1. Department of Public Health Global Health Burden: Scope of Health Promotion Dr Padam Simkhada

2. Overview Key changes Key challenges Scope of health promotion

3. Any changes? What’s changed?

4. Changing in causes of death Respiratory Diseases Cardiovascular diseases Other Infectious Diseases TBDiarrhoeal Diseases InjuriesCancer Source: WHO 1999 1909 1999 Percentage distribution

5. 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 Period 90 80 70 60 50 40 30 Expectation of life at birth (years) More developed World Less developedLeast developed Source: Population division of the Dept. of Economic and Social Affairs, United States Secretariat (2003). World Population Prospects: The 2002 Revision Highlights. New York: United Nations. Life expectancy trends

6. Population structure

7. Changing patients Expectations  Engagement  Rights  Responsibilities  Entitlement  Empowerment  Age  ; Morbidity 

8. Other Global Health Promotion Issues Behaviour change -smoking, sexual Health sector reforms- centrally driven, de- centralisation Growth of Private Health Care providers Environmental change- global warming, Trauma- road traffic accidents Movement of qualified health staff from poor to rich countries- “double effects” Tobacco industry shifted its focus from western countries to developing country markets, with major implications for health promotion Political change-free markets, capitalism

9. Major underlying risk factors Underweight Unsafe sex High blood pressure Tobacco consumption Alcohol consumption Unsafe water and sanitation Iron deficiency Indoor smoke pollution High cholesterol Obesity Physical inactivity Low fruit and vegetable intake Occupational risks Vitamin A deficiency Unsafe health care Illicit drugs Zinc deficiency

10. Challenges ??

11. Population growth Source: United Nations Populations Division, World Population Prospects, The 2004 Revision, medium variant. Developing countries Billions Developed countries

12. Changing in Health Inequality Distribution of Income 82.7% 11.7% 2.3% 1.9% 1.4% World Population arrange by income Richest 20% Second 20% Third 20% Poorest 20% Fourth 20% Source: Walley J, Wright J, and Hubley J (2001)

14. National trend: Rich-poor gap in delivery by SBA in Nepal

15. Trend: ≥4 ANC visits by wealth quintiles

19. Digital divide One of the biggest global health challenges is access to information

21. The global distribution of health workers

22. Conclusions Inequality Universal coverage Nutrition transition: high levels of child under-nutrition and adult obesity coexist Double burden of diseases Communicable, maternal, perinatal and nutritional conditions Non communicable diseases Injuries Health promotion can play important role

23. Department of Public Health Thank You !