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write the background part, all other parts are done
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Nepal 2
Identification of Key Health Issues
Group members: Weiwei Wu, Chansoo Park, Yunjie Chai, and Siya Kashwala
BrainStorm Area
● Could look into lung cancer/COPD rates and risks among lower-income groups in Nepal.
○ Smoking rates (Intervention Program: raise awareness on risks associated with smoking, provide
educational materials to target population, and provide access to resources for smoking cessation like behavioral counseling or medication)
■ Around 30% of the population in Nepal smoke
○ Biomass fuel use among families living in poverty
○ Air quality/pollution
○ Late diagnosis -> high mortality rate in older people
● Population:
– Older population versus younger population lung cancer rates OR women versus men
– COPD patients (ameliorate), potential COPD population (prevention)
● Objects: undecided yet: options – mortality, incidence, management??
● Risk factors: Age, gender difference, air pollution, occupational exposures, healthcare
resources, lack of awareness, climate and geography
● Direct / surrogate estimates of COPD:
Materials:
– General:
1 https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
2 Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and
territories, 1990-2019: results from the Global Burden of Disease Study 2019
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9326843/
– Risk factor:
1 The burden of chronic respiratory diseases in adults in Nepal: A systematic review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264743/
2 Levels and determinants of health literacy and patient activation among multi-morbid COPD people in
rural Nepal: Findings from a cross-sectional study
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233488
– Intervention:
1 Community-based management of COPD in Nepal https://pubmed.ncbi.nlm.nih.gov/28000600/
2 Using a co-design process to develop an integrated model of care for delivering self-management
intervention to multi-morbid COPD people in rural Nepal.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874656/
———————————————————————————————————————
Background (Describe the relevant background for your country and health issue)
COPD Epidemiologic Burden
The Nepal Health Research Council recently reported that the prevalence of COPD in the
country is 11.7% (Adhikari et al., 2020). This figure indicates a substantial burden of disease
within the population. In 2016, the prevalence of COPD in Nepal was 4,810 cases per 100,000
population, which notably exceeded the global rate of 3,628 cases per 100,000 population
(Adhikari et al., 2018). In 2019, an estimated 21,603 Nepali individuals died from indoor air
pollution due to solid fuels used for heating and cooking (IHME 2022). Additionally, in the same
year, around 21.9% of the population in Nepal smoked daily (IHME, 2022). From 1990 to 2019,
there was an increase in deaths attributed to outdoor air pollution, representing a relative change
of +291.0% (IHME, 2022). In 2015, Nepal was ranked among the top 4 countries with the
highest age-standardized DALYs rates due to COPD (Adhikari et al., 2018). As the population
continues to age, the burden of COPD is anticipated to rise significantly due to the escalating
incidence, death, and DALYs rates associated with advancing age (Adhikari et al., 2018).
COPD Trends in Nepal
Over the past few decades, there has been a notable rise in both the incidence and
prevalence of COPD in Nepal. The WHO has projected that COPD-associated mortality will
increase in the next few decades by 160% in the Southeast Asia region (Adhikari et al., 2018). In
1990, the average death rate for COPD, spanning both sexes and all age groups was
approximately 69.84 deaths per 100,000. By 2019, this rate had substantially increased to 103.5
deaths per 100,000 (IHME, 2022). The air quality index is at its peak during the winter months,
when the use of indoor heating is common, which further exacerbates respiratory conditions.
PM2.5 concentrations consistently register higher levels each year between November through
April (IQAIR, 2023). COPD has been a longstanding issue in Nepal and ongoing efforts are
required to reduce its prevalence and improve the quality of life for those affected.
Key Population Affected
COPD is one of the most common non-communicable diseases (NCDs) in the adult
populCOPD is common among Nepali adults, constituting 43% of outpatient visits. Adult COPD
prevalence was 22.7%, with 54.9% being women. Most patients lacked formal education
(73.1%) and worked in farming (39.4%) or as housewives (36.8%). Many were current/former
smokers (Adhikari et al., 2020). Prevalence is three times higher in individuals aged 60+ than in
those aged 20-39. Karnali, the least developed region, had the highest prevalence (25.1%) due to
limited COPD services (Bolger, 2023).
Structural Determinants for COPD
Smoking and exposure to biomass fuels are major risk factors for COPD. More than 28%
of Nepalese men and 8% of women smoke, while 66% of households use biomass fuels
(Adhikari et al., 2020). Women’s exposure to biomass fuel is higher due to household chores,
which is estimated to contribute to the rising prevalence of COPD in women (Budhathoki et al.,
2021). Nepal’s poor air quality results from urbanization, industrial growth, and vehicle
emissions (Diwakar, 2023) also poses a threat to health. In recent years, air pollution in Nepal
has been 4.9 times higher than the WHO’s recommended pollution levels (WHO, 2023). Nepal’s
terrain, surrounded by high mountains, and lack of proper regulatory policies exacerbate the
problem (Gallant, 2021). Lack of awareness about COPD, low health literacy, education, and
economic status also increase the risk of COPD (Adhikari et al., 2020).
Stakeholders and Potential Partners in Addressing COPD in Nepal
Stakeholders: The involvement of both internal and external stakeholders is crucial in
addressing the escalating burden of COPD in Nepal. Internal stakeholders primarily encompass
government agencies, including the Ministry of Health and Population Nepal and the Department
of Health Services (Ministry of Health, Nepal, 2019). Local NGOs, being closely involved in
community-based programs and grassroots interventions, also have a vested interest in this issue
(Gautamet al., 2017). Most significantly, COPD patients and their families, bearing the direct
brunt of the disease, are primary stakeholders in any discussion, decision, or initiative related to
COPD management and prevention.
On the extrinsic or external front, International Organizations like the WHO and United
Nations Development Program (UNDP) have consistently shown commitment to global health
and can provide technical support, funding, and expert advice (WHO, 2023). External NGOs,
especially those focusing on respiratory diseases and global health, can provide a wealth of
experience from interventions in other settings and can help in tailoring strategies specific to
Nepal.
Potential Partnerships：Local NGOs play an irreplaceable role due to their grassroots
reach and deep understanding of community dynamics. Their collaboration ensures that
interventions are culturally sensitive and tailored to the community’s needs. Furthermore, the
inclusion of community leaders and local influencers, such as religious leaders and community
elders, is pivotal. Given their influential status in the Nepali socio-cultural fabric, their
involvement can facilitate better community acceptance and adherence to any proposed
interventions. This collaboration ensures that health programs are successful, as their
endorsements can break cultural barriers and encourage preventative measures. On the healthcare
front, local hospitals can provide critical infrastructure and expertise, while pharmaceutical
entities can offer essential medications and treatments (Gautamet al., 2017).
External international organizations such as the WHO and UNDP bring a global
perspective, expertise, and funding that can be harnessed to implement effective COPD
interventions. Their global networks and resources can facilitate the introduction of best
practices and research in the Nepali context. Furthermore, collaboration with external NGOs that
have a health focus can infuse new strategies and technologies to combat the increasing COPD
incidence, especially given their experience in varied settings.
Why COPD is a Key Health Issue in Nepal
COPD is not just a health concern; it’s a socio-economic and developmental issue for
Nepal. The rising morbidity due to COPD affects the quality of life of individuals and their
families. The increased prevalence, as seen in the earlier section of this report, emphasizes the
rapid increase in the disease’s burden (Gautamet al., 2017). Furthermore, with COPD patients
accounting for a significant portion of outpatient visits, the burden on the healthcare system is
evident. As the healthcare infrastructure grapples with limited resources, the rising incidence of
COPD threatens its capacity. Economically, the direct costs associated with medical treatments,
combined with indirect costs like lost productivity due to illness, strain both individual families
and the nation at large. With Nepal’s unique topographical challenges, the interplay of indoor and
outdoor pollution, and socio-cultural practices, COPD emerges as a multifaceted health issue
requiring urgent attention and multi-stakeholder intervention (Momtazmanesh, 2023).
References
Adhikari, T. B., Acharya, P., Högman, M., Neupane, D., Karki, A., Drews, A.,
Cooper, B. G., Sigsgaard, T., & Kallestrup, P. (2020). Prevalence of chronic obstructive
pulmonary disease and its associated factors in Nepal: Findings from a community-based
household survey. International Journal of Chronic Obstructive Pulmonary Disease,
Volume 15, 2319–2331. https://doi.org/10.2147/copd.s268110
Adhikari, T. B., Neupane, D., & Kallestrup, P. (2018). Burden of COPD in Nepal.
International journal of chronic obstructive pulmonary disease.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810531/#:~:text=The%20current%20pr
evalence%20of%20COPD,UI%3A%205%2C097.9%E2%80%935%2C532.3%5D).
Bolger, R. (2023a, June 20). The EU has banned synthetic turf that uses old tyres. why
isn’t Australia following suit? ABC News. https://www.abc.net.au/news/2023-0620/synthetic-turf-no-moratorium-chief-scientist-knowledge-gaps/102497698
Budhathoki, P., Shrestha, D. B., Sedhai, Y. R., Baniya, R., Bhatt, A., Chaudhary, K.,
Acharya, A., & Rajkarnikar, R. (2021). Prevalence and risk factors of COPD in Nepal: A
systematic review and meta-analysis. TP41. TP041 DIAGNOSIS AND RISK
ASSESSMENT IN COPD. https://doi.org/10.1164/ajrccmconference.2021.203.1_meetingabstracts.a2273
Diwakar. (2023, May 20). Poor air quality in Kathmandu: Causes, consequences and
solutions explained. OnlineKhabar English News. https://english.onlinekhabar.com/poorair-quality-in-kathmandu-explain.html
Gallant, C. (2021, April 13). Nepal’s lingering pollution is becoming hazardous to its
people. The Organization for World Peace. https://theowp.org/nepals-lingering-pollutionis-becoming-hazardous-to-its-people/
Gautam, R., Neupane, D., Karki, A., & Kallestrup, P. (2017). Community-based
management of COPD in Nepal. The Lancet Respiratory Medicine, 5(1).
https://doi.org/10.1016/s2213-2600(16)30431-3
Institute for Health Metrics and Evaluation (IHME). (2022). Health-related SDGs.
Seattle, WA: IHME, University of Washington. https://api.healthdata.org/sdg/v1/docs
IQAIR. (2023). World Air Quality Index (AQI) ranking.
https://www.iqair.com/us/world-air-quality-ranking
Ministry of Health, Nepal. (2019). Annual Health Report. Kathmandu: Government of Nepal.
Momtazmanesh, S., Moghaddam, S. S., Ghamari, S.-H., Rad, E. M., Rezaei, N., Shobeiri, P.,
Aali, A., Abbasi-Kangevari, M., Abbasi-Kangevari, Z., Abdelmasseh, M., Abdoun, M.,
Abdulah, D. M., Md Abdullah, A. Y., Abedi, A., Abolhassani, H., Abrehdari-Tafreshi,
Z., Achappa, B., Adane Adane, D. E., Adane, T. D., … Farzadfar, F. (2023). Global
burden of chronic respiratory diseases and risk factors, 1990–2019: An update from the
global burden of disease study 2019. eClinicalMedicine, 59, 101936.
https://doi.org/10.1016/j.eclinm.2023.101936
WHO. (2023). Kathmandu, Nepal. World Health Organization.
https://www.who.int/initiatives/urban-health-initiative/pilot-projects/kathmandu
Individual Team Member Contribution:
● Background → Yunjie Chai
● Key Health Issue
○ 2a – 2b → Siya Kashwala
■ Epidemiologic Burden
■ COPD Trends in Nepal
○ 2c – 2d → Chansoo Park
■ Key Population Affected
■ Structural Determinants of COPD
○ 2e – 2f → Weiwei Wu
■ Stakeholders and Potential Partners in Addressing COPD in Nepal
■ Why COPD is a Key Health Issue in Nepal
GH500 Critical Issues in Global Health — Fall 2023
Identification of Key Health Issue
Group Submission
Due October 4, 2023 at 10 pm
Assignment Overview
Each group will be asked to identify a health issue of importance in their focal country. Selection of this
health issue will be informed by preceding classwork and individual assignments. The selected health
issue will be the focus of further assignments, including the final group presentation.
The health issue does not need to be the most pressing, urgent, or grave health issue in your country.
Rather, the health issue should be justifiable as a health issue of concern for a population in the
country and you simply need to justify why it is a health issue that deserves focus. This assignment will
serve as the foundation for your future assignments, so the more focused and specific you can be about
your health issue, the more it will help with your subsequent assignments (specifically the root cause
analysis and the solution pitch).
This assignment is designed to partially address the following MPH/MSPH Foundational Competency:
Design a population-based policy, program, project or intervention.
Specific Instructions
Work as a group to (1) provide key background information about your country and (2) identify and
summarize a key health issue in 2-pages of single-spaced text (12-point font and margins >1/2”), with a
range of +/- 0.25 of a page.
1. For the Background section consider the following areas and leverage data collected as part of Week
4 Disease Board Post and Week 3 and 4 in-class activities, as well as reputable news media, published
articles, CIA fact sheet, etc. Your background section needs to be succinct yet provide enough sociocontextual and health information to support your identified health issue and proposal.
• Population size (current estimate, trends over the last 10 years)
• Current GDP and general comparison with other countries
• Relevant history (e.g., civil unrest, political instability, social change)
• Geography and physical landscape
• DALYs (causes of death, life expectancy, notable sex differences)
2. For the Key Health Issue, you must describe:
a. The scope of the problem (e.g., measures of disease occurrence: prevalence, incidence,
mortality)
Fall 2023
b. Trends over time (highlight whether this a longstanding or emerging problem)
c. The key populations affected and/or at risk (e.g., young/old, men/women, marginalized groups,
persons with disabilities)
d. Key structural determinants including sociocultural context (poverty, education, physical
environment, policies, discrimination, etc.)
e. Stakeholders/ potential partners working on an initiative(s) to address this issue (e.g.,
governmental organizations, non-governmental organizations, intergovernmental agencies,
communities, academia, etc.)
f. Summary justification of why this is a key health issue (e.g., large burden, human rights issues,
other considerations).
Suggested Process for Teamwork
• Each group will use information and roles identified in the group agreement and set dates for
completing the assignment. You can use your group work area on Canvas or Google Drive for
your collaboration.
• Individually, review key data (e.g., health indicators) for the country using tools you have
learned in this class and in other settings (e.g., IHME tools like GBD Compare). Identify 2-3
health issues that you believe are worth exploring. Consider whether the health issue is likely to
have actionable evidence-based solutions.
• As a group, discuss ideas generated through individual research. Develop a consensus around a
single key health issue. Again, consider whether the health issue is likely to have actionable
evidence-based solutions.
• As a group, divide writing and research responsibilities. Compose your write-up and review/edit
as needed.
• Please remember to narrow down your selected Key Health Issue to a specific health condition.
Example: focus on lung cancer as opposed to cancers overall. Avoid choosing a risk factor or
root cause as the health issue of focus for this assignment (e.g., unhealthy diet, tobacco
smoking, climate change, gender inequity, air pollution). If you are interested in a risk factor or
determinant per se (rather than a specific health outcome), you will still be able to address
those as a part of your proposed solution to the health issue in the last assignment.
Individual team member contribution
• At the end of your document please describe the contributions of each team member to the
final product in bullet-point format. This may include sections written, information
researched, data analyzed, and contributions during in-class activities. This does not count
towards the 2-page limit.
• You will also receive a survey to rate your contribution and that of your group members to the
work.
• Your individual contribution to the work is worth three points. Individual score is informed by
declaration of team members’ contribution at end of document, engagement in in-class
activities that informed the assignment, and the peer-review survey.
Submission Guidelines
Fall 2023
•
Only one group member needs to submit on behalf of the group. Submissions are due on
Canvas.
Resources
• Global Burden of Disease (GBD) Study, GBD Compare tool: https://vizhub.healthdata.org/gbdcompare/
• World Health Organization (WHO) Global Health Observatory http://www.who.int/gho/en/
• Additional resources on this google sheet here.
Grading Rubric
Element
1. Background
2. Key Health Issue
a. Scope of the
problem
b. Trends over
time
c. Key
populations
affected
d. Structural
determinants
e. Actors and
stakeholders
f. Summary
justification
3. Referencing
4. Assignment Length
5. Writing quality
Total
Fall 2023
Description
Describe the relevant background for your country and
health issue
Points
3
Describe the epidemiologic burden
3
What is the brief history of the issue in this country?
2
2
Identify target population for future interventions
(demographics, location, socioeconomic groups, etc.)
What are the key structural determinants for this
health issue, including sociocultural considerations?
Who are the stakeholders/ potential partners for an
initiative to address this issue?
Why is this a key health issue?
3
Use proper referencing and in-text citations using APA
or AMA style; at least 5 references recommended. See
Week 0 resources for guidance on citations (“Good
Scholarship”) and referencing styles.
The submission is approximately 2 pages long, with a
range of +/- 0.25 of a page. To be specific, the
submission should fall between 1.75 and 2.25 pages.
Writing is clear, free of grammatical errors and
engaging
0.5
2
3
0.5
1
20
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