1. BME 301 Lecture One

2. Overview of Lecture 1 Course Overview: Course organization Course goals Four questions we will answer Technology assessment – The big picture Activities we will do World health: an introduction

3. Course Organization People Syllabus Website: http://www.bme.utexas.edu/faculty/richards- kortum/BME301 http://www.bme.utexas.edu/faculty/richards- kortum/BME301 BME 301 Roadmap

4. Design of New health Technologies Health Technology Assessment Ethics Management The Science of Understanding a Disease. Preclinical Testing Abandoned due to poor technical performance, efficacy, efficiency, and safety, ethical, legal, or social issues. Clinical Trials Adoption and Diffusion Roadmap for BME 301

5. Four Questions What are the major health problems worldwide? Who pays to solve problems in health care? How can technology solve health care problems? How are health care technologies managed? BME 301 Concept map

6. Start here What are the problems in health today? Advance to next unit Screening and Prevention Diagnosis Treatment and Therapy Definition of Health Role of World Health Organization Health Data Types and Uses Sensitivity and Specificity PPV EpidemiologyBurden of Disease QALY, DALY,HRQL Mortality Ages 15-44 AIDS/HIV Accidents Interpersonal Violence Mortality Ages 45-60 Respiratory Cancers TB Heart Disease Cerebrovascular disease Developing and Developed World Contrasts

7. Who pays to solve problems in health care? How have health care costs changed over time? Advance to next unit What contributes to increasing health care costs? International International Start here United States Vendor/Purchaser System – choice dependent on ability to pay Financing of the system Health Technology Development Provider of services Hospitals Nonprofit Private (for profit) Public Ambulatory Care Private Practice Public Health Services Voluntary Agencies University Student Private insurance HMO PPO Public (tax based) Medicare/Medicaid Military Out of pocket expenses Canada Universal Insurance 13 provincial systems Hospitals – nonprofit (all government funded) Government sets ceilings on gross revenue for physician private practices. India Public – free treatment health centers Private care – for profit usually urban areas Western and traditional medicine International aid – especially in rural areas Angola 27 year civil war “Near absence” of government Displacement and malnutrition International aid only source of health care.

8. Start here How can we use science and technology to solve problems in health care? Advance to next unit How do we test and refine innovations? Case studies Technology Assessment: The Big Picture Biological plausibility Clinical Trials Where do innovations come from? Patient Outcomes Societal Outcomes Early Detection of Cancer Prevention of Infectious Diseases Technical Feasibility Science Drives Engineering Scientific Method Engineering design Treatment of Heart Disease Microorganisms Immunity Vaccines HIV Cost effectiveness Pre-cancer  cancer transformation Detection of Morphologic Changes Gene Chips – molecular changes CervixBreastProstate The circulatory system Arteriosclerosis CABG PTCA Heart Failure LVAD Transplant Outcomes Cost effectiveness Outcomes Cost effectiveness

9. How are health care technologies managed? Examples: MRI Laparoscopic cholecystectomy Vitamin C treatment for scurvy Research Funding Regulatory Approval ReimbursementDiffusion

10. Three Case Studies Prevention of infectious disease HIV/AIDS Early detection of cancer Cervical Cancer Ovarian Cancer Prostate Cancer Treatment of heart disease Atherosclerosis and heart attack Heart failure

11. Activities Homework (HW) Web Assignments (WA) Class Activities (CA) Projects Due dates

12. Technology Assessment What is it? Why do we need it? Example Bone marrow transplants for breast cancer

13. Start here What are the problems in health today? Advance to next unit Screening and Prevention Diagnosis Treatment and Therapy Definition of Health Role of World Health Organization Health Data Types and Uses Sensitivity and Specificity PPV EpidemiologyBurden of Disease QALY, DALY,HRQL Mortality Ages 15-44 AIDS/HIV Accidents Interpersonal Violence Mortality Ages 45-60 Respiratory Cancers TB Heart Disease Cerebrovascular disease Developing and Developed World Contrasts

14. What is health?

15. WHO Definition of Health “Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity.”

16. Some Perceptions of Health Pain, fever, symptoms of illness Interference with normal activities Deviation from a pre-determined norm Ability to respond to stress and physical insult

17. Individual Health vs. Population Health Pooled figures such as: Infant mortality rates Numbers of deaths and causes Immunization rates

18. Example of Health Data

19. Questions about health data Why do we need it? What data do we need? Where do we get it? How do we use it?

20. Why do we need health data? From 1870-1900: Biomedical science advanced more than it had in previous 3 millennia Darwin’s concept of evolution Chemistry Microscopy Field based research around the world Means, transmission, causative agent of almost every important infectious disease In this period, governmental health agencies were first established.

21. World Health Organization Established by charter of the UN after World War II Headquartered in Geneva Mission: “Attainment by all peoples of the highest possible level of health” Website: http://www.who.int/en/

22. Functions of the WHO Services to governments: Epidemiologic intelligence International standardization of vaccines Reports of expert committees Data on world health problems Member countries must provide certain info in regular reports Disease outbreaks Health of population Steps to improve health

23. Uses for health measures Identify emerging problems (early warning) Rubella during pregnancy Thalidomide during pregnancy AIDS  Kaposi’s sarcoma, PCP Help determine public policy Estimate impact of health problems # people affected, ages, locations Set priorities for funding Educate legislators Monitor progress toward goals

24. Types of health data Data on the population # of people Age, sex, ethnic origin, urbanization Vital statistics Live births Deaths (including infant deaths) by sex, age, cause Health statistics Morbidity by type, severity and outcome Data on reportable diseases Tumor registries Statistics about health services # and type of facilities # and qualifications of health personnel Services and utilization rates Costs and payment mechanisms

25. Quantitative measures of health Incidence Number of new cases of a disease in a population over a period of time Annual incidence rate

26. Quantitative measures of health Prevalence Number of existing cases of a disease in a given population at a specific time Point prevalence

27. Quantitative measures of health Mortality rate Mortality = Death Crude death rate, Infant, Neonatal, Post-neonatal, Maternal Age adjustment is important because different populations have very different age distributions Mortality Rate Infant mortality rate

28. Quantitative measures of health Morbidity rate Morbidity = a diseased state Why is it important? Estimate magnitude of health problem Detect epidemics Mandatory notification Cholera Plague Yellow fever Evaluate preventive measures

29. Burden of disease Quality adjusted life year (QALY) Measure of quality adjusted life years gained by an intervention Disability adjusted life year (DALY) Years of disability free life lost Combines several elements Levels of mortality by age Levels of morbidity by age Value of a year of life at specific ages Examples: Stroke: 6 DALYs Car accidents: 9 DALYs Self inflicted injuries: 17 DALYs Violence: 9 DALYs Lower respiratory infections: 1 DALY HIV: 28 DALYs

30. The study of global health Epidemiology The study of the prevalence and spread of disease in a community Measures of health Vary throughout the world Burden of disease Varies throughout the world How can technology impact health and disease? Varies throughout the world We will examine in detail in BME 301

31. Leading causes of mortality in Member States 1998

33. Group 1 = communicable diseases, maternal/perinatal conditions, nutritional deficiencies Group 2 = Non-communicable diseases (cardiovascular, cancer, mental disorders) Group 3 = Injuries

34. Mortality from cervical cancer in 1990 (per 100 000 age standardized world population) From: Jones: BMJ, Volume 319(7208).August 21, 1999.505-508

35. Income

36. Sources of World Health Data The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Murray CJL, Lopez AD, eds. Harvard School of Public Health on behalf of the World Health Organization and the World Bank, 1996. World Health Organization Annual Reports International Agency for Research in Cancer

37. Summary of Lecture One Course organization What is health? Role of WHO Health data and uses

38. Assignments Due Next Time WA1