Thursday, October 31, 2013

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. 

Wednesday, October 30, 2013

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

Tuesday, October 29, 2013

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 7th-9th 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?

Sunday, October 27, 2013

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.  






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

[News release]

 

 

Friday, October 25, 2013

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.                       
    

Thursday, October 17, 2013

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.

Wednesday, October 16, 2013

Obesity....not just for America.

Obesity is a rather large, no pun intended, problem in the United States.  When I hear the mention of obesity I immediately think of the US.  However, this is quickly becoming a problem for many other countries  across the world.  The CIA reported the top 10 countries  in the world with the highest obesity rates and five of the countries are in Oceania, four are in the Middle East and then the United States. Worldwide obesity rates have doubled since 1980.  In 2008, 35% of the adults aged 20 and over were overweight and 11% were obese. (WHO)  That was back in 2008, since then obesity rates have been rising faster and faster with each new year.  As you can see this is a problem.

The expansion in the world's waistline caught the eye of the WHO and in May of 2004 they adopted a Global Strategy on Diet, Physical Activity and Health.  "This new strategy provided recommendations for Member States, WHO, international partners, private sector, civil society and nongovernmental organizations on the promotion of healthy diets and regular physical activity for the prevention of  noncommunicable diseases. " (WHO diet).  First lady, Michelle "Guns" Obama is the creator and leader of the Let's Move program here in the US.  Her program fights to get kids moving, how to be active on a daily basis and to educate kids on eating healthy and making better choices when it comes to nutrition and health habits. (Let's Move) This effort has been wildly successful.  The efforts of the program have decreased childhood obesity by 13% in Mississippi as well as a decrease in Philadelphia, New York City and California.  (Let's Move)
The US has made it a focus to slim down our population and clean up our plates to a healthier version.  Other countries are catching on slowly. But when will this become a more urgent focus? I realize that obesity may not be a problem for all countries or has not been a problem for as long as it has been here in the US. BUT obesity is almost entirely  PREVENTABLE! There needs to be a bigger movement towards bringing global obesity rates down and then maintain those rates.  Obesity leads to a number of diseases that are once again PREVENTABLE.

Being a personal trainer for many years now, I have a passion for helping other people reach a new healthier version of themselves.  Why not a new healthier version of the overweight countries? I know that weight loss is hard work, but it can be done.  Weight loss is a joint effort and requires many resources, especially on a global scale, however the benefits of a healthy population are exponential.  With health care being such a pain these days, why not make the extra effort to work towards staying out of the hospital and doctor's office.  Healthy individuals means less money having to be pumped into poor health care infrastructures, means more people back at work and working more productively, which means a stimulus in the economy, which means a way of overcoming debt and unemployment.  


In closing, here comes the personal trainer, go out a make a healthy decision every day.  Even if it is just a small one. Every step counts and together our efforts can make the world a better place. 




Immunizing Nomadic People in Ethiopia



Due to the recent discussion about immunizations in class, I found this article from the World Health Organization very applicable. We have discussed the campaigns and case studies devoted to vaccinating children across the globe. The Expanded Programme on Immunization focuses on remote areas and populations with high mortality rates among children under 5. I recall one of the barriers to reaching herd immunity is the population of nomadic people. Since they are moving from one place to another, it becomes difficult to vaccinate their children.

Enter Ethiopia. Only 17% of its 91 million people live in urban areas. This data is evidence of the special effort needed to reach the remote populations, specifically nomadic populations in Afar. The region is also known as the Afar Depression, for its low sea-point level. The people of Afar must move around to find other sources of food and water for their livestock. Afar is also well-known for its low childhood immunization rates. DTP immunization rates for 1 year olds is far below the WHO Regional Average, at about 45% in 2010, compared with the 65% average. If DTP immunization rates are low, you can speculate that immunization rates for MMR and other diseases is also low. 

After a deadly outbreak of measles took place, officials decided to take action. The Enhanced Routine Immunization Activity previously accomplished success in immunizing nomadic families in Somali. Officials decided to replicate the same program to raise immunization rates in Afar. The program consisted of (1) partnering with local leaders, government and non-governmental organizations and international organizations like UNICEF (2) win local support (3) train health workers to administer vaccines (4) register children for immunization (5) home visits (6) coordinate adequate supplies.

The program took a total of 3 months, with immunizations traveling to the child instead of the child traveling to the immunization. Unfortunately, WHO did not provide any data or numbers showing the increased rates of immunization. Data may come at a later point in time. However, healthcare workers from the Afar health posts were interviewed and felt the campaign was an improvement from past efforts. Mobilizing local capacity was one of the most critical aspects of the campaign.

ERIA first began in Somalia. Officials believe the campaign was so successful in Somalia because of the support from community elders. Once the elder(s) in the tribe gives the approval and support for the vaccine, mothers and fathers are encouraged to vaccinate all of their children. However, it is not easy work for the healthcare workers that are delivering the immunizations. Most often, it takes hours of traveling to reach a village and there can be miles between houses. House-to-house immunization was the only way to ensure immunizations were received in this area.

It has been interesting to learn about the different methods to immunize large populations. As a public health program planner, you must take into consideration the way people live in each area. Somalia and Afar’s success may not translate to urban areas of China. National Immunization Days may not translate to areas like Afar, where families are moving from place to place. Proper planning and consideration is needed in this critical health issue.  


Reference: http://www.who.int/features/2012/immunization_ethiopia/en/index.html

"Be the change that you wish to see in the world."

The inspiration for this blog posting came from Dr. Einterz's lecture last night in class. "Be the change you wish to see in the world" has been dear to me since my Junior year of high school when I received a silver bracelet with this saying engraved into it. Dr. Einterz was inspirational, refreshing, and in my opinion, what we need more of in this world, especially working in the health and public health field. We have discussed many aspects of health, global health, and public health so far this semester. We have learned about approaches and interventions that have succeeded, and those that have failed. Don't get me wrong, I believe that the majority of people that invest their life into this field do so to make the world a better place, but I do believe that sometimes a very important "something" is missing. This something, is "care". In my opinion, it was totally, and completely evident that Dr. Einterz didn't feel that need to be superior, or a "know it all" when he began his work with AMPATH, but that he cared. I can understand how it would be easy to go into a country where things are falling apart before your eyes and to take control, take the lead, and do things the "Western" way, without much regard to the culture of those who you are working with. I sat amazed as he talked about the impact that AMPATH has had, as he admitted to being "ignorant and stupid", and as he referred to "we" as the partnership between IU health and those who are the head of the program in sub-Saharan Africa. His presentation got me thinking about another saying that I hold dear to my heart, "Never think that a few caring people can't change the world. For, indeed, thats all who ever have."- Margaret Mead. I believe that care is what makes AMPATH as successful as it has been, and as it will continue to be. I am thankful for those people who have the better interest of others in mind, and for those that can admit to not knowing everything and take the back seat and learn from others, even if they may not be as "educated" as we are. It really is true that we can change the world, but, it all starts with us, the individual.

Thursday, October 10, 2013

Infant and Maternal Mortality Rate Industrialized Nations

The United States has a very low maternal mortality rate in comparison with the rest of the world however it has one of the highest rates when just comparing it to other industrialized countries. It is also higher than most countries for infant mortality rate. According to the central intelligence agency the United States has an infant mortality rate of 5.9 per 1,000 live births and maternal mortality rate of 21 per 100,000 births. Comparing this to countries such as japan (IMR = 2.17 per 1,000 and MMR = 5 per 100,00) or Germany ( IMR=3.48 per 1,000 and MMR 3.48 per 100,000) (1) raises the question as to why the United States’ rates are higher. As we’ve learned in class there are many factors that can contribute to death rates such as culture and traditions and these differences can also be seen in birthing practices. There has always been discussion on the best ways to give to birth whether it’s with a mid-wife, at home, water birth, c-section, or a traditional birth in a hospital, if women should get an epidural ect. There are many benefits and risks for all methods, such as laying down in a hospital allows doctors and other health professionals to clearly see the birth allowing them to identify any complications but this is also thought to be more uncomfortable for the mother and increase pain during delivery. Other methods such as using a stool or birthing ball are thought to be more comfortable and make birth easier because of the help of gravity. The mothers and babies comfort is very important but how much, if any, does one method over another increase or decrease the chances of maternal or infant death. The World Health Organization has statistics that show that c sections were used for 17.4% of all births, where .4% was thought to unnecessary c-sections. C-sections in the United States was 30.3% with 10.8% thought to be unnecessary and in Germany 27.8% of all births and 1.4% unnecessary.  One study also found that only 6% women needed a c section who received care in mid wife led centers compared to 24% (2) who gave birth in a traditional hospital. Another source also states that in Germany it is much more prevalent to use a midwife than it is in the United States and in Japan painkillers during birth are used less than in the United States.(3) There are always unpredictable issues and complications that can arise during birth that a OBGYN would be able to use their expertise, knowledge and skills to save the mother and/or baby’s life. I am not implying that one birthing method is better than another, as I mentioned before I think its most important that the mother, father and baby feel comfortable, confident and remain safe throughout the entire birthing process. Before I had a women’s health course I never would have considered using a midwife, birthing ball or anything other than the traditional method in the United States but I do find it interesting and unfortunate that the Unites States is one of the worse industrialized countries in terms of maternal and infant mortality rates, whether birthing methods contribute to that or not.
                                                                                    

Wednesday, October 9, 2013

Climate Change


       
 
        Almost all of us are aware of climate change and its consequences. We also know that human activities are increasing emission of greenhouse gases and that can cause long-term climate change. In the past three decades global temperature has become warmer by 0.6°C and has caused more flooding in some parts of the world and drought in other parts. Climate change is likely to have major effect on crop, loss of biodiversity, and the supplies of freshwater, and as a result increasing number of people at risk for hunger. The impacts of climate change would be incidence of infectious disease such as cholera, malaria, meningitis and also malnutrition which is the cause of more than three million deaths each year.
        Climate change affects all around the world but more likely hits poor population in developing countries especially dry regions such as the eastern Mediterranean and North Africa.  We know that the lack of water sanitation is an environmental health issues in most African counties and that exacerbates the impacts of climate change on human health in such regions.  In 1997 heavy rain caused cholera epidemic in countries located in east Africa such as the United Republic of Tanzania, Kenya, Guinea-Bissau, Chad and Somalia. Cholera epidemic also were reported in Peru, Nicaragua and Honduras.
       While floods contaminate public water supplies with bacteria and parasites, drought increase concentration of pathogens in water supplies and causes skin infections. Drought also causes meningitis epidemic. Every five to ten years bacterial meningococcal causes meningitis epidemic in the African meningitis belt and it happens in the middle of dry season and end by start of rain season. In 1996 climate change, increased in temperature, and decreased in rain fall which influenced the spread of the meningitis in the northern Nigeria, Kenya, Uganda, Rwanda, Zambia and the United Republic of Tanzania and infected thousands of people. Severe drought also influences the incidence of plague outbreak which infects humans through the bite of rodent fleas.                                          
         The impact of climate change on human health, ecosystems, cultural, social and economic development is significant. In order to reduce the impacts of climate change there must be policies, laws and regulations, and also the government enforcement on industries to modernize their equipment in order to reduce CO2 emission level to meet with the latest standards, they should introduce a program that rewards industries who meet or bit CO2 emission at the level of standard (such as tax credit, equipment upgrade, etc.)  Public Health system should expand their efforts in more advertisement and educational programs about climate change through social media and schools. Climate change needs to be discussed more frequently and we should share our ideas and technologies globally. By appropriate interventions such as providing services for safe drinking water global health could mitigate the impact of climate change and protect public health. Climate change can be slowed down by collaboration of every individual, community, organizations and the government to make wiser decisions.
 
References
Global climate change: implications for international public health WHO
Evaluation of the Costs and Benefits of Water and Sanitation ...WHO


Climate Impacts on Water Resources | Climate Change | US EPA
Chapter 3: Plague - World Health Organization
 

 


 

Monday, October 7, 2013

How do we guarantee the safety of public health workers abroad?

Last week, the case study in Bangladesh highlighted the training of young married women educating their peers about family planning methods.  One of my questions was how did the health workers behind the intervention ensured the security of these women and or themselves as they traveled from house-to-house in a male-dominated society, especially where the practice of purdah, or seclusion of women from public observation by wearing concealing clothing from head to toe or the use of high walls, curtains, and screens erected within the home (1) occurs.  One of the possible security measures I remember being mentioned was husbands or male relatives accompanying the female health workers to and fro.

Polio eradication has been the goal of the Global Polio Eradication Initiative, a multi-organization effort which includes the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), and the United Nations Children’s Fund (UNICEF) since 1994 (2, 5).  The polio eradication strategy includes routine immunizations, supplementary immunizations, surveillance, and targeted “mop-up” campaigns.  Today, polio is endemic in Afghanistan, Nigeria and Pakistan (2).  Every step of their strategy requires trained staff.  Earlier today, I saw a headline of a bomb attack on a Pakistani polio vaccination center, killing two health workers and one policeman (3, 4).  These attacks on international health workers have been going on for years where many believe that polio immunization is “a conspiracy by the Americans to sexually sterilise children and thereby control the population of Muslims” (5).

I tried to find more information about how this intervention was put in place, especially how foreign health workers are approaching the Pakistani, in this case.  We keep talking about voluntary participation as part of an ethical intervention, but I am curious to see what the Pakistani themselves (or any other population of interest) are saying about us and how they feel about the immunization programs for instance.  In the case of Pakistan, there seems to be an incredible level of resistance from the military and even religious leaders, so I feel as though lack of communication is to blame.  Due to all of this violence, 240,000 children missed their immunization.

Jaci previously wrote about the effect of the war in Syria where people fled their homes to save themselves from war while unsanitary conditions and water await them at refugee camps (7).  Syrians fled to stay alive, but the untold half of the story involves health workers (foreign or natives).  I have had a couple friends work for NGOs in Africa, and most recently, one of them had to be evacuated from the Central African Republic (CAR) due to a rebel coup.   All of the violence we see in the world today, especially in countries in need, prevent indigenous populations from getting help and health workers from helping, as Mercy Corps Country Director Jean-Philippe Marcoux  noted “Before the coup, the humanitarian situation in CAR was already dire. Now it’s even worse” (8).  He adds “Well, it was never really “safe” to go back in. But we knew that there were a lot of people affected and that we needed to get back respond to this emergency in whatever capacity we could.  We focused on restarting things in Bangui so we’d be operational from our country headquarters and be prepared to take advantage of even the small chances when we could get out into the field” (8).  These people are just awesome, risking their own lives to save others!







A Grain of "Golden Rice"



Genetically modified organisms (GMOs) are receiving increasing attention in the global arena.  A GMO refers to an organism that has been genetically engineered in a laboratory in order to promote, decrease or modify particular traits. Recombinant technologies may also be used to alter an organism’s DNA with genes from an unrelated species. Much of this technology has been applied to increasing crop yields and in combating micronutrient malnutrition. In 2002 Ross Welch from the USDA wrote a report in the Journal of Nutrition calling for more research in plant breeding as “doing this would dramatically contribute to improving the health, livelihood and felicity of numerous resource-poor, micronutrient-deficient people in many developing countries and would contribute greatly to sustaining national development efforts in these countries” (Welch, 2002).
An example of this type of work is the product “Golden Rice.” A rice product has been produced that is genetically engineered with plant genes so that the grains contain beta-carotene (source of vitamin A). Non-modified rice grains have the capability to produce beta-carotene, but during development, the expression of this gene is turned “off.” The addition of plant genes essentially modifies the rice to turn this gene “on.” Again, the impetus behind this crop (according to the Golden Rice Humanitarian Board which oversees the project) was conceptualized as a way to improve the nutrition of children in developing countries who suffer from deficiencies in vitamin A leading to blindness, reduced immune response, impaired hematopoesis (red blood cell production) and skeletal growth and premature death.
However, despite the fact that the technology of GMOs in general as been touted by researchers as a way to “feed the world” and as an important piece of improving global health, it faces heavy criticism in many circles. Some say efforts are not health and humanitarian focused, but profit-driven as relatively few companies and institutes control the research. In briefly researching the Golden Rice project in particular, I found a laundry list of organizations involved in funding the effort. These include the Rockefeller Institute, Gates Foundation, USAID, Philippines Dept. of Agriculture, Swiss Federal Funding, the European Commission and the Syngenta Foundation. Research has primarily taken place at the International Rice Research Institute (IRRI) in the Philippines. 
Countering this is an article from the NPR which cited the fact that the one of the individuals currently in charge of the Golden Rice project at the IRRI was also the inventor of Monsanto’s patented “round-up ready” gene we discussed in class last week. A lot of controversy surrounds Monsanto’s monopoly of the gene pool in regards to soybeans and corn and some of these voices fear a similar result as this technology becomes globalized.  Information found on the Golden Rice Humanitarian Board site does however state that free access to the technology is available to resource-poor farmers through sub-licensing and they will have ownership of their seeds (i.e. able to save seeds). Other worries include loss of biodiversity in crops, future soil infertility and dependency on a centralized food system.
These arguments don’t even begin to scratch the surface of the debate surrounding GMOs including wars over types of labeling and transparency. Could the delivery of nutritious crops in this way eventually harm developing countries if they become dependent on a particular food supply? Are the intentions of researchers on projects like Golden Rice truly humanitarian or do they become become profit-driven because of the way our regulatory/delivery system works? I didn’t even address issues of whether GMOs themselves have intrinsic adverse health effects, which is also highly controversial. I thought it was interesting that aside from the product itself, there’s a huge debate over the balance of power.

Sources:
Charles, D. (2013). In a grain of golden rice, a world of controversy over GMO foods. Retrieved from http://www.npr.org/blogs/thesalt/2013/03/07/173611461/in-a-grain-of-golden-rice-a-world-of-controversy-over-gmo-foods
Welch, R.M. (2002). Breeding strategies for biofortified staple plant foods to reduce micronutrient malnutrition globally. American Society for Nutritional Sciences. U. S. Department of Agriculture, Agricultural Research Service, U. S. Plant,
Soil and Nutrition Laboratory. Ithaca, NY.

Sunday, October 6, 2013

Mercury and Ruin

Mercury and Ruin
In many developing countries, a steady income is worth more than its weight in gold in providing for a family and putting food on the table. In Prestea, Ghana, however, the steady income is gold. Over 150 small gold mines can be found in the little town of ~35,000. The miners use liquid mercury to separate the gold from the other elements found in the soil in their backyards. The use of mercury is so extensive that red smog covers the town and paints the local livestock with a light-red hue. Pictures like this can be seen in the 50+ developing countries in Asia, Africa, and South America where approximately 15 million people use mercury to extract gold out of the earth. The neurological and developmental effects of mercury poisoning are concerning especially when considering the ~3 million women and children who work in environments where liquid mercury exposure is not only routine, it is part  of their livelihood. Mercury exposure in children and developing fetuses is especially concerning as it can impair neurological development resulting in losses in cognitive thinking, memory, attention, language skills, and find motor and visual special skills. Certainly not something we would want our children to be exposed to
Artisanal and small-scale gold mining (ASGM) is the largest consumer of Mercury in the world. Not surprisingly, it also is the largest contributor of mercury air and water pollution combined with only coal combustion contributing more than ASGM in air pollution. Clearly, this is an important issue that the United Nations Environment Programme is holding the Minimata Convention on Mercury from the 9th to the 11th of Oct. 2013 to address. The aim of this convention is to adopt a global policy that will protect people and the environment from harmful mercury exposures. This topic must be addressed cautiously as ASGM is a powerful way to bring wealth into an impoverished country. Gold can be sold for 70% or more of international prices making it an excellent commodity for international trade and economic growth. Already, ASGM accounts for 15% of the global gold supply and 90% of the gold mining workforce. Reducing mercury levels may be good for the environment and individual exposures to mercury, but what about the 90% of gold miners that would be out of work with no means to provide for their families? Sure they may not die from mercury poisoning, but I would bet that some of them would rather die from that than starvation.
Mercury pollution is a growing national environmental concern. ASGM, unlike industrial gold mining processes, does not typically practice sound waste management. In some cases, the waste is discharged into rivers adding to the growing concern of mercury in aquatic life. Fish species worldwide contain anywhere from 0.05 to 1.4 mg/kg with fish higher in the food chain accumulating the most mercury. This is concerning as the pervasiveness of the problem is doubly complicated as the consumption of mercury-containing fish and aquatic life is considered to cause the most harm to humans. Other forms of mercury can be inhaled as a vapor and cause effects such as tremors, kidney effects, respiratory failure, and death to name a few. The exposure method of inhalation is quite common in areas where ASGM activity is present. The processed used to extract gold with mercury involves evaporating the mercury from a mercury/gold mixture known as an amalgam. Nearly all vapors of this sort produce mercury levels that exceed the WHO limit of 1,000 ng/m3 for public exposure. These exposures could in many instances be chronic in the sense that mercury is an element and cannot be broken down except for nuclear decay.
This economic, health, and environmental issue is not one that can be easily remedied. Many do not know of mercury’s harmful effects and lack the resources or knowledge to use safer techniques. The prospect of a steady gold income is certainly a boon for the many poor who live in developing countries around the world. But at what cost to their health and the environment? How effective would a program be that empowered ASGM workers with safer, more efficient, and more productive techniques? Would it not increase the wealth of the area, encourage local doctors and nurses to stay in the area (thus curbing the brain drain), better facilitate international trade, provide money for food and clean water, provide a safer work environment, and curb mercury pollution? Perhaps we will find out after the Minimata Convention on Mercury that convenes later on this week. Let us hope this works. I really like my sushi.



UNEP. Global Mercury Assessment. UNEP Mercury Programme. http://www.chem.unep.ch/mercury/Report/Chapter4.htm#4.2. Accessed October 6, 2013.
EPA. Heath Effects. EPA Mercury. http://www.epa.gov/hg/effects.htm#content. Updated July 9, 2013. Accessed October 6, 2013.

UNEP. Reducing Mercury Use In Artisanal and Small-Scale Gold Mining. UNEP. http://www.unep.org/hazardoussubstances/Portals/9/Mercury/Documents/ASGM/Techdoc/UNEP%20Tech%20Doc%20APRIL%202012_120608b_web.pdf. Accessed October 6, 2013.

M.C. Gold mining in Ghana: Playing with Mercury. The Economist. http://www.economist.com/blogs/baobab/2013/09/gold-mining-ghana?fsrc=scn/fb/wl/bl/playingwithmercury. Published September 30, 2013. Accessed October 6, 2013.


Wednesday, October 2, 2013

Why One-Child Policy in China works?


The case study about Bangladesh’s family planning program reminded me of a similar program in China. I was impressed by the different outcomes between the family planning program of Pakistani government in the early 1960s and China’s One-Child Policy. Both of them used coercive method to ensure the execution (Levine, 2007; Wang, 2011). As a result, however, Pakistani government collapsed since the program conflicted with the local needs, while tight One-Child Policy has been sustained for about thirty years since 1979 (Levine, 2007; Coale, 2011). One issue that attracts my attention is that why such a policy, which contributes to many negative consequences, has retained for a long period in China. There are global efforts in birth control since high fertility could increase obstetric risk and the number of maternal deaths (Ronsmans, & Graham, 2006). Thus, I think looking at the role of politics and other values in China’s birth control program can offer some lessons in global health intervention in family planning.

The “One-Child” policy restricts urban couples can only have one child, unless one of the couples is ethnic minority or couples are both only children themselves (Li, 1998). The Chinese government proposed this policy to relieve the pressure of social, economic, and environmental problems (Rocha da Silva, 2006). From early 1980s to 2011, as authorities claimed, the policy had prevented 400 million births in China (Han, 2011). How credible is it? I think it appears an over-generous assumption that magnifies the benefit of birth control program. Although some independent scholars dispute the measure, it is undeniable that the policy reshapes millions of lives (Alcorn, 2013). Nevertheless, undesired consequences also occur as the policy is being conducted, such as violent abuses, forced abortion, and sex-selective abortion (Wang, 2011). The policy is challenged for violating a human right of individuals’ reproductive freedom (Wang, 2012). However, the reality is that One-Child Policy has been retained for so long. Why the heavy-handed policy can be endured by one billion of Chinese population? Except for the tough approach which formulates that breaching the role carries a heavy financial penalty (Wang, 2012), I think there are several key elements for Chinese family planning policy.

First of all, the value system of the nation on the basis of Confucian emphasizes that people should put the prosperity of the country beyond individuals interests (Li, 1998). People are taught to take their social responsibility. I recall one slogan that is prevalently used in mass media to encourage people adhere to the policy: "For a prosperous, powerful nation and a happy family, please practice family planning." It has been a consensus, since reform of new China, that families and individuals would not live a happy life without the country’s prosperity (Alcorn, 2013). This ideology of dominant Party of China was deeply embedded in people’s mind (Wang, 2012).

Furthermore, an important contributor to the policy is that the support for safe, efficient, and free or low cost contraception is available at different level in national network (Li, 1998). More than 98% of contraceptive devices and medicine are provided broadly without charge. In addition, regular health service for couples receives increasing attention, and education programs are offered as well. Enlightened by our discussion in the class, I was thinking what role the cultural beliefs about “big family” play in the family planning program? Similar with many other counties, the Chinese believe more children bring happiness to the family. To deal with this traditional norm, the education programs claim that through birth control the family expends fewer time and money on children, and thus people have more money to invest and give the child a better future (Han, 2011). After criticism and slight loose in the recent years, it is claimed that the government will have a relax enforcement of the policy as the leadership has been shifted to new leaders since 2012 (Alcorn, 2013). I think it may be a hint which indicates the strong relationship between politics and birth control program. The government now looks at the benefits of population growth that may promote economic growth.
 

 
 
Reference:
Ronsmans,Carine, & Graham,Wendy J. (2006). Maternal mortality: who, when, where, and why, The Lancet 368, 1189-99.
Levine, Ruth (2007). Case Studies In Global Health: Millions Saved. Jones & Bartlett Learning.
Alcorn, Ted (2013). China's new leaders cut off one-child policy at the root, The Lancet 381, 23–29.
Wang, Feng. (2011). The future of a demographic overachiever: long-term implications of the demographic transition in China. Population and Development Review 37: 173–190.
Rocha da Silva, Pascal. (2006). The politics of one child in the People's Republic of China. University of Geneva. 22–8.
Coale, Ansley J. (2011).  Population Trends, Population Policy, and Population Studies in China. Population and Development Review 7 (1). 
Li, Wei-xiong. (1998). Family planning in China. Ethik Med 10: S26–S33
Han, S.S. (2011). 400 million births prevented by one-child policy. People's daily..
Wang, Feng et al,. (2012). Population, Policy, and Politics: How Will History Judge China’s One-Child Policy? Population and development review 38: 115–129