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Framework for Rebuilding Public
Health Systems in Somalia
Fozia Abrar, MD, MPH
Department Head/Medical Director
HealthPartners Occupational and
Environmental Medicine
Life expectancy at birth: 50 yrs.
Maternal mortality ratio: 1044 per 100,000 live
births ( WHO- world health statistics 2010)
U5 mortality rate: 200 per 1,000 births
Access of population to clean water: 29% national
( 59% urban, 11% rural)
Infant mortality rate: 113/1000
Childhood immunization coverage<30%
• It is estimated that Somali children have the
highest infant and child mortality and morbidity
rates in the world.
Lack of access to primary and basic secondary
health services.
Lack of access to safe water and sanitation
Lack of access to conduct vaccination and other
life-saving activities in some regions continues to
impact negatively on the health of children.
Leading causes of Death in
Infectious Disease (HIV,TB)
 ARI (children)
 Diarrheal Diseases ( Children)
 Measles
 Poverty/Malnutrition
Contributing factors to
Maternal Mortality
FGM related complications
 Malnutrition/anemia in pregnancy
 Inadequate maternal health services
 Delayed referral systems
 Unskilled birth attendants
Major human costs of Somalia since 1991
450,000–1,500,000 excess deaths caused by Somalia’s
intermittent conflicts
Nearly one million Somalis live as refugees in Kenya, Djibouti,
Ethiopia and one third of Somalis are currently displaced.
 350,000 to 750,000 people are facing famine conditions and are
at risk of death
Disease Outbreaks are challenge in South Central Somalia.
OCHA ( United Nation Office for the Coordination of
Humanitarian Affairs)
Public health programs have an
opportunity cost
Difficult to attach value to something
 The cost of providing services to thousands
of polio victims if child was not vaccinated.
 Preventing HIV infection by changing
behavior versus treating cases
 Preventing heart disease, stroke versus
treating complications: death
Public health programs cont’d
Preventing diabetes versus treating
 Reducing tobacco use versus treating lung,
throat cancer, MI
 Access to prenatal care versus maternal and
infant deaths
 Preventing maternal/infant HIV
transmission versus treatment
Leading Causes of Death in USA
(Minino et al 2002)
Heart Diseases
 Cancer
 Cerebrovascular Disease
 Chronic (lower) Respiratory Disease
 Unintentional Injuries
 Diabetes Mellitus
 Influenza
Recommendations for the Future
Training community health care workers to work
with and among pastoralist and agro-pastoralist
Role of Diaspora is very important in rebuilding the
health and education sector
Strengthening MCH and Health posts
Access to safe water and sanitation
– Trained/motivated public Health workers
– Money from major donors
– Building public health clinics
– Strengthening local health departments
– Public/private initiatives
– Investing in prevention/community medicine.
Investing in prevention
Heath education
 Childhood immunization
 Maternal health programs
Role of the Diaspora Community
 Teaching at local universities
 Visiting professors
 Sponsoring medical students
Role of donors
 Capacity-building
Role of the government
Reestablishing the National Health Policy: to
provide equitable and affordable preventive
and curative health care services and thus
ultimately better health status ie. reduce
morbidity and mortality that will increase
life expectancy”
 Building capacity of health centers