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  <head>
    <title>103-03 Disease burden, implementation, global health, and planetary health</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Disease burden, implementation, global and planetary health">
      <outline text="Measuring burden">
        <outline text="Counts depend on population size"/>
        <outline text="Rates need numerator, denominator, time"/>
        <outline text="Incidence: new events among those at risk"/>
        <outline text="Prevalence: existing disease">
          <outline text="Rises with incidence and duration"/>
          <outline text="Better survival can raise prevalence"/>
        </outline>
        <outline text="Case fatality depends on detection and definition"/>
        <outline text="Population mortality also depends on incidence"/>
        <outline text="Death certification carries uncertainty"/>
      </outline>
      <outline text="Standardisation and summary measures">
        <outline text="Crude rates mislead across age structures"/>
        <outline text="Direct: rates applied to a standard population"/>
        <outline text="Indirect: observed versus expected ratio"/>
        <outline text="Standardisation does not explain differences"/>
        <outline text="Life expectancy: hypothetical cohort">
          <outline text="Not one newborn&#x27;s prediction"/>
        </outline>
        <outline text="Healthy life expectancy adjusts for nonfatal states"/>
        <outline text="DALYs: years of life lost plus years with disability"/>
        <outline text="QALYs mostly used in economic evaluation"/>
        <outline text="Weights do not measure a person&#x27;s worth"/>
      </outline>
      <outline text="Attribution, surveillance, and data">
        <outline text="Attributable burden uses a counterfactual"/>
        <outline text="PAF: exposure prevalence, relative risk, causality"/>
        <outline text="Fractions can sum beyond one hundred per cent">
          <outline text="Risk factors overlap and interact"/>
        </outline>
        <outline text="Passive surveillance cheap but incomplete"/>
        <outline text="Active surveillance improves ascertainment"/>
        <outline text="Sentinel sites deep but may not represent"/>
        <outline text="Syndromic surveillance fast, less specific"/>
        <outline text="Testing changes create apparent trends"/>
        <outline text="Modelled certainty is not observed data"/>
        <outline text="Registration investment improves health"/>
      </outline>
      <outline text="Implementation science">
        <outline text="Evidence-based interventions into routine practice"/>
        <outline text="Effectiveness versus implementation"/>
        <outline text="Acceptability, adoption, fidelity, sustainability"/>
        <outline text="No access means no population benefit"/>
        <outline text="Fidelity preserves core causal functions">
          <outline text="Distinguish adaptation from active component loss"/>
        </outline>
        <outline text="Logic models make assumptions testable"/>
      </outline>
      <outline text="Programme evaluation and scale-up">
        <outline text="Process, outcome, impact"/>
        <outline text="Cluster and stepped randomised designs">
          <outline text="Rollout logistics do not ensure no bias"/>
        </outline>
        <outline text="Interrupted time series: level and trend"/>
        <outline text="Difference-in-differences: parallel trends"/>
        <outline text="Regression discontinuity uses a threshold"/>
        <outline text="Low reach can widen inequity"/>
        <outline text="Reach times effectiveness"/>
        <outline text="Scale-up is not a multiplied pilot"/>
      </outline>
      <outline text="Global health and assistance">
        <outline text="Transnational determinants, institutions, inequities"/>
        <outline text="Colonial history, trade, debt shape priorities"/>
        <outline text="Short external projects draw staff away"/>
        <outline text="Equitable partnership shares agenda and data"/>
        <outline text="Aid may be volatile and donor-directed"/>
        <outline text="Vertical, horizontal, diagonal approaches"/>
        <outline text="Parallel systems weaken sovereignty"/>
      </outline>
      <outline text="Emergencies and health security">
        <outline text="Violence or disaster with displacement"/>
        <outline text="Minimum service packages"/>
        <outline text="Accountability to affected people"/>
        <outline text="Vulnerability does not erase consent"/>
        <outline text="Prevent, detect, respond to cross-border threats"/>
        <outline text="Narrow wealthy-country focus undermines cooperation"/>
        <outline text="Transparency and fair countermeasures"/>
      </outline>
      <outline text="Planetary health">
        <outline text="Climate affects heat, food, water, air, infection"/>
        <outline text="Risks vary by place, work, age, housing"/>
        <outline text="Probability shifts across many events"/>
        <outline text="Mitigation versus adaptation"/>
        <outline text="Health system emissions"/>
        <outline text="Decarbonisation can align with health">
          <outline text="Removal without alternatives transfers risk"/>
        </outline>
        <outline text="Life-cycle assessment beyond visible waste"/>
        <outline text="One Health: humans, animals, environment">
          <outline text="Not every spillover is predictable"/>
        </outline>
        <outline text="Pollution burdens distributed unevenly"/>
        <outline text="Precaution is not evidence-free prohibition"/>
        <outline text="Polluters must not externalise costs"/>
      </outline>
      <outline text="Accountability">
        <outline text="Metrics reveal need and guide action"/>
        <outline text="Judge by reach, quality, equity, sustainability"/>
        <outline text="Responsibility across borders and generations"/>
      </outline>
    </outline>
  </body>
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