Cholera in Haiti

We have talked about the situation in Haiti a little in class but I wanted to expand on it a little more. In January 2010 Haiti suffered a major earthquake resulting in the deaths of thousands of people. Estimates currently place the number at over 200,000. In October 2010 the first case of cholera in Haiti occurred with an outbreak being determined on October 22, the first one in over a century¹. Cholera is a bacterial infection that causes diarrhea that can lead to severe dehydration and even death². Water that is contaminated by feces of an infected person or food that comes in contact with contaminate water can pass the bacteria on².

I came across the article "UN caused deadly cholera in Haiti, covered it up, lawsuit says" recently³ and it points out some interesting things about international aid and how good intentions can have unfortunate consequences.  UN Peacekeepers from Nepal (where cholera is endemic) were sent to Haiti after the devastating earthquake. There is evidence to suggest that these UN workers introduce cholera into the country. They were stationed near a tributary of the Artibonite River which is a source of drinking water. There were reports of leaking sewage pipes from this camp draining into the river³. According to the CDC there were 470,000 cases of cholera with 6,631 deaths in Haiti one year after cholera was introduced. Current numbers (October 2013) are estimated to be 684,085 cases and 8,361 deaths².

The families of those who lost loved ones to cholera are suing the UN for introducing Cholera that led to the death of thousands. What I had not realized was that the UN reportedly has immunity to such claims. I am not sure what I think of the organization having this wide reaching immunity. I think it is the responsibility of the organization to make sure they are not making an already bad situation worse.  While the UN has settled claims in the past, it remains to be seen what little or any compensation the families may receive³.

What is most important is the battle against Cholera itself. While there is a strong push to combat Cholera through vaccinations and chlorine treatment of water, proper sanitation and waste management is needed to stop the spread. It is estimated that costs to improve the sanitation is estimated to be between $746 million to $1.1 billion^4,5. Including the cost of improved sanitation, the Ministry in Haiti estimates it will take approximately $2.2 billion to completely eradicate Cholera from Haiti. UN will contribute $23.5 million which turns out to be only about 1% of what is needed⁵.

The situation in Haiti shows how even with good intentions international help can make things worse especially if new diseases are introduced. The little media that has focused on this situation feels to me like the UN wanted as little attention drawn to it as possible. Even if it cannot be proven in a court of law that the UN was responsible for the outbreak, I would think they would still want to do more to help eradicate it. Not only would providing more support for sanitation improvements help eradicate Cholera but it can also help with other waterborne illnesses⁴.   

1.Center for Disease Control, (2011). Cholera in haiti: One year later. Retrieved from website: http://www.cdc.gov/haiticholera/haiti_cholera.htm

2. Center for Disease Control, Travelers' Health. (2010).Cholera in haiti. Retrieved from website: http://wwwnc.cdc.gov/travel/notices/watch/haiti-cholera

3. Schectera, A. (2013, October 08). UN caused deadly cholera in haiti, covered it up, lawsuit says. NBC news investigations, Retrieved from http://investigations.nbcnews.com/_news/2013/10/08/20874045-un-caused-deadly-cholera-in-haiti-covered-it-up-lawsuit-says?lite

4. Periago, M. R., Frieden, T. R., Tappero, J. W., De Cock, K. M., Aasen, B., & Andrus, J. K. (2012). Elimination of cholera transmission in Haiti and the Dominican Republic. The Lancet, 379(9812), e12-e13.

5. Adams, P. (2013). Cholera in Haiti takes a turn for the worse. The Lancet,381(9874), 1264.

Mental health of international students

I was impressed with this week’s readings since I am very interested in mental health, especially among young people. Why is mental disorder a global problem in young people? I think it is related to the characteristics of youth. Young people are in the stage of transformation. They may start facing a number of challenges, such as building romantic relationship, peer pressure of using alcohol and tobacco, and stress of education and employment (Patel et al., 2007). As emerging adults, young people’s self-control on emotion and behavior is relatively weak, and they are greatly influenced by environmental and cultural factors.

We talked a lot about migration and mental health in class, which reminded me of the research I am interested in. I want to explore experiences of mental health in international students in the US. It is reported that over 700,000 international students at colleges enrolling in the US in 2010, according to the Open Doors report. China, with nearly 158,000 students, is the leading sending country. China, India and South Korea account for almost half of the international enrollments in the US.

International students are attracted by advanced technology, newest information, strong educational system and scholarship policy in the US (Sandhu, 1995). It is also a trend influenced by globalization. Transition to university could a tremendous change for young people, especially for international students, because they have to deal with cultural relocation and tend to experience more psychological problems than do American students (Leong & Chou, 1996). For example, differences in cultural values of international students, particularly Asian students, may cause social interaction problems, and thus lead to stress. The learning process of fitting the norms of the dominant culture is hard, requiring time and energy for many international students (Hsieh, 2006). Another example for reason of mental disorder can be that Chinese students and perhaps other Asian students as well, are supposed to obligate, respect, and have duty to their parents. The pressure to meet parental expectations often brings psychological stress and depression (Sue & Sue, 1997).

In particular, it is interesting to look at different meanings of mental health in different cultures. Based on what I have read, Western meanings of mental health emphasize that individuals should function well in different contexts, and meantime they should attempt to resist external difficulties to assist their own functions (Read & Wallcraft, 1995). By contrast, Chinese people tend to choose self-control, rather than to change the external environment (Liu, 2009). They are taught by Confucianism, an influential ideological concept in China, to restrain emotions and avoid the expression of intense/negative emotions, in order to achieve balance and peace (Yip, 2005). In this way, the different concepts of mental health may partly explain why Chinese international students are likely to underuse mental health services, or not adhere to treatment and therapy (Liu, 2009).

Therefore, what can be done to help deal with the mental health problems in international students? There may be cultural stigma and lack of information about availability of mental health service, which result to failure of seeking professional help (Pedersen, 1991). So it is important for mental health service professionals to improve cultural sensitivity, and counseling office can be located near to health center so as to reduce stigma (Wei et al., 2007). Additionally, I was thinking perhaps the universities can make efforts to promote contact with family and parents, taking the role of family communication into account. For example, mail the information (in native language) about activities, events, and services in the college to parents to show that the universities concern about and value international students, and encourage parent improve communication with their children. I was reminded of my personal experience that in my first year at Purdue, I received a birthday card, which was written in Chinese, Korean, Japanese and other languages, from the university. It was fantastic and really warming my heart. You see young people are easily moved and influenced… But the interventions are far more than that.

  

References:

  Vikram Patel, Alan J Flisher, Sarah Hetrick, Patrick McGorry, Mental health of young people: a global public-health challenge, The Lancet, Volume 369, Issue 9569, 14–20 April 2007, Pages 1302-1313.

  Liu, M. 2009. Addressing the mental health problems of Chinese international college students in the United States. Advances in Social Work, 10: 69–86.

Leong, F. T. L., & Chou, E. L. (1996). Counseling international students. In P. B. Pedersen, J. G. Draguns, W. J. Lonner, & J. T. Trimble (Eds.), Counseling across cultures (pp. 210-242). Thousand Oaks, CA: Sage.

  Sue, D., & Sue, D. W. (1997). Counseling Strategies for Chinese Americans, in C. C. Lee (Ed.), Multicultural issues in counseling: New approaches to diversity (pp. 79-90). Alexandria, VA: American Counseling Association.

  Wei, M., Heppner, P. P., Mallen, M., Ku, T.-Y., Liao, K. Y.-H., & Wu, T. F. (2007). Acculturative stress, perfectionism, years in United States, and depression among Chinese international students. Journal of Counseling Psychology, 54, 385–394.

  Pedersen, P. B. (1991). Counseling international students. The Counseling Psychologist, 19, 10-58.

  Yip, K. S. (2005). Chinese concepts of mental health: Cultural implications for social work practice. International Social Work, 48, 391–407.

  Read, J., & Wallcraft, J. (1995). Guidelines in equal opportunities and mental health. London: MIND Publications.

  Sandhu, D. S. (1995). An examination of the psychological needs of the international students: Implications for counseling and psychotherapy. International Journal for the Advancement of Counseling, 17, 229-239.

  Hsieh, M. (2006). Identity negotiation among female Chinese international students in second-language higher education. College Student Journal, 40(4), 870-884.

  http://www.iie.org/Who-We-Are/News-and-Events/Press-Center/Press-Releases/2011/2011-11-14-Open-Doors-International-Students

Mental Health in America Amongst Children and Adolescents

After the readings and in class discussion last night I found myself curious to learn more about how mental health affects children and adolescents. Mental health is something that I believe many associte with adults, and the elderly, but, rarely with children and adolescents. According to the National Alliance on Mental Health:

Four million children and adolescents in this country suffer from a serious mental disorder that causes significant functional impairments at home, at school and with peers. Of children ages 9 to 17, 21 percent have a diagnosable mental or addictive disorder that causes at least minimal impairment.¹

Half of all lifetime cases of mental disorders begin by age 14. Despite effective treatments, there are long delays, sometimes decades, between the first onset of symptoms and when people seek and receive treatment. An untreated mental disorder can lead to a more severe, more difficult to treat illness and to the development of co-occurring mental illnesses.³

It is not only terrifying, but, also shocking to believe that adolescents and children are developing mental disorders by the time they turn 14 years old. It causes me to wonder what has changed, or happened in our country to see this increase in mental disorders amongst not only adults, but children and adolescents as well. Can we blame these mental disorders on increasing amounts of stress? Bullying? Lack of sleep? Globalization? Immigration? Lack of parenting? When one starts to think about the factors contributing to the rise in mental health it becomes frightening. Suicide is the third leading cause of death in youth ages 15 to 24- and over 90% of children and adolescents who commit suicide suffer from a mental disorder.

There is a positive to all of this though. According to the NAMH "early identification and intervention can minimize the long-term disability of mental disorders." I believe that due to the increase in knowledge about the adverse affects of mental health people will be more likely to speak up and ask for help, or to even address and acknowledge that something "isn't right." In the past having a mental disorder labeled one as "crazy", but nowadays, more people are becoming diagnosed (1/4 adults live with a mental illness (nabi.org). Like everything else in public health, it is important for individuals like you and I to raise awareness and educate those around us.

Sources:

http://www.nami.org/
http://nmha.org

Genital mutilation: arguments and considerations

I want to start this post by asking a question: do you believe that it is ethically responsible for us as a society which regularly practices male circumcision to condemn female genital mutilation?

First, let me explain: since reading about female genital mutilation in class, I was interested to learn more. While doing this, I ran across some very interesting comparisons and arguments made by people from the US. They argued (on comments sections for articles vilifying FGM (female genital mutilation)) that it is hypocritical for US writers to complain about FGM when they themselves (presumably they are male) were subject to a procedure of male genital mutilation without their consent. This is where my question originates from.

Personally, before even considering the ethics, I wanted to understand the risks and benefits of both male circumcision and FGM. The best place to find this information has been WHO, of course. Looking at their factsheet on FGM (WHO, 2013) they discuss a variety of negative side effects which can include:

- severe pain
- shock
- urine retention
- cysts
- infertility
- increased risk of child birth complications and newborn deaths

This list in not exhaustive but it highlights some of the potential dangers. Compare this with male circumcision (WHO & UNAIDS, 2007) and you see that male circumcision has complications in infants from .2-.4% and complications can include bleeding or excess skin.

It becomes seemingly harder to compare the two when looking at the potential health benefits. WHO cites no known health benefits from FGM (WHO, 2013) and they (WHO & UNAIDS, 2007) cite that there is "substantial evidence" that male circumcision protects against urinary tract infections, syphilis, penile cancer, and HIV. However, this "substantial" evidence is not enough to have the American Academy of Pediatrics to fully support the procedure (AAP, 2012).

Before accepting this information as pure fact, I want to propose a possibility. Male circumcision is something that is done here at the US quite frequently (75% at the age of 15+ (WHO & UNAIDS, 2007)). As a country that is a scientific powerhouse, it is logical that we try to find justifications for our societal practices. Compared with countries which typically practice FGM (Sub-Saharan Africa mainly (WHO, 2013)), these do not have the money, expertise, or motivation to find scientific justifications for their actions. So, I believe it is most likely that there are benefits to FGM that are probably not found. We as a society don't want to find support for something we condemn, after all.

But FGM is so terrible to the women, yeah? However, FGM is typically done using inappropriate tools (razor blades, knives, pieces of glass) or environments (not in a hospital) (Skolnik, 2008). What if FGM was actually performed in hospital by doctors with appropriate tools? Would the consequences decrease? What if FGM existed in a society where medical practices were becoming better and safer?

Finally, let's look at the real reasons why both male circumcision and FGM are still practiced today. Both WHO sources cite social reasons as being the main driving force behind both. As both are the result of social forces, I find the two to be more similar than is presented.

Ethically I think that we need to understand that we are not any better than they are. Yes our medical system is better and our ability to practice safe medicine is better and our research is better. Does this mean the procedure itself is inherently "better" or "more acceptable"? No. The facts are that we as a society are regularly cutting away at male genitalia using little evidence that we actively search for to support the continued practice. Do you think FGM is bad? I do. Now that I have become aware of the social factors and influences behind male circumcision I can say my opinion has changed, or perhaps been truly formed for the first time. Male circumcision is and unnecessary and archaic procedure which has no place this day and age.

Sources:
AAP. (2012). Circumcision Policy Statement. Pediatrics, 130(3), 585-586.

Siegfried, N., Muller, M., Deeks, J., Volmink, J., Egger, M., Low, N., . . . Williamson, P. (2005). HIV and male circumcision - a systematic review with assessment of the quality of studies. The Lancet, 5(3), 165-173.

WHO & UNAIDS. (2007). Male circumcision: global trends and determinants of prevalence, safety and acceptability. Geneva.

World Health Organization. (2013, February). Female genital mutilation. Retrieved from World Health Organization: http://www.who.int/mediacentre/factsheets/fs241/en/

Medical Tourism and Globalization

        Medical tourism is a phenomenon that has been steadily increasing. It can be defined as “patients (that) are seeking to reduce costs of treatment through international outsourcing of medical and surgical care” (Forgione and Smith 2006). In the past, it was merely a tactic used by the rich in developing countries to achieve quality healthcare that their host country just couldn’t provide. However, it is no longer just an option to the rich, but is now a possibility for middle-class citizens of developed countries with high healthcare costs.  The cost of health expenditures and waiting times in developed countries such as the U.S., Great Britain, and Canada drive their citizens to seek affordable or timely healthcare elsewhere.
       With the desperation to achieve affordable healthcare no longer bound by national borders, other countries started to take notice of a market that could possibly bring money into their economy. Countries in Asia, and particularly Southeast Asia, decided they could market their countries as medical tourism destinations, and provide top of the line medical care to international patients at a fraction of the cost that it would cost them in their own country, but still more than it would cost for the host country’s local patients (Turner 2007). A heart valve replacement that would cost $160,000 in the US, would cost 9,000 in India, and 10,000 in Singapore; a knee replacement in the US would cost 40,000, but in India it would cost 8,500, and in Thailand it would cost 10,000 (AMA). So why is the price differential so steep? There are three main reasons: lower labor costs, lower or no malpractice costs, and lower pharmaceutical costs (Forgione and Smith 2006).
        The “Trickle Down” (Ramirez de Arellano 2007, Turner 2007) effect is commonly cited as a positive outcome for host countries who participate in medical tourism. It states that revenues acquired through this new market will “stimulate the economic growth and development” (Connell 2011) of the country in more sectors than just health related areas. However, as we have discussed globalization’s effects in this class, we are aware that the economic benefits to the poor in these countries are questionable.
       Countries in Southeast Asia have opened their borders to international patients, and created large, private hospitals that have top-of-the-line facilities and personnel to cater to international patients’ needs. However, the problem is that these hospitals are not only too expensive to cater to the locals of these countries, but the influx of international patients getting expensive operations is slowly driving up the national costs of healthcare for the entire domestic population. As privatization of healthcare is beginning to occur in these countries, the public facilities are becoming dormant, as physicians who used to work in these government run facilities are now being recruited to these impressive, private facilities, creating an “internal brain drain” (Godwin 2004) of medical personnel.
       Is medical tourism ultimately going to be detrimental to the domestic populations of these countries who are trying to turn a profit by creating a market for international patients? In countries where there are great social and structural inequalities, it seems to me that commodifying health before all have access to basic healthcare is going to create even greater inequalities instead of decreasing them, leaving some even further behind.

References

Connell, John. 2011. “A new inequality? Privatisation, urban bias, migration and medical tourism.” Asia Pacific Viewpoint 52(3):260-271.

Forgione, Dana A. and Pamela C. Smith. 2006. “Medical Tourism and Its Impact on the US Health Care System”. J Health Care Finance 34(1): 27-35.

Godwin, S. K. 2004. “Medical Tourism: Subsidising the Rich”. Economic and Political Weekly 39(36): 3981-3983.

Ramirez de Arellano, Annette B. 2007. “Patients without Borders: The emergence of Medical Tourism.” International Journal of Health Services 37(1): 193-198.

Turner, Leigh. 2007. “ ‘First World Health Care at Third World Prices’: Globalization, Bioethics and Medical Tourism.” BioSocieties 2:303-325.

Polio Outbreak in Syria

Recently in class, we briefly discussed polio and how difficult it can be to vaccinate against and prevent in war torn areas, so when I saw this article I thought it would be very fitting. On October 29, 2013, the UN confirmed a polio outbreak in Syria, which had been polio free since 1999. The UN reported 10 confirmed cases of wild polio virus type one and was still investigating another 12 cases that had been reported in the two weeks prior. Most of the victims were infants and toddlers under the age of two. It is thought that the disease may have been brought into Syria by Islamic militants from Pakistan, where polio still widely exists.

Syria’s civil war began in 2011 and before the war about 95% of children were immunized against polio, which is the rate needed for herd immunity. However, the UN estimates that since the beginning of the war roughly 500,000 children have not been vaccinated. As of right now, all cases have occurred in northeastern Syria, near Deir al-Zour. It is estimated that over 100,000 children in Deir al-Zour alone are at risk of contracting polio. Currently over 4 million Syrians have been displaced within Syria and another 2 million have left the country for Jordan, Lebanon, Turkey and Egypt. As well all know (especially after reading the articles for this week), communicable diseases, such as polio, can spread vary easily with population movements. Also what makes the situation dangerous is the fact that polio targets vulnerable populations. That combined with low immunization rates and moving refugees, living in overcrowded, unsanitary conditions could explode into a much larger outbreak, not to mention that added stress of reported increases in measles, typhoid and hepatitis A. So what are Syria and neighboring countries doing?

Syria and aid agencies are increasing their efforts to immunize 2.4 million children and 8 million others against not only polio but also measles, mumps and rubella. Save the Children called for vaccination ceasefires so that vaccination campaigns could take place on both sides of the conflict. Neighboring Lebanon, which is sheltering about 700,000 Syrian refugees, will give the polio vaccine to all children under the age of 5 in the country. However, unless a ceasefire does occur, I think it will be very difficult for Syria to successfully vaccinate everyone that needs to be vaccinated. How can a country with so much civil unrest and war even begin to organize a national effort to prevent polio? And until the conflict in Syria comes to an end, neighboring countries that are receiving refugees face the challenge of not only successfully preventing disease outbreaks in refugee camps, but also stopping the spread of disease to their own citizens. This will take a continuous effort, because as more refugees come, more vaccinations and prevention measures will have to take place. I only hope that some solution or measure of peace is reached before more innocent children die or become permanently crippled from a 100% preventable disease.

References:      

http://www.globalpost.com/dispatch/news/regions/middle-east/syria/131029/un-confirms-polio-outbreak-syria

http://www.globalpost.com/dispatch/news/regions/middle-east/syria/131026/united-nations-vaccinate-105-million-syria-fight-poli

http://www.bbc.co.uk/news/world-middle-east-24726592

Disease Outbreak in Middle East

Middle East Respiratory Syndrome, aka MERS, was first reported in 2012 and has now taken the front page of news headlines again in November 2013. MERS is a respiratory illness caused by coronavirus. Coronaviruses are a common human virus that can result in upper-respiratory tract illnesses. These viruses were first identified in the 1960’s and have 5 different types. The virus spreads easily through the air by coughing or sneezing or through contact by touching or shaking hands. Therefore, most humans will have suffered from one of these types within their lifetime, with symptoms such as cough, sore throat and fever.

Unfortunately, the MERS strand of coronavirus seen in or around the Arabian Peninsula has caused serious illness and some cases have resulted in death. People infected with this strand have experienced severe acute respiratory illness with symptoms of cough, fever and shortness of breath. The largest concentration of cases is in Saudia Arabia with 124 cases and now 52 deaths since September 2012.

What is currently being done? After the first case was found in 2012, an international team of experts came together to set a case definition and implement surveillance and notification standards. Information was circulated to healthcare workers. Whenever an outbreak was cited, an emergency team would make a visit to the specific healthcare facility. Epidemiologists have seen a higher number of cases in older men and in people with underlying conditions. Blood testing is done on patients with suspected condition, to look for gene targets.  

Why is this virus taking front-page headlines again? 4 more cases of the virus have been found in Saudi Arabia and Oman, within days of one another. Patients diagnosed with the virus range from age 23 to 89 years of age, one is a healthcare worker and was in close contact with a previously lab-confirmed case. An Emergency Committee has been convened under World Health Organization, but the virus has not met the criteria for a Public Health Emergency. Healthcare workers in this region and across the globe are encouraged to continue surveillance of these symptoms and to report any unusual patterns. Also, recent travelers to the Middle East who contract similar symptoms are encouraged to see their healthcare providers.

We have talked extensively and read numerous articles about globalization in this class. One of the downsides of globalization is the increase in travel, thus the spread of communicable diseases. Think about how easily MERS can travel back to the United States: An American man travels to Saudi Arabia on business and shakes the hand of a Saudi man who is carrying the virus. The American starts to experience symptoms of cough and fever on the plane ride back home. After coughing into his hand on the plane, he then helps the flight attendant pass a cup of cola to the passenger to his right. Now the passenger to his right has picked up the virus. As his plane lands home, he has now brought the virus back to the United States and infected at least one other person.

I believe the Emergency Committee is the right step to ensuring this disease does not begin to spread across the globe. It is essential organizations such as the CDC and WHO keeps on their toes and “over-reacts” in order to protect our global health.

http://www.cdc.gov/coronavirus/about/index.html

http://www.cdc.gov/coronavirus/mers/faq.html

http://www.who.int/csr/don/2013_10_31/en/index.html

http://www.cnn.com/2013/10/31/health/mers-virus-update/index.html?hpt=he_c2

Monsanto- Seeds of Corruption?

Since Monsanto has come up a couple of times now in our class discussions and I hail from a largely agricultural community, I thought I would do some research about the company and its practices.    

            In the early 1990’s, Monsanto launched its genetically modified cotton seeds in India, which is the third largest cotton producer in the world (Robin, 2010).  In 1993, Monsanto negotiated an agreement with India’s largest seed company, Maharashtra Hybrid Seeds Company (Mahyco) in order to import seeds from the United States to crossbreed with local Indian hybrid seeds to create a new seed.  When India’s Genetic Engineering Approval Committee ruled that it was okay to plant the genetically modified seeds in 2002, local farmers bought them.  At first, farmers didn’t have to use as many pesticides because of the way the seeds were modified, but eventually insects built up a resistance to the chemicals.  Additionally, the yields did not increase and farmers got less money for their cotton because the fibers were shorter than that grown from the traditional seeds (Robin, 2010).  Since the seeds cost much more than the traditional seeds, farmers thought that it was not worth it.  Luckily, it is illegal to patent seeds in India, so the farmers could plant different seeds the following year without worrying about legal action from Monsanto as farmers in the United States would (Monsanto is able to do this by claiming that the technology from their seed is in the soil, therefore planting other seeds is prohibited because you would be using their technology without paying for the seeds). 

            Unfortunately, because of the low yields, farmers are forced to purchase more seeds, which puts them further in debt, especially since Monsanto continuously increases the price of their seeds.  So why would the farmers keep buying from them?  Monsanto advertises yields that are exaggerated up to 5 times their actual yield: advertised 1500/kg/year, but only produced 300-400 kg/year on average (Zhou, 2013).  This cycle of low production and increasing debt has actually contributed to an increased suicide rate among farmers in India; the country has seen over 250,000 farmer suicides between 1995 and 2010 (Zhou, 2013).   As we discussed in class, many of the battles with large corporations such as Monsanto take place in the courtroom, but who is going to represent the poor?  They are not in a position of power to make their voices heard against Monsanto’s false claims.  People such as Vandana Shiva are doing their part to raise awareness, but there needs to be more advocacy. 

            Another reason that Monsanto’s practices are a public health issue is that through patent law, they are able to control the food supply.  Once they gain patents on genetically modified seeds and those seeds become the norm, the company can collect royalties.  Farmers will depend on the company to supply seeds, and Monsanto will be able to charge whatever it wants.  As Vandana Shiva stated in an interview, “They control the seeds, they control the food supply” (Robin, 2010). 

Robin, Marie-Monique.  (2010). The World According to Monsanto: Pollution, Corruption,        and the Control of Our Food Supply. The New Press: New York.

Zhou, Mary. (2013). “Seeds of Corruption: The Monsanto Protection Act.”  Berkeley Political            Review. April 13. 

Air-pocalypse in China

I stumbled across an article just recently on a current event that happened in China (Is China's pollution really getting worse?) due to the poor air quality.  The article immediately took me back to when I was there studying aboard a couple of summers ago.  In the summer of 2011, I traveled to Beijing China and studied Tai Chi at Beijing Sport University.  Living on campus and being fully immersed in the Chinese culture and student population was exhilarating and eye opening.  The hospitality of the students was endearing and made us feel somewhat at home even though we were on the other side of the globe.  The food was delicious and never failed to surprise us either.  The whole trip was a once in a lifetime experience and I could talk about it for days.  However, there were a couple of things I noticed while living there, one thing that I noticed in particular while in China, was the extremely poor air quality and dirtiness of the city.  There were always piles of trash along the streets, in alleys and bathrooms.  The air was so hazy some days I thought it was a cloudy day until someone told me otherwise.

I understand that Beijing is highly populated if not over populated, thus producing a lot of waste and air pollution.  The air quality was so poor in the in city that most days were very hazy and we could not see the sun or more than a mile in front of us.  Also, I ended up getting sick with a sinus infection due to the poor air quality; I will spare you the details of that.  Back to the article, this article reported "that schools were closed in Harbin, China because people were having trouble seeing their own fingers."  “Also, traffic ground to a halt in the city, and two buses went off route unintentionally due to the thick sight blocking haze.  The recent rise in pollution was due to the heat being turned on.”  "The state controls when the heat turns on. It goes on for everyone at the same time on the same day.  The spike in Harbin is due to the fact that they just turned on the heat, and the heat demands the burning of coal." (Global Post)  To have a city shut down due to daily routine inhibiting air pollution is an outrage! Not only is this completely unhealthy for the people but for the earth as well.  Not to mention when a city shuts down, so does production, goods and services and now education.

“In July China invested 1.7 trillion yuan ($277 billion) to combat air pollution over the next five years.” “The government plans to reduce air emissions by 25% by 2017 compared with the 2012 levels in northern China.” (Huffington post)  It is good to see action taking place to combat such an ‘air-apocalypse’. 

I could not imagine being trapped in a polluted environment like that.  I wonder how the people of China feel about this and if the government has even spent time with the people to get their insight. I know extreme measures are needed now to save the city and even the country…but there has got to be something that can be done to help the people living in this smog filled environment. What do you think? Classmates from China, what are you experiences with this?

http://www.globalpost.com/dispatch/news/regions/asia-pacific/china/131022/air-pollution-smog-harbin

http://www.huffingtonpost.com/2013/07/25/china-air-pollution-plan_n_3649353.html

Decriminalizing Drugs Impact on Drug Use

Drug use is a problem worldwide.  The world drug report showed that one in twenty people world wide used illicit drugs in 2012.¹ In addition 1 in 200 people in the world have problems with their drug use. ¹ Each country has their own laws regarding the severity of drug related crimes such as possession, causing the prisons to become overcrowded.  This is especially true in the United States  where drugs were  involved in 78% of all violent crime and 83% of property crime in 2006. ² It should also be noted that the United States has the highest incarceration in the world.  The highest incarceration rate comes with a hefty price tag, in 2010 the estimated cost to keep one person in prison a year was $ 31,307. ³ So how should the countries like the United States handle this problem? Many would suggest harsher punishments and penalties for those who are caught using illegal drugs, even though American has some of the harshest punishments in the world for those who are caught with drugs and still have one of the highest rates for marijuana and cocaine use. ⁴ Portugal took a different approach. In 2001 Portugal became the first European nation to decriminalize all drugs, including methamphetamines, heroin, cocaine, and marijuana. ⁴ Those that were caught with small amounts of drugs are sent to a panel for treatment. The panel includes a social worker, psychologist, and legal advisor for appropriate treatment instead of jail.  I’m sure that this was, and perhaps still is a very controversial topic on whether this was the right approach to take but the Cato paper reported that between 2001 and 2006 the rates among 7^th-9^th grade students for illicit drugs fell about 3.5%. Also from 1999 to 2003 the incidence of HIV infections fell about 17%. Not only did this law lower the use of drugs but it also over doubled the number of people who were using buprenorphine and methadone for drug treatments. It will be interesting to see if other countries take this approach.  ⁴ I am not sure if this will be as effective in other countries that are much larger than Portugal, Portugal is a much smaller country with the population of 10,781,459. However, when the prohibition took place in the late 1920s businesses failed because they could no longer make a profit. The jail systems also became over flooded and the police could not keep up. In addition the government tax revenue decreased just due from the lack of alcohol sales. ⁵ The government benefitting from drug taxes is also currently being discussed this week as well. The state of Colorado made the recreational use of marijuana legal in 2012 and voted on what percent should it is taxed.  The only other state where marijuana is legal has a 25% tax and predicts that it will make profit of about 2.1 billion dollars within the first five years.⁶  The question is it the best and more beneficial choice from having strict laws or will more people be benefit from less strict laws?

1.       http://www.theguardian.com/news/datablog/interactive/2012/jul/02/drug-use-map-world

2.       http://www.casacolumbia.org/templates/PressReleases.aspx?articleid=527&zoneid=68

3.       http://www.vera.org/sites/default/files/resources/downloads/Price_of_Prisons_updated_version_072512.pdf

4.       http://content.time.com/time/health/article/0,8599,1893946,00.html#ixzz2j87mO6vk

5.       http://www.pbs.org/kenburns/prohibition/unintended-consequences/

6.       http://www.businessweek.com/news/2013-06-24/race-for-marijuana-between-states-cast-in-doubt-by-u-dot-s-dot-taxes

Global Health Challenges of Alzheimer’s Disease

          Alzheimer’s is an age related brain disease and is a most common cause of dementia. Alzheimer’s disease affects on memory, thinking skill, behavior and impairs ability to perform every day activities. There are several factors that increase the chance of getting Alzheimer’s disease like age, genetic, environment, and lifestyle. Also, there are other risk factors that accelerate the development of Alzheimer’s disease such as diabetes, heart disease, and other chronic conditions. Fortunately, some of these risk factors can be controlled or change. Studies suggest that healthy diet, exercise, social support, keeping brain active may help to reduce the chance of developing Alzheimer’s.

         Unfortunately, lack of knowledge about the diagnosis of Alzheimer’s disease in early stage is a significant problem even in developed countries. In such countries only 20-50% of cases of dementia are recognized and most of the time patient is in an advanced-stage. Studies show that the changes in cell brain of Alzheimer’s patient start several years before the first symptoms appear.

         Even though, Alzheimer’s disease is not a normal part of aging but the disease most likely starts after age 60 and risk goes up with age. Almost 5 percent of men and women age between 65-74 and about 50 percent of those who are 85 years and older have Alzheimer’s disease.

       Alzheimer’s Disease International (ADI) is a network of 78 Alzheimer associations around the world. It was funded in 1984 and support people with dementia and their families in their corresponding countries. They provide information, resources, and skills and share them throughout the world. Their goal is to make a better quality of life for people with this disease and their families.

       According to the 2012 report of Alzheimer’s Disease International (ADI) commissioned and WHO almost 35.6 million people in 2010 have lived with Alzheimer’s throughout the world. They have estimated by 2030 the number of people with Alzheimer's is expected to double (65.7 million) and more than triple by 2050 (115.4 million). Around 58% of Alzheimer’s patients live in developing countries.

       In addition,   this report provides the annual cost of care giving, treatment, and loss of income of people with Alzheimer’s disease in the world, which is more than US$ 604 billion. This report makes it clear by growing number of dementia; global health poses the significant challenge in the future. WHO has considered dementia as a global health priority.

      Overall, Early diagnosis and intervention play an important role of closing the treatment gap and  provide a better quality of life among those who are at risk of getting Alzheimer’s. The greater investment is needed to implement a broad research over onset of the symptoms of Alzheimer’s and the main cause of this disease to help scientists to determine the proper treatment for Alzheimer’s disease. But until then, the government agencies, legislators, residential and community care providers, and professional should facilitate the availability and access to diagnostic and support system at all stages of Alzheimer’s disease and improving the quality of health care, social care and long-term care support and services for people with Alzheimer’s. Public health systems play a key role in advocating for rapidly growing aging nation. They should conduct a broad surveillance and promote public awareness of dementia and brain health.  

http://www.nia.nih.gov/alzheimers/publication/preventing-alzheimers-disease/what-alzheimers-disease#sthash.jaSemNgv.dpuf

http://www.nia.nih.gov/alzheimers/publication/preventing-alzheimers-disease/risk-factors-alzheimers-disease#sthash.RoH4vL4c.dpu

http://www.nia.nih.gov/alzheimers/publication/preventing-alzheimers-disease/search-alzheimers-prevention-strategies#sthash.yre9nzwB.dpuf

 http://www.nia.nih.gov/alzheimers/publication/preventing-alzheimers-disease/so-what-can-you-do#sthash.ULLZG6Qu.dpuf

http://www.nia.nih.gov/alzheimers/publication/part-2-what-happens-brain-ad/hallmarks-ad#sthash.rJRNKYPH.dpuf

www.who.int/entity/mediacentre/news/releases/2012/dementia_20120411/en/ - 30k

[News release]

 

 

Culture and International Health

            Culture is an ambiguous term. It can be, and is, operationalized differently depending on the agenda of the researcher, the topic of research, or the outcome that one is looking for. It can be observed in different levels, whether it be the culture of a country (macro), a state/territory/province (mid-range), or of a village (micro), and often times is evaluated based on the different cultural values that the researcher, knowingly or unknowingly, bring from his/her own point of view. When I say culture, I am referring to the meaning-making processes, point-of-views, and framework of a group that guides the actions and problem-solving processes of the individuals within that group (Kao et al., 2004; Swindler; 1986). Common characteristics that are threaded throughout culture are:

 1) learned from birth through the processes of language acquisition and socialization, 2) shared by all members of the same cultural group, 3) an adaptation to specific environmental and technical conditions, and therefore 4) a dynamic, ever-changing process (Kagawa-Singer 2012:357; Leininger, 1995).

                  The above characteristics illustrate the reciprocal nature of culture.  #3 in particular, “an adaptation to specific environmental and technical conditions”, brings to the forefront that culture is, in part, a result of the conditions that a community experiences as a way to not only make sense of life, but to survive.  #4 goes further to explain that culture is dynamic, not static, and will continue to change as life changes.

When I look at this definition, it makes me realize a more careful consideration of culture in developing and implementing health interventions should be a priority. It is important to ask ourselves, as researchers, not just what problem we are trying to address, but also what is creating the problem, and how culture interacts with the problem. We must take into account the size of the group we are trying to generalize about. If we are trying to create and implement a national scale intervention, we must recognize that there will be within level differences of culture that makes the applicability of that intervention vary depending on the cultural clashes within a country.  Further, recognize that culture clashes that seem to be between what we deem the “civilized” majority and the “uncivilized” minority may speak about the inequalities embedded within the social structure of that country. There are different levels of culture that need to be taken into consideration:

-Macro: national culture (values, behavior, environment)

            -Middle-Range: States/territories/Provinces

-Micro: Villages (taking into special consideration the marginalized and poorer populations that are usually silenced, and victims of social inequality)

            Without knowing who you are trying to target with your intervention, and what possible cultural differences lies between and within these different levels of organization, the effectiveness of the intervention can be entirely compromised. For example, in Dutta-Bergman’s article on the Santali (2004), trying to promote national family planning to a village whose culture revolves around large families not because they are primitive, but because the culture of their village promotes many children to bring in money and labor into their family’s income due to their marginalized status, the intervention is not going to be successful. This also points to structural violence’s role in causing harm to certain populations. Culture has become a scapegoat of failed public health interventions, but there needs to be a deeper look at how culture has arisen in populations.

References:

            Dutta-Bergman, Mohan J. 2004. “Poverty, Structural Barriers, and Health: A Santali narrative of Health Communication.” Qualitative Health Research 14(8): 1107-1122.

Kagawa-Singer, M. 2012.”Applying the concept of culture to reduce health disparities through health behavior research.” Preventative Medicine 555(5):356-361.

Kao, H.F., M.T. Hsu, & L. Clark. 2004. “Conceptualizing and critiquing culture in health research.” Journal of transcultural nursing 15:269-277.

Leininger, M. 1995. Trancultural Nursing: Concepts, Theories, Research, and Practice. McGraw Hill: New York.                                   

Swidler, A. 1986. “Culture in Action: Symbols and Strategies.” American Sociological Review 51:273-286.                       

    

Health as a human right in modern society

After the universal declaration of human rights (UDHR) in 1948, health right issues have been expanded continuously. Discussion on health as a right has reflected changes of the global society’s environment and culture. Modern society has several issues which have to be addressed in terms of health as a right. 

Rapid advances of the medical knowledge and treatment cause information inequality between doctors and patients. Though some argues that patients’ accessibility to the medical information has increased, specialization in medical treatment enables expertise to control people in the way that they want. Since patients’ health-related information is sensitive personal information as well as difficult for patients to interpret and assess themselves, collection, store, use and exchange of the information is critical issues. Medical information monopoly-related issues can be addressed as a civil right in the sense that they are related to the rights to know. Privatization of the medical treatment should also be addressed in terms of public health. Though it emphasizes high quality medical service, it generates several issues which conflict with rights to health since limited populations are capable of the access.

In addition, globalization generates transnational issues such as an increase of migration workers and refugees. Previous political efforts to ensure their right were addressed in the boundary of the nation-state, but as national boundary has been blurred, the issues such as a citizenship of the immigrants become politically sensitive and start to be considered from the universal view. In this sense, their health issues also should be approached as a human right (Toole & Waldman, 1993).

Furthermore, we should also consider laborer health. Basically, health issues of that group of people has not been broadly discussed and approached only in terms of hazard environment in the workplaces. However, as labor market becomes flexible according to the restructuring of the employment and the advent of new societal/economic system, variety of social issues has come up which promote health problems. For example, stresses from the contingent employment, layoff and employment instability cause depression, and even in extreme cases they lead serious problem such as suicide. Therefore, the labor health could be a crucial topic to be addressed in modern society.

Lastly, world’s environmental problems are also the main issues which have to be addressed from the health as a human right’s perspective since they are directly related to the health of mankind. Changes in the ecosystem including global warming increase health risk for all individuals. To ensure and realize the optimal health of the people all around the world, not only the public interventions are required such as health and medical treatment system, but also various conditions which compose of human life should be improved. Natural environment is one of the most important conditions, so it should be discussed in the boundary of health as a human right. As examined so far, societal, economic and environmental changes across the world pose several issues which can be considered in the health right perspective. Based on these general ideas, each of these issues is needed to be investigated further.

 

 

References

Toole, M. J., & Waldman, R. J. (1993). Refugees and displaced persons. Jama, 270(5), 600-605.