User:Daisymartin/sandbox

Evaluating Two Articles

Health in Ghana

This article is is C/B class article of high importance in all of the projects that are evaluating it. It needs more work as there are many dead links, many statements are not cited or too broad, and significant coverage on prevalent health concerns in Ghana is lacking. This article also talks about the health care system in Ghana, but it is very brief. In the talk page, a proposal to merge National Health Insurance Scheme (Ghana) with the Health in Ghana article has been made. I believe that it would be better to have all of this information in one place because I believe the article on the National Health Insurance Scheme in Ghana is crucial to understanding the current state of healthcare in Ghana. I would not have found the National Health Insurance Scheme (Ghana) article if I had not gone on the talk page. I would have preferred that more information on the National Health Insurance Scheme had been in the Health in Ghana article because the latter already has a brief section on the National Health Insurance, but upon reading it, I wanted to know more about the health policy. Additionally, I believe the organization and structure of the article is unsatisfactory. This article needs to be reorganized and expanded upon.

Upon looking at the Table of Contents, I notice that only HIV/AIDS is listed under the diseases subheading. The "Diseases" subheading lists many prevalent diseases, but does not give any more information.The only disease it gives more information on is "HIV/AIDS" under a subheading within "Diseases" but the section is extremely sparse as it does not give more than numbers of people affected with HIV/AIDS. Other prevalent diseases such as malaria, diarrhea, diabetes, asthma, upper respiratory tract infections, and skin diseases are not included despite the fact that they are major diseases in the area. I plan to expand and elaborate upon the diseases talked about under the "Diseases" subheading. Additionally, "Women's Heath" is given a disproportionate amount of coverage, so to fix this I believe other areas of the article should be expanded. Women's health is undoubtedly important, but in an article titled "Health in Ghana" I believe more coverage on other health related problems should exist.

In the talk page, many Wikipedians questioned whether the "Water Supply and Sanitation" subheading should be included as many people question its relevance. I believe it is very relevant as it affects health and the prevalence of diarrhea in Ghana. Perhaps changing subheading1 to "Community Health" and having "Sanitation" and "Water Supply" as subheadings2 under the larger "Community Health" heading would make those topics more cohesive in the article. Also a discussion of geographical, financial, and political constrains to community health in Ghana would be appropriate here. Distinguishing between urban and suburban areas in this discussion is also necessary.

This article has many links; however, many of the links are to websites and articles and a minority are peer reviewed sources. Many paragraphs and pieces of information are also not cited which raises a question about the article's credibility in addition to the fact that many statements that are not cited and are very broad. More peer reviewed sources should be used when expanding on this article and when adding citations to statements in this article that are not currently cited. Replacing current sub-par citations with peer reviewed article citations should also be done if possible.

Public Health

This article is a C class article and is of high importance. The talk page is fairly empty, but says this article needs to be rewritten to be more readable so I will be heavily editing the sentence structure and word choice so that it flows better while still conveying the same quality of information. This article hasac a lot of very important information, but there is a lot that I believe needs to be added while keeping readability and reliability, and neutrality in mind.

Upon looking at the table of contents, I notice that the article's "Developing Countries" subheading us sparse even though the public health approach is an important one in developing countries. I would add to the article's "Developing Countries" subheading. Under that subheading there is only one smaller heading on the Sustainable Development Goals. I also would like to include a section on common public health interventions in developing countries such as building new clean water wells, constructing tippy taps, education models, agroecology, medical outreach volunteer programs, and mobile clinics. I believe a including a subheading which covers the discussion surrounding the outcomes of these interventions in developing countries is important. I also believe that public health is important in developed countries but the differences and problems notable in that circumstance should be elucidated.

I would also merge the very short "Community Health" article with this one as they are very intertwined as I am learning in a Public Health class I am currently taking that focuses on community health and development.

This article also includes some questionable sources and needs more peer-reviewed sources.

Beginning Bibliography

Health in Ghana

1. This article expands on the traditional heath practices in Ghana as I believe the section is very general and has many statements not supported by citations. This article offers many similar claims and would be able to be used to cite pieces of information that are without a citation as well as adding more information.
2. This journal article discusses the shift to a democratic system in Ghana under which the National Health Insurance Scheme was created. I will add more information on NHIS to this article in order to bridge the gap from when the article discusses traditional medicine to the NHIS. Although the request to merge the NHIS article has been denied, I thought there was a disconnect and an ambiguity as to when the NHIS was implemented and who has access to these government health programs.
3. This journal article from the early 1900s highlight relevant major diseases such as hepatitis, glaucoma, cirrhosis, appendicitis, and cervical cancer which I plan to include under the Diseases subheading1 each as individual subheadings2 expanding on the prevalence of each of these diseases, current accessible therapies, and community health affects.

Public Health

4. This journal article is very useful here and possibly in the Health in Ghana article as well as it discusses the public health issue of enteric infections which are a huge problem in developing countries across the globe as a result of poor quality water and sanitation. I will use this article to create a subheadings2 possibly titled "Water and Sanitation" under the subheadings1titled "Developing Countries as I believe this section needs much more added to it and this is a highly important public health problem.

5. This journal article discusses a framework which discusses ways in which you can evaluate how successful public health interventions were in developing countries. I will include this under the "Developing Countries" heading1 as it is important to include this discussion in an article from an unbiased point of view and this per reviewed article will give me a good start on allowing me to do so.

6. This article, in conjunction with a few other articles on community health in developed countries, is useful as I plan to add a "Community Health" subheading2 under the "Current Practices" subheading1. Although there is brief mention of community health, I believe this is a very important focus in public health as an academic discourse as well as in practice.

Summarizing and Synthesizing

My work is in bold.

Health in Ghana

Following a controversial election, Ghana underwent a democratization through the mid 1990s that left Ghana a model for other African countries.

Social Welfare policies, political mobilization, social spending

Editing Health in Ghana

copied from Health in Ghana:

Health in Ghana includes the healthcare systems on prevention, care and treatment of diseases and other maladies.

History

The First Lady of the United States, Mrs. Pat Nixon visits a child in a hospital in Ghana, 1972.

The Precolonial Period

Ghana versus United Kingdom; physicians and professional nurses monthly salary comparison chart

In precolonial Ghana, traditional village priests, clerics, and herbalists were the primary care givers, offering advice and treatment to the sick. Premodern traditional beliefs stressed the combination of spiritual and physical healing with priests and clerics identifying the supernatural causes of disease and its remedies and herbalists offering medicinal herbs. The intersection of spirituality and medicine can be seen in priests using practices such as divination to determine the cause of illness and suggesting curative sacrifices before prescribing medicinal herbs obtained from herbalists.

The Colonial Period

In 1874 Ghana was officially proclaimed a British colony. Ghana proved to be an extremely dangerous disease environment for European colonists driving the British Colonial Administration to establish a Medical Department bringing about an introduction to a formal medical system, consisting of a Laboratory Branch for research, a Medical Branch of hospitals and clinics, and the Sanitary Branch for public health centered near British posts and towns. In addition to hospitals and clinics staffed with British medical professionals, these select towns were also provided anti-malaria medication to be distributed to colonists and to sell to local Ghanaians. in 1878, the Towns, Police, and Public Health Ordinance was enforced, initiating the construction and demolishing of infrastructure, draining of the streets, and issuing of fines to those that failed to comply with the heads of the colony. In 1893, a Public Works Department was introduced to implement a working sanitation system in urban colonial centers.

After the World War II it became increasingly clear that with improved transportation worldwide, international health policy needed to be strengthened. Organizations such as the World Health Organization and the United Nations Children's Fund were active in providing money and support to provide additional western medical care in Ghana. These organizations provided, "financial and technical assistance for the elimination of diseases and the improvement of health standards." Traditional health practices were not recognized by these initiatives or the British Medical Department in urban areas and were shunned by Christian missionaries in rural areas. However, traditional priests, clerics, and herbalists still remained important health providers especially in rural areas where health centers were scarce.

The Nationalist Period

Ghana gained its independence in 1957 and in held its first multiparty elections as a republic in 1960 electing Kwame Nkrumah as Ghana’s first President as part of the Convention People's Party. While in office, Nkrumah pushed health and education policies that aimed to make these services more available and accessible; however, these policies were sill mainly targeted at urban populations with 76% of doctors practicing in urban areas while only 23% of the population lived there. In addition, Nkrumah placed a new emphasis on preventative, community based healthcare financed entirely through general taxation but with free public healthcare and large government spending, Ghana found itself struggling economically. Not long after Nkrumah left office in 1966, subsequent governments decided to continue to keep out of pocket fees low in addition to cutting government healthcare spending with the 1969 Hospital Fees Decree and the 1970 Hospitals Fees Act in the hopes to recover fees and bolster the economy. Even with the cut in government spending, economic conditions continued to worsen as did healthcare services. By the 1980s, many social services, including healthcare, were inadequate and could not provide sufficient care and drugs despite the fact that healthcare was virtually free.

The Rawlings Regime

On December 31, 1981, Jerry Rawlings overthrew the Limann government and became the Head of State of Ghana. With the World Bank and International Monetary fund pressing the government to cut public spending, the new regime passed the Hospital Fees Regulation in 1985 which resulted in greater out of pocket fees with the aim to be able to finance the drugs and resources the healthcare system needed. This became the “cash and carry” system which required Ghanaians to pay out of pocket fees at each point of service. According to a number of empirical studies, this excluded many individuals from public healthcare who could not afford to pay these fees resulting in many Ghanaians belonging to the lower and middle classes to be dissatisfied with the cash-and-carry system.

The Fourth Republic

In the early 1990s, a democratic movement resurfaced and began to sweep through Africa. In response to democratic demands, the Rawlings regime transitioned to create a political party, the National Defense Congress (NDC), legalized political parties, and organized Presidential and Parliamentary elections in 1992 during which Rawlings won with 58.3 percent of the vote. The new democratic constitution under Rawlings included provisions to better social policies such as education and healthcare. In 1996, a Medium Term Health Strategy was adopted that signified a shift from time-restricted, rigid projects to a more holistic approach that would better help develop the health sector. In 1997, a Health Fund was launched to provide a pool of funding for the sector. Still, however, the biggest barrier to Ghanaians receiving proper healthcare was the high out of pocket fees. Despite exemptions expansions and infrastructure that increased access to healthcare, out of pocket fees remained a huge barrier. In the election of 2000, John Kufuor as part of the New Political Party (NPP) won over the NDC candidate and in 2003 he launched the National Health Insurance Scheme as under the National Health Insurance Act, providing universal healthcare to all Ghanaians.

Healthcare

See also: National Health Insurance Scheme (Ghana), List of hospitals in Ghana, and Optometry in Ghana

Ghana health care providers monthly salary and income chart

Komfo Anokye Teaching Hospital, Kumasi

In Ghana, most health care is provided by the government and is largely administered by the Ministry of Health and Ghana Health Services. The healthcare system has five levels of providers: health posts, health centers and clinics, district hospitals, regional hospitals and tertiary hospitals. Health posts are the first level of primary care for rural areas.

These programs are funded by the government of Ghana, financial credits, Internally Generated Fund (IGF), and Donors-pooled Health Fund. Hospitals and clinics run by Christian Health Association of Ghana also provide healthcare services. There are 200 hospitals in Ghana. Some for-profit clinics exist, but they provide less than 2% of health care services.

Health care is very variable through Ghana. Urban centres are well served, and contain most hospitals, clinics, and pharmacies in the country. Rural areas often have no modern health care. Patients in these areas either rely on traditional African medicine, or travel great distances for health care. In 2005, Ghana spent 6.2% of GDP on health care, or US$30 per capita. Of that, approximately 34% was government expenditure.

In 2015, life expectancy at birth was 66.18 years with males at 63.76 years and females at 68.66 years. Infant mortality is at 37.37 per 1000 live births. The total fertility rate is 4.06 children per woman among the 15 million Ghanaian nationals. In 2010, there were about 15 physicians and 93 nurses per 100,000 persons.

In 2010, 5.2% of Ghana's GDP was spent on health, and all Ghanaian citizens had access to primary health care. Ghanaian citizens make up 97.5% of Ghana's population. Ghana's universal health care system has been described as the most successful healthcare system on the African continent by the renowned business magnate and tycoon Bill Gates.

National Health Insurance

NHIS

National Health Insurance Scheme
Agency overview
Formed	2003
Jurisdiction	Republic of Ghana
Parent agency	Parliament of Ghana
Website	Official Website

Main article: National Health Insurance (Ghana)

Ghana has a universal health care system, National Health Insurance Scheme (NHIS), and until the establishment of the National Health Insurance Scheme, many people died because they did not have money to pay for their health care needs when they were taken ill. The system of health which operated prior to the establishment of the NHIS was known as the "Cash and Carry" system. Under this system, the health need of an individual was only attended to after initial payment for the service was made. Even in cases when patients had been brought into the hospital on emergencies, it was required that money was paid at every point of service delivery. When the country returned to democratic rule in 1992, its health care sector started seeing improvements in terms of:

• Service delivery
• Human resource improvement
• Public education about health condition

even with these initiatives in place, many still could not access health care services because of the cash and carry system.

The idea for the National Health Insurance Scheme (NHIS) in Ghana was conceived by former president John Kufuor who when seeking the mandate of the people in the 2000 elections, promised to abolish the “cash and carry system” of health delivery. Upon becoming president, former president Kufuor pushed through his idea of getting rid of “cash and carry” and replacing it with an equitable insurance scheme that ensured that treatment was provided first before payment. In 2003, the scheme was passed into law. Under the law, there was the establishment of National Health Insurance Authority which licenses, monitors and regulates the operation of health insurance schemes in Ghana. Like many countries in the world, Ghana's health insurance was fashioned out to meet specific needs of its citizens. Since its inception, the country's health facilities have seen constant rise in patient numbers and a considerable reduction in deaths.

Disease

Ghanaian biochemist presenting a gene bank in Ghana

According to the World Health Organization, the most common diseases in Ghana include those endemic to sub-Saharan African countries, particularly: cholera, typhoid, pulmonary tuberculosis, anthrax, pertussis, tetanus, chicken pox, yellow fever, measles, infectious hepatitis, trachoma, malaria, HIV and schistosomiasis. Though not as common, other regularly treated diseases include dracunculiasis, dysentery, river blindness or onchocerciasis, several kinds of pneumonia, dehydration, venereal diseases, and poliomyelitis.

In 1994, the WHO reported malaria and measles were the most common causes of premature death. In 1994, 70 percent of deaths in children under five were caused by an infection compounded by malnutrition. A 2011 report by the Ghana Health Service said that malaria was the primary cause of morbidity and about 32.5 percent of people admitted to Ghanaian medical facilities were admitted because of malaria.

Malaria

According to the Centers for Disease Control and Prevention, malaria was the third leading cause of death and accounted for 8% of all deaths in Ghana in 2012 despite the fact that malaria is preventable and curable. Malaria occurs every year and affects people of all ages and demographics with women and children under 5 being the most vulnerable groups. In addition, poor communities disproportionately are affected by infectious diseases when compared to wealthy communities are due to lack of access to mosquito nets, adequate healthcare, and anti-malaria medication. According to the 2014 Ghana Demographic and Health Survey, the prevalence of malaria in children ages 6 months to 5 years is 36%. Insecticide treated mosquito nets have been identified as a cost-effective and sustainable public health method to combat malarial infections. The Ministry of Health and the Ghana Health Service mass distribute the nets free of charge at schools and clinics. At least one Insecticide-treated mosquito net is owned by 68% of all households in Ghana; however, the Ghana Health and Demographic Survey sees large gaps between insecticide treated mosquito net ownership and use meaning that many with access to the nets are not effectively using them.

HIV/AIDS

Main article: HIV/AIDS in Ghana

Like other countries worldwide, HIV/AIDS is present in Ghana. In 2014, the estimated people that had HIV were 9,200 people out of Ghana's entire population of 28.21 million. In 2014, the HIV prevalence rate was 1.47% showing an increase from 1.3% in 2012. In response to the HIV epidemic, the Government of Ghana established the Ghana AIDS Commission, which coordinates efforts amongst international organizations and other parties to support education about eradication of HIV/AIDS throughout Ghana by the year 2022.

Health informatics of Ghana's population satisfaction with health care in Ghana and health care provider information

Women's health

See also: Women in Ghana

Ghanaian female surgeon performing an operation.

The health of women in Ghana is critical for national development. Women’s health issues in the country are largely centered on nutrition, reproductive health and family planning. Reproduction is the source of many health problems for women in Ghana. The Ghana Living Standards Survey Report of the Fifth Round revealed that about 96.4% of women reported that they, or their partners, were using modern forms of contraception.

This statistic has significant importance in reducing the spread of HIV/AIDS, which affected 120,000 women in Ghana in 2012 (of the 200,000 people living with the disease in Ghana in 2012). Interventions for improving the health of women in Ghana, such as the Ghana Reproductive Health Strategic Plan 2007-2011, focus on maternal morbidity and mortality, contraceptive use and family planning services, and total empowerment of women.

Maternal and child health care

The 2015 maternal mortality rate per 100,000 births for Ghana was 319. This is compared to 409.2 in 2008 and 549 in 1990. The under 5 mortality rate, per 1,000 births is 72 and the neonatal mortality as a percentage of under 5's mortality is 39. In Ghana the number of midwives per 1,000 live births is 5 and the lifetime risk of death for pregnant women 1 in 66.

Breast cancer

Ghanaian female surgeon preparing to perform an operation

In Ghana, breast cancer is the leading malignancy. In 2007, breast cancer accounted for 15.4% of all malignancies, and this number increases annually. Roughly 70% of women who are diagnosed with breast cancer in Ghana are in the advanced stages of the disease. In addition, a recent study has shown that women in Ghana are more likely to be diagnosed with high-grade tumors that are negative for expression of the estrogen receptor, progesterone receptor, and the HER2/neu marker. These triple negative breast tumors are more aggressive and result in higher breast cancer mortality rates.

Explanations for the delayed presentation among women in Ghana have been traced to the cost of, and access to, routine screening mammography. Furthermore, women with breast cancer in Ghana describe a feeling of hopelessness and helplessness, largely due to their belief in fatalism, which contributes to denial as a means of coping. Mayo et al. (2003) concludes, however, that lack of awareness may be a more critical variable than fatalism in explaining health care decisions among women in Ghana.

Over the past decade, international delegations and nongovernmental organizations have started responding to the growing problem of breast cancer in Ghana. In particular, the Breast Health Global Initiative, the Zurak Cancer Foundation, and Susan G. Komen for the Cure are helping to increase early detection and reduce the breast cancer mortality rate in the country. Through public education, awareness, training, and particularly promotion of early detection practices, international aid groups have helped in improving the situation in Ghana.

Water supply and sanitation

Main article: Water supply and sanitation in Ghana

Since 1994, the water supply and sanitation sector has been gradually modernized through the creation of an autonomous regulatory agency, introduction of private sector participation, and decentralization of the rural supply to 138 districts, where user participation is encouraged. The reforms aim at increasing cost recovery and a modernization of the urban utility Ghana Water Company Ltd. (GWCL), as well as of rural water supply systems. The National Water Policy (NWP), launched at the beginning of 2008, seeks to introduce a comprehensive sector policy.

Water resources

Ghana is well endowed with water resources. The Volta River system basin, consisting of the Oti River, Daka River, Pru River, Sene River and Afram River as well as the White Volta and Black Volta rivers, covers 70% of Ghana's total land area. Another 22% of Ghana is covered by the southwestern river system watershed comprising the Bia River, Tano River, Ankobra River and Pra River. The coastal river system watershed, comprising the Ochi-Nawuka River, Ochi-Amissah River, Ayensu River, Densu River and Tordzie River, covers the remaining 8% of Ghana.

Furthermore, groundwater in Ghana is available in mesozoic and cenozoic sedimentary rocks and in sedimentary formations underlying the Volta Basin. Lake Volta, with a surface of 8,500 km², is the Earth's largest artificial lake. In all, the total actual renewable water resources are estimated to be 53.2 billion m³ per year.

Public Health

Enteric infections, cholera, typhoid fever, rotavirus diarrhea, enterotoxigenic E. coli diarrhea, and shigellosis are making people sick

Many of these infections come from people drinking unclean water

Vaccines to protect people from these infections are a Public Health Goal

Editing Public Health

copied from public health:

Developing countries

Emergency Response Team in Burma after Cyclone Nargis in 2008

There is a great disparity in access to health care and public health initiatives between developed nations and developing nations. In the developing world, public health infrastructures are still forming. There may not be enough trained health workers or monetary resources to provide even a basic level of medical care and disease prevention. As a result, a large majority of disease and mortality in the developing world results from and contributes to extreme poverty. For example, many African governments spend less than US$10 per person per year on health care, while, in the United States, the federal government spent approximately US$4,500 per capita in 2000. However, expenditures on health care should not be confused with spending on public health. Public health measures may not generally be considered "health care" in the strictest sense. For example, mandating the use of seat belts in cars can save countless lives and contribute to the health of a population, but typically money spent enforcing this rule would not count as money spent on health care.

Large parts of the developing world remained plagued by largely preventable or treatable infectious diseases. In addition to this however, many developing countries are also experiencing an epidemiological shift and polarization in which populations are now experiencing more of the effects of chronic diseases as life expectancy increases with, the poorer communities being heavily affected by both chronic and infectious diseases. Another major public health concern in the developing world is poor maternal and child health, exacerbated by malnutrition and poverty. The WHO reports that a lack of exclusive breastfeeding during the first six months of life contributes to over a million avoidable child deaths each year. Intermittent preventive therapy aimed at treating and preventing malaria episodes among pregnant women and young children is one public health measure in endemic countries.

Each day brings new front-page headlines about public health: emerging infectious diseases such as SARS, rapidly making its way from China (see Public health in China) to Canada, the United States and other geographically distant countries; reducing inequities in health care access through publicly funded health insurance programs; the HIV/AIDS pandemic and its spread from certain high-risk groups to the general population in many countries, such as in South Africa; the increase of childhood obesity and the concomitant increase in type II diabetes among children; the social, economic and health effects of adolescent pregnancy; and the public health challenges related to natural disasters such as the 2004 Indian Ocean tsunami, 2005's Hurricane Katrina in the United States and the 2010 Haiti earthquake.

Since the 1980s, the growing field of population health has broadened the focus of public health from individual behaviors and risk factors to population-level issues such as inequality, poverty, and education. Modern public health is often concerned with addressing determinants of health across a population. There is a recognition that our health is affected by many factors including where we live, genetics, our income, our educational status and our social relationships; these are known as "social determinants of health." The upstream drivers such as environment, education, employment, income, food security, housing, social inclusion and many others effect the distribution of health between and within populations and are often shaped by policy. A social gradient in health runs through society. The poorest generally suffer the worst health, but even the middle classes will generally have worse health outcomes than those of a higher social stratum. The new public health advocates for population-based policies that improve health in an equitable manner.

Health Aid in Developing Countries

Main article: Aid

Health aid to developing countries is an important source of public health funding for many developing countries. Health aid to developing countries has shown a significant increase after World War II as concerns over the spread of disease as a result of globalization increased and the HIV/AIDS epidemic in sub-Saharan Africa surfaced. From 1990 to 2010, total health aid from developed countries increased from 5.5 billion to 26.87 billion with wealthy countries continuously donating billions of dollars every year with the goal of improving population health. Some efforts, however, receive a significantly larger proportion of funds such as HIV which received an increase in funds of over $6 billion dollars between 2000 and 2010 which was more than twice the increase seen in any other sector during those years. Health aid has seen an expansion through multiple channels including private philanthropy, non-governmental organizations, private foundations such as the Bill & Melinda Gates Foundation, bilateral donors, and multilateral donors such as the World Bank or UNICEF. Recent data, however, shows that international health aid has plateaued and may begin to decrease.

Debates

Debates exist questioning the efficacy of international health aid. Proponents of aid claim that health aid from wealthy countries is necessary in order for developing countries to escape the poverty trap. Opponents of health aid claim that international health aid actually disrupts developing countries' course of development, causes dependence on aid, and in many cases the aid fails to reach its recipients. For example, recently, health aid was funneled towards initiatives such as financing new technologies like antiretroviral medication, insecticide-treated mosquito nets, and new vaccines. The positive impacts of these initiatives can be seen in the eradication of smallpox and polio; however, critics claim that misuse or misplacement of funds may cause many of these efforts to never come into fruition.

Economic modeling based on the Institute for Health Metrics and Evaluation and the World Health Organization has shown a link between international health aid in developing countries and a reduction in adult mortality rates. However, a 2014-2016 study suggests that a potential confounding variable for this outcome is the possibility that aid was directed at countries once they were already on track for improvement. That same study, however, also suggests that 1 billion dollars in health aid was associated with 364,000 fewer deaths occurring between ages 0 and 5 in 2011.

Sustainable Development Goals

Further information: Sustainable Development Goals

To address current and future challenges in addressing health issues in the world, the United Nations have developed the Sustainable Development Goals 2015 building off of the Millennium Development Goals of 2000 to be completed by .2030. These goals in their entirety encompass the entire spectrum of development across nations, however Goals 1-6 directly address health disparities, primarily in developing countries. These six goals address key issues in global public health: Poverty, Hunger and food security, Health, Education, Gender equality and women's empowerment, and water and sanitation. Public health officials can use these goals to set their own agenda and plan for smaller scale initiatives for their organizations. These goals hope to lessen the burden of disease and inequality faced by developing countries and lead to a healthier future.

The links between the various sustainable development goals and public health are numerous and well established:

• Living below the poverty line is attributed to poorer health outcomes and can be even worse for persons living in developing countries where extreme poverty is more common. A child born into poverty is twice as likely to die before the age of five compared to a child from a wealthier family.
• The detrimental effects of hunger and malnutrition that can arise from systemic challenges with food security are enormous. The World Health Organization estimates that 12.9 percent of the population in developing countries is undernourished.
• Health challenges in the developing world are enormous, with "only half of the women in developing nations receiving the recommended amount of healthcare they need.
• Educational equity has yet to be reached in the world. Public health efforts are impeded by this, as a lack of education can lead to poorer health outcomes. This is shown by children of mothers who have no education having a lower survival rate compared to children born to mothers with primary or greater levels of education. Cultural differences in the role of women vary by country, many gender inequalities are found in developing nations. Combating these inequalities has shown to also lead to better public health outcome.
• In studies done by the World Bank on populations in developing countries, it was found that when women had more control over household resources, the children benefit through better access to food, healthcare, and education.
• Basic sanitation resources and access to clean sources of water are a basic human right. However, 1.8 billion people globally use a source of drinking water that is fecally contaminated, and 2.4 billion people lack access to basic sanitation facilities like toilets or pit latrines. A lack of these resources is what causes approximately 1000 children a day to die from diarrhoel diseases that could have been prevented from better water and sanitation infrastructure.

U.S. Global Health Initiatives

Main article: Global Health Initiatives

The U.S. Global Health Initiative was created in 2009 by President Obama in an attempt to have a more holistic, comprehensive approach to improving global health as opposed to previous, disease-specific interventions. The Global Health Initiative is a six-year plan, "to develop a comprehensive U.S. government strategy for global health, building on the President's Emergency Plan for AIDS Relief (PEPFAR) to combat HIV as well as U.S. efforts to address tuberculosis (TB) and malaria, and augmenting the focus on other global health priorities, including neglected tropical diseases (NTDs), maternal, newborn and child health (MNCH), family planning and reproductive health (FP/RH), nutrition, and health systems strengthening (HSS)." The GHI programs are being implemented in more than 80 countries around the world and works closely with the United States Agency for International Development, the Centers for Disease Control and Prevention, the United States Deputy Secretary of State.

There are Seven Core Principles:

1. Women, girls, and gender equality
2. Strategic coordination and integration
3. Strengthen and leverage key multilaterals and other partners
4. Country-ownership
5. Sustainability through Health Systems
6. Improve metrics, monitoring, and evaluation
7. Promote research and innovation

The biggest fund of the Global Health Initiatives is the Global Fund to fight Aids, Tuberculosis, and Malaria created in 2001 which received $19 billion in health aid between 2002 and 2010. The Global Health Initiatives have been largely successful in achieving their stated goals, but the narrow focus of their goals leaves the question on how and if these initiatives have bettered public health in developing countries overall. In addition, limitations to measuring and implementing these health interventions is that most interventions need to be evaluated over longer periods of time to see results, but if progress is not seen in the short term, the likelihood of continued funding is undermined. The aid effectiveness agenda is a useful tool for measuring the impact of these large scale programs such as the The Global Fund to Fight AIDS, Tuberculosis and Malaria and the Global Alliance for Vaccines and Immunization which have been successful in achieving rapid and visible results. The Global Fund claims that its efforts have provided antiretroviral treatment for over three million people worldwide. GAVI claims that its vaccination programs have prevented over 5 million deaths since it began in 2000.

Ghana

Though curable and preventative, malaria remain a huge public health problem and is the third leading cause of death in Ghana. In the absence of a vaccine, mosquito control, or access to anti-malaria medication, public health methods become the main strategy for combating malaria prevalence. Distribution and sale of insecticide-treated mosquito nets is a common, cost-effective anti-malaria public health intervention; however, barriers to use exist including social and behavioral determinants which have not only been shown to affect malaria prevalence rates but also mosquito net use.

Health Policy Interventions and Systems in Developing Countries

• increase the number of health professionals through strengthening local medical school education programs
• strengthening the healthcare system through policy - more health centers in rural communities
• improving infrastructure- sanitation, water, transportaton
• improving health education beginning in primary schools
• address community health issues identified through community heath assessments
• community based participatory action research

Evaluating the Impact of Public Health Interventions in Developing Countries

There is a general consensus that randomized controlled trials (RCT) are a necessary measure for evaluating the efficacy of medical interventions such as vaccines and pharmaceuticals; however, recent studies have shown that this has been extended to public health interventions as well. Pocock et al said there are, " serious concerns regarding inadequacies in the analysis and reporting of epidemiological publications," calling for standardized measured for evaluating health interventions, both medical and in public health. When evaluating the effectiveness of public health interventions, epidemiologists must look at the intervention's efficacy as well as cost, logistics, and secondary effects by conducting randomized control trials and observational studies.

2nd Bibliography and Annotations

My Bibliography can be found below and are the sources numbered 25-40 in the RefList at the very bottom of my Sandbox.

Sources 1-6 below are from my beginning bibliography and sources 7-24 appear on my Sandbox due to my copyedit of my articles and are existing sources on my articles, not the sources that I will be including.

Health in Ghana Bibliography

1. Although this journal article is from 1981, I believe it contains crucial information regarding the sociopolitical and political economy context surrounding the shift from national healers during the colonial era to the National Health Insurance Scheme created in 2003. My article covers precolonial traditional practices well and includes good content on the National Health Insurance Scheme; however, how the healthcare system had evolved from the time when Ghana gained its independence in 1957 to the modern National Health Insurance Scheme is is missing. This article fills in the gaps which I believe is useful because peer reviewers have asked me to clarify what "precolonial" and "modern" means in relation to Ghana and with this article I can provide dates and the names of politicians that created healthcare policies throughout the years. In addition, I believe that understanding the current state of healthcare in Ghana is implicated in understanding how the system came to be.
2. This journal article discusses the shift to a democratic system in Ghana under which the National Health Insurance Scheme was created. I will add more information on NHIS to this article in order to bridge the gap from when the article discusses traditional medicine to the NHIS. Although the request to merge the NHIS article has been denied, I thought there was a disconnect and an ambiguity as to when the NHIS was implemented and who has access to these government health programs.
3. This source is a book and is not a peer-reviewed article; however, it does contain a lot of valuable and accurate information regarding traditional health practices in Ghana useful to the History section. The book is titled Ghana: A Country Study and its original source is the U.S. Library of Congress. I mainly obtained information from the Health and Welfare section
4. This source from the CDC is also not a peer-reviewed article. However, it is the best article I have found that details the top modern-day health concerns and causes of death in Ghana currently, as well as discusses the current CDC programs in place to combat these diseases. I believe this Information is necessary in the Heath in Ghana article because as the article stands, coverage is disproportionately focused on HIV/AIDS and Women's Health which are among top health concerns but there are others of importance such as malaria, stroke, lower respiratory infections, and others.
5. This journal article discusses the epidemiological transition in Ghana from the colonial to modern period. This article compares the distribution and prevalence of diseases in urban and rural areas in Ghana's capital, Accra, which is a discussion I believe is extremely important in the Health in Ghana article. The article also gives context to the construction of pipe-borne water implemented by the colonial government in 1904 and completed in 1914 during in response to Public Health concerns before the plague of 1908. I would add this discussion to the Water and Sanitation subheading of the Health in Ghana article as it clearly shows how water and sanitation influences health. On the talk page comments were made about removing the Water and Sanitation subheading, but I believe it should be kept and expanded upon.
6. This journal article includes statistics on the prevalence, risk, and illness experience of chronic diseases in Ghana over the last fifty years.It also discusses the implications of governance and donor activities in public health policy in Ghana. It includes a useful table of the top 10 in-patient causes of death in the 10 different regions in Ghana.
7. This journal article includes disease statistics and national strategies for prevention and control of noncommunicable diseases. It includes a list of WHO resolutions to combat noncommunicable diseases and promote good health as well as a discussion on the status of such policies.
8. This report from the Ghana Statistical Service and Ghana Health Service includes valuable information on the geography, economy, and history of Ghana in relation to its implications on health. In addition it includes information on household conditions, water and sanitation, family planning, maternal health, nutrition, malaria, HIV/AIDS, and more.
9. This journal article discusses how rapid urbanization from 1900-1940 affected health. It includes a discussion on water supplies, sewage, rubbish disposal, housing schemes, mosquito control, and curative services

Public Health Bibliography

10. This article discusses the public health intervention of introducing mosquito nets to communities where Malaria is prevalent. This article focuses on both rural and urban areas in the Accra region in Ghana. It discusses how social determinants of health such as social and personal factors are implicated in interventions for malaria control. Public health interventions are the most widely used mechanisms for controlling malaria in developing countries. This is useful for the Country Examples section in the Public Health article.

11. This journal article discusses the implementation of a community pharmacy in order to ensure safe usage of drugs. Pharmacists are an important part of primary health as well as public health. This is useful for the Country Examples section in the Public Health article.

12. This very useful article discusses the implementation of a pipe-borne water system as a public health measure in Ghana. This will also be useful in the subheading I will create under the Country Examples section in the Public Health Article.

13. This journal article is a case study on how the National Health insurance Scheme affected public health in Ghana and is useful for the Country Studies Section.

14. This website is not a journal article; it is a World Economic and Social Survey from the United Nations discussing health policy interventions in order to make strides towards the Millennium Development Goals. This will be useful for the section I am adding on Health Policy Interventions.

15. This journal article discusses disease control priorities in developing countries as life expectancies increase and economies grow calling for a greater need for management of chronic diseases and not simply infectious, parasitic childhood diseases. This is useful for the Developing Countries section.

16. This book by the World Health Organization discusses equity, social determinants and public health programs for many public health goals such as combating cardiovascular disease, diabetes, neglected tropical diseases, and more. This is useful for the Developing Countries subheading.

Final Annotated Bibliography

Area: Health in Ghana

1. Twumasi, P. A. (1981). Colonialism and international health: A study in social change in Ghana. Social Science & Medicine. Part B: Medical Anthropology, 15(2), 147-151. doi:10.1016/0160-7987(81)90037-5

           This journal article traces the development healthcare in Ghana as it was influenced by international actors from the precolonial period to the nationalist period. Twumasi explains how Christian missionaries, European colonists and international actors such as the World Health Organization shaped healthcare in Ghana. Twumasi’s analysis elucidates the fact that many health policies in colonial Ghana were put into place to serve the British colonists in urban areas establishing the urban centered-health system we still see today. He also discusses the fact that traditional practices were not recognized by these international actors which caused tension between these differing medical ideologies. This article was very useful for me in editing the history section as there was little about how colonialism affected healthcare prior to my edits as well as little in journals covering colonial health besides this useful article. My Practice Experience provides western healthcare services to people with HIV/AIDS and malaria in addition to western health education to rural areas; therefore, it is extremely important to understand the transition in healthcare prior and before western influences to emphasize the need to maintain cultural humility when providing in any sector, including the healthcare sector. It is important to include the local community in decision making instead of pushing ideals onto them.  

2. Carbone, G. (2011). Democratic demands and social policies: The politics of health reform in Ghana. The Journal of Modern African Studies, 49(3), 381-408. Retrieved from http://www.jstor.org/stable/23018898

           This article describes how politics, namely the democratic shift following Ghana’s independence in 1957, affected health policy. Carbone claims that effective policies emerge in Ghana as politicians compete for popularity and power. Carbone details the evolution of healthcare from independence, to the onset of the “cash-and-carry” system put into place during Jerry Rawlings’ regime, and finally to the democratic shift and multiparty election on 1992 which spurred health reform beginning with an expansion on fees exemptions and ultimately resulting in the universal healthcare in place today, the National Health Insurance Scheme. This source proved to be very valuable to me in editing the history section of the Health in Ghana article which was at first very confusing, incomplete, and lacking citations. Using this article, I was able to fill in the gap between colonial period and modern day health. This article relates to my Practice Experience because it is extremely important to understand the history and political economy context surrounding the evolution of healthcare when analyzing its strengths and its limitations. I believe that understanding the current state of healthcare in Ghana is implicated in understanding how the system came to be.

3. Berry, L. B. & Library Of Congress. Federal Research Division. (1995) Ghana: A Country Study. [Washington, D.C.: Federal Research Division, Library of Congress: For sale by the Supt. of Docs., U.S. G.P.O] [Pdf] Retrieved from the Library of Congress, https://www.loc.gov/item/95018891/.

           This source is a book from the Library of Congress and offers a comprehensive overview of the history, geography, economy, government, and society of Ghana. The sections that were useful to me were the Health and Welfare and Health Care sections in which Berry describes the traditional, precolonial health practices of Ghana and how they began to change at the onset of British colonial rule. This source was useful in editing the history section because it provided useful and accurate information about precolonial healthcare which is hard to find from a secondary source. This source is relevant to my Practice experience because it will help me understand the historical background between the interplay of traditional and western health practices in Ghana today as well as to understand that traditional practices have had a history of being disregarded and fighting to remain a healthcare option.

4. The Centers for Disease Control and Prevention. (2016, May 11). Global Health - Ghana. Retrieved from https://www.cdc.gov/globalhealth/countries/ghana/

This source is a webpage from the Centers for Disease Control and Prevention which contains health statistics such as the top causes of death, life expectancy, infant mortality rate, population size, and an overview of the health projects the CDC and Ghana are collaborating on. This article was useful in bolstering the Diseases section lead, creating a malaria subheading, and edit the HIV/AIDS subheading adding to it as well as updating statistics. This article is relevant to my Practice Experience since my practice experience works closest with alleviating these two diseases in addition to research and data collection pertaining to prevalence, correlations, and effectiveness of interventions. It was useful to read what was currently being done by the CDC in addition to reading the Presidents’ Initiatives.

5. Agyei-Mensah, S., & Aikins, A. D. (2010). Epidemiological Transition and the Double Burden of Disease in Accra, Ghana. Journal of Urban Health, 87(5), 879-897. doi:10.1007/s11524-010-9492-y

           This article describes the transition of disease prevalence in relation to historical influences and discusses the policy that was put into place during these periods. Agyei-Mensah identifies the colonial period as a time where communicable diseases were the main cause of morbidity and mortality, especially in poor communities. He identifies the post independence period as a time where noncommunicable diseases began increasing in prevalence among mostly wealthy communities and the post structural adjustment period as the outbreak of the HIV/AIDS epidemic. He claims the epidemiological transition seen in Ghana can be modeled by the “protracted polarized model” because the major causes of morbidity and mortality are both infectious and chronic diseases and this “protracted” double burden is “polarized” with wealthy communities at higher risk for chronic diseases while poor communities have the “double burden” of both infectious and chronic diseases. This source was useful in editing the history lead because it ties shifts in health and history together in an effective way and allowed me to add the epidemiological transitions to their respective sections in the history section. This source is useful to my Practice Experience because it highlighted the fact that health disparities lie along class lines as well as further explained the effects of structural adjustment programs on healthcare in Ghana.

6. Ghana Statistical Service. (2014, October). Ghana Demographic and Health Survey 2014. [Pdf] Retrieved from https://dhsprogram.com/pubs/pdf/fr307/fr307.pdf

           This source is a a survey conducted by the Ghana Statistical Service, Ghana Health Service, and the DHS Program in 2014. This source statistics relating to geography, history, economy, demographics, family planning, fertility, infant and child mortality, maternal health, child health, malaria, HIV/AIDS, and Millennium Development Goal indicators. This source was valuable in editing the Diseases section of the Health in Ghana article because I was not only able to update disease prevalence and add to the sparse HIV/AIDS section, but I was able to begin creating a malaria subheading. This article is useful to my Practice Experience because it provides me with tangible quantitative data of the prevalence of HIV/AIDS and malaria across differing age groups. These two diseases are the ones my Practice Experience works most closely with and attempts to combat.

7. de-Graft Aikins A. (2007, December). Ghana’s neglected chronic disease epidemic: a developmental challenge. Ghana Medical Journal. 2007;41(4):154-159. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350116/

This Journal article discusses the historical, financial, and social limitations to combating chronic diseases in Ghana. This article also states important figures such as the fact that even though hypertension has a national prevalence of 28.7% whereas malaria has a national prevalence of 3.2%, malaria receives millions of dollars in funding whereas hypertension is largely ignored. Aikins claims this is due to a lack of monetary resources, knowledge, and the fact that medical departments were initially built in order to combat infectious diseases. This article allowed me to include statistic and figures necessary for creating a “Chronic Diseases” subheading under the “Diseases” heading of the health in Ghana article. This source is useful for my PE as it has made me realize that even though malaria and HIV are important public health concerns, there is a whole other huge category of diseases that affect far more people and requires immediate health attention, programs and policies.

Sector: Public Health Bibliography

8. Afridi, M. A., & Ventelou, B. (2013, February 13). Impact of health aid in developing countries: The public vs. the private channels. Economic Modeling. 2013; 31:759-765. Retrieved from https://www.sciencedirect.com/science/article/pii/S0264999313000126

           This journal article discusses efficient allocation of health aid to developing countries from international donors. This article states that health aid has increased drastically in the last few decades and gives concrete numbers on the total number of dollars wealthy, developed countries spend on international aid. The article claims that donating money to health does not necessarily improve population health and explores the validity of this statement through economic modeling using data from the Institute for Health Metrics and Evaluation and the World Health Organization. Modeling has shown a link between international health aid in developing countries and a reduction in adult mortality rates. This source was useful in creating the “Health Aid in Developing Countries” section in the Public Health article because it provided me with concrete figures on international health aid spending, its outcomes, and highlighted the important fact that international aid has increased as a result specific moments in history such as globalization post World War II and the HIV/AIDS epidemic. This article is useful for my Practice Experience as it has made me think more critically about the efficacy of international health aid and the different channels of donation such as private, bilateral, and multilateral.

9. Bendavid, E., & Bhattacharya, J. (2014, June). The Relationship of Health Aid to Population Health Improvements. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777302/

           This journal article from PubMed explores the correlation between increasing health aid and improvements in population health. This source does not state causation, but it includes statistics on trends relating aid as a whole and aid to a specific initiative to statistically significant decreases in deaths in individuals between the ages 0 and 5. This source also incudes a discussion on the debates surrounding whether or not aid is helpful which was extremely valuable to add to the “Debates” subheading under the “Developing Countries” heading of the Public Health article. This source is also useful for my Practice Experience as it is important to understand and consider the debates surrounding the implications of international aid, both good and bad, in order to be able to think critically about the impacts I will be having.

10. Jamison, D. T., & Mosley, W. H. (2011, October 7). Disease control priorities in developing countries: Health policy responses to epidemiological change. American Journal of Public Health. Retrieved from https://ajph.aphapublications.org/doi/10.2105/AJPH.81.1.15

           This journal article discusses how policymakers evaluate, prioritize, and initiate public health initiatives. This article also points out that the epidemiological shift another source saw in Accra, Ghana is seen in developing countries around the world allowing me to cite this source in my additions to the “Developing Countries” heading of the Public Health article. This source is useful for my Practice experience because my practice experience conducts research on current public health problems in the community in order to determine future courses of action and understanding this epidemiological shift and how new health policies are implemented after need is seen is useful. This source provides me with a framework for doing so that I will use to help me think about how to create a structured, timed plan.

11. The Henry J. Kaiser Family Foundation. (2011, February). The U.S. Global Health Initiative (GHI) Fact Sheet. Retrieved from https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8116.pdf

           This source is a factsheet from the Kaiser Family Foundation on the Global Health Initiatives. This source explains that the Global Health Initiatives is an umbrella term for many health programs in place in over 80 countries around the world. It explains the structure, budgeting, and Seven Core Principles. Citing this source, I created a “U.S. Global Health Initiatives” subheading under the “Developing Countries” heading of the Public Health article complete with a list of the Seven Core Principles. I believe this was a necessary addition to the other global health program on the page which was the Sustainable Development Goals. This article is useful for my Practice Experience because prior to discovering the Global Health Initiatives, I did not know of any other large scale global health efforts besides those included in the Sustainable Development Goals. Now, I will look further into these initiatives put into place in Ghana as well as others to get a better understanding of what kinds of sources of aid are surrounding me.

12. Agyepong, I. A., & Manderson, L. (1999, January). Mosquito avoidance and bed net use in the Greater Accra Region, Ghana. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10081239

           This journal article investigates factors associated with mosquito net usage in addition to discussing malaria as a public health issue. This article claims that in the absence of anti-malaria vaccines, limited access to anti-malaria medication, and a lack of sustainable vector control, public health measures are the most cost-effective way to reduce the prevalence and severity of malaria. These measures include reducing breeding sites, screening doors and windows, insecticide sprays, prompt treatment following infection, and usage of insecticide treated mosquito nets; however, barriers to usage occur such as cost, household and family organization, or access to resources. This source was useful as it allowed me to add a section on Ghana to the “Country Studies” section of the public health article

13. Shwank, O. (2012). Global Health Initiatives and Aid Effectiveness in the Health Sector. Retrieved from http://www.un.org/en/development/desa/policy/wess/wess_bg_papers/bp_wess2012_schwank.pdf

           This source is a background paper from the World Economic Survey which discusses global health needs and the impact and efficacy of the Global Health Initiatives on the overall health of developing countries. This article also provides information and statistics on the financing of these public health measures which was useful to add to the “Health Aid in Developing Countries” subheading I created. I was also able to use this source to add information about the efficacy of these initiatives. This article is useful for my Practice experience as it gave me some insights as to the impact of health interventions similar to the ones my Practice Experience currently carries out.

14. World Health Organization. (2010). Equity, Social Determinants and Public Health Programmes. Retrieved from https://books.google.com/books?hl=en&lr=&id=7JxutqCmctUC&oi=fnd&pg=PP2&dq=health policy interventions - the United Nations&ots=XFMwxom9Gd&sig=lQ1on9AhLBEDaFRYFyGvpvy8WtI#v=onepage&q=health policy interventions - the United Nations&f=false

           This source is a book by the World Health Organization which discusses equity, social determinants and public health programs for many public health goals such as combating cardiovascular disease, diabetes, neglected tropical diseases, and more. This is useful for the Developing Countries subheading as social determinants are key players in the quality of public health in communities. This source is useful for my Practice Experience as it has helped to to think not only of health from a medical model, but from a social model, and also recognizing that these two are heavily intertwines in their impacts on health.

My Contributions

Health in Ghana

I rewrote the entire history section, added a sentence to the diseases lead, created a Malaria subheading section, added to the HIV/AIDS subheading, and created a chronic diseases subheading.

Public Health

I added two sentences to the Developing Countries lead, created a Health AId in Developing Countries subheading, created a debates subheading within Developing countries, created a U.S. Global Health Initiatives Subheading, and Added Ghana to the Country Examples list. My Contributions to this article can me seen below with my contributions in bold:

copied from public health:

Developing countries

Emergency Response Team in Burma after Cyclone Nargis in 2008

There is a great disparity in access to health care and public health initiatives between developed nations and developing nations. In the developing world, public health infrastructures are still forming. There may not be enough trained health workers or monetary resources to provide even a basic level of medical care and disease prevention. As a result, a large majority of disease and mortality in the developing world results from and contributes to extreme poverty. For example, many African governments spend less than US$10 per person per year on health care, while, in the United States, the federal government spent approximately US$4,500 per capita in 2000. However, expenditures on health care should not be confused with spending on public health. Public health measures may not generally be considered "health care" in the strictest sense. For example, mandating the use of seat belts in cars can save countless lives and contribute to the health of a population, but typically money spent enforcing this rule would not count as money spent on health care.

Large parts of the developing world remained plagued by largely preventable or treatable infectious diseases. In addition to this however, many developing countries are also experiencing an epidemiological shift and polarization in which populations are now experiencing more of the effects of chronic diseases as life expectancy increases with, the poorer communities being heavily affected by both chronic and infectious diseases. Another major public health concern in the developing world is poor maternal and child health, exacerbated by malnutrition and poverty. The WHO reports that a lack of exclusive breastfeeding during the first six months of life contributes to over a million avoidable child deaths each year. Intermittent preventive therapy aimed at treating and preventing malaria episodes among pregnant women and young children is one public health measure in endemic countries.

Each day brings new front-page headlines about public health: emerging infectious diseases such as SARS, rapidly making its way from China (see Public health in China) to Canada, the United States and other geographically distant countries; reducing inequities in health care access through publicly funded health insurance programs; the HIV/AIDS pandemic and its spread from certain high-risk groups to the general population in many countries, such as in South Africa; the increase of childhood obesity and the concomitant increase in type II diabetes among children; the social, economic and health effects of adolescent pregnancy; and the public health challenges related to natural disasters such as the 2004 Indian Ocean tsunami, 2005's Hurricane Katrina in the United States and the 2010 Haiti earthquake.

Since the 1980s, the growing field of population health has broadened the focus of public health from individual behaviors and risk factors to population-level issues such as inequality, poverty, and education. Modern public health is often concerned with addressing determinants of health across a population. There is a recognition that our health is affected by many factors including where we live, genetics, our income, our educational status and our social relationships; these are known as "social determinants of health." The upstream drivers such as environment, education, employment, income, food security, housing, social inclusion and many others effect the distribution of health between and within populations and are often shaped by policy. A social gradient in health runs through society. The poorest generally suffer the worst health, but even the middle classes will generally have worse health outcomes than those of a higher social stratum. The new public health advocates for population-based policies that improve health in an equitable manner.

Health Aid in Developing Countries

Main article: Aid

Health aid to developing countries is an important source of public health funding for many developing countries. Health aid to developing countries has shown a significant increase after World War II as concerns over the spread of disease as a result of globalization increased and the HIV/AIDS epidemic in sub-Saharan Africa surfaced. From 1990 to 2010, total health aid from developed countries increased from 5.5 billion to 26.87 billion with wealthy countries continuously donating billions of dollars every year with the goal of improving population health. Some efforts, however, receive a significantly larger proportion of funds such as HIV which received an increase in funds of over $6 billion dollars between 2000 and 2010 which was more than twice the increase seen in any other sector during those years. Health aid has seen an expansion through multiple channels including private philanthropy, non-governmental organizations, private foundations such as the Bill & Melinda Gates Foundation, bilateral donors, and multilateral donors such as the World Bank or UNICEF. Recent data, however, shows that international health aid has plateaued and may begin to decrease.

Debates

Debates exist questioning the efficacy of international health aid. Proponents of aid claim that health aid from wealthy countries is necessary in order for developing countries to escape the poverty trap. Opponents of health aid claim that international health aid actually disrupts developing countries' course of development, causes dependence on aid, and in many cases the aid fails to reach its recipients. For example, recently, health aid was funneled towards initiatives such as financing new technologies like antiretroviral medication, insecticide-treated mosquito nets, and new vaccines. The positive impacts of these initiatives can be seen in the eradication of smallpox and polio; however, critics claim that misuse or misplacement of funds may cause many of these efforts to never come into fruition.

Economic modeling based on the Institute for Health Metrics and Evaluation and the World Health Organization has shown a link between international health aid in developing countries and a reduction in adult mortality rates. However, a 2014-2016 study suggests that a potential confounding variable for this outcome is the possibility that aid was directed at countries once they were already on track for improvement. That same study, however, also suggests that 1 billion dollars in health aid was associated with 364,000 fewer deaths occurring between ages 0 and 5 in 2011.

Sustainable Development Goals

Further information: Sustainable Development Goals

To address current and future challenges in addressing health issues in the world, the United Nations have developed the Sustainable Development Goals 2015 building off of the Millennium Development Goals of 2000 to be completed by .2030. These goals in their entirety encompass the entire spectrum of development across nations, however Goals 1-6 directly address health disparities, primarily in developing countries. These six goals address key issues in global public health: Poverty, Hunger and food security, Health, Education, Gender equality and women's empowerment, and water and sanitation. Public health officials can use these goals to set their own agenda and plan for smaller scale initiatives for their organizations. These goals hope to lessen the burden of disease and inequality faced by developing countries and lead to a healthier future.

The links between the various sustainable development goals and public health are numerous and well established:

• Living below the poverty line is attributed to poorer health outcomes and can be even worse for persons living in developing countries where extreme poverty is more common. A child born into poverty is twice as likely to die before the age of five compared to a child from a wealthier family.
• The detrimental effects of hunger and malnutrition that can arise from systemic challenges with food security are enormous. The World Health Organization estimates that 12.9 percent of the population in developing countries is undernourished.
• Health challenges in the developing world are enormous, with "only half of the women in developing nations receiving the recommended amount of healthcare they need.
• Educational equity has yet to be reached in the world. Public health efforts are impeded by this, as a lack of education can lead to poorer health outcomes. This is shown by children of mothers who have no education having a lower survival rate compared to children born to mothers with primary or greater levels of education. Cultural differences in the role of women vary by country, many gender inequalities are found in developing nations. Combating these inequalities has shown to also lead to better public health outcome.
• In studies done by the World Bank on populations in developing countries, it was found that when women had more control over household resources, the children benefit through better access to food, healthcare, and education.
• Basic sanitation resources and access to clean sources of water are a basic human right. However, 1.8 billion people globally use a source of drinking water that is fecally contaminated, and 2.4 billion people lack access to basic sanitation facilities like toilets or pit latrines. A lack of these resources is what causes approximately 1000 children a day to die from diarrhoel diseases that could have been prevented from better water and sanitation infrastructure.

U.S. Global Health Initiatives

Main article: Global Health Initiatives

The U.S. Global Health Initiative was created in 2009 by President Obama in an attempt to have a more holistic, comprehensive approach to improving global health as opposed to previous, disease-specific interventions. The Global Health Initiative is a six-year plan, "to develop a comprehensive U.S. government strategy for global health, building on the President's Emergency Plan for AIDS Relief (PEPFAR) to combat HIV as well as U.S. efforts to address tuberculosis (TB) and malaria, and augmenting the focus on other global health priorities, including neglected tropical diseases (NTDs), maternal, newborn and child health (MNCH), family planning and reproductive health (FP/RH), nutrition, and health systems strengthening (HSS)." The GHI programs are being implemented in more than 80 countries around the world and works closely with the United States Agency for International Development, the Centers for Disease Control and Prevention, the United States Deputy Secretary of State.

There are Seven Core Principles:

1. Women, girls, and gender equality
2. Strategic coordination and integration
3. Strengthen and leverage key multilaterals and other partners
4. Country-ownership
5. Sustainability through Health Systems
6. Improve metrics, monitoring, and evaluation
7. Promote research and innovation

The biggest fund of the Global Health Initiatives is the Global Fund to fight Aids, Tuberculosis, and Malaria created in 2001 which received $19 billion in health aid between 2002 and 2010. The Global Health Initiatives have been largely successful in achieving their stated goals, but the narrow focus of their goals leaves the question on how and if these initiatives have bettered public health in developing countries overall. In addition, limitations to measuring and implementing these health interventions is that most interventions need to be evaluated over longer periods of time to see results, but if progress is not seen in the short term, the likelihood of continued funding is undermined. The aid effectiveness agenda is a useful tool for measuring the impact of these large scale programs such as the The Global Fund to Fight AIDS, Tuberculosis and Malaria and the Global Alliance for Vaccines and Immunization which have been successful in achieving rapid and visible results. The Global Fund claims that its efforts have provided antiretroviral treatment for over three million people worldwide. GAVI claims that its vaccination programs have prevented over 5 million deaths since it began in 2000.

Country Examples

Ghana

Though curable and preventative, malaria remains a huge public health problem and is the third leading cause of death in Ghana. In the absence of a vaccine, mosquito control, or access to anti-malaria medication, public health methods become the main strategy for reducing the prevalence and severity of malaria. These methods include reducing breeding sites, screening doors and windows, insecticide sprays, prompt treatment following infection, and usage of insecticide treated mosquito nets. Distribution and sale of insecticide-treated mosquito nets is a common, cost-effective anti-malaria public health intervention; however, barriers to use exist including cost, hosehold and family organization, access to resources, and social and behavioral determinants which have not only been shown to affect malaria prevalence rates but also mosquito net use.