International Health We are not alone in the world We have much better health than most but only rank 37 th in total health We have slipped every year for the last 40 years Why?

International health Perspectives – Health access – What health care to give – Equity – Disasters and epidemics

Access Alma Atta accords 1983 Basic health care costs less than public health Is it effective without PH? What is Public Health? Plural health systems

Access In traditional societies, the decision to seek healthcare is a rational choice of a household Not individual choice Therefore there are inequities that exist Gender Age Contribution based

Access Married more than never married Education matters Income may matter Household size Cost Distance to care Need, ADLs Available health systems

Access and Health Status Less care, poorer health More acute morbidity and chronic morbidity Higher mortality Males better than females—patriarchy and empowerment

What health care Developed country costs much more than basic care Health care budgets Epidemics and plagues

Equity Different from equality Gender Race Education and income Need and dependency At risk populations

Disasters and epidemics McNeill—Plagues and Peoples Diamond Guns, Germs and Steel Farmer—Infections and Inequalities

Epidemics Can shape the economic and social destiny of cultures Western culture and dominance was shaped by the Black death AIDS Bird Flu Katrina