SARS_xray.jpg on August 22, 2012. US government image.



Vignette #2: Conflict and Food Insecurity in Mali

Drought, food prices, and plagues of insects threatened the food production of crops grown in Mali, like rice.3

In January 2012, fighting began between government forces and rebels in Mali. The conflict, combined with other events of political instability, led to a mass displacement of people.

A UN relief agency said that as of July 2014 128,866 people remained displaced. Over 160,000 people had registered with the UN as refugees. These refugees had fled to the neighboring countries of Niger, Burkina Faso, and Algeria. Between asylum seekers, refugees, and internally displaced persons, there were 428,902 people of concern in Mali.

In addition to having people displaced, Mali was at risk of famine. People in Mali needed food, water, and shelter. The World Food Program had reached many people, but it was believed that millions more still needed food.

Experts were also concerned about cholera. There had been reports of 140 cases of cholera and 11 deaths, and there was fear that the disease was going to spread. Unsanitary living conditions in refugee camps or temporary settlements are often the environment in which diseases like cholera spread quickly. UN agencies requested contributions from donors to help with the increasingly serious situation, but they were far from reaching the amount of funds needed to address the complex humanitarian emergency.

Questions:

Why was global cooperation needed in Mali?

What aspects of the situation in Mali could a cooperative effort address?

3 Image retrieved from http://commons.wikimedia.org/wiki/File:Mali_ricefarmers.jpg on September 12, 2012. US government image.



Vignette #3: Cyclone in Myanmar

The cyclone caused much destruction.4

In May 2008, a cyclone tore through the southern coastal region in Myanmar. The cyclone killed 138,000 people and left hundreds of thousands of people homeless. A cyclone is a violent tropical storm that is similar to a hurricane.

After the cyclone, there were short- and long-term needs. In the short term, survivors needed emergency care for injuries and the basic necessities for survival, like food and water. In the long term, they needed assistance reconstructing the infrastructure for health, shelter, food, and transportation.

Myanmar didn’t have the resources to adequately respond to the needs of its people in either the short or the long term. Even before the cyclone, rural areas in Myanmar had poor sanitation services and lacked clean water. These areas also lacked the health care professionals needed to deliver critical services.

Outside help wasn’t allowed to immediately aid the people of Myanmar. Myanmar was run by a military regime, and for three weeks after the disaster, the regime refused to let in international aid groups. Many countries and relief agencies were outraged about the regime blocking their own people’s access to critical help.

After much political pressure, including a visit from the UN secretary general, international aid agencies were finally allowed to enter the country. But even after the agencies were allowed in, their activities and communication were heavily monitored, and many of the agencies felt that the government didn’t allow them to do their work effectively. For example, the government didn’t allow aid groups assigned to one section of the country to communicate with aid groups assigned to another region. These groups needed to communicate to get a big picture of the damage and assess the needs.

These aid agencies believe that the delay in response may have contributed to the high rates of mortality. They think that if they had been allowed immediate access to the country, lives would have been saved.

Questions:

Why was global cooperation needed in Myanmar after the cyclone?

What hindered the cooperative effort?

4 Image retrieved from http://commons.wikimedia.org/wiki/File:USDS_Nargis_Rangoon_Sign.jpg on August 22, 2012. US government image.



Vignette #4: Earthquake and Tsunami in Japan

The disaster in Japan was responsible for hundreds of thousands of collapsed buildings. This image shows the

damage in Iwate Prefecture.

On March 11, 2011, a 9.0 magnitude earthquake rocked Japan. The earthquake triggered catastrophic tsunami waves, and then the tsunami caused a number of accidents at a nuclear power plant.

The disaster resulted in almost 16,000 deaths as well as injuries and missing people. Roads and railways were damaged. Millions of households went without water and electricity. There were 340,000 displaced people. The accidents at the nuclear power plant released radiation, causing widespread fear.

Even though Japan is a developed country with sophisticated emergency response systems, the scale of the disaster was so great that outside assistance was needed.

Japan requested search and rescue teams from Australia, New Zealand, South Korea, the United Kingdom, and the United States. Aid organizations from around the world came to meet the island nation’s need, and more than $1 billion was donated to the Japanese Red Cross. The money raised was used to rebuild hospitals that were destroyed and helped elderly citizens who lost their homes, and to meet other needs.

Powerful earthquakes that have their epicenter on the ocean floor can trigger tsunamis that are very distant from where the actual earthquake occurs. A system of warning centers is in place to alert far-away populations who do not feel the earthquake that they could experience a tsunami. In the case of the 2011 Japanese earthquake, the Pacific Tsunami Warning Center in Hawaii posted an alert. As a result of the warning, countries took immediate action. For example, Russia evacuated 11,000 residents from coastal areas. In Papua New Guinea, patients were evacuated from a hospital before it was hit by waves, causing millions of dollars of damage.

Questions:

Why was global cooperation needed in Japan?

How was the cooperative effort effective?




Graphic Narrative: Successful Cooperative Action for Global Health


Directions: With your group, you are going to research a successful and effective cooperative action for improving global health and then create a graphic narrative using PowerPoint slides to present your findings. Follow the steps below.

Choosing a Global Health Issue With your group, choose an issue that required cooperative action to feature in your narrative. You may choose one of the following issues. If you choose one not on this list, report your choice to your teacher.

Use the link provided in this list to begin your research about the cooperative action. Verify other sites that you use for research with your teacher.

Smallpox (http://www.who.int/features/2010/smallpox/en/index.html)

Landslide in Guatemala, 2015 (http://www.aljazeera.com/news/2015/10/death-toll-rises-guatemala-landslide-151004054723648.html)

Avian influenza (http://www.who.int/topics/avian_influenza/en/)

Yellow fever in Mali (http://www.who.int/features/2008/mali_vaccine/en/index.html)

H1N1 pandemic (http://www.who.int/csr/disease/swineflu/en/index.html)

Malaria in Tanzania (http://www.who.int/features/galleries/2006/malaria/gallery/en/index.html)

2011 hurricane season (http://www.redcross.org/images/MEDIA_CustomProductCatalog/m8540111_Disaster-Relief-Program-Review-2011.pdf)

Earthquake in Chile, 2010 (http://www.redcross.org/images/MEDIA_CustomProductCatalog/m3140112_ChileEarthQuakeOneYearReport.pdf)

Volcanic eruption in Iceland, 2010 (http://reliefweb.int/report/iceland/iceland-volcanic-eruption-prompts-european-red-cross-response)

IDP crisis in Pakistan (http://www.globalhumanitarianassistance.org/crisisbriefing/crisis-briefing-humanitarian-funding-analysis-pakistan-idp-crisis)

West Africa hunger crisis (http://www.savethechildren.org/site/apps/nlnet/content2.aspx?c=8rKLIXMGIpI4E&b=7942601&ct=11595901)

Purpose Your goal is to tell the story of a creative, effective approach that solved a specific global health problem. Your narrative should be both factual and engaging. It should illustrate the importance of a cooperative approach to solving global health issues.



Information Your Graphic Narrative Should Contain You should include the following basic information:

Background information about the issue you have chosen. What happened, and when and where did it happen?

Why was a cooperative effort a good solution?

What groups, countries, and key individuals were involved in the cooperative effort?

What were the key factors and innovations that led to success?

Outline Your Slides After you collect all your information, work with your group to outline what content you will put on each slide. Think about how the slides will work together to convey your message. You may want one to be a title slide that calls attention to the main idea of your graphic narrative. Then the other slides can give information to support it. You might want eight slides instead of six, but more than that will become unwieldy for this format.

Once you have outlined the content for each slide, have each group member create two of the slides, or divide the number of slides you have decided you need so that all members create at least two slides.

Using PowerPoint Slides Choose a Theme

With your group, choose a visual theme for your slides. Decide on a PowerPoint template to use, or choose the fonts and colors you will use to create your own template. This will give your finished graphic narrative a polished, cohesive look.

The Slides

The graphic narrative should have images that are both informative and persuasive. Professionals often use PowerPoint slides to create visual displays of different kinds, because the slides can be printed from a computer. Each slide should include some kind of visual such as a photo, a chart, a graph, a map, or an illustration that conveys the message of the slide.

Look for images as you work on NGO sites, like the Red Cross or the WHO, or on sites that contain free images, like Wikimedia Commons. On your slide, in a line of small print under the photo, give credit to the site where you got the image and give the photographer’s name if it is provided.

The Text

The text accompanying each slide tells the story and helps the viewer understand the visual. When you are in the PowerPoint program, click Notes Page on the View tab. The space for writing text will appear below the slide.

Choose Your Format Graphic narratives are easier to read and flow more naturally if they are in a storyboard format. Storyboards have a horizontal layout rather than a vertical one. Sometimes storyboards have text right below each visual element, and sometimes the text is next to the visual or placed in a way that works best to convey the message. You can cut the notes apart from the slide and play with different placements to find a way that is inviting to read.



Here is the simplest way to format your graphic narrative. It does not involve cutting the text apart from the slide:

Slide 1 visual

Title slide

Slide 2 visual

Slide 3 visual

Slide 4 visual

Slide 1 text Slide 2 text Slide 3 text Slide 4 text

Slide 5 visual

Slide 6 visual

Slide 7 visual

Slide 8 visual

Conclusion

Slide 5 text Slide 6 text Slide 7 text Slide 8 text

Put It All Together Share the drafts of your slides with your group. Give each other feedback about the images you have chosen and the clarity of the information expressed. Spend a few minutes revising your slides based on the feedback you received. Then print the slides. As a group, work together to arrange your slides and text on your poster board in an organized way that clearly presents the information.

Make sure your graphic narrative meets or exceeds the following assessment criteria:

The graphic narrative demonstrates an understanding of the health issue it presents and the cooperative effort undertaken to address the issue.

The text of the graphic narrative enriches understanding of the visual it accompanies and tells the story of the cooperative global health effort in an engaging way.

The graphic narrative clearly explains why cooperation was needed and what key factors and innovations led to success.

Visuals are used effectively to convey information.

The slides are presented in a way that holds the viewer’s attention and walks the viewer through the narrative in a compelling and logical order.

The graphic narrative is neat and uses proper spelling and grammar.




Culminating Project Work: Intervention Strategies


Directions: In your culminating project group, read and review the argument you and your group members wrote during Lesson 10.

In the space provided below, write a brief description of the health issue you have chosen. Next, discuss interventions that could be effective in addressing the issue. Come up with as many ideas as you can for each type of intervention (individual, systems, and community). If you don’t think a certain type of intervention would be appropriate for the issue, explain why. Fill in the chart with your ideas. Be as specific as possible.

Do some research online to generate innovative strategies. You may find that the following website gives you some new ideas for using social media to create an intervention: http://mashable.com/2012/04/16/disaster-relief-online/

An example is shown below.

Intervention Type (individual, systems, community)

Why it could be effective

Why it might not work

A school-based program to discourage students from smoking combined with a mass media blitz and a program aimed at parents and community leaders

Community Addresses the issue from many angles and gets stakeholders involved (parents, school administration, public)

This will help, but one-on-one counseling of students who are actively smoking would be another component to consider

Write a description of your culminating project health issue here:



Intervention Type (individual, systems, community)

Why it could be effective

Why it might not work


AOHS Global Health

Lesson 13 Developing the Case for a

Health Issue In this lesson, students use the knowledge they have gained in this course to focus on their culminating project. First, they analyze a sample culminating project presentation, and then they research and outline slides for their own presentation.

Advance Preparation

In Class Periods 2–4, each student will need access to a computer for Internet research.


Lesson Framework


Display understanding of the underlying determinants, risk factors, and intervention strategies that form the basis of global health initiatives*

Demonstrate the ability to conduct effective research on a health issue that merits consideration to be a global initiative

Construct a persuasive argument in support of a global initiative on a selected health issue




AOHS Global Health Lesson 13 Developing the Case for a Health Issue



Develop components of a personal portfolio (National Health Science Standards 2015, Standard 4.41)



Recognize methods for building positive team relationships (such as: mentorships and teambuilding) (National Health Science Standards 2015, Standard 8.21)

Analyze attributes and attitudes of an effective leader (National Health Science Standards 2015, Standard 8.22)

Apply effective techniques for managing team conflict (negotiation, assertive communication, gather the facts, clear expectations, mediation) (National Health Science Standards 2015, Standard 8.23)



Assessment


A detailed outline of content for culminating project PowerPoint slides (Student Resource 13.2)

Assessment Criteria: Culminating Project Presentation Outline (Teacher Resource 13.3)

Prerequisites Knowledge of environmental, nutritional, and behavioral risk factors with respect to health

Knowledge about the scope of health determinants

Knowledge of the characteristics of individual, systemic, and community interventions


Teacher Resources Teacher Resource 13.1, Sample Project Presentation: Lymphatic Filariasis (separate PowerPoint

Show file)

Teacher Resource 13.2, Rubric: Culminating Project Presentation

Teacher Resource 13.3, Assessment Criteria: Culminating Project Presentation Outline

Teacher Resource 13.4, Key Vocabulary: Developing the Case for a Health Issue

Teacher Resource 13.5, Bibliography: Developing the Case for a Health Issue



Student Resources Student Resource 13.1, Planning: Culminating Project Work

Student Resource 13.2, Outline: Culminating Project Presentation




Sticky notes, one per student

Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1 25 Culminating Project Work: Planning Meeting

In this activity, students make plans to complete the remainder of the work for their culminating project.

Before this activity begins, review the component of the culminating project (PowerPoint slideshow) that students will be completing in this lesson and in Lesson 14. (You may want to refer to the Overview of Culminating Project document, which is included in the Course Planning Tools documents for this course.)

Have students assemble in their culminating project groups and take out their portfolio with the project work they have completed so far. Explain that during this lesson, they will outline the content of their presentation. In Lesson 14, they will create the slides for their presentation, add an audio narrative, and present to an expert panel who will judge whether their issue is worthy of being the focus of the international health summit. Give students the date for their final presentation, and impress on them the importance of this event. Remind them that they should plan to dress in business attire for the event, and review what business attire is and is not, as needed.

Advise students that all group members need to contribute their share and do their best work for their culminating project, and that each member will be expected to take responsibility for some important tasks. Refer students to Student Resource 13.1, Planning: Culminating Project Work, and ask them to look at the first chart about



Step Min. Activity

assigning a role to each group member.

Go over the four roles listed in the chart as a class, and ask students to suggest what types of skills would be valuable for each role. Allow students a few minutes to assign roles, and encourage them to consider their skills and strengths as they make decisions. Then ask groups to record which person will take each role listed on their chart.

Next, instruct the newly designated project managers to lead their group as they assess the work they have already completed. Refer them to the second chart (Review Completed Work) in Student Resource 13.1, and have students work in their groups to complete the chart.

Then refer students to the third chart (Plan Remaining Work) in Student Resource 13.1, and explain that all of the project components listed in the left column will be assigned to them over the next two weeks.

Ask students to fill in the date on which they will present their project to an expert panel and an outside audience at the bottom of the chart, and point out that they are expected to work diligently to complete each aspect of the project in order to be ready for the presentation. If students have access to the Internet, consider instructing them to use an online calendar (such as Google calendar) to create a shared schedule with project goals and deadlines. Answer any questions students have about the project components, and then ask project managers to lead a brief discussion with their group about their ideas for how they are going to approach the remaining tasks and any challenges that they anticipate. Instruct them to write in the chart what they need to know to complete each item.

Finally, allow each project manager to share with the class challenges that his or her group anticipates and ways that the group is going to try to meet those challenges.

To conclude, explain that time management and staying on top of various tasks are important skills that will help them succeed in their culminating project and will also help them succeed in their future careers.

2

25 Culminating Project Work: Analyzing a Sample Project

The purpose of this activity is for students to analyze a sample culminating project and begin to envision what their own project will look like.

Have students recall that at the beginning of the course they viewed a sample culminating project presentation. Explain that they are going to watch the presentation again. Remind students that the target audience for the presentation is global health experts who will be determining if their health issue is worthy of being a focus of the international summit.

Write the following questions on the board, and ask students to keep them in mind as they watch the presentation:

What key types of information are presented in the project?

How is the information organized?

What do you find most convincing about this presentation?

How do the slides and audio work together to tell a story?

What did you learn that you think will help you when you create your presentation?



Step Min. Activity

Using an LCD projector, show the slideshow in Teacher Resource 13.1, Sample Project Presentation: Lymphatic Filariasis (separate PowerPoint Show file). When you open the file, the slideshow should begin. (Tip: Right-click the file and select Show. Or, to start the show from within PowerPoint, click the slideshow icon at the bottom of the PowerPoint window. Press Esc to end the show.) Be sure to have speakers turned on so that students hear the audio narration.

Have students discuss the questions on the board and their responses with their culminating project groups. Instruct them to write their ideas in their notebook. Then have groups share their responses with the class.

Next, give each student a copy of Teacher Resource 13.2, Rubric: Culminating Project Presentation. As a class, review the items in the Exemplary column. Then have students view the sample presentation again and think about how they would assess this presentation using the rubric. After the second viewing, ask students to discuss in their group their ideas about how the sample project meets the exemplary criteria on the rubric, and then have them share their ideas with the class. Answer any questions students have about how their project presentation will be assessed.

With the remaining time, answer general questions that students may have about how to approach this type of project.

To conclude, emphasize that while the sample project is a valuable model, groups will need to find their own unique approach to addressing the challenges of the project.

CLASS PERIOD 2

3 25 Culminating Project Work: Section Overviews

Students begin determining roles and conducting planning for their culminating project presentations.

To begin, ask student volunteers to say what they have learned in the course about creating a persuasive argument. Student responses might include “taking a clear stance” or “using facts to support your argument.” Create a list of student responses on the board. Then remind students that the main purpose of their presentation is to convince the audience that their health issue is worthy of being a focus of the summit. Explain that to accomplish this, they will need to use everything they have learned about creating a persuasive argument.

Then refer students to Student Resource 13.2, Outline: Culminating Project Presentation. Remind them that in this lesson, they are outlining their presentation, and in Lesson 14 they will create their slides and audio narration. Point out that there is an overview chart and an outline chart in this resource, and students will start by focusing on the overview chart. Refer students to Step 1: Project Overview Chart in Student Resource 13.2. Explain that as a first step, they will:

Go over the sections of their presentation as a group and write down the main ideas they want to emphasize in each section in the third column of the chart.

Assign a section leader for each section of the presentation and write that person’s name in the first column of the chart. Explain that the section leader will take responsibility for his or her section of the presentation. The section leader will do the research and create the materials for that section.



Step Min. Activity

If students have Internet access, another option is to have them use a cloud-based application like Google Docs to upload, edit, and review documents as a group.

Answer any questions students have about how to work through this chart. Encourage students to consider their interests and strengths as they assign sections. Circulate as students work, and give them guidance on any sections they are struggling with.

Explain to students that their overview chart is just a start; they will have the next two class periods to research and outline their presentation.

Tell students that working as a group to determine members’ strengths and interests when assigning roles in a project is an activity that they will likely do in their careers.

4

25 Culminating Project Work: Presentation Outline

The purpose of this activity is for students to research and create an outline, in a chart format, that they will use to create their culminating project presentation. This activity also focuses on the following college and career skill:


Draw students’ attention to Step 2: Project Outline Chart. Advise students that they are now going to begin to research their sections of the presentation. Explain that each student should research his or her topics and fill in the outline chart for those slides. Tell students that if they need more room, they may recreate the chart in their notebook or work in the chart on their computer. Explain that each student’s chart will be assessed individually. Review the assessment criteria as a class and make sure students understand how their work will be assessed. Answer any questions students have about assessment. Emphasize that the work they do on this outline chart is important because it will serve as a detailed guide when they create their presentation.

Tell students that even though they may be doing research individually, they should continue communicating with their group members to make sure that everyone stays on track, that their work isn’t redundant, and that they don’t let any important pieces fall through the cracks. Remind students to share good resources they find with their group and to provide their group’s chief researcher with the sources that they use for their research.

Circulate as students work, making sure that they stay focused on their topic, and answer any questions that they have about research.

At the end of the class period, explain that students will have time in the next two class periods to complete their research and outline before submitting the outline chart for assessment.

In the final few minutes, distribute sticky notes. Ask students to write down one question or concern they have about the process of working on their culminating project and the progress of their research so far. Ask them to put the notes on the door as they leave, and explain that this will be their “ticket” out the door. Tell them that you will respond to their concerns at the beginning of the next class period.

CLASS PERIOD 3



Step Min. Activity

5

50 Culminating Project Work: Presentation Outline (Continued)

Students continue to work on the outline of their project slides.

Begin by spending a few moments responding to concerns that students expressed in their “ticket out the door” at the end of the last class period. If necessary, meet individually with students or groups as they are working on their outlines to address any specific concerns.

Have students get to work researching and completing their section of the group outline. Remind them to check their work against the assessment criteria, and remind them that their work will be assessed individually.

Tell students that they have one more class period to complete their outline.

CLASS PERIOD 4

6

50 Culminating Project Work: Presentation Outline (Continued)

Students complete the outline of their project slides.

Have students get to work researching and completing their section of the group outline. Remind them to check their work against the assessment criteria, and remind them that their work will be assessed individually.

When there are about 15 minutes left in the class period, instruct groups to read through all sections of their outline together and check for accuracy and completeness. Advise students to make changes to their section based on group members’ feedback. Circulate while groups are working, and help them resolve issues as necessary.

When students have completed their work, collect the outlines and assess them using Teacher Resource 13.3, Assessment Criteria: Culminating Project Presentation Outline. Remind students to add their outline chart to their project portfolio.

To conclude this lesson, ask each group to share with the class something they have learned during this lesson about working together as a team.

Extensions

Content Enrichment Tell students to identify a nonprofit organization that works on the health issue they are focusing

on for their culminating project. Have students create a list of questions that they have about the health issue and then correspond with a representative from the organization. Students’ questions may be about topics such as professions that focus exclusively on the issue, effective interventions, or raising awareness.

Familiarize students with the Tedx Talk guide for speakers at http://storage.ted.com/tedx/manuals/tedx_speaker_guide.pdf. It is a distillation of guidance on making powerful presentations. They can then search the Ted Talk site for presentations on topics that interest them and see if the presenters are persuasive and engaging.



STEM Integration Technology: Arrange for students to meet with your school’s media specialist to go over the

specifics of creating a self-running slideshow for the culminating project and to discuss technology that will be available to them. They create their slideshow in Lesson 14, but thinking about how to incorporate media early on could be helpful.

Technology: Have students create an educational website about the health issue that they are focusing on for their culminating project. Tell them that the purpose of their site is to raise awareness about the health issue and that teens are their target audience. Encourage them to use social media to promote their site.

Technology: Have students watch this Prezi presentation on how to create a great PowerPoint presentation at https://prezi.com/_eye9eo4l-h-/10-characteristics-of-effective-power-point-slides/. Offer students the option of creating a Prezi for their presentations instead of narrated PowerPoint presentations.

Additional Cross-Curricular Ideas Geography: Have students create maps that show the areas of the world that are affected by the

health issue that their culminating project group is focusing on. Encourage them to be accurate and make their maps as professional as possible. You may wish for them to view the following maps for ideas:

o Cholera, areas reporting outbreaks, 2010–2011 http://gamapserver.who.int/mapLibrary/Files/Maps/Global_Cholera_ITHRisk_20120118.png

o Estimated TB incidence rates, 2010 http://gamapserver.who.int/mapLibrary/Files/Maps/Global_TB_incidence_2010.png

o Number of malaria reported deaths, 2010 http://gamapserver.who.int/mapLibrary/Files/Maps/Global_Malaria_ReportedDeaths_2010.png

History or Art: Instruct students to create an illustrated timeline that shows major events in the history of the health issue that their culminating project group is focusing on. Encourage them to use a variety of images on their timeline, such as illustrations, photographs, charts, and diagrams. You may wish for them to view the following timeline to get ideas:

o AIDS Retrospective Slideshow: A Pictorial Timeline of the HIV/AIDS Pandemic http://www.webmd.com/hiv-aids/ss/slideshow-aids-retrospective


AOHS Global Health


Health Issue

Teacher Resources


Teacher Resource 13.1 Sample Project Presentation: Lymphatic Filariasis (separate PowerPoint Show file)

Teacher Resource 13.2 Rubric: Culminating Project Presentation

Teacher Resource 13.3 Assessment Criteria: Culminating Project Presentation Outline

Teacher Resource 13.4 Key Vocabulary: Developing the Case for a Health Issue

Teacher Resource 13.5 Bibliography: Developing the Case for a Health Issue




Rubric: Culminating Project Presentation

Student Names:_____________________________________________ Date:_______________

Exemplary Solid Developing Needs Attention

Comprehension of Subject Matter

All of the content is accurate and complete and communicates a complete understanding of the topic.

Most of the content is accurate and shows mastery of the topic.

The content shows some flaws and omissions and illustrates only partial knowledge of the topic.

Much of the content is inaccurate and confusing and communicates very little understanding of the topic.

Visual Design The assignment is highly attractive, well designed, and professionally laid out. Appropriate graphics are used tastefully, effectively support the content, and make it easy to follow.

The assignment is attractive and has a good design and an organized layout. Graphics help support the content.

The assignment contains graphics and multimedia, but it lacks good design and organization. Too many or too few graphics are used and are ineffective in supporting the content.

The assignment is messy and contains no coherent visual design. Graphics are not present at all or, if present, distract from the content.

Content Organization/ Flow

The content is clearly organized, with a logical flow of connected ideas and effective transitions.

The content is organized, and most ideas are well connected with effective transitions.

The ideas are sound, but the content is not well organized and needs more effective transitions.

The content is extremely disorganized. The transitions between ideas are unclear or nonexistent.

Use of Thinking Strategies

The presentation uses a wide variety of thinking strategies to communicate ideas, including but not limited to:

Comparing Contrasting Analyzing Predicting Appraising Questioning Evaluating Interpreting Theorizing

The presentation uses some thinking strategies to communicate ideas, including but not limited to:


The presentation uses one or two thinking strategies to communicate ideas, including but not limited to:

Comparing Contrasting Analyzing Predicting Appraising Questioning Evaluating Interpreting

Theorizing

The presentation does not use thinking strategies to communicate ideas.

Labels and Titles

The labels and titles are concise and clearly fit the content.

The labels and titles are somewhat concise and fit the content.

The labels and titles are somewhat vague and do not fit the content.

The labels and titles are all confusing and do not fit the content.

Mechanics There are no grammatical, spelling, or punctuation errors.

There are few grammatical, spelling, or punctuation errors.

There are some grammatical, spelling, or punctuation errors.

There are many grammatical, spelling, or punctuation errors.




Required Format

The format conforms to the required specifications.

The format has only very minor deviations from the required specifications.

The format does not meet the assignment specifications.

The format is completely different from the assignment specifications.

Elements and Examples

All required elements are included in the assignment. Some additional elements are included to enhance the assignment. All of the evidence and examples (facts, statistics, and real-life experiences) are specific and relevant.

All elements are included in the assignment. Most of the evidence and examples are specific and relevant.

One or two of the required elements are missing. At least one piece of evidence or one example is relevant.

More than two elements are missing. Evidence and examples are not relevant.

Slideshow Preparedness

The slideshow is completely prepared and well rehearsed. The slideshow and audio move correctly from one slide to the next with no glitches.

The slideshow is prepared but needed more rehearsal. The slideshow and audio move correctly from one slide to the next with one or two glitches.

The slideshow was somewhat prepared, but it is clear that there was not enough rehearsal. The slideshow and audio do not run smoothly, and some slides lack audio.

The slideshow was not ready to be presented. The slides do not run smoothly, and narration is missing.

Narration

All narration is loud, clear, and at the appropriate speed. Narrators do not stumble over words or mispronounce. The narrators sound natural and exude enthusiasm about the content.

Most narration is loud, clear, and at the appropriate speed. Narrators may stumble or mispronounce a few words. The narrators sound enthusiastic about the content.

Much of the narration is too soft, mumbled, or too fast. It is hard to understand and follow some of what the narrators are saying, and words are mispronounced. There is not much enthusiasm in the voices.

All of the narration is too soft, mumbled, or too fast. Words are mispronounced or repeated, and it is hard to follow. There is a lack of enthusiasm in the voices.

Length The presentation covers all aspects of the topic well and falls within the specified length.

The presentation adequately covers all aspects of the topic within the specified length.

The assignment is a bit shorter or longer than the specified length.

The assignment is much shorter or longer than the specified length.


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Assessment Criteria: Culminating Project Presentation Outline

Student Name:______________________________________________________________

Date:_______________________________________________________________________


Met Partially Met

Didn’t Meet

Possible slide titles are clear, appropriate, and compelling. □ □ □

The graphics that are proposed are relevant to the topic of the slide, compelling, and easy for the audience to understand. At least one graphic is proposed for each slide. At least one image is a chart or graph.

□ □ □

The proposed information to include in slides and narration is relevant and engaging. It covers the most important points about the topic and supports graphics and images that appear on the slide.

□ □ □

The sources used to obtain information are reliable and respected in the global health community. All sources are noted.

□ □ □

The chart is neat and uses proper spelling. □ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Key Vocabulary: Developing the Case for a Health Issue

Term Definition

advocate To support an issue by argument; to speak or write in favor of an issue; to recommend publicly.

endemic Characteristic or prevalent in a particular country, region, or area.

eradicate To do away with completely, eliminating the risk of future infection or disease.

lymphatic filariasis (LF) A neglected tropical disease, also referred to as elephantiasis that is transmitted through mosquito bites and can cause permanent disfiguration and disability. Approximately 1.3 billion people in 72 countries are at risk.

stance A position taken about a specific issue.




Bibliography: Developing the Case for a Health Issue

The following source was used in the preparation of this lesson and may be useful for your reference or as a classroom resource.



AOHS Global Health


Health Issue

Student Resources


Student Resource 13.1 Planning: Culminating Project Work

Student Resource 13.2 Outline: Culminating Project Presentation




Planning: Culminating Project Work


Directions: Use the charts below to track the status of your group's culminating project work. Assign a role to each group member and record that person’s name in the third column of the first chart. Review the status of project work you have already completed and record this in the second chart. Use the third chart to track the components of your project that you will be working on in this lesson and in Lesson 14.

Assign a Role to Each Group Member

Role Description Person Assigned to This Role

Project Manager Maintain organization of group’s materials; keep group on schedule.

Chief Researcher Validate sources used for research; act as liaison with teacher on research issues.

Lead Designer Use PowerPoint skills to oversee the design of the template for the presentation.

Audio Technician Record the audio narrative in a PowerPoint slideshow, managing the timing for each slide, volume control, and a smooth transition from slide to slide.

Review Completed Work Note the date when you completed each project component and whether you have received an assessment from your teacher. If you need to do more work on any of these assignments, note this in the Remaining Work column, and assign a group member to take the lead on remaining work.

Product Date Completed

Assessment(s) Received?

Remaining Work Lead Person for Remaining Work

Observations: Environmental Health Issues (Lesson 8)

Examination: Nutrition in Global Health (Lesson 9)

Notes: Behavioral Risk Factors (Lesson 10)

n/a

Writing Assignment: Pressing Health Issue



Product Date Completed

Assessment(s) Received?

Remaining Work Lead Person for Remaining Work

Argument (Lesson 10)

Culminating Project Work: Intervention Strategies (Lesson 12)

Plan Remaining Work For each task, fill in the projected completion date under the lesson number as soon as your teacher gives you a due date. Record the actual date when you submit the project component to your teacher. Discuss what you will need to know to complete each task, and record your thoughts. As you learn more, add information in the Notes column. Use this tracking tool until you have completed all project work. If you need more space, use a page in your notebook for the chart, or work on the chart on your computer.

Project Component

Projected Completion Date

Actual Completion Date

What We Need to Know to Complete This Task

Notes

Create PowerPoint outline

Lesson 13

Date:

Create first draft of PowerPoint slides

Lesson 14

Date:

Create narrative audio in PowerPoint

Lesson 14

Date:

Complete final PowerPoint presentation

Lesson 14

Date:

Present to the expert panel and outside audience Date, time, and venue:




Outline: Culminating Project Presentation

Student Name:_______________________________________________ Date:__________________

Directions: Follow the steps in this resource to create an outline of your culminating project presentation. You will probably want to have about 20 slides in your presentation, and each group member will take responsibility for some of the slides. Review the assessment criteria at the end of this resource before you begin work on your outline.

Step 1: Project Overview Chart This chart gives you a basic structure for your presentation. Read the questions for each section, and discuss as a group the points you already know about your topic that should be included in each section. Take notes in the Group Discussion Notes column of the chart. Then assign a leader for each section, and note the leader’s name in the space provided in the first column of the chart. The section leader will be responsible for researching and outlining the slides for his or her section of the presentation. Try to divide the work evenly among group members.

Section of Presentation

Examples of Questions That Could Be Addressed

Group Discussion Notes

Introduction

(2–4 slides)

Section leader:

How can you describe the health issue in a few words? Why is the health issue important? What are the most important facts and figures that could help introduce the issue? Is there a personal story that could draw audience members into the presentation?

Description of the health issue

(4–8 slides)

Section leader:

Is there relevant historical or background information that the audience should know to understand the health issue? What are the symptoms of the disease or condition? What is the cause of the disease? How is the disease diagnosed? How does the disease progress? What is the treatment for the disease? Is there a cure? What are the preventive methods? What interventions have been used to address the issue? Which interventions have been successful? Which have not?



Section of Presentation

Examples of Questions That Could Be Addressed

Group Discussion Notes

Determinants

(3–5 slides)

Section leader:

What are the determinants? How does the health issue impact individuals? How does it impact society?

Special Focus

(3–5 slides)

Section leader:

What geographic region does the health issue particularly impact? What makes that region stand out? What is the quality of life like for people in that region? How have global health workers been trying to address the health issue in the region? What are the relevant interventions that have succeeded or failed?

Conclusion

(1–2 slides)

Section leader:

What outcome are people who work on this health issue hoping for? What are the challenges in obtaining this outcome? How might increased attention or focus on this issue improve the outcome?

List of Sources

(1 slide)

Chief researcher:

What sources will your group use to research your presentation? What sources will you use for images?

Step 2: Project Outline Chart Research the sections that your group has assigned to you. Begin by referring to your portfolio and looking at the relevant information that you have collected on the health issue throughout the course. Then move on to other resources. Remember that you are creating a presentation to show to a panel of global health experts. Your sources must be reliable and respected in the global health community. Note your sources as you research so that you can find the information and images you need when you create your slides. The chief researcher will use the information in your outline to keep track of all the sources and be responsible for creating the last slide in your presentation, which will list the sources.

Information to Include in Your Outline Chart

Possible titles for the slide

Think about the big picture. What would you want your audience to know if they only read the slide title? Write down a couple of options so that you and your group can choose the best title and make it fit with the rest of the presentation.

Possible graphics or images



Think about a picture, diagram, or graphic that would clearly communicate the main message of your slide to your audience. Include more than one idea for a graphic or image in your chart. Save images that you think you may want to use, and keep track of where you retrieved the images from. Remember, you will want to appropriately credit the images that you use.

Websites that may have images you can use: Google images at https://images.google.com/, the CDC’s library for images of public health, known as PHIL, the Public Health Image Library, at http://phil.cdc.gov/phil/home.asp.

Information to write on the slide or include in your narration

You need to choose your information carefully. Think of the points that are most important to your audience to see or hear, and think of ways to capture your ideas in an image and just a few words. Think about the narration your audience will hear while they watch your presentation. The narration needs to be compelling so that it will hold the interest of your listeners. Perhaps some slides should be accompanied by an emotional plea or a very crisp and clear statement of fact.

As you work on your research, fill in the chart on the following pages of this resource.

When all of your group members have outlined their sections, combine your chart pages. The combined document will ultimately serve as the master outline for your presentation. You will submit the work that you did individually for assessment. (Remember to review the assessment criteria before you start working on your part of the outline.)

An example of how to use the chart is shown below.

Section and Slide #

Possible Slide Titles

Graphics or Images to Include on Slide

Information to Include on Slide or in Narration, and List of Sources

Introduction Slide 4

The scale of the problem is immense.

120 million people are infected.

Pie chart showing 1/5 of the world’s population is at risk for contracting the disease.

Map of world highlighting countries that are affected.

Explanation of the information in the chart or the map.

120 million people in 72 countries are infected.

Narration should have a sentence that challenges the audience to tackle the issue.

Source: CDC: Lymphatic Filariasis, http://www.cdc.gov/parasites/lymphaticfilariasis/



Section and Slide #






Section and Slide #




Additional Notes for Your Section:

Make sure your outline chart meets or exceeds the following assessment criteria:

Possible slide titles are clear, appropriate, and compelling.

The graphics that are proposed are relevant to the topic of the slide, compelling, and easy for the audience to understand. At least one graphic is proposed for each slide. At least one image is a chart or graph.

The proposed information to include in slides and narration is relevant and engaging. It covers the most important points about the topic and supports graphics and images that appear on the slide.

The sources used to obtain information are reliable and respected in the global health community. All sources are noted.

The chart is neat and uses proper spelling.


AOHS Global Health

Lesson 14 Project Presentation

In this lesson, students complete the final steps of their culminating projects. In the process, they consider the characteristics of a good narrative, develop their PowerPoint slides, and add audio to their presentations. They present their work to an expert panel and an invited audience.

Advance Preparation

This lesson includes the final presentation of the students’ culminating projects. The presentation should be a major event with an invited audience. See Teacher Resource 14.1, Guide: Planning for the Presentation, for details of how to prepare for the event.

You will need three to five global health professionals to serve on the expert panel. The expert panel evaluates whether the health issues presented in culminating project presentations are worthy of being the focus of an international health summit. See Teacher Resource 14.2, Guide: Expert Panel, for details about assembling the expert panel.

In Class Period 1, each student will need access to a computer for Internet research. In Class Periods 1–5, each project group will need a computer equipped with a sound card, microphone, and speakers, as well as with Microsoft PowerPoint or similar presentation software.

In Class Period 4, each group will need a quiet area to create the audio recording for their presentation. Prior to this class period, you may wish to select designated areas at your school where groups can work on their recordings in quiet, without background noise.

This lesson is expected to take 7 class periods. The number of class periods needed for this lesson will vary depending on how many culminating project groups you have and whether the culminating project presentations take place during class time.

Lesson Framework


Demonstrate the ability to present a proposal for the health issue that deserves to be the next global health initiative

Identify any uncertainty he or she has about making a persuasive case for addressing a specific health issue

AOHS Global Health Lesson 14 Project Presentation



Model verbal and nonverbal communication (National Health Science Standards 2015, Standard 2.11)



Summarize professional standards as they apply to hygiene, dress, language, confidentiality, and behavior (National Health Science Standards 2015, Standard 4.12)

Develop components of a personal portfolio (National Health Science Standards 2015, Standard 4.41)



Recognize methods for building positive team relationships (such as: mentorships and teambuilding) (National Health Science Standards 2015, Standard 8.21)

Apply effective techniques for managing team conflict (negotiation, assertive communication, gather the facts, clear expectations, mediation) (National Health Science Standards 2015, Standard 8.23)


Demonstrate use of file organization and information storage (National Health Science Standards 2015, Standard 11.33)

Assessment


Global health initiative self-running slideshow Rubric: Culminating Project Presentation (Teacher Resource 14.4)

Prerequisites Ability to create slides using PowerPoint

Understanding of major ideas in global health

Understanding of professional attire and behavior




Teacher Resources Teacher Resource 14.1, Guide: Planning for the Presentation

Teacher Resource 14.2, Guide: Expert Panel

Teacher Resource 14.3, Presentation and Notes: Characteristics of a Good Narrative (includes separate PowerPoint file)

Teacher Resource 14.4, Rubric: Culminating Project Presentation

Teacher Resource 14.5, Note-Taking Tool: Expert Panel

Teacher Resource 14.6, Key Vocabulary: Project Presentation

Student Resources Student Resource 14.1, Reading: Characteristics of a Good Narrative

Student Resource 14.2, Practice: Characteristics of a Good Narrative

Student Resource 14.3, Guide: Final Presentations Preparation

Student Resource 14.4, Chart: Slides Review

Student Resource 14.5, Assignment: Audio Recording

Student Resource 14.6, Feedback Form: Culminating Project Presentation

Equipment and Supplies Whiteboard, blackboard, or flip chart

Computer connected to an LCD projector and speakers

Computers equipped with a sound card, microphone, and speakers; Internet access; and Microsoft PowerPoint or similar software (one for each group of students)

Sticky notes

Lesson Steps

Step Min. Activity

CLASS PERIOD 1



Step Min. Activity

1

25 Presentation: Characteristics of a Good Narrative

In this activity, students identify the characteristics of a good narrative. This activity develops students’ listening and note-taking skills.

To prepare, make notes to guide class discussion using Teacher Resource 14.3, Presentation Notes: Characteristics of a Good Narrative. Have Teacher Resource 14.3, Presentation: Characteristics of a Good Narrative (separate PowerPoint file), ready to show as a full-screen slideshow using an LCD projector.

To begin, write the following question on the board:

What makes a self-running slideshow different from a presentation delivered by a presenter?

Ask students to discuss their responses with their culminating project group, and then have groups share their responses with the class. List their responses on the board.

Then have students create a two-column chart in their notebook with the following headings:

Tips for Good Narrative Content

Tips for a Good Audio Recording

Explain that students are going to watch a brief presentation on the characteristics of a good narrative and that they should write down tips in their chart as they watch.


This presentation is duplicated as Student Resource 14.1, Reading: Characteristics of a Good Narrative. If an LCD projector is unavailable, students can read the presentation, answer the discussion questions in their notebook, and discuss their answers as a class. This student resource is also useful for review.

After the presentation, ask students to meet in their culminating project groups. Refer them to Student Resource 14.2, Practice: Characteristics of a Good Narrative. Tell students to read the instructions, and then answer any questions.

When students have completed the resource, have each group read their narratives aloud. Then have the class vote on which narrative they think is the most effective, and have volunteers give their reasons why.

To conclude, point out that knowing how to prepare a brief, engaging narrative is a skill that will be useful in both college and career.

2

25 Culminating Project Work: Preparing to Create Final Presentations

The purpose of this activity is for each group member to take responsibility for the aspect of the presentation work he or she is taking the lead on. This activity also focuses on the following college and career skill:

Demonstrating initiative and resourcefulness in challenging situations

Instruct students to gather in their culminating project groups, and refer them to Student Resource 14.3, Guide: Final Presentations Preparation. Explain that each group member has work to do during this activity according to his or her role as lead designer,



Step Min. Activity

audio technician, chief researcher, or project manager. Have students read their section of the guide, assign them to computers, and answer any questions.

Next, meet with all of the lead designers to make sure that they understand their responsibilities.

Then meet with the audio technicians to make sure that they understand their responsibilities. Make sure that by the end of the class period, all of the sound technicians have a working understanding of how to create an audio recording in PowerPoint.

After you have met with the lead designers and audio technicians, circulate to see if the project managers or chief researchers have questions.

Ask students to complete their prep work for homework. Emphasize that the more they invest in preparation, the more efficient they will be when they begin creating their slides.

CLASS PERIOD 2

3

50 Culminating Project Work: Creating Slides and Narrative Notes

In this activity, groups choose the template that they will use for their project and begin their work creating slides and notes. This activity also focuses on the following college and career skills:

Prioritizing and completing tasks without direct oversight


Have students gather in their culminating project groups. Ask the lead designers to share with the group their two template suggestions, pointing out the merits of each. Remind designers that they should refer to Student Resource 14.3 to recall why they chose those templates. Instruct groups to choose a template that they will use.

Then tell students to refer to the outline that they created in Lesson 13 (Student Resource 13.2, Outline: Culminating Project Presentation). Explain that they will now begin creating their slides and their narrative in their chosen template, using the outline as a guide. Before students begin, write the following reminders on the board and go over them as a class:

Each presentation, in total, should be about 20 slides.

Narrative notes should be between one and three sentences. The audio will be recorded later.

Each student should create the slides for the part of the presentation that he or she outlined. When all the slides are complete, the lead designer will compile them into one presentation.

Students should adhere closely to the outline. They may improve the outline based on feedback they received on their outline assessment in Lesson 13, but otherwise, this is not the time to make major changes to the topics or content.

Explain to students that they will have the rest of the class period and time in the next class period to create drafts of their slides and notes. Explain that they will record the audio later in the lesson. Ask the project manager to make sure that the work is being



Step Min. Activity

done in a timely manner.

If audio technicians need additional time learning how to make the audio work, advise them to use part of this time for that task.

As students work, meet with each group to review their template choice and make suggestions about the best ways to utilize their template. Answer any questions that groups have about the content and format of their presentations.

At the end of the class period, remind students that they will have time in the next class period to finish creating their slides and notes. Emphasize that careful time management is important not only in this task but in most professional work as well.

CLASS PERIOD 3

4

30 Culminating Project Work: Creating Slides and Narrative Notes (Continued)

In this activity, students continue creating the slides and narrative notes for their presentations.

Have students get right to work continuing to create their slides and narrative notes in their template, using their outline chart (Student Resource 13.2) as a guide. Tell students that they will have about 30 minutes to complete the drafts of their slides before they submit them to the lead designer.

As students work, circulate and meet briefly with the project managers to check on the groups’ progress and to answer any questions about content, the template, or the remaining work on the project.

5

20 Culminating Project Work: Group Review of Slides and Narrative

The purpose of this activity is for groups to compile slides into one presentation and review their presentations to make sure that they meet the criteria on the rubric.

Instruct students to give the lead designer access to their slides. Then have lead designers compile the slides into one presentation, using the outline chart (Student Resource 13.2) to decide the order of the slides.

While the lead designer works, instruct the other group members to refer to Teacher Resource 14.4, Rubric: Culminating Project Presentation. Explain that as the lead designer compiles the slides, the other group members should carefully review the criteria on the rubric. Emphasize that their goal is to meet the criteria in the Exemplary column.

Refer students to Student Resource 14.4, Chart: Slides Review. Have students read the directions, and then answer questions. Next, have each group go through their presentation together, with each student reading aloud the narrative that he or she has written. Tell students that after each slide, they should pause and note in the chart things they think could be improved.

After groups have gone through their presentations, ask project managers to lead a discussion in which students share their notes for improvement. Tell students that they should consider their group’s feedback as they discuss the slides that they created, and



Step Min. Activity

take notes about specific improvements that they will make on their slides for homework.

Then instruct project managers to create a list in their notebook of the work that each member is going to do to revise his or her slides. Tell project managers that they should make sure that everyone in their group is clear about the work that they are going to do outside of class. Ask project managers to verify with the audio technician that they will be ready to record their narration at the beginning of the next class period.

To conclude, point out to students that much of the work they are doing is without your direct guidance and that the ability to work independently is a useful professional skill.

CLASS PERIOD 4

6

40 Culminating Project Work: Creating Audio Narrative

Students begin recording their audio narrative.

Groups will each need a quiet area during this activity to create the audio recording for their presentation. Prior to this activity, you may wish to select and arrange for designated areas at your school where groups can work on their recordings in quiet, without background noise.

Have students meet in their culminating project groups and review revisions that they completed for homework.

Then explain that students are going to work on their audio recording. Tell students that it is important that they record their audio in a quiet place, without background noise. Assign groups to the designated locations where they will work.

Refer students to Student Resource, 14.5, Assignment: Audio Recording. Have group members read the instructions and the steps together. Answer any questions. Emphasize that since they may be working in a location where they have no direct access to you during the activity, they should make sure that they are clear about the assignment now.

Then have groups move to the designated recording areas and begin their work. Circulate among groups, answering questions that come up.

When about 10 minutes remain of the class period, have students congregate again as a class, and tell them that they will have an opportunity to make one more recording during the next class period. Suggest that if they are not satisfied with the quality of their recording, they may wish to practice their narrative at home.

7 10 Culminating Project Work: Preparing to Meet with the Expert Panel

Prior to this activity, decide the order in which groups are going to show their presentations. You will provide students with the order during this activity.

The purpose of this activity is for students to learn how the culminating project event will be structured and for students to prepare to meet the expert panel and the outside audience.

To begin, explain to students how the culminating project event will be structured. (You



Step Min. Activity

may wish to refer to Teacher Resource 14.1, Guide: Planning for the Presentation, and Teacher Resource 14.2, Guide: Expert Panel.)

Inform students which group will go first, second, third, and so on, and make sure all groups know on which day they will present, if you are spreading presentations across two days.

Provide students with information about the professionals who will be on the expert panel, including their names, their professions, and where they work.

Then explain the format for the culminating project event:

Beginning with the first group, group members introduce themselves and explain in one or two sentences why their group chose their health issue to focus on.

The group presents its slideshow.

Group members answer questions from the expert panel and from other members of the audience. Each student should be prepared to answer questions about the section of the presentation that he or she researched and wrote. Students should also be prepared to contribute information to their group members’ responses.

Remaining groups present in the designated order, following the same format.

After all of the groups have presented, the expert panel will address the following questions:

o If you had to choose one of the issues to be the focus of the international health summit, which would it be and why?

o What convinced you of the worthiness of the health issue?

After you have reviewed the format, ask volunteers to name important points of professional conduct and dress, and create a list on the board. Sample responses may include “look people in the eye when speaking to them” and “shake hands when you meet someone.” Make sure that students are prepared to come to the event dressed and acting professionally.

For homework, instruct students to write down in their notebook ideas about what their group should say when they introduce themselves to the panel. Explain that they should come to class prepared to formulate a one- or two-sentence introduction with their group.

CLASS PERIOD 5

8

20 Culminating Project Work: Final Audio Recording

In this activity, students finalize their audio recording.

To begin, refer groups to the rubric (Teacher Resource 14.4) and ask them to review the sections that address the audio recording. Then instruct groups to view their presentation with the audio, making notes in their notebook about slides they think could be improved and ways to improve them. After they have viewed the presentation, have students share their ideas within their group and decide which slides need to be recorded a final time.

Then have groups re-record slides that still need improvement. Help each group find a quiet space where they can record. Students may also use this time to add finishing



Step Min. Activity

touches to their slides. Tell students that this is their opportunity to make all final changes to the slides in preparation for presenting their work to the expert panel.

9

25 Culminating Project Work: Dry Run

In this activity, students go through a dry run of their presentation.

To begin, remind students that to introduce their presentation, they will briefly explain why they chose the issue they are focusing on. Ask students to read aloud to their group the introductory sentences that they wrote for homework. Then instruct them to work together to formulate a polished one- or two-sentence introduction that they agree on. Explain that they can choose to use one member’s sentences or that they can take the best parts of two or more members’ ideas.

When they have completed their introduction, ask them to choose who in their group will be the speaker for this part of their presentation. Have that person practice the introduction a few times in front of the group. Encourage students to practice professional behavior in addition to what they are going to say.

Next, explain that students are going to do a dry run, or a rehearsal, of their presentation. Note that all presenters, no matter how many times they have presented before, practice like this to make sure their presentation is as engaging and informative as possible. Tell them that the dry run will include:

The introduction

Their self-running slideshow

A mock question-and-answer session

To prepare for the question-and-answer session, instruct each student to think of one question to ask a fellow group member about that group member’s section. Tell them to write the question in their notebook.

Have students go through their dry runs. Encourage them not to pause the slideshow in the middle of the dry run. After the slideshow, have students ask their fellow group members the questions that they wrote down in their notebook. Encourage students to give brief, clear responses. Tell them that if they don’t know the answer to a question, they should defer to another group member or simply say that they don’t know but that they would like to find out. Before they present to the panel, they could research the answer so that if they are actually asked this question, they are prepared to answer it.

Answer any final questions that students have about the format and schedule for the presentations.

10 5 Culminating Project Work: Feedback Forms

In this activity, students receive instruction on the feedback forms that they will use to take notes on their peers’ presentations.

Refer students to Student Resource 14.6, Feedback Form: Culminating Project Presentation, making sure that students have enough copies to provide feedback for each of the groups. Tell students that, in addition to the feedback they receive from you, they will also receive feedback from their classmates. Explain that students will fill out feedback forms after each group’s presentation. Tell them that they should take the



Step Min. Activity

entire presentation—the introduction, the slideshow, and the group’s response to questions—into consideration as they fill out the forms.

Answer any questions students may have about the feedback forms.

Tell students that they are now ready to deliver their presentations in front of a live audience. Congratulate them on their hard work in getting to this point. Encourage them to get a good night’s sleep before the presentations and to eat a healthy meal beforehand. Also remind them to dress in business attire and to come ready to proudly present their work.

CLASS PERIOD 6

11

10 Culminating Project Work: Event Introductions

In this activity, you set the stage for the culminating project presentations to an expert panel and an invited audience.

Before the event begins, make sure you have the PowerPoint presentations available on a computer with good speakers that are connected to an LCD projector, and test them to make sure the audio is working correctly. Also write these questions on the board or on a sheet of chart paper:

Is this health issue worthy of being the focus of an international summit? If yes, what are the elements that make a strong case for including this issue in the summit?

If you could choose only one issue for the summit to focus on, which would be your top choice, and why?

Make sure students are actively involved in greeting visitors as they arrive, and ask the expert panel to sit in a designated area. Pass out copies of Teacher Resource 14.5, Note-Taking Tool: Expert Panel, to panel members and suggest that they may want to use it to take notes during the presentations.

To begin the event, thank everyone for attending, and congratulate the students on their hard work.

Then explain how the event will proceed. Explain that each group will give their presentation and that each presentation will be followed by a brief period for questions and answers from the expert panel and the audience members.

Next, explain to the audience that as each group presents its health issue, the expert panel will judge whether the health issue is worthy of being the focus of an international health summit.

Ask the members of the expert panel to introduce themselves to the students and the audience by saying their name, their profession, where they work, and what their interest is in health issues that are worthy of being the focus of an international health summit.

12 40 Culminating Project Work: Presentations



Step Min. Activity

In this activity, students deliver their presentations.

The groups that you have chosen to present on the first day now deliver their presentations. Each group should first give their introduction and then show their self-running slideshow using an LCD projector. After each presentation, allow a few minutes for expert panel members and other members of the audience to ask questions. Remind students to complete a feedback form for each presentation. As each group presents, use Teacher Resource 14.4 to assess the presentation.

At the end of the class period, collect the feedback forms for that day’s presentations. Organize the forms by group and review the forms for any inappropriate comments. Make sure students have a few moments to interact with the audience and thank expert panel members and others in the audience for attending.

CLASS PERIOD 7

13

35 Culminating Project Work: Presentations (Continued)

In this activity, the remaining groups deliver their presentations.

Each group should first give their introduction and then show their self-running slideshow using an LCD projector. After each presentation, allow a few minutes for expert panel members and other members of the audience to ask questions. Remind students to complete a feedback form for each presentation. As each group presents, use Teacher Resource 14.4 to assess the presentation.

14 15 Culminating Project Work: Expert Panel Review

In this activity, expert panel members provide students with feedback.

After the last presentation, give the expert panel four or five minutes to compare notes and come to a decision about which issues they would choose to be the focus of an international summit and why they think there is a strong case for their choice. Also ask the expert panel to choose the issue that they think would be the very best choice and explain why.

You may want to ask students to serve refreshments to other guests while the panel deliberates.

After a few minutes, ask a spokesperson for the panel to reveal the panel’s decisions, and then encourage panel members to point out how groups did an exemplary job of convincing the audience of the worthiness of their issue.

Collect the feedback forms for that day’s presentations from students. Organize the forms by group and review the forms for any inappropriate comments.

To conclude, thank the students for their dedication and commitment to the project and thank the expert panel members and audience for their interest and participation. Make sure students have a few moments to interact with the audience and thank expert panel members and others in the audience for attending.

Tell students that they will have a chance to review the feedback on their presentations at the beginning of the next, and final, lesson of the course.



Extensions

STEM Integration Technology: Have students create a website to showcase their culminating project work using cut-

and-paste and drag-and-drop templates on weebly.com, webs.com, or another available site. Explain that they can convert their PowerPoint slide presentation to a video file using Microsoft PowerPoint 2010 or 2013 and then upload it to one of these free sites.

Additional Cross-Curricular Ideas English Language Arts: Have students submit articles about their experience of presenting their

work in front of a panel of global health professionals to the school newspaper or website. They can also submit them to the local newspaper and to the organizations represented by the expert panel. Finally, they can submit their articles to the National Academy Foundation, which welcomes input from the students it serves.


AOHS Global Health


Teacher Resources


Teacher Resource 14.1 Guide: Planning for the Presentation

Teacher Resource 14.2 Guide: Expert Panel

Teacher Resource 14.3 Presentation and Notes: Characteristics of a Good Narrative (includes separate PowerPoint file)

Teacher Resource 14.4 Rubric: Culminating Project Presentation

Teacher Resource 14.5 Note-Taking Tool: Expert Panel

Teacher Resource 14.6 Key Vocabulary: Project Presentation




Guide: Planning for the Presentation

The students’ presentation of their project is the culmination of all the hard work they have put into this course. Therefore, it is important that the final presentation be staged as a special event, with an expert panel of health professionals and with invited guests such as NAF academy advisory board members, school administrators and teachers, community leaders, health professionals, and parents. (See Teacher Resource 14.2, Guide: Expert Panel, for instructions and tips on assembling the expert panel.)

Step 1: Schedule It Properly Consider the number of groups that will be presenting and allow 10–12 minutes per group. Their actual presentation should be 5–6 minutes long, but time is needed for groups to introduce themselves and then respond to questions after the presentation. In addition, transition time is needed between the groups. Keep in mind that the number of class periods allowed for this lesson may need to be adjusted based on the number of groups you have.

Once you know how much time you need to allow, decide whether to hold the event during school hours or outside of class time. Consider when your students and invited guests are most likely to be available. It may be easier to attract parents, NAF academy advisory board members, community professionals, and local leaders to an evening event that will not take time out of their workday. If you do decide to hold the event outside of class time, make sure to notify the students as soon as possible so that you have time to handle scheduling conflicts.

Step 2: Invite the Right People It is vital that this presentation be done for a broader audience than just you and the rest of the class. In addition to the professionals you will invite to serve on the expert panel, consider designing (or having your students design) an invitation or flyer that can be distributed to interested parties.

Here are some of the people you may want to invite:

School administrators, guidance counselors, other teachers, and school board members

NAF academy advisory board members

Local internship providers

Local business leaders

Anyone who has assisted your class in any way—guest speakers, for example

Local middle and high school guidance counselors (to help recruit future AOHS students)

Parents, guardians, friends, and relatives of the students

Step 3: Make It Celebratory The students need to get the message that this is a big deal.

If possible, consider using a larger room, perhaps with a podium at one end for students who are presenting. Arrange the room so that the expert panel is seated together in a designated area at the front of the room.



Make arrangements for refreshments to be available before or after the presentations. The PTA or parents group may be able to assist in this, or discuss other options with your school administration.

Reinforce the significance of the event by emphasizing to the students that they dress nicely, in appropriate business attire.




Guide: Expert Panel

Students will be delivering their presentations to a broad audience of family, guidance counselors, NAF academy advisory board members, and others. Perhaps most importantly they will be presenting in front of an expert panel who will judge if they have achieved one of the major goals of the project: to convince the panel that the issue the group has chosen is worthy of being the focus of an international summit.

In preparation for the presentations, invite a panel of three to five global health professionals to attend the presentations and provide students with feedback on their work from a professional point of view. You may consider including NAF advisory board members and other professionals who have been guest speakers during the course. If you need suggestions about professionals who would be qualified to serve on the expert panel, consider asking your NAF academy advisory board members for ideas.

Make sure to provide the following information to experts who will serve on the panel:

Date(s), time, and location of the event. If the event is split over two days, make sure they understand they must attend both sessions.

A summary of what the event is about, such as the following:

o Students have been studying global health issues this semester, and for their culminating project each group has chosen a health issue that they think is worthy of being a focus of an international health summit. Their presentation is designed to convince a panel of experts that the issue they have chosen is worthy of being the focus of an international health summit.

What you are expecting from panel members:

o To ask students challenging—but reasonable—questions about the content of their presentations

o To judge the presentations based on their persuasiveness

o To confer with the other members of the panel to evaluate which issues are worthy of being the focus of an international health summit, and which issue is the most worthy of being the focus of the summit




Presentation Notes: Characteristics of a Good Narrative


In this presentation, we are going to learn about the characteristics of a good narrative. There are two main aspects of your narrative to focus on: the content of the narrative, or what you say in the narrative, and the audio recording. First, we are going to discuss the content.

Presentation notes



The first rule of thumb for creating good narrative content is to keep your narrative for each slide brief. You are likely to lose your audience if the narrative for a slide is longer than three sentences. Often one sentence is best. Since you can’t use a lot of words, every word in your narrative needs to count. Carefully read your narrative and determine if there are irrelevant or repetitive words or phrases that can be taken out.

Presentation notes



It’s important that your narrative focus on the topic presented in the slide the audience is viewing. When you write your narrative, check to make sure all of the points are closely related to the main topic of the slide.

Presentation notes



Your narrative should not simply repeat the information that is on your slides. Instead, you want the information on your slides and the information in your narrative to support each other.

Presentation notes



Creating good narrative content is key to a successful presentation. Next, we’ll discuss creating a good audio recording.

Presentation notes



To make a great audio recording, it’s important to speak clearly. Remember, audience members will not be watching you as you speak, and therefore, they cannot look at you for nonverbal cues, like hand gestures or facial expressions. Also, speak naturally. Don’t overdo it by adding too much drama or emotion to your voice, but also avoid having your voice sound too flat or dull. Don’t ad lib, or make things up, as you record.

Presentation notes



Stand up while you are recording the audio, which will help you feel more energized and help you breathe better. As you are recording, have water available and take sips if your throat or mouth feels dry. Keeping your vocal cords hydrated will help the sound of your voice. As you record, relax and don’t rush your words. You should also consider speaking to your group as you record. This will help your voice sound as if it is engaged with an audience.

Presentation notes



Practice, practice, practice! Read aloud to your group. Have them listen with their eyes closed and then give you feedback about how natural you sound and what the clarity and quality of your voice sounds like.

Remember, unlike a live presentation, an audio recording means you have several opportunities to go back and make changes to get the recording right. Good luck!

Presentation notes



Professionals who have the task of creating presentations that cover a lot of information have to keep their audience engaged, not overwhelmed. They keep a roadmap in mind. A roadmap is three or four points that the listener will be able to know, understand, do, or take away from the presentation.

As you create your own presentation, think about the most important points that you want your audience to retain. It will help you to keep focused.

Presentation notes




Rubric: Culminating Project Presentation

Student Names:_____________________________________________ Date:_______________


Comprehension of Subject Matter

All of the content is accurate and complete and communicates a complete understanding of the topic.

Most of the content is accurate and shows mastery of the topic.

The content shows some flaws and omissions and illustrates only partial knowledge of the topic.

Much of the content is inaccurate and confusing and communicates very little understanding of the topic.

Visual Design The assignment is highly attractive, well designed, and professionally laid out. Appropriate graphics are used tastefully, effectively support the content, and make it easy to follow.

The assignment is attractive and has a good design and an organized layout. Graphics help support the content.

The assignment contains graphics and multimedia, but it lacks good design and organization. Too many or too few graphics are used and are ineffective in supporting the content.

The assignment is messy and contains no coherent visual design. Graphics are not present at all or, if present, distract from the content.

Content Organization/ Flow

The content is clearly organized, with a logical flow of connected ideas and effective transitions.

The content is organized, and most ideas are well connected with effective transitions.

The ideas are sound, but the content is not well organized and needs more effective transitions.

The content is extremely disorganized. The transitions between ideas are unclear or nonexistent.

Use of Thinking Strategies

The presentation uses a wide variety of thinking strategies to communicate ideas, including but not limited to:


The presentation uses some thinking strategies to communicate ideas, including but not limited to:


The presentation uses one or two thinking strategies to communicate ideas, including but not limited to:


The presentation does not use thinking strategies to communicate ideas.

Labels and Titles The labels and titles are concise and clearly fit the content.

The labels and titles are somewhat concise and fit the content.

The labels and titles are somewhat vague and do not fit the content.

The labels and titles are all confusing and do not fit the content.

Mechanics There are no grammatical, spelling, or punctuation errors.

There are few grammatical, spelling, or punctuation errors.

There are some grammatical, spelling, or punctuation errors.

There are many grammatical, spelling, or punctuation errors.




Required Format The format conforms to the required specifications.

The format has only very minor deviations from the required specifications.

The format does not meet the assignment specifications.

The format is completely different from the assignment specifications.

Elements and Examples

All required elements are included in the assignment. Some additional elements are included to enhance the assignment. All of the evidence and examples (facts, statistics, and real-life experiences) are specific and relevant.

All elements are included in the assignment. Most of the evidence and examples are specific and relevant.

One or two of the required elements are missing. At least one piece of evidence or one example is relevant.

More than two elements are missing. Evidence and examples are not relevant.

Slideshow Preparedness

The slideshow is completely prepared and well rehearsed. The slideshow and audio move correctly from one slide to the next with no glitches.

The slideshow is prepared but needed more rehearsal. The slideshow and audio move correctly from one slide to the next with one or two glitches.

The slideshow was somewhat prepared, but it is clear that there was not enough rehearsal. The slideshow and audio do not run smoothly, and some slides lack audio.

The slideshow was not ready to be presented. The slides do not run smoothly, and narration is missing.

Narration

All narration is loud, clear, and at the appropriate speed. Narrators do not stumble over words or mispronounce. The narrators sound natural and exude enthusiasm about the content.

Most narration is loud, clear, and at the appropriate speed. Narrators may stumble or mispronounce a few words. The narrators sound enthusiastic about the content.

Much of the narration is too soft, mumbled, or too fast. It is hard to understand and follow some of what the narrators are saying, and words are mispronounced. There is not much enthusiasm in the voices.

All of the narration is too soft, mumbled, or too fast. Words are mispronounced or repeated, and it is hard to follow. There is a lack of enthusiasm in the voices.

Length The presentation covers all aspects of the topic well and falls within the specified length.

The presentation adequately covers all aspects of the topic within the specified length.

The assignment is a bit shorter or longer than the specified length.

The assignment is much shorter or longer than the specified length.


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Note-Taking Tool: Expert Panel

Instructions: This chart is designed to help you evaluate each health issue that is presented. After all groups have made their presentations, you will confer with other expert panel members to decide which health issues are worthy of being the focus of an international health summit. You will also choose one issue that is most worthy of being the focus of such a summit and give reasons for your choice.

Health Issue Strong Points That Made the Argument Convincing

Weak Points or Information Missing from the Argument




Key Vocabulary: Project Presentation

Term Definition

compile To put documents or other materials together in one work.

dry run A rehearsal or practice event.

enunciate To pronounce in an articulate way.

volume Fullness or intensity of sound.


AOHS Global Health


Student Resources


Student Resource 14.1 Reading: Characteristics of a Good Narrative

Student Resource 14.2 Practice: Characteristics of a Good Narrative

Student Resource 14.3 Guide: Final Presentations Preparation

Student Resource 14.4 Chart: Slides Review

Student Resource 14.5 Assignment: Audio Recording

Student Resource 14.6 Feedback Form: Culminating Project Presentation




Reading: Characteristics of a Good Narrative

In this presentation, we are going to learn about the characteristics of a good narrative. There are two main aspects of your narrative to focus on: the content of the narrative, or what you say in the narrative, and the audio recording. First, we are going to discuss the content.



The first rule of thumb for creating good narrative content is to keep your narrative for each slide brief. You are likely to lose your audience if the narrative for a slide is longer than three sentences. Often one sentence is best. Since you can’t use a lot of words, every word in your narrative needs to count. Carefully read your narrative and determine if there are irrelevant or repetitive words or phrases that can be taken out.



It’s important that your narrative focus on the topic presented in the slide the audience is viewing. When you write your narrative, check to make sure all of the points are closely related to the main topic of the slide.



Your narrative should not simply repeat the information that is on your slides. Instead, you want the information on your slides and the information in your narrative to support each other.



Creating good narrative content is key to a successful presentation. Next, we’ll discuss creating a good audio recording.



To make a great audio recording, it’s important to speak clearly. Remember, audience members will not be watching you as you speak, and therefore, they cannot look at you for nonverbal cues, like hand gestures or facial expressions. Also, speak naturally. Don’t overdo it by adding too much drama or emotion to your voice, but also avoid having your voice sound too flat or dull. Don’t ad lib, or make things up, as you record.



Stand up while you are recording the audio, which will help you feel more energized and help you breathe better. As you are recording, have water available and take sips if your throat or mouth feels dry. Keeping your vocal cords hydrated will help the sound of your voice. As you record, relax and don’t rush your words. You should also consider speaking to your group as you record. This will help your voice sound as if it is engaged with an audience.



Practice, practice, practice! Read aloud to your group. Have them listen with their eyes closed and then give you feedback about how natural you sound and what the clarity and quality of your voice sounds like.

Remember, unlike a live presentation, an audio recording means you have several opportunities to go back and make changes to get the recording right. Good luck!



Professionals who have the task of creating presentations that cover a lot of information have to keep their audience engaged, not overwhelmed. They keep a roadmap in mind. A roadmap is three or four points that the listener will be able to know, understand, do, or take away from the presentation.

As you create your own presentation, think about the most important points that you want your audience to retain. It will help you to keep focused.




Practice: Characteristics of a Good Narrative

Student Names:_______________________________________________ Date:__________________

Directions: After you watch the presentation Characteristics of a Good Narrative, write a narrative for the slides on this resource to put into practice what you have learned. Look at the information both on the slides and in the notes. Work with your group to write a narrative in the space below each section of notes that would be appropriate for an audio recording. The narrative should be brief, stay on topic, and support the information given on the slide. Every word in the narrative needs to count.

Sample Slide 1:

Obesity is a serious problem. It can result in problems like increased risk of heart disease, high blood pressure, diabetes, breathing problems, and trouble sleeping. Being a few extra pounds overweight does not mean that you are obese. For children and teens, obesity typically begins between the ages of 5 and 6 or during adolescence. There are many causes of obesity. They include poor eating habits, overeating, lack of exercise, a family history of obesity, low self‐esteem, and stressful life events. Poor eating habits may involve snacking throughout the day instead of having meals, or eating only junk food. If teens spend all of their time in front of a computer or watching television, they are not getting enough exercise. This can result in obesity. Stressful life events for teens could include moving to a new school or experiencing a death in the family. Stressful life events can contribute to obesity.

Your Narrative for This Slide:



Sample Slide 2:

At the Center for Healthy Africa, we focus our health education budget on four pressing issues: malnutrition, malaria, HIV/AIDS, and maternal health. We divide our resources equally among these four issues. This means that we spend the same amount on each issue. One quarter of our budget is focused on malnutrition. One quarter is focused on malaria. One quarter is focused on HIV/AIDS. And one quarter is focused on maternal health. We’ve chosen these issues to focus on because we believe that they are the most pressing issues facing communities in Africa today. Our health education programs involve sending representatives into communities to talk about the issues, passing out educational brochures, and hosting local radio programs where experts address the issues.

Your Narrative for This Slide




Guide: Final Presentations Preparation

Student Name:_______________________________________________ Date:__________________

Directions: Follow the directions in the section on your project role, which describe the preparatory work you must do to create your group’s culminating project PowerPoint presentation. Your teacher will meet separately with the lead designers and audio technicians to go over their responsibilities and answer any questions. Remember, the more preparatory work you do, the more organized and ready your group will be to create your presentation.

My assigned role: ____________________________________________________________

Lead Designer

Your group will create your PowerPoint presentation using a PowerPoint template. The preparatory work that you are responsible for is to choose two template designs to suggest to your group. You should spend your time looking at different templates and carefully selecting two that you think would work well for your health issue. As you look at templates, consider these tips:

Select a template that is simple, straightforward, and attractive.

Don’t choose a template that has too many graphic features. Remember, you are going to be adding photos, illustrations, and other graphics to your presentation. You don’t want your slides to look cluttered.

Select a template that looks professional and sophisticated and that conveys the tone of your topic. For example, while a template that looks elegant or sporty may be attractive, it’s probably not appropriate for the content of your presentation. Ask yourself, “Is this a template that health professionals would use to make an important presentation?”

Make sure the fonts you choose, the font size, and the colors will make all text easy for viewers to read.

Follow these steps to locate PowerPoint templates on your computer:

1. Open PowerPoint.

2. In the File menu, click New, and then in the Available Templates and Themes list, click Themes.

3. Scroll to see all of the themes. These themes are the templates you can choose from.

4. Each theme has a name. (For example, the sample presentation you saw on lymphatic filariasis was created using the theme called Civic.) When you see a theme that you think might work, open the template to try it out.

5. On the Home tab in the Slides group, click Layouts to see what different slide layouts look like in the selected theme.

Select two templates that you like, and then think about the reasons that the templates are good design choices for presenting information about your group’s health issue. Then write down your reasons in the following chart. When you share your selections with your group, go over your reasons with your group members.



First template selection: Second template selection:

Reasons I think it would be a good choice: Reasons I think it would be a good choice:

Audio Technician

You group’s presentation will have a recorded audio element, like the sample presentation you saw on lymphatic filariasis. In this activity, you will learn how to record audio in PowerPoint. At this point, don’t worry about what makes a good audio recording; you will discuss that with your group later. Instead, focus on understanding and practicing how to make a recording and make changes to it.

Go to the Microsoft Office article “Add Narration to a Presentation” (http://office.microsoft.com/en-us/powerpoint-help/add-narration-to-a-presentation-HA001230306.aspx). This page gives you step-by-step instructions on how to record audio in PowerPoint. The two sections that you want to focus on are:

Record a Narration Before a Presentation

Re-record Part of a Narration

Open a practice presentation in PowerPoint, and follow the steps in the online instructions to create audio for the presentation. Use a chart like the one below to take notes on important steps you need to remember. If there is a step that is confusing to you, make a note about questions you want to ask your teacher. You may also want to get help from the audio technicians in other groups.

Remember, it is your responsibility to lead your group in this important aspect of your project. Use this time to make sure that you understand how to correctly record, save, and make changes to the audio.

Step What I Need to Do Questions for My Teacher

Getting ready to record

Checking the microphone levels



Step What I Need to Do Questions for My Teacher

Saving the audio

Making changes to the audio

Chief Researcher

As you saw in the sample presentation, you need to include a list on the last slide of your presentation of all the sources that your group has used for research. You are responsible for creating this list. For now, list the sources in a Word document. Later, you will transfer the list to a slide in your presentation. Remember, it is important to list every source that each of your group members used. This includes sources used to get images, find facts, and read about background information. Check with your group members to make sure that you have collected all of their sources.

As you create your list of sources, follow these tips:

For each source, first list the name of the website. Then put a colon. After the colon, put the article title or the page name. Put quotation marks around article titles. On the next line, put the URL. Here are two examples:

o Centers for Disease Control and Prevention: “Malaria” www.cdc.gov/MALARIA/

o The New York Times: “For Intrigue, Malaria Drug Gets the Prize” www.nytimes.com/2012/01/17/health/for-intrigue-malaria-drug-artemisinin-gets-the-prize.html

Do not use acronyms. For example, Centers for Disease Control and Prevention is appropriate; CDC is not.

Create your list in alphabetical order, using the first letter of the name of the website.

You may add to the list as you complete your project work, but use this time to create as comprehensive a list as possible now.



Project Manager

During this preparatory time, you are responsible for making sure that your group’s loose ends are tied up and that your group is ready to move on to the next step of creating your presentation.

Begin by reviewing your teacher’s feedback on your outline chart. What feedback did your teacher give that is important to share with your group? Use a chart like the one below to organize your thoughts about your teacher’s feedback. An example of how to fill in the chart is shown.

Teacher Feedback Suggestions about How to Improve

Too many slides in the conclusion Consider cutting last slide since the information on that slide is repetitive

Then check in with each of your group members. See if they are having any specific problems that need to be resolved. In your notebook, make a list of problems and figure out what the next steps are to address the problems.

Before the end of the class period, call a brief meeting with your group to review what everyone has accomplished during this class period. Go over your teacher’s feedback and any outstanding problems. Finally, make sure that everyone is clear about any work that needs to be done outside of class. For example, the chief researcher may complete his or her list of sources at home, or the lead designer may want to spend more time reviewing templates in PowerPoint. Get the necessary help for any group members who are experiencing difficulties.




Chart: Slides Review


Directions: Create a chart in your notebook like the one below. With your group, go through your presentation. Have each group member read aloud the narrative notes for the slides he or she created. After each slide, pause to make notes in the chart about improvements that you think could be made to the slide. Examples are shown. As you work, keep in mind the criteria in the Exemplary column on the rubric (Teacher Resource 14.4).

After you have gone through the entire presentation, share your notes with the members of your group. As you get feedback about the slides that you created, make notes in the Revisions to My Slides section of this resource about improvements that you will make to your slides. You will work on these improvements outside of class.

Slide Number

Group Member Who Created the Slide

Suggestions for Improvement

4 Marissa Numbers on graph are too small to read. Make numbers bigger.

Transition between Slides 4 and 5 is not smooth. Add a transition sentence.

16 Hector Narrative notes are too long. Shorten narrative by 1 or 2 sentences.

Revisions to My Slides

Slide #: Improvements that I will make:






Assignment: Audio Recording


Directions: Your teacher will direct your group to a quiet location where you will create your audio recording for your presentation. Follow the steps below.

Step 1: Overview of the Audio Recording Process

The audio technician should explain to your group how the process of recording audio works. Ask the audio technician any questions that you have.

Step 2: Review Notes

As a group, review your notes about tips for creating good audio. Point out tips that you feel are important to keep in mind.

Step 3: Test for Background Noise

The audio technician should run a brief recording test to make sure that there isn’t background noise. If there is background noise that your group can’t control, such as music coming from a nearby classroom, consult with your teacher.

Step 4: Make the First Recording

Make your first recording of your narrative. Group members should speak the narrative for the slides that they created. Remember to observe all the tips you have learned about speaking well during a recording!

Step 5: Review the Recording

After the first recording is complete, review the narrative as a group and discuss how to improve it, using the following questions as a guide. As you review the recording, make notes in your notebook about specific things you need to pay attention to, such as enunciating your words more clearly.

Is the voice quality clear?

Does the person speak at an appropriate volume—not too loud or too soft?

Does the person speak at an appropriate rate—not too fast or too slow?

Does the person enunciate his or her words? Are there words that are mumbled or rushed through? Are there words or phrases that are hard to understand?

Does the person sound natural—not dramatic or excited, not bored or sleepy?

Step 6: Practice Your Narrative with a Partner

Work in pairs to practice saying your narrative aloud, keeping improvements that you are going to focus on in mind. When it is your turn to listen to your partner, you may wish to close your eyes to better focus on the quality of your partner’s voice and not be distracted by facial expressions or gestures.

Step 7: Make a Second Recording

After you are done practicing with partners, do a second recording. When the recording is complete, ask the audio technician to allow you to re-record any slides that you may have erred on.

You will have an opportunity to make one more recording during the next class period. You may wish to practice your narrative at home to prepare for this final recording.




Feedback Form: Culminating Project Presentation

Names of Presenters:________________________________________________________________

Health Issue Presented: _________________________________________________

Based on the presentation, would you choose this health issue as worthy of being a focus at an international health summit?

What are three strong, persuasive elements in the presentation?

1.

2.

3.

What are your unanswered questions or lingering doubts about this health issue? What could the group do to convince you that this issue is worthy of being a focus at an international summit?

1.

2.

3.


AOHS Global Health

Lesson 15 Working in Global Health and

Course Closure In this lesson, students consider health careers within a global context. They read about professions in global health and reflect on jobs that might be right for them. They meet global health professionals and inquire about their skills, knowledge, and experience. Students update their resume to reflect the skills and knowledge they have gained about global health. Students also profile leaders who are making a difference in global health and reflect on their own career aspirations. Students conclude the course by reflecting on what they have learned.

Advance Preparation

In Class Period 1, you will need access to the YouTube video “Honouring Heroes in Health” at http://www.youtube.com/watch?v=UwjHTKEVJaw. If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

Line up a guest speaker, or several guest speakers, to talk with your students during Class Period 3. The speakers should be global health professionals who are prepared to discuss their own job history, what they do now, and what they look for in someone applying for an internship or entry-level position. Tell the guests that the students will be asking a lot of questions and that their visit will be interactive.

In Class Periods 3 and 4, each student will need access to computers for Internet research.

Before Class Period 5, ask students to bring a printed copy of the most current version of their resume to class to update. If any students do not have a resume, you may want to work with them to develop a resume before this class period.

This lesson is expected to take 5 class periods but could be extended if more guest speakers can be secured.

AOHS Global Health Lesson 15 Working in Global Health and Course Closure


Lesson Framework


Reflect on which global and public health professions are personally appealing and why

Identify major milestones in the career paths of successful global health professionals and reflect on personal aspirations for working in global and public health

Summarize key learning across the whole subject of global health

Evaluate personal experience and performance in the course



Apply employability skills in healthcare (Healthcare Foundation Standard 4.21)

Research levels of education, credentialing requirements, and employment trends in health professions (National Health Science Standards 2015, Standard 4.31)

Distinguish differences among careers within health science pathways (diagnostic services, therapeutic services, health informatics, support services, or biotechnology research and development) (National Health Science Standards 2015, Standard 4.32)

Identify strategies for pursuing employment (National Health Science Standards 2015, Standard 4.42)





Explain the healthcare worker’s role within their department, their organization, and the overall healthcare system (Common Career Technical Core 2012, HL 2)

Evaluate the roles and responsibilities of individual members as part of the healthcare team and explain their role in promoting the delivery of quality health care (Common Career Technical Core 2012, HL 3)



Assessment


Biographical profile of a successful global health professional (Student Resource 15.4)

Assessment Criteria: Biographical Profile of a Global Health Professional (Teacher Resource 15.2)

Prerequisites Knowledge of health care careers and career pathways


Teacher Resources Teacher Resource 15.1, Guide: Qualifications and Skills

Teacher Resource 15.2, Assessment Criteria: Biographical Profile of a Global Health Professional

Teacher Resource 15.3, Key Vocabulary: Working in Global Health and Course Closure

Teacher Resource 15.4, Bibliography: Working in Global Health and Course Closure

Student Resources Student Resource 15.1, Chart: Career Pathways

Student Resource 15.2, Reading: Global Health Professions Employment Overview

Student Resource 15.3, Wish List: Interesting Jobs

Student Resource 15.4, Biographical Profile: Global Health Professional

Equipment and Supplies Whiteboard, blackboard, or flip chart

LCD projector and computer to show a video

Computers with Internet access (one student per computer)

All students will need a printed copy of the most current version of their resume



Lesson Steps

Step Min. Activity

CLASS PERIOD 1

1 15 Culminating Project Work: Project Presentation Debrief

Students have a chance to review and discuss peer feedback on their culminating project presentations.

Prior to this class period, review all feedback from the project presentations, check for any inappropriate comments, and organize the feedback by project group.

Ask students to move into their project groups for one last time. Distribute the completed peer feedback forms to each group and give them time to review and discuss the comments from their peers. When students have finished their discussion, ask them to return to their seats to take a few minutes to assess their own project and their work in this course.

Giving groups time to review feedback on their presentations helps them to understand their strengths and weaknesses. This insight prepares them for future group presentations, as they can use this feedback and apply it to other public speaking and presentation contexts.

2

15 Video: Global Health Careers Aspirations

Prior to class, prepare to project the following YouTube video or another short video “Honouring Heroes in Health” about global health workers at:

(http://www.youtube.com/watch?v=UwjHTKEVJaw)

If your school does not allow access to YouTube, you may wish to download the video to your computer in advance using KeepVid (see keepvid.com) or a similar program.

To introduce this activity, ask students if the work they did on the culminating project gave them some ideas for careers in global health that appeal to them personally. Take some suggestions from volunteers. Then ask for thoughts on what factors are important to them when they think about a career for themselves. Suggestions might include a job that pays well or that is in a place they’d like to live.

Tell students that they will be watching a video about how some people who live in developing countries make career decisions. Ask them to think about how their process of making career decisions is similar to or different from that of the professionals in the video.

Using an LCD projector, show students the video “Honouring Heroes in Health” (http://www.youtube.com/watch?v=UwjHTKEVJaw). Then ask student volunteers to respond to the following questions:

What points about the career decisions of the professional you saw in the video can you relate to?

What are your aspirations for making a contribution in health?

Point out that looking at health careers in a global context is a challenge, and that in



Step Min. Activity

this lesson, they will have several opportunities to look at their own career path.

3 15 Think, Pair, Share: Considering Professional Roles

The purpose of this activity is for students to prepare to explore specific professional opportunities in global health by recalling the careers they know something about.

Tell students that in this activity, they are going to think about these careers in a global health context. Refer students to Student Resource 15.1, Chart: Career Pathways, and ask them to read the directions. Have students choose careers that interest them in three different pathways and circle their choices.

Then, to help students understand what a health career might look like in a global health context, share with students the following example:

Mental health counselors work in clinics here in our town. They work with people who may be experiencing a divorce or recovering from an addiction, but these professionals also work in global health. For example, some counselors respond to extreme natural disasters, such as the Haiti earthquake. They are trained to work with survivors who may have lost everything, helping them express their grief and create a plan to rebuild their lives.

Then have pairs discuss the two questions at the end of the resource and write a response to each.

When students are done writing, ask volunteers to share their responses with the class, and answer any questions students have about career opportunities in global health.

To conclude, explain that while many global health professionals have jobs that are unique to global health, other professions, such as nurse or dentist, can be pursued in a global health context. Tell students that they will learn more about the types of global health careers in this lesson.

4 5 Reading: Global Health Professions Employment Overview

The purpose of this activity is to provide students with an overview of the different jobs available in global health and help students reflect on jobs that might be right for them. This activity also focuses on the following college and career skill:


Refer students to Student Resource 15.2, Reading: Global Health Professions Employment Overview, and Student Resource 15.3, Wish List: Interesting Jobs. Ask students to read the directions in Student Resource 15.3, and then answer any questions. Go over the example as a class. Explain that this assignment will help them think about specific jobs that might interest them as well as the qualities they would need to succeed in those jobs.

Ask students to complete the reading and their job wish list for homework and come to the next class period ready to share their wish list. Encourage them to visit the website listed, which contains a wealth of information about careers in public and global health.

CLASS PERIOD 2



Step Min. Activity

5 10 Homework Review: Job Wish List

In this activity, students share their job wish lists.

Ask students to take out their job wish lists (Student Resource 15.3) and share what they wrote with a partner. Once partners have had a couple of minutes to discuss, go around the room and ask each pair to share at least one job that they found appealing, along with the reasons why.

6 30 List, Group, Label: Job Qualifications

This activity develops students’ ideas about the job qualifications they consider important. (See The NAF Learning Handbook for more information on the List, Group, Label strategy.)

Write this prompt on the board:

List the personal and professional qualifications that you think would ensure success in a global health profession.

Have students brainstorm anything they can think of that would apply to the prompt, and list all the ideas on the board. See Teacher Resource 15.1, Guide: Qualifications and Skills, for a list of qualifications and characteristics the students should identify.

If students have trouble coming up with ideas, suggest that they think about one of the jobs on Student Resource 15.3, Wish List: Interesting Jobs. Then ask the whole class to suggest skills or knowledge a person might need to succeed in that job.

Once the class has listed 15 to 30 of these qualifications, guide students to organize the qualifications into the following categories:

Skills

Knowledge

Personal Characteristics

Experience

Next, place the students into small groups. Ask them to look over the categories of qualifications and answer the following questions:

Identify which qualities have been the most helpful while you completed the culminating project. Which qualities have you developed or improved upon during project work?

Which qualities will you need in order to complete an internship successfully?

Which qualities and skills do you think you will gain with an internship?

While the students discuss, circulate around the classroom, answering any questions.

Point out that knowing one’s own strengths, skills, and experiences is a necessary first step to applying for a job or an internship.

7 10 Guest Speaker Preparation: Meeting a Global Health Professional

This activity prepares students to take an active role when a global health professional



Step Min. Activity

visits the classroom.

Tell students that a global health professional will visit the class to talk about his or her career. Note what an excellent opportunity this visit is to learn what the work is like and which qualities and experiences are most important.

1. Ask students to take a moment to think about what they might ask the visiting speaker, and then have them write down two or three questions in their notebook.

2. Go around the room and ask each pair to share one question they thought of. Encourage students to copy down into their notebook any good questions they hear. Let the students know that you may call on any of them to ask a question, so this list is good preparation for that.

Make sure students understand that they are expected to take notes during the speaker’s visit. Have them start a new page in their notebook and label it with the guest speaker’s name and the date of the visit. Suggest that they plan to write down each question as it is asked and then make notes on the important elements of the speaker’s response. Remind them that they should not aim to write down everything that the speaker says but to focus on key points.

Students are now primed to hear from the visiting expert.

CLASS PERIOD 3

8 35 Guest Presenter: Working in Global Health

Students have an opportunity to ask a global health expert questions and also work on their public speaking skills.

Begin the class period by introducing the expert(s) you’ve invited. Ask class visitors to briefly describe the following:

Position in the global health field and responsibilities in this role

Work history and how they settled into their current position

Educational background and how educational experiences prepared them for work

Paths that they or their colleagues took to get into global health: what they studied in college, what related service work they did, and so on

Important items to include on a resume to get hired for a job or internship in global health

Use these prompts together with any additional questions that you think might help set context for your students.

Invite students to ask questions. If there are no volunteers, remind students to use the list of questions they made in their notebook. Then ask for volunteers again. If there are still no volunteers, choose a student.

At the end of the visit, make sure that students thank the expert(s). Tell students that they will have an opportunity to reflect on the interview during the next class period.

Hearing from a global health professional reinforces for students that the skills they are learning in this class are not merely theoretical ones but ones that people in their community use each day to support themselves. By meeting someone currently



Step Min. Activity

employed in global health, students are better able to imagine themselves in such a role, knowing that global health is a vibrant field—one in which they are very likely to be able to find a role in the future.

9

15 Biographical Profile: Writing about a Global Health Professional

The purpose of this activity is for students to learn and write about professionals who have succeeded in the field of global or public health and to reflect on how these professionals can serve as an inspiration for their own careers.

To begin this activity, ask student volunteers to name global health professionals who have inspired them. They may give specific names, such as Bill and Melinda Gates, or they may just give a description of the professionals, such as volunteers who work for Doctors without Borders. Make a short list on the board, and then tell students that in this activity, they will have a chance to profile a global health worker that they find inspirational.

Refer students to Student Resource 15.4, Biographical Profile: Global Health Professional. Go over the instructions and assessment criteria as a class, and then ask students to read the example. Call on students to give their ideas about how the example meets or does not meet each of the assessment criteria.

Ask students to begin by selecting the person they want to profile. Point out that the list on their assignment sheet showcases a variety of professions, and they should choose one that interests them personally.

Then have students get to work on their profiles. Explain that they will have 35 minutes in the next class period to complete their profile, so they should complete their research and fill out the table on the assignment sheet for homework.

CLASS PERIOD 4

10

50 Biographical Profile: Writing about a Global Health Professional (Continued)

In this activity, students write their biographical profiles. This activity focuses on the following college and career skill:


Have students get right to work writing their biographical profiles. Remind students to make sure that their work meets the assessment criteria. Circulate while students are working and answer any questions.

When about 15 minutes remain in class, organize students into groups of four. Tell them to summarize their profiles for their group mates and to answer questions about the person they profiled.

To conclude, reconvene as a class and ask student volunteers to answer this prompt:

The most important qualities people in global health need in order to love their work are….

Write these qualities on the board. Remind students that all of these people were once



Step Min. Activity

high school students trying to figure out what career would fit them best.

Instruct students to submit their completed profiles, and assess them using Teacher Resource 15.2, Assessment Criteria: Biographical Profile of a Global Health Professional.

CLASS PERIOD 5

11 25 Update: Professional Resume

In this activity, students evaluate their current resume draft and identify any updates they need to make.

At least one day before this activity, instruct students to bring a printed copy of the most recent copy of their resume to class.

Point out to students that a resume is a type of biographical profile, and it is important that they keep their resume up-to-date as they learn more about health science. Ask students to get out the copy of their latest resume. Then ask them to consider the following:

What skills, knowledge, and experience can you now add to your resume?

To help them get started, suggest that perhaps they’ve completed an internship or a summer job since the last time they worked on the resume. At a minimum, they should be able to list the slideshow they created for their culminating project for this course, as well as their knowledge of global health topics and their ability to work with graphs and statistics. If they are listing coursework on their resume, they can list this global health course. Ask students to share with the class what they are thinking of adding to their resume, which may help jog other students’ memories and give them ideas as well.

Ask students to make notes on their resume of any changes they want to make. Instruct them to use their notes to update the electronic copy of their resume when they have some time outside of class.

Next, have students pair with a neighbor to discuss how they are going to phrase their revisions. Ask pairs to work together to come up with the most professional and succinct way to express the changes they want to make. Ask volunteers to share their thoughts; open a brief discussion on whether there are any further improvements they could make. Encourage students to take additional notes on the printed copy of their resume if they hear something they want to incorporate into their own revisions.

Consider having the students share their resume with NAF academy advisory board members for feedback, particularly if the students have made substantial changes.

12 25 Notebook Reflection: At the End of the Course

This activity provides a final opportunity for students to reflect on and talk about what they have learned in this course.

Ask students to write a brief response to two of the following prompts:

What did you expect to learn in this course, and how did the course meet (or fail to



Step Min. Activity

meet) those expectations?

What are the most important things you learned in this course?

How has your understanding of global health changed during this course?

What is your overall evaluation of this course? Explain.

Tell students to look through their course notebook to help them think about what to say. After about 15 minutes, ask each student to choose one answer to share with the class. Encourage the class to write down anything they want to remember from their classmates’ remarks. Leave several minutes to make any final comments you wish to share with your students.

Extensions

Content Enrichment Conduct a Work-Based Learning (WBL) activity: Demonstrate the value of internships by showing

students the video "Internships Offer Meaningful Real-World Learning" on Edutopia, at http://www.edutopia.org/is-school-enough-real-world-internship-video. In the video, Noah interns at a nonprofit working to protect his city’s local water source, and he gains both knowledge and skills in the process. Have students think of their dream company or nonprofit and then identify a possible internship position they could hold. Next, have students consider and list possible skills and knowledge they would gain in such a position.

Introduce students to some of the self-evaluation tools designed to help people choose a career, such as those in What Color Is Your Parachute? Select a tool or tools appropriate for your students, and have the students complete the tool(s) in the classroom. To find further career resources, check with your school’s career or college office, if one exists.

Ask members of the NAF academy advisory board to review student resumes and provide students with constructive comments.

Ask students to organize their thoughts about the course once more. This time, however, ask them to comment specifically on which parts of the course they liked the most, which they thought were the most difficult, which they wished they had more time to complete, and so on.

Encourage students to create a list of ideas, recommendations, and improvements they would make if they had to teach the course the following semester, and to organize these suggestions into categories for presentation.

Instruct each student to write a letter to next year’s class on how to be successful, with hints and suggestions for making the course more successful for the incoming class. Create a binder of these letters to share with next year’s class.

STEM Integration Math: Demonstrate how salaries compound over time by having students calculate annual raises.

For example, ask them to compare starting salaries of $25,000 and of $40,000, assuming 5% increases each year.

Technology: Guide students to create a LinkedIn account if they haven’t already done so. Then instruct them to find a global health professional whom they’d like to contact via LinkedIn and ask for an informational interview.



Technology: Provide students with a list of online job boards, such as:

o Monster, http://jobsearch.monster.com/

o Idealist, http://www.idealist.org/

o WHO Employment, http://www.who.int/employment/en/index.html

o CDC Employment, http://www.cdc.gov/employment/recruitment/

Then encourage students to find job listings for the roles that most appeal to them. Ask students to explain the factors they think make one type of job more interesting than others—for instance, is advancement, money, or the location of the job key?

Additional Cross-Curricular Ideas English Language Arts, Science: Have students create a resume of a famous person in a health

care profession, such as Jonas Salk, Mary Stuart Fisher, Marie Curie, or Dr. David Livingstone. This resume should include education, experience, and skills based on what is known of that person. Make sure students use proper format and display the resume when completed. This can be an effective way of reviewing work from a particular historical period or of introducing real-life biographies into a science class. All other subjects: Tell students to ask other teachers whether an end-of-term summary and evaluation would be valuable in their courses. Students can write a letter to another teacher that makes the case for such an activity.


AOHS Global Health


Course Closure

Teacher Resources


Teacher Resource 15.1 Guide: Qualifications and Skills

Teacher Resource 15.2 Assessment Criteria: Biographical Profile of a Global Health Professional

Teacher Resource 15.3 Key Vocabulary: Working in Global Health and Course Closure

Teacher Resource 15.4 Bibliography: Working in Global Health and Course Closure




Guide: Qualifications and Skills

Use this information to guide the discussion on qualifications and skills.

Skills The following skills are important in global health:

Strong analytical and problem-solving skills, and the ability to think logically

Strong math and science skills

Good communication and presentation skills

Ability to manage multiple tasks at once

Ability to read and write in more than one language

Ability to make important decisions in a crisis or high-pressure environment

Knowledge The following knowledge is useful to have in global health:

Knowledge of the political, social, and economic issues in low- and middle-income countries

Knowledge and appreciation of different cultures

Knowledge of changing relationships between countries and between political and social groups

Knowledge of geography

Personal Characteristics Organizations tend to look for employees who:

Work well under pressure

Are detail oriented but still see the big picture

Take initiative—they find what needs to be done and do it

Are passionate about their work

Can be team players

Are self-motivated—they work independently, with little supervision

Have a professional attitude

Are flexible and able to cope with ever-changing priorities

Have a great respect for cultural differences

Demonstrate a commitment to public service

Experience Many global health organizations place great value on hands-on experience; volunteer work and internships count. They also look for candidates who have lived and worked in another country.




Assessment Criteria: Biographical Profile of a Global Health Professional

Student Name:______________________________________________________________

Date:_______________________________________________________________________


Met Partially Met

Didn’t Meet

The profile clearly explains why the professional’s contribution to public or global health is important, by providing both general information about the professional’s background and specific information about his or her accomplishments.

□ □ □

The profile demonstrates an understanding of the challenges and rewards of working in global health, as well as the skills, knowledge, and experience needed.

□ □ □

The profile provides a thoughtful reflection on how learning about the professional has affected the student’s ideas about his or her own career in public or global health.

□ □ □

The profile is neat and uses proper spelling and grammar. □ □ □


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________




Key Vocabulary: Working in Global Health and Course Closure

Term Definition

altruism An unselfish concern for other people’s welfare.

entry level Designation for a starting-level position at a business that requires a minimum amount of experience.

internship Temporary on-the-job training and experience in a particular career or field that is either paid or not paid.




Bibliography: Working in Global Health and Course Closure


Online “Candy Lightner.” Biography.com, http://www.biography.com/people/candy-lightner-21173669?page=1 (accessed October 29, 2015).

“Economists.” Bureau of Labor Statistics, http://www.bls.gov/ooh/Life-Physical-and-Social-Science/Economists.htm (accessed October 29, 2015).

“Environmental Scientists and Specialists.” Bureau of Labor Statistics, http://www.bls.gov/ooh/life-physical-and-social-science/environmental-scientists-and-specialists.htm (accessed October 29, 2015).

“Epidemiologists.” Bureau of Labor Statistics, http://www.bls.gov/ooh/life-physical-and-social-science/epidemiologists.htm (accessed October 29, 2015).

Global Health Workforce Alliance (GHWA). “Honouring Heroes in Health.” YouTube video, 6:11. March 1, 2011. http://www.youtube.com/watch?v=UwjHTKEVJaw (accessed October 29, 2015).

“Health Educators and Community Health Workers.” Bureau of Labor Statistics, http://www.bls.gov/ooh/community-and-social-service/health-educators.htm (accessed October 29, 2015).

“Interpreters and Translators.” Bureau of Labor Statistics, http://www.bls.gov/ooh/Media-and-Communication/Interpreters-and-translators.htm (accessed October 29, 2015).

“Medical and Clinical Laboratory Technologists and Technicians.” Bureau of Labor Statistics, http://www.bls.gov/ooh/healthcare/medical-and-clinical-laboratory-technologists-and-technicians.htm (accessed October 29, 2015).

“Statisticians.” Bureau of Labor Statistics, http://www.bls.gov/ooh/math/statisticians.htm (accessed October 29, 2015).

“WHO Employment.” WHO, http://www.who.int/employment/vacancies/en/ (accessed October 29, 2015).


AOHS Global Health


Course Closure

Student Resources


Student Resource 15.1 Chart: Career Pathways

Student Resource 15.2 Reading: Global Health Professions Employment Overview

Student Resource 15.3 Wish List: Interesting Jobs

Student Resource 15.4 Biographical Profile: Global Health Professional




Chart: Career Pathways

Student Name: Date:

Directions: Look at the health care careers in the chart below. Circle three careers that interest you. Then read and discuss the questions at the end of this resource. Write your responses in the space provided.

Therapeutic Services Diagnostic Services Health Informatics Support Services Biotechnology R and D

Acupuncturist

Anesthesiologist/Assistant

Anesthesia Technologist/Technician

Art/Music/Dance Therapist(s)

Athletic Trainer

Audiologist

Certified Nursing Assistant

Chiropractor

Chiropractic Assistant

Dental Assistant/Hygienist

Dental Lab Technician

Dietitian/Nutritionist

EMT/Paramedic

Endodontist

Exercise Physiologist

Home Health Aide

Kinesiotherapist

Licensed Practical Nurse

Massage Therapist

Medical Assistant

Mental Health Counselor

Naturopathic Doctor

Audiologist

Blood Bank Technology Specialist

Cardiovascular Technologist

Clinical Lab Technician

Clinical Laboratory/Technologist

Computer Tomography (CT) Technologist

Cytogenetic Technologist

Cytotechnologist

Dentist

Diagnostic Medical Sonographer

Electrocardiographic (ECG) Technician

Electroneurodiagnostic Technologist

Electronic Diagnostic (EEG) Technologist

Exercise Physiologist

Geneticist

Geriatrician

Admitting Clerk

Applied Researcher

Compliance Technician

Clinical Account Manager

Clinical Account Technician

Clinical Data Specialist

Community Services Specialist

Data Quality Manager

Epidemiologist

Ethicist

Health Educator

Health Information Mgmt. Administrator

Health Information Mgmt. Technician

Health Care Access Manager

Health Care Administrator

Health Care Finance Informatician

Animal Behaviorist

Biomedical/Clinical Engineer

Biomedical/Clinical Technician

Clinical Simulator Technician

Central Service Manager

Central Service Technician

Community Health Worker

Dietary Manager

Dietetic Technician

Environmental Health Advocate

Environmental Health Practitioner

Environmental Services/ Specialist

Facilities Manager

Food Safety Specialist

Health Advocate

Biochemist

Bioinformatics Scientist

Biomedical Chemist

Biomedical Manufacturing Technician

Biostatistician

Cancer Registrar

Cell Biologist

Clinical Data Management Specialist

Clinical Pharmacologist

Clinical Trials Monitor

Clinical Trials Research Coordinator

Crime Scene Investigator

Diagnostic Molecular Scientist

Forensic Biologist

Forensic Chemist

Forensic Odontologist

Forensic Pathologist

Genetic Counselor

Geneticist-Lab Assistant



Therapeutic Services Diagnostic Services Health Informatics Support Services Biotechnology R and D

Nurse Anesthetist

Nurse Midwife

Nurse Practitioner

Occupational Therapist/Assistant

Oral Surgeon

Orientation/Mobility Specialist

Orthodontist

Orthoptist

Orthotist/Prosthetist/Technician

Pedorthist

Perfusionist

Pharmacist

Pharmacy Technician

Physical Therapist/Assistant

Physician (MD/DO)

Physician Assistant

Podiatrist

Psychologist

Psychiatrist

Radiation Therapist

Recreation Therapist

Registered Nurse

Rehabilitation Counselor

Respiratory Therapist

Speech-Language Therapist

Surgical Technician

Veterinarian

Veterinarian Assistant

Wellness Coach

Histotechnician

Histotechnologist

Magnetic Resonance Technologist

Mammographer

Medical Technologist/ Clinical Laboratory Scientist

Nuclear Medicine Technologist

Optician

Ophthalmologist

Ophthalmic Assistant/Technologist

Optometrist

Pathologist

Pathologists’ Assistant

Phlebotomist

Polysomnographic Technologist

Positron Emission Tomography (PET) Technologist

Radiologic Technologist

Radiologist

Speech-Language Pathologist

Information Privacy Officer

Managed Care Contract Analyst

Medical Coder

Medical Historian

Medical Illustrator

Medical Information Technologist

Medical Librarian

Medical Transcriptionist

Patient Account Manager

Patient Account Technician

Patient Advocate

Patient Information Coordinator

Project Manager

Public Health Educator

Quality Management Specialist

Quality Data Analyst

Research and Decision Support Specialist

Reimbursement Specialist

Risk Manager

Unit Coordinator

Utilization Manager

Utilization Review Manager

Hospital Maintenance Engineer

Industrial Hygienist

Interpreter

Marital, Couple, Family Counselor/Therapist

Materials Manager

Medical Health Counselor

Mortician/Funeral Director

Nurse Educator

Occupational Health Nurse

Occupational Health & Safety Expert

Social Worker

Transport Technician

Lab Technician

Medical Editor/Writer

Microbiologist

Molecular Biologist

Nurse Researcher

Packaging Technician

Patent Lawyer

Pharmaceutical/Clinical Project Manager

Pharmaceutical Sales Representative

Pharmaceutical Scientist

Pharmacokineticist

Pharmacologist

Product Safety Scientist

Process Development Scientist

Processing Technician

Quality Assurance Technician

Quality Control Technician

Regulatory Affairs Specialist

Research Assistant

Research Scientist

Toxicologist



Think about one of the careers that you circled. If a person in this profession worked in global health, what additional or special training, skills, knowledge, and responsibilities might he or she have?

Think about one of the careers that you circled. Why might someone in this profession want to work in global health?




Reading: Global Health Professions Employment Overview

There are many ways to work in global health and a large number of professions that serve global health needs. These professions include doctors and nurses, but they also include career paths that you may not expect. You don’t need to be trained in a medical profession to work in global health. For example, people trained in communications, engineering, ecology, and finance can all play important roles in global health.

People choose to enter global health professions for a number of reasons. Some people are driven by altruism, or an unselfish concern for other people’s welfare, and a commitment to public service. Others are seeking adventure and want to satisfy a curiosity about cultures other than their own. Working internationally can come with challenges, such as difficult living and working conditions, the risk of disease and injury, and separation from family and friends. But not all global health work involves travel. For example, a scientist searching for a cure for AIDS may work in a laboratory close to home—and yet the scientist’s work may touch lives around the planet.

Types of Employers A broad range of organizations employ people in global health. The following table gives information about different types of global health employers. One approach to figuring out what global health career may be right for you is to consider what type of organization you might want to work for.

Type of Employer Brief Description Examples

Government agencies

Provide a wide range of health activities that support health programs in mostly low- or middle- income countries.

USAID

Centers for Disease Control

Nongovernmental organizations (NGOs)

Smaller local NGOs likely focus on one health issue or one population, such as reproductive care in Bangladesh. Larger international NGOs may focus on many issues, such as water, sanitation, and pollution in low- and middle-income countries.

Oxfam

Save the Children

Organizations involved with the delivery of humanitarian services or financial services

Provide services including:

Clinical services in low- or middle-income countries in response to a natural disaster or complex humanitarian emergency

Services that are part of a short-term medical mission, such as dental care to children in Guatemala

Financial assistance to low- and middle-income countries

Doctors without Borders

The World Bank

UN agencies Provide services to people around the world. The UN is the world’s largest international employer, with 60,000 staff members globally and 4,500 in the United States.

World Health Organization

UNICEF



Type of Employer Brief Description Examples

Academia Provide education, training, and research opportunities in global health. University academic departments that address global health issues include anthropology, economics, medicine, political science, and public health.

International Health at Johns Hopkins University

Global Health Program at New York University

Policy organizations

Focus on research and analysis of key policy matters, using research to try to influence policymakers.

Center for Global Development

Council on Foreign Relations

Advocacy organizations

Raising awareness and funding for global health issues.

Bill and Melinda Gates Foundation

AIDS United

Global Health Careers In addition to thinking about what type of employer you’d like to work for, you should also consider what type of job you might like to have and whether the demand for the profession will stay strong in the future. You know about a range of health care careers that have a global health context, such as pediatricians, registered nurses, and mental health counselors. Below are some other careers to consider. Remember, there are a lot of possibilities out there.

Biostatistician

A biostatistician is a type of statistician who works mainly in public health and medicine. Biostatisticians use mathematical techniques to analyze and interpret data and draw conclusions. Many economic, social, political, and military decisions rely on the work of statisticians. A biostatistician might design a study that tests whether a new drug could successfully treat tuberculosis or help identify the source of an Ebola outbreak. People who enter this line of work excel at math and computing.

Communications specialist

A communications specialist leads a global health organization’s communication efforts. This may include writing and editing a magazine, a newsletter, website, or other materials that the organization publishes as well as managing social media. It may also involve setting up interviews between staff members and journalists, managing social media, or creating and leading major health campaigns. Communication specialists have excellent writing skills and the ability to connect with a variety of people.

Emergency operations center manager

An emergency operations center manager oversees a center’s ability to effectively respond to disasters and other emergency situations in a particular area. The goal of this professional’s work is to lessen the impact of a disaster on a population. Responsibilities may include training people in disaster preparedness, monitoring events to anticipate possible threats, and coordinating relationships with other groups, like the Red Cross or the military. People who do this type of work have excellent leadership skills and the ability to make decisions under pressure and perform effectively in crisis situations.

Environmental health scientists

Environmental health scientists study how environmental factors affect human health. This may involve educating the public about health risks related to the environment, such as air toxins released after an accident at a chemical plant. Their work involves collecting and analyzing environmental data, such as



samples of air, soil, and water, and creating plans to prevent, control, or fix environmental problems, such as a polluted drinking water supply. Environmental scientists have a strong interest and background in the sciences and the natural world, as well as in human behavior.

Health economists

Health economists research and analyze economic issues related to health and global affairs. Their work involves conducting surveys and collecting and analyzing data using mathematical models and statistical techniques. They often advise think tanks, governments, and international organizations on solving economic problems. They may also use economic concepts to address health issues such as studying the effect of cigarette taxes on smoking rates. Economists excel in math and have a deep knowledge about global history.

Health educators

Health educators develop programs and materials to encourage people to make healthy decisions. They teach people about healthy behavior, such as proper nutrition and physical activity. During emergencies, health educators are often responsible for providing safety information to the public. Some health educators work with policymakers to create public policies that support healthy behaviors. A health educator may specialize in a particular health topic, such as controlling malaria in sub-Saharan Africa. Health educators have excellent communication skills. They are able to connect with a wide variety of people on topics that may be sensitive or difficult to discuss.

Medical laboratory scientists

Medical laboratory scientists work in labs. They collect and perform tests on samples, such as body fluids and tissues. They operate sophisticated laboratory equipment, like cell counters. Their work may involve developing a new vaccine, studying a disease outbreak, testing a disease treatment, or researching a new strain of a disease. Medical laboratory scientists are detail oriented and have a deep knowledge of human biology.

Research epidemiologists

Epidemiologists investigate the causes of disease and other public health problems. They work to prevent public health problems from spreading or from happening again. Their work may involve collecting and analyzing data, which includes observations, interviews, and samples of bodily fluids. Epidemiologists have investigative minds as well as strong communication skills, because their work often involves explaining their findings to policymakers and the public.

Translators

Translators work in the written language. They convert information from one language to another. Translators may be responsible for translating medical documents, technical reports, lab results, legal documents, speeches, or policy briefs. They are expected to create high-quality documents that are accurate and precise. Translators who work for large organizations like the WHO may be required to know six or more languages. Translators are detail-oriented people who work efficiently and carefully. As well as being proficient in several languages, they must also respect and understand cultural differences.

The following website is an excellent places to explore careers in global health. It also describes the degrees and training required for different professions:

http://explorehealthcareers.org/en/Field/11/Public_Health

Getting Started To identify a career that may be a good fit for you, it’s important to become familiar with different types of opportunities to work in global health. Once you find a career you’re interested in, you will want to



understand the background, such as the education and work experience, needed for that career. Then you can make a plan to gain the knowledge, skills, and experience you’ll need. You’ll also want to identify people who can serve as role models or mentors.

While the requirements for global health jobs vary greatly, all global health careers require a common set of skills and knowledge. These include an understanding of key political, social, and economic issues in low- and middle-income countries and an appreciation for different cultures. They also often include knowing more than one language and having the experience of living and working in another country.

To succeed in global health, a bachelor’s degree is a minimum expectation, and in many cases an advanced degree is necessary. Many aspiring global health workers choose to do their graduate work overseas. Internships and work study in a variety of global health fields, such as HIV/AIDS and maternal health, also put you on the right track for landing the global health job you want.

Strong math, health, and science grades in high school, including your grades in AOHS, will help you get into a good college program, which in turn can help you get the right internship or entry-level job to start you off in a global health profession.




Wish List: Interesting Jobs

Student Name: Date:

Directions: Refer to Student Resource 15.2, Reading: Global Health Professions Employment Overview, and write down at least three jobs that you read about that you might want to do. Then write down why the job interests you and include at least two or three examples of skills, knowledge, and personal characteristics a person needs to have in order to succeed in that job. An example is shown.

Job Title Why It Interests Me Skills, Knowledge, or Personal Characteristics

Needed

Translator I would like to work for a large, international organization like the WHO, which employs many translators. Because my father is Brazilian and my mother is Cuban, I am already fluent in Spanish, Portuguese, and English, and I’m interested in learning more languages.

Detail oriented

Proficient in several languages

Respectful of cultural differences




Biographical Profile: Global Health Professional

Student Name: Date:

Directions: Write a brief biographical profile of a global or public health professional who inspires you. Your profile should include the following types of information:

A description of the person’s background and his or her contribution to global health

Important milestones in the professional’s life, such as life-changing decisions, challenges encountered, and major accomplishments

How learning about the professional’s work inspires you and impacts your own career aspirations

Before you begin your work, analyze the example profile and read the assessment criteria at the end of this assignment sheet.

Step 1: Choose a Professional Choose one of the following professionals to write your biographical profile about. You may also choose someone who is not on this list. Consider choosing someone you’ve learned about in this course, a guest speaker you’ve interacted with, or a global health professional you or your family know personally. If you choose someone who is not on this list, make sure to tell your teacher your selection before you begin researching and writing.

Johanne Sekkenes, nurse for Doctors without Borders

o http://www.doctorswithoutborders.org/person-profile/johanne-sekkenes-nurse

William Foege, an epidemiologist instrumental in the eradication of smallpox

o http://en.wikipedia.org/wiki/William_Foege

o http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=01262005

Donald Francis, one of the early scientists researching HIV and AIDS

o http://en.wikipedia.org/wiki/Don_Francis

Yusuf Hamied, a scientist and chairman of a socially conscious pharmaceuticals company

o http://en.wikipedia.org/wiki/Yusuf_Hamied

o http://www.theguardian.com/world/2003/feb/18/aids.sarahboseley13

Margaret Chan, the director of the World Health Organization

o http://en.wikipedia.org/wiki/Margaret_Chan

o http://www.nejm.org/doi/full/10.1056/NEJMp068299

David Satcher, a former US surgeon general who advocated for minority health issues

o http://en.wikipedia.org/wiki/David_Satcher

o http://www.pbs.org/newshour/bb/health-jan-june02-satcher_1-21/

António Guterres, the UN high commissioner for refugees

o http://www.unhcr.org/pages/49c3646c8.html



o http://en.wikipedia.org/wiki/Ant%C3%B3nio_Guterres

Donald McNeil, a New York Times reporter on global health

o http://topics.nytimes.com/top/reference/timestopics/people/m/donald_g_jr_mcneil/index.html

o http://www.fnsreporting.com/Portfolio/Technical%20Documents/sacredheart/images/mcneil.pdf

Step 2: Research and Write Your Biographical Profile Use the links given in Step 1 to research the professional you’ve chosen to write about. As you research, take notes in the chart below. The chart explains what each paragraph in your profile should be about. When you have completed your research, write your profile on a separate sheet of paper (or on your computer) using your notes to guide you. When you have finished writing, review your profile and make sure that your work meets or exceeds the assessment criteria.

What Each Paragraph Should Be About

Notes

In the first paragraph, explain the contribution the person you’ve chosen has made to public or global health. In this paragraph, also give information about the person’s background, such as education received, jobs held, places the person has lived, or relevant personal experience he or she has had.

In the second paragraph, focus on one or two accomplishments the person has made or challenges he or she has faced and overcome.

In the third paragraph, focus on how learning about the person’s career has affected you. Say what



you are inspired by or explain how learning about the person has given you an idea about your own career path.

Make sure your work meets or exceeds the following assessment criteria:

The profile clearly explains why the professional’s contribution to public or global health is important, by providing both general information about the professional’s background and specific information about his or her accomplishments.

The profile demonstrates an understanding of the challenges and rewards of working in global health, as well as the skills, knowledge, and experience needed.

The profile provides a thoughtful reflection on how learning about the professional has affected the student’s ideas about his or her own career in public or global health.

The profile is neat and uses proper spelling and grammar.

Example Profile: Candace “Candy” Lightner Candy Lightner is an activist, lobbyist, and lecturer who helped found Mothers Against Drunk Driving, a pivotal organization in the fight against drunk driving. Lightner did not have a background in activism or politics. She was born in 1946 and raised in a military family, and went to college in Sacramento, California. She had three children. She worked as a real estate agent and dental assistant. After her 13-year-old daughter was hit and killed by a drunk driver, she formed MADD just four days later.

One of MADD’s and Lightner’s most significant accomplishments is raising awareness about drunk driving. Prior to her work, drunk drivers often received light punishments for hitting or killing people. Her work changed that. Another monumental accomplishment was advocating for a national law raising the legal drinking age to 21.

I am inspired by Lightner’s work because she turned her grief and rage into action. After her daughter’s death, she quit her job and used her savings to form MADD. She was driven by the idea that tougher laws could save lives. She worked tirelessly to realize this vision. One thing I take away from Lightner’s story is that people in public health often take personal risks. I see myself as someone who, like Lightner, is compelled to make a difference and is willing to make personal sacrifices to do so.

Whole Course - NAF Curriculum

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Transcript of Whole Course - NAF Curriculum