# Review sessions ## Session 4 NCD Question 1 You are a civil servant in the Ministry of Health in a middle-income country that has not yet signed the Framework Convention on Tobacco Control (FCTC). Your Health Minister has asked you for a briefing document that succinctly address three key areas: i)  describe three main adverse health effects of smoking and the supporting epidemiological        evidence  (10%); > - cancers, respiratory diseases, cardiovascular diseases; > - note 8mn attributable deaths annually, 80% of smokers live in LMICs; > - enormous body of evidence from Doll and Bradford Hill in 1950 to present: WHO, WB, Framework Convention Alliance, CDC ii) discuss what trade liberalisation has meant for the global tobacco industry in recent years,      and the role of the FCTC in addressing this (40%); > - define “tobacco industry” (those companies and persons involved in cultivation, manufacture, transportation and distribution, advertising of tobacco products including cigarettes, chewing tobacco, snus, cigars, cigarillos, loose tobacco, e-cigarettes and Heat-not-Burn products); > - define trade liberalisation (removal or reduction in trade practices that thwart the free flow of goods between countries, and illustrate with WTO, EU -  more specifically, note impacts of General Agreement on Trade and Tariffs (GATT)  in the 1990s; how this led to industry consolidation; opening of previously restricted markets;  increased competition; and greater availability of cheaper products (potentially a public good, but in case of harmful products such as tobacco). > - describe the FCTC (an internationally agreed treaty adopted at the WHA in 2003 in response to the global tobacco pandemic; encompasses universal standards stating the dangers of  tobacco and limiting its use; limitations – i.e. while legally binding, it only establishes commitment and intent, remains responsibility of state parties to the convention to enact commitments. iii) advise the minister on four measures (two supply side and two demand side) that you       recommend your government undertake in support of tobacco control, and clearly support your advice with concepts learned in this module (50%).       Demand - tax increases that result in an increase of the sales price of tobacco products; - effective measures to provide protection from exposure to tobacco smoke in indoor workplaces, public transport,      indoor public places and, as appropriate, other public places - comprehensive ban of all tobacco advertising, promotion and sponsorship  - health warnings on packs /plain packaging Supply - eliminate all forms of illicit trade in tobacco products - sale to minors - provide economic alternatives for tobacco farmers, workers ## Session 5 Illicit trade Critically evaluate TWO measures to address tobacco smuggling. Include a discussion of the impact of tobacco smuggling on health; the actors responsible for implementing and monitoring measures to address tobacco smuggling; as well as potential barriers to the implementation and monitoring of such measures. Illustrate your discussion with relevant examples. 1. Define tobacco smuggling 2. Define the impact of tobacco smuggling on health 3. Who are the actors responsible for this? WTO, WHO, tobacco industry 1. Economic effect: [[Tobacco industry, for all the wealth-creating activities remain in their home countries while the production or local management are relocated to different markets]] 4. Global policy:, [[Framework Convention on Tobacco Control]], [[MediLedger]], [[Protocol to Eliminate Illicit Trade in Tobacco Products]] 5. Barriers: 1. Inadequate tracking of cigarettes from points of manufacture to points of sale 2. Tobacco companies actively opposing control measures, and getting countries to work together to improve the tracking of cigarettes 3. The [[Protocol to Eliminate Illicit Trade in Tobacco Products]] is voluntary, carry no penalties, and are therefore relatively ineffective. ## Session 6 Illicit trade ## Session 9 SRH ![[GHM104 Session 9 past exams.png]] ![[GHM104 Session 9 possible answers.png]] ## Session 10 WHO's Health System building blocks are criticized because of it is static and focus on government; people or the community is being left out in the building blocks [[Diagonal Approach]] is disease specific results through improved health systems through the improved health system building blocks. There are case studies such as breast cancer in Mexico, and HIV/AIDS integration into primary health care. ## Session 11 [[Emerging donors]] Exam Question: Define "new' or "emerging" aid donors, and discuss at least two benefits and two criticism of their increased role in the provision of international aid. Strengths/Benefits • Well positioned to support LMICs overcome challenges they have recently faced too • Provision of financial assistance, technical assistance, medical goods and services • Improve access to medicines • Health LMIC economic development and poverty reduction • Play increased role in global health governance, advocating for issues important to Global South Limitations/criticisms • Lack of transparency • Weak/no engagement in macro-economic or social policy dialogue with recipient countries • Limited engagement in donor-coordination mechanisms at national/global levels • Assistance tied to stand alone projects rather than overall health systems support • Independent/unregulated actions potentially undermine global efforts for protect human rights and humanitarian principles # Past exams ## Q1. Critically analyse the role of multi-national corporations (MNCs) in the ‘non-communicable disease (NCD) pandemic’ and the influence that MNCs have on the development of a global policy response to NCDs. Illustrate your discussion with examples ### Commentary This question expected students to draw primarily on materials from sessions 1: Introduction, session 4: Global health policy responses to the noncommunicable disease pandemic and session 14: Conclusion. Excellent answers would provide accurate and nuanced definitions for noncommunicable diseases (NCDs) and multinational corporations (MNCs), while explaining how MNCs contribute to the NCD pandemic. Answers were also expected to discuss the influence that MNCs had on global policy responses to NCDs while using at least one example to illustrate the argument. For example, they could explain how the tobacco industry had sought to weaken global policy efforts to reduce smoking by defusing calls for legislation through lobbying, aggressive marketing or other tactics. Answers that expanded on their definition of NCDs by justifying the need for a global response to these diseases; or that explained how global policy failed to jointly address NCDs in major development commitments such as the Millennium Development Goals; or that expanded on the role of MNCs in the NCD pandemic by discussing the challenges of regulating MNCs received higher grades. ### Practice ## Q2. Drawing on the Pandemic Influenza Preparedness (PIP) framework, critically discuss challenges to providing equitable support for low- and middle-income countries (LMICs) to enable them to strengthen their preparedness for a possible influenza pandemic. Illustrate your reasoning with relevant examples ### Commentary This question expected students to draw primarily on the materials from session 2: Strengthening preparedness for pandemic influenza. Excellent answers would provide a comprehensive definition of a pandemic and critically discuss challenges facing global efforts to strengthen preparedness for pandemic influenza, particularly in LMICs. Moreover, responses needed to provide a detailed explanation of the PIP framework and discuss how it was innovative in seeking to redress inequities left unaddressed by other agreements such as the International Health Regulations. The response was further expected to explain how the PIP framework could support LMICs during an influenza pandemic while using examples. For instance, the answer might have argued that the PIP framework supported LMICs by enabling cash benefits to be channelled through the World Health Organization to countries most in need or how it aimed to improve access to vaccines and other pandemic-related supplies in LMICs. Answers that expanded on the definition of a pandemic perhaps by referring to the requirements that need to be met for it to be considered a pandemic; or that discussed the PIP framework’s limitations, such as the lack of guidance on equitable rationing of vaccines during scarcity; or that provided other well-justified points, received higher grades. ### Practice ## Q3. Antimicrobial resistance (AMR) is an issue of global policy concern. In what ways is the rise of AMR affected by expanded access to pharmaceuticals and how can AMR be reduced? Reference the access to pharmaceuticals framework and illustrate your answer with specific examples. ### Commentary This question was primarily based on session 5: Access to pharmaceuticals in a globalized world. Excellent answers were expected to demonstrate an excellent understanding of the challenges to the continuous supply of essential medicines and fully explain the elements of the access to pharmaceuticals framework. Answers were expected to also critically discuss how the rise of AMR was driven, shaped or exacerbated by factors in each of the four domains of the access to pharmaceuticals framework. For instance, if drugs were not affordable, individuals might buy them from cheaper (including illegal/unregulated) sources that may be substandard, further contributing to AMR. Answers were expected to also include possible solution areas such as improving border controls of pharmaceutical products to reduce trade in illicit medicines or improving the regulatory capacity of drug regulatory authorities through staff training. Answers that proposes cross-cutting solutions to ensure the continuous supply of essential medicines or that engage with examples in greater depth received higher grades. ### Practice ## Q4. Discuss TWO benefits and TWO disadvantages of vertical health programmes. Critically compare vertical, horizontal and diagonal approaches to explain whether the disadvantages of vertical programmes can be addressed through horizontal or diagonal approaches. Use examples to illustrate your argument. ### Commentary This question is primarily based on session 10: Can we reconcile horizontal versus vertical approaches to global health? Excellent answers would provide excellent analysis and accurate and complete definitions for vertical, horizontal, and diagonal programmes, while referring to examples. The answer should also provide a well-substantiated discussion of two benefits and two disadvantages of vertical health programmes, while critically comparing their relative advantages and disadvantages with those of other types of programmes. For example, the answer may explain how diagonal programmes address some of the disadvantages of the vertical approach by supporting the coordination of efforts between disease-specific programmes and general health services. Answers that expand on their definition of these approaches perhaps by referring to which types of programmes are preferred by specific actors; that discuss how the disadvantages of the vertical approach can be overcome; or that explain additional elements when comparing the three approaches, perhaps by critically discussing how vertical, horizontal and diagonal approaches are not mutually exclusive and may serve a purpose at a specific point in time while providing examples, may receive higher grades ### Practice ## Q5. Discuss the challenges posed by the involvement of multiple actors in global health policy making. Critically evaluate ONE process by which global health actors organize to overcome these challenges. What effects has this process had on global health policymaking? Use examples to illustrate your answer. ### Commentary This question primarily draws on the study materials for session 1: Introduction. Excellent answers would provide a complete definition of global health policy-making, while presenting a well-justified discussion of challenges related to the involvement of multiple actors. The answer should also fully explain one process by which global health actors have organized to overcome some of the challenges previously described. Students should also explain what effects this process had on global health policy-making. For example, the answer may refer to the challenge in the global health policy arena posed by multiple, and often competing frameworks put forth by a diversity of public and private sector actors. Referring to this challenge, the student may explain the role of global health diplomacy in mediating competing interests and building consensus by bringing together different actors to address specific health issues. Answers that expand on challenges related to the involvement of multiple actors in global health policy-making; complement their explanation of the different ways global health actors organize to have a greater effect on global health policy-making; or further elaborate on these processes perhaps by referring to innovations in global health governance, would have received higher grades ### Practice ## Q6. Compare the concepts of health equity and health equality. In your response, critically discuss why measuring health equity is important for policy making. Use examples to illustrate your answer. ### Commentary This question primarily draws on the study materials for session 13: How do we address health equity in a globalising world? Excellent answers would provide correct and comprehensive definitions for health equity and health equality. They should also critically compare the concepts of health equity and health equality, by explaining their relative differences and similarities and referring to examples. The answer should also demonstrate ability for critical analysis by discussing the importance of measuring health equity for policy-making. For example, the answer may explain how past public and global health initiatives have only examined population level data, which can mask inequities within distinct groups. They may also refer to the contributions of the DALYs and QUALYs in furthering our understanding of health inequities by highlighting the differences in burden of ill health not just in death. Answers that expand on their comparison of health equity and health equality by, for instance, referring to different concepts of justice, such as Rawl’s or Sen’s theories or the role of the social determinants of health; that discuss policy approaches to address health inequities and their underlying causes by perhaps discussing the concept of ‘progressive universalism’; or that expand on the importance of measuring health equity for policy-making, would receive higher grades. ### Practice ## Q7. Apply the third component (“different and competing conceptions of what constitutes global order and relevant policies”) of the global policy framework to discuss the roles and competing discourses of at least TWO actors involved in the formulation of global policy for sexual and reproductive health (SRH). ### Commentary This question is primarily based on sessions 1: Introduction and 9: Global dimensions of sexual and reproductive health. Excellent answers would provide a comprehensive and clear definition of sexual and reproductive health and of competing discourses. They would also discuss how competing discourses of sexual and reproductive health hindered the development of a global policy by for example explaining the challenges of moving from a traditional health-based approach to a human rights approach to public health to develop global health policy for sexual and reproductive health, or other examples. The answer should also critically assess how the discourse of at least two actors involved in the global policy response for sexual and reproductive health compete in its global framing by convincingly comparing and contrasting their views on this issue. These actors may include civil society actors, United Nations member states or Permanent Observers (such as The Holy See), bilateral agencies (such as USAID), the World Health Organization, among others. Answers that critically assess additional elements related to the definition of sexual and reproductive health perhaps by referring to its four components; expand on the discussion of competing discourses, for example by defining framing as a way of packaging and positioning an issue; or that provide examples illustrating how advancing sexual and reproductive health is linked to the promotion of human rights in general, may receive higher grades ### Practice ## Q8. Critically analyse the impact of global environmental change (GEC) on emerging infectious diseases (EIDs) and consequences for population health. Illustrate your argument with examples. ### Commentary This question draws primarily on the materials from session 8: Environmental change and emerging infections. Excellent answers would provide excellent analysis and accurate and complete definitions of global environmental change and emerging infectious diseases, while considering relevant examples of these. The answer should also provide a well-substantiated argument about the consequences of global environmental change and emerging infectious diseases on population health by explaining the process of emergence of these diseases. For example, the essay may explain how deforestation has an impact on infectious diseases by describing how these emerge, while also paying attention to the health and economic effects of global environmental health and emerging infectious diseases on populations. Answers that elaborated further on this issue by explaining how globalization facilitates the spread of pathogens; that examine the different types of emerging infectious diseases; or that critically reflect on inequitable effects of global environmental change and emerging infections on populations, may receive higher grades. ### Practice ## Q9. Can the principles of good governance (as described by the OECD) be applied to improve governance of global health problems? Illustrate your answer with examples and include consideration of the linkages between national and global policymaking. ### Commentary This question draws primarily on materials from session 14: Conclusion. Excellent answers should provide a clear justification for considering good governance principles at the global level, along with comprehensive and correct definitions of good governance and global health problems. The answer should also present a clear case for or against the relevance of the principles of good governance, as described by the OECD, to address global health problems by critically applying these principles to an example. For instance, the 2014-2016 Ebola virus outbreak generated some lessons associated with the response to a cross-border health problem including the importance of establishing clear lines of accountability at the World Health Organization-level, or of improving the global system for preventing and responding to outbreaks, which is related to the principle of forward vision, among others. Answers that contrast governance and policy-making for health at national and global levels, or that critically discuss how good governance principles are norm or value-based, may receive higher grades. ### Practice