As described by the World Health Organization (WHO), health financing involves the generation, allocation and use of financial resources in health systems. The aim of health financing is to make funding available, provide financial incentives to health service providers and ensure that all individuals- irrespective of wealth and social class, have access to effective public health and personal health care. Policies regarding health care financing are aimed towards universal health coverage especially relating to:
- Sources and ways to raise and pool together sufficient funds for health
- Means to overcome financial barriers that cause disparities in health care
- Ways to increase healthcare access as well as provide equitable and efficient variation of health services
Health financing ensures the provision of funds and resources needed for the operation of health systems. It is a major determinant of the performance of health systems, and can be assessed in terms of equity, efficiency, and health outcomes in a particular country or region. Directing public funds towards services that address the healthcare needs in a population is essential for a country to prosper health-wise, and attain universal health coverage (UHC) – the gold standard for health financing. UHC is a system of healthcare financing that ensures all populations and communities can access and use the health care services they need. These services may be preventive, curative, palliative or rehabilitative and should be efficient, economical, effective and of good quality. The current system of financing in health care- UHC is based on three major principles including:
- Equitable access to health services
- Standardized and excellent quality of health services
- Protection against financial-risk
UHC is rooted in the 1948 constitution of WHO which documented health as fundamental human right. Subsequently, the Alma Ata declaration emphasized the Health for All agenda in 1978. Health financing is crucial to both the quality and accessibility to healthcare. Although not fully implemented in many countries due to private out of pocket financing, UHC is the WHO recommended method of healthcare financing because of its benefits. Private financing and out of pocket payment perpetuates inequities in healthcare accessibility and use. Consequently, public funding aims to achieve UHC which seeks to eliminate these inequities by providing the same quality of care to all people across board- rich or the poor, in rural or urban communities. The future of health financing is tending towards UHC for most developed countries, although there is still some private funding. However, in undeveloped countries like Nigeria, where the government doesn’t care about citizens, private out of pocket funding is still foremost.
Globally, infectious diseases have remained the leading cause of death. Years ago, scientists assumed that the battle against these diseases was finally over; unbeknownst to them, this battle was far from being over. Events in the last few decades emphasize this persistence. New diseases such as AIDS, Legionnaire disease, and hanta-virus pulmonary syndrome have emerged while diseases that seemed eradicated such as malaria and tuberculosis are re-surging. The resurgence of previously conquered infections may be due to factors that include the characteristics of the pathogen and inefficient public health standards to guarantee their extinction.
Emerging infectious diseases (EID) are diseases whose incidence have increased in recent years, with the potential to continue increasing in the future. They usually have the following characteristics: have not or rarely occurred in human population before, occurred in the past and affected few people in secluded locations or have just been recently identified. On the other hand, re-emerging infectious diseases are diseases that caused national or global health problems in the past and were eradicated, but somehow have re-surfaced again to constitute outbreaks. Emerging and Re-emerging diseases go hand in hand- sometimes, infectious disease specialists classify the latter as a subcategory of the former. Reemerging infections account for about 12% of all human pathogens and may result from the following:
- Complacency, carelessness and lack of effective public health standards (Drug resistant tuberculosis, Poliomyelitis)
- Newly identified organism (Severe acute respiratory syndrome, HIV/AIDS)
- Evolution of a known strain (Influenza, Tuberculosis)
- Spread to a new population (West Nile fever)
- Spread to a region undergoing ecologic transformation (Lyme disease)
- Microbial adaption (Influenza A)
- Changing human susceptibility, demographics and trade (HIV, SARS)
- Climate and weather (West Nile Disease )
- Economic development and invention (Antibiotic resistant strains)
- Poverty and social inequality (Tuberculosis)
- Bioterrorism (2001 Anthrax attacks)
- Dam and irrigation system construction (Malaria and other mosquito borne diseases)
- Zoonotic encounters (HIV)
Notably, Tuberculosis for instance re-emerged due to the evolution of Mycobacterium Tuberculosis, the causative organism. This pathogen evolved and became resistant to the antibiotics it was once sensitive to. This occurs through mutation, genetic exchange or abuse of antibiotics. Malaria has also become drug resistant and the vector, mosquito, has acquired resistance to pesticides. Furthermore, the resurgence of diseases such as diphtheria and whooping cough (pertussis) was due to inadequate vaccination which occurs when the proportion of immune individuals in a population falls below an expected threshold.
Despite the challenges of emerging and re-emerging infectious diseases, research shows that there is hope; noteworthy breakthroughs include:
- Increased vaccination
- Development of HIV protease-inhibitor drugs which when used in combination with other anti-HIV drugs, dramatically decreases deaths from AIDS
- Research on the ecology of disease organisms—their reservoirs, modes of transmission, and vectors, revealing preventive measures to interrupt disease cycle and prevent outbreaks.
Hearing loss is a major public health problem, affecting 360 million people worldwide. It is the third most common health problem in the United States (US) – with about 48 million Americans having lost some degree of hearing. It affects quality of life and relationships, and may result in depression, social isolation, unemployment, high blood pressure and increased risk of falls. Major factors that cause and facilitate hearing loss include aging, illness, genetics, medications and noise.
Statistically, humans begin to lose hearing from about 30 to 40 years. Age is the strongest predictor of hearing loss among adults aged 20 and above, with the greatest burden on people aged 60 and above. Age related hearing loss is called Presbycusis, and occurs gradually as individuals become older- one third of people aged 65-74 and about half of people aged 75 and above. This could be as a result of the fact that over the years, the ear’s efficiency to hear gradually wears out due to the following: changes in the structures of the inner ear, changes in blood flow to the ear, impairment in the nerves responsible for hearing, changes in the way that the brain processes speech and sound, damage to the tiny hairs in the ear responsible for transmitting sound to the brain, diabetes, poor circulation, exposure to loud noises, use of certain medications, family history and smoking. There is no cure for age-related hearing loss; however, doctors may recommend the following to improve hearing: hearing aids, assistive devices, such as telephone amplifiers, lessons in sign language or lip reading and cochlear implant. In addition to aging, noise is another factor that wears out hearing especially when it’s loud or constant. Some jobs such as Carpentry and Plumbing increase the risk of hearing loss since workers are exposed to dangerous noise levels daily- 44% of carpenters and 48% of plumbers report some hearing loss .
Based on which part of the auditory system is affected, there are 3 major types of hearing loss and they include sensorineural, conductive and mixed hearing loss. Sensorineural hearing loss occurs when the inner ear (cochlea) or hearing nerve in the brain is damaged. Some possible causes are aging, excessive exposure to loud noise, viral or bacterial infections, medications, ear tumor and other hereditary factors. Conductive hearing loss occurs when there is inefficient conduction of sound through the ear canal, ear drum or middle ear. Possible causes include ear infection, presence of fluid or foreign objects in the middle ear, scarring of the eardrum, build-up of wax, ossicles dislocation, otosclerosis and tumors. Finally, mixed hearing loss results from a combination of sensorineural and conductive hearing loss, affecting both the middle ear and inner ear. Hearing loss can also be classified based on the severity of the problem- four classes exist and they include: Mild hearing loss- where it’s hard to comprehend every word in a noisy background; Moderate hearing loss- where words have to be repeated before they’re comprehended; Severe hearing loss- where it becomes difficult and impossible to follow a conversation without a hearing aid and Profound hearing loss- where it’s impossible to hear people unless they shout.
Symptoms of hearing loss vary broadly depending on the type, cause and severity of the problem. In general, affected people may experience one or more of the following: difficulty understanding conversations, difficulty hearing without repetition, increased difficulty communicating in noisy environments and tinnitus, or ringing sounds in the ears. Hearing loss can be diagnosed by a series of tests such as initial examination using an otoscope, pure tone test, bone conduction test, speech test, tympanometry and audiogram. Given that most cases of hearing loss are untreatable, irreversible and can only be managed, it is best to prevent the problem. Recommended prevention methods include avoiding repetitive exposure to loud sounds and wearing ear protection when exposed to loud sounds.
Several factors pose threats to the health, well-being and safety of populations, as well as the economy of countries across the world. These factors include public health issues such as communicable or infectious diseases, bio-terrorism, natural disasters, man-made disasters, and non-communicable diseases.
The importance of global health protection and security has become more necessary given the advent of many epidemics and threats to global health security. The world today is synonymous to a global village, with high rates of mobility and connection through airplanes, speed boats and trains. Consequently, the impact and effect of diseases and other health problems can spread across wide geographical regions in a matter of hours. As the Center for Disease Control and Prevention (CDC) puts it, an outbreak anywhere, is indeed a threat everywhere. More so, there is need for protection against biological warfare (Bio-terrorism) which involves the use of biological weapons- toxins and infectious agents such as bacteria, viruses, and fungi, as an act of war to kill or debilitate humans, animals or plants.
The aim of global health protection and security is to remain one step ahead of potential outbreaks, and to be prepared to act quickly in the case of emergencies. This preparation involves having both the human and financial resources sufficient to handle any outbreak. Lack of emergency preparedness and weakness in the health system allows for diseases to thrive and spread, ultimately transforming local outbreaks into global epidemics. During an outbreak, time is of the essence, therefore it is essential to detect, prevent and rapid spread of diseases immediately. Early intervention and outbreak control prevents morbidity and mortality that can potentially overwhelm the health system and economy. Furthermore, outbreaks- like other accidents are unpredictable and can happen at any time with grave consequences. These consequences include the cost of controlling outbreaks, decrease in travel and tourism and instability of businesses, staggering economic growth, increase in the cost of health services and disruption in international trade. In the United States (US), The Commission on Global Health Risk Framework for the Future (CGHRFF) estimates a total cost of $6 trillion USD for global pandemics.
Different countries have different bodies responsible for global health protection and security. In the US, Division of Global Health Protection (DGHP) of the CDC is responsible for protecting citizens from public health problems in this regard. There is need for a worldwide effort through the Global Health Security Agenda, to strengthen every country’s capacity to prevent, detect, and respond to health threats in order to protect the health and security of the world. Data collection through disease monitoring and surveillance are important components of global health protection and security. Additionally, countries need to support each other and share resources during health emergencies. To be secure, countries must have the public health capacity to identify health threats, stop outbreaks from becoming epidemics, and save lives.
The Organization for Economic Co-operation and Development (OECD) defines life expectancy (LE) as the number of years, on the average, that an individual can expect to live assuming that the death rate at the time of the estimate remains constant. It is usually calculated at birth or a particular period and varies based on several factors including gender, socio economic status, country of birth, place of residence and death rate at the time of calculation. A decline in death rate results in a corresponding increase in actual life spans compared to the life expectancy calculated at the time of birth. However, an increase in death rate will result in decrease in actual life spans, compared to that calculated at birth. Life expectancy is a significant and frequently used health status indicator because it reflects the overall wellbeing and quality of life in a country or region. Increase in LE is a consequence of several factors, including higher standards of living, healthy lifestyle, better education and accessibility to health services. LE is also useful in understanding the demographics and needs of a population.
On the other hand, healthy life expectancy (HLE) is the number of years- on the average, that an individual is estimated and expected to live in good health at a specific age, after taking mortality and morbidity data into account, as well as the health status of the specified population. Unlike LE, HLE takes into consideration, factors such as quality of life and specific health status or conditions of the population. It can be used to determine and monitor the health status of populations. Using HLE estimates of countries, important needs such as future health services, health program evaluation and health trends analysis can be prepared for, and carried out effectively. In the United States, the Centre for Disease Control and Prevention (CDC) used data from the National Vital Statistics Systems (NVSS), U.S. Census Bureau and Behavioural Risk Factor Surveillance System (BRFSS) to estimate HLEs for persons aged 65 years, by sex and race. Findings from these calculations showed that from 2007 to 2009, women had a greater HLE than men at 65 years across the US while whites had a greater HLE than blacks, except in Nevada and New Mexico.
The difference between life expectancy (LE) and healthy life expectancy (HLE) is that the former describes the average number of years a person can expect to live based on current mortality rates for the population while the latter estimates the approimate healthy years that a person can expect to live on the basis of the current mortality rates plus the distribution of health status in the population. The difference between LE and HLE is a function of health status which represents the quality of the life. Consequently, LE is usually longer than HLE, however, the extra number of years expected to be lived may not necessarily be healthy and worthwhile. According to World Health Organization (WHO), in 2015, the global population had an average LE of 71.4 years at birth while the average HLE was 63.1 years. Considering the 2015 data presented by WHO, people remain very healthy and are able to work or contribute to the economy up to 63 years, however, at 71, chronic diseases become more prominent, significantly reducing the quality of life. It is important to know that these numbers are only averages and will differ from individual to individual based on more personalized and specific factors.