Contraversial diabetes treatment ruling

Insulin injections for students

The article “Supreme Court Decision on Insulin Injections Shapes the States Use of School Nurses” was found online at the California Healthline. This article discussed the decision made by California Supreme Court in the case of American Nurses Association v. Torlakson and its repercussions on diabetic children and nurses. It states there was a unanimous decision made by the states supreme court that will give public schools the right to allow unlicensed, but trained, school personnel to administer insulin to children. The article goes on to explain the risks and benefits for the children involved and also the concern of school nurses for their future employment. While both these topics have implications for the wellbeing of the community, the court’s decision tends to favor the children’s potential health benefits. In the context of the children, there is great benefit to having non-nurse personnel trained to help administer insulin at schools. This will allow children not in the vicinity of school nurses to receive potentially lifesaving injections. Schools may not have school nurses on staff due to budgets or nurses may not be available at the time of a diabetic emergency. The counter argument to this potential lifesaver is that insulin can be a very lethal drug. Strict protocols and training are required for nurses to administer the drug and the American Nurses Association feels that having unlicensed personnel administering the medication are inherently dangerous. This argument also stemmed into unresolved discussions of liability and responsibility of improper use. Additionally, the article discusses the American Nurses Association’s fear that this decision with further decrease the use for school nurses and lead to even fewer jobs in an already declining profession. The state level government decision will have great effects on the public sector of schools and school employees, but also on private sector including nurses.

In general, I believe that this law may be potentially negative for public health in California. I think that this law is not only a liability nightmare but also a step away from a more permanent solution. Depending on the proportions of type I and type II diabetic students, it could be argued that this favors management rather than treatment. Would it not be better to have a well-trained nurse present to administer drugs and also encourage proper treatment (diet, exercise, etc.) for the afflicted youth? If the law were to cause a decrease in the number of school nurses, I believe this would be harmful to public health. Finally, the law’s main purpose is for the safety of the school children in case of an emergency. There is no doubt the proper administration of insulin to children in need would be a positive process for public health. However, it is well known that there are harmful effects to improper administration and this law is essentially allowing less qualified individuals assume the risks of this administration. Do you think non-medical personal should be able to administer insulin injections instead of nurses?

 

Gorn, D. (2013, August 19). Supreme Court Decision on Insulin Injection Shapes the State's Use of School Nurses. California Healthline. Sacramento, California.

 

International Health Promotion and Sports

 

It is well established that non-communicable diseases are increasing as the major causes of death among the world’s population. Among the major killers are cardiovascular disease, cancer, stroke and diabetes. Although each of the major agents of death in the world have their own complications and intricacies, most have a common association to similar risk factors. These risk factors include things like obesity, high blood pressure, poor diet, and lack of exercise.  MDG 4: Reduce child mortality is a complicated issue inciting many creative solutions and interventions. One class of interventions to increase physical activity and promote healthy dieting among youth is sport. Sport’s unique and universal power to attract, motivate and inspire makes it a highly effective tool for engaging and empowering individuals, communities and even countries to take action to improve their health (WHO, 2003) (Sports and Health: Preventing disease and promoting health).

The obvious benefits of sports are simple. Increased participation in sports will increase physical activity and improve health. However there are many more benefits to participating in sports that scope beyond the physical realm. According to the WHO, regular participation in appropriate physical activity and sport provides people of  all ages and conditions with a wide range of physical, social and mental health benefits (WHO, 2003)  Physical activity and sport also help to improve diet and discourage the use of tobacco, alcohol and drugs. As well, physical activity and sport help reduce violence, enhance functional capacity, and promote social interaction and integration (WHO, 2003).

It is obvious that sports can also be very influential to public opinion. Professional athletes and teams can often help to advocate for human rights ideals, healthy lifestyles, and moral and ethical codes. Programs like NFL Play60 encourage frequent exercise and also promote ideals like fairness and respect. The world’s largest sport, futbol/soccer has similar programs like UEFA’s RESPECT Your Health, and FIFA anti-racism campaigns. These programs reach out to millions of athletes and viewers alike to encourage beneficial health messages. Sport can play a valuable role as a communication, education and social mobilization vehicle. Sport’s entertainment appeal, amplified by global telecommunications, has made it one of the most powerful communication platforms in the world (Sports and Health: Preventing disease and promoting health).

The social aspects of sport can be very beneficial to the challenging topic of mental health. The social network and inclusion, particularly in team sports can provide numerous mental health benefits. In youth sports this serve as a healthy outlet for challenges faced in childhood.

There may be limitations to the role of sport in international health, but generally I think it brings people of different cultures together, one game at a time and provides great opportunity for promoting a healthy world. Limiting violence and rioting associated with sporting events and promoting respectful competition is a major priority for sports programs throughout the world. Encouraging professional athletes to advocate against these behavior and promote positive ones may lead to even better health outcomes.

World Health Organization, Health and Development Through Physical Activity and Sport (Geneva, 2003) at 1, online: WHO, http://whqlibdoc.who.int/hq/2003/WHO_NMH_NPH_PAH_03.2.pdf>. [WHO, Physical Activity].

Sports and Health: Preventing disease and promoting health. (n.d.). Retrieved from sports and health: right to play: http://www.righttoplay.com/canada/our-impact/Documents/Final_Report_Chapter_2.pdf

dietary supplements

Through globalization and cultural integration, many traditional medical remedies and practices have become relevant in media and consumer life. From this trend we now see practices such as acupuncture, meditation, various diets, home remedies and energy therapy becoming more prominent in United States culture.

Modern day health care has increasing expanded into various medical practices and theories. It is well documented that complementary and alternative medicine (CAM) usage has increased significantly over the last century and is now frequently being incorporated into conventional medical practices. Under the broad heading of CAM, there is a huge industry for non-drug substances with theoretical health benefits. These substances are often referred to as dietary supplements and constitute a multi-billion dollar industry. The currently accepted definition of “dietary supplement” was defined by congress in the Dietary Supplement Health and Education Act (DSHEA) of 1994.

“A dietary supplement is a product taken by mouth that contains a "dietary ingredient" intended to supplement the diet. The "dietary ingredients" in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. Dietary supplements can also be extracts or concentrates, and may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders. They can also be in other forms, such as a bar, but if they are, information on their label must not represent the product as a conventional food or a sole item of a meal or diet (“Overview of dietary”, 2012)”

Dietary supplements are used by many Americans; with most research suggesting nearly half of American adults use them. There is much criticism of the efficacy and safety standards dietary supplements are held to.  It is well established that the dietary supplement industry is a huge, highly profitable industry, but this has not always been true. There has been a nearly exponential expansion of the supplement industry in the last two decades. One reason why the supplement industry has expanded so rapidly is the growing interest in alternative medicine in American culture. Since the 1980’s there has been a growing trend of using holistic or natural remedies.  Holistic medicine has been a largely accepted practice in eastern civilization for centuries, but is now gaining popularity in western civilization. The growing interest in dietary supplements was a motivating factor behind significant changes in policy that lead to huge changes in the dietary supplement industry. Government regulation of dietary supplements was originally strictly enforced by the Food and Drug Administration (FDA). However, over the past 50 years changes in legislation made by congress have gradually decreased the role of the FDA in dietary supplement regulation and placed more responsibility on the manufacturers to produce safe and effective products.

Perhaps the most influential piece of legislature passed, The Dietary Supplement Health and Education Act (DSHEA) marked one of the largest changes in dietary supplement regulation. Following numerous legal challenges of the FDA’s authority to regulate aspects of dietary supplement sales, congress was forced to repeal the FDA’s dietary supplement regulations in 1983. At this point, The Nutrition Labeling and Education Act (NLEA) of 1990 authorized the FDA to require manufacturers of dietary supplements to provide evidence that there products were safe before sale and to approve the health claims made about these products before they could be used in marketing (Blendon et al, 2001). The industry continued to challenge this legislature until a new act was proposed. Media campaigns encouraged the public to demand easy access to reasonably priced dietary supplements (Nichter & Thompson, 2006).

Ultimately, DSHEA redefined dietary supplements as neither a food nor a drug, but rather a special category under the general umbrella of “foods”, which does not require the same standards of either of the other categories (“Overview of dietary”, 2012). The new act required that a manufacturer is responsible for determining that the dietary supplements it produces are safe and that any representation or claims made about them are substantiated with adequate evidence to show that they are not false or misleading. This essentially meant that dietary supplements no longer needed FDA premarket approval to be marketed.

Since the approval of DSHEA in 1994, the use of dietary supplements in the U.S. has grown exponentially.  Dietary supplement now play a large role in American health culture and represent a multi-billion dollar industry. In 1994, the U.S. sales of dietary supplements were $8.8 billion. In less than a decade after DSHEA was passed, U.S. sales increased to $18.7 billion in 2002 and continued to increase to $20.8 billion in 2004 (Nichter & Thompson, 2006).  The eruption in production and sales after the approval of DSHEA not only reflected the ease in releasing new dietary supplement products to the market, but also the growing demand from the public.

The lack of stricter regulations leaves consumer vulnerable to false or misleading claims, contaminated supplements, ineffective supplements, risks for drug-nutrients interactions, and unsafe supplements. I would argue that most Americans are not educated on the supplements they take or the regulation standards to which they are held. It is an important public health initiative to advocated for knowledge before consumptions and stricter regulatory standards.

References

Blendon, R. J., DesRoches, C. M., Benson, J. M., Brodie, M., & Altman, D. E. (2001). Americans' views on the use and reuglation of dietary supplements. Arch Intern Med, 161, 805-810.

Gardiner, P., Russell, P., & Shaughnessy, A. F. (2008). Herbal and dietary supplement-drug intrerations in patients with chronic illness. American Family Physician, 77(1), 73-78.

Mason, M. J. (1998). Drugs or dietary supplements: Fda's enforcement of dshea. Journal of Public Policy and Marketing, 17(2), 296-302. Retrieved from http://www.jstor.org/stable/30000778

U.S. Food and Drug Administration, U.S. Department of Health & Human Services. (2012). Overview of dietary supplements. Retrieved from U.S. Governement Printing website: http://www.fda.gov/food/dietarysupplements/consumerinformation/ucm110417.htm

Cohen, P. (2012). Assessing supplement safety-the fda's controversial proposal. New England Journal of Medicine, 366, 389-391

Nichter, M., & Thompson, J. J. (2006). For my wellness, not just my illness: North americans' use of dietary supplements. Culture, Medicine and Psychiatry, 30, 175-222.

malaria prevention

Hope for reducing Malaria?

In 2010 an estimated 219 million cases of malaria occurred worldwide and 660,000 people died, most (91%) in the African Region (CDC, 2013). This global pandemic has been a huge public health issues , particularly in Africa. Although numerous interventions have been used to reduces the deaths from malaria, long term, more cost effective solutions still elude researchers.

Developing an effective vaccine has been a major goal in global health for years. However, malarias unique and cyclic pathology has challenged researchers in developing an effective vaccine to prevent infections. To date numerous vaccines have been developed and tested but none have been licensed.

The RTS,S malaria vaccine candidate was created in 1987 by researchers at GlaxoSmithKline laboratories. Early clinical development was done in collaborations with the Walter Reed Army Institute for Research. In 2001, GlaxoSmithKline and the PATH Malaria Vaccine Initiative, with grant monies from the Bill & Melinda Gates Foundation, entered into a public-private partnership to develop an RTS,S-based vaccine for infants and young children living in malaria-endemic regions in sub-Saharan Africa (Malaria Vaccine Initiative PATH, 2013).

The RTS,S vaccine boosts the immune response to attack the p.falciparum  malaria parasite when it firsts enters the host bloodstream. It is designed to prevent the parasite from infecting, maturing, and multiplying in the liver (Malaria Vaccine Initiative PATH, 2013).

The vaccine has already been through the first two phases of clinical trials and is currently undergoing phase three trials.  Because the vaccine has a clinically accepted safety profile, it is now being administered in a blind study to test for phase III efficacy.  This phase started in May 2009 and delivers vaccine to children and young in seven sub-saharan African countries. Countries included in the study include Burkina Faso, Gabon, Kenya, Malawi, Mozambique, and Tanzania. In total 15,460 participants were recruited for the study. Each participant received three initial doses and  some were selected to receive a fourth to test the efficacy of a booster. Those in the study that received placebo did not leave empty handed. As an incentive to participate in the study, free healthcare was provided to participants.

Initial results  of the Phase III trials have been promising. After a year of follow-up  New England Journal of Medicine reported  that three doses of RTS,S reduced clinical malaria by 56% in children 5-17 months of age at first vaccination. In infants 6-12 weeks of age at first vaccination with RTS,S, clinical malaria was reduced by 31%. Results after a three year follow up showed that infants between 6-12 weeks of age, efficacy against clinical malaria were 27% and 444 cases of clinical malaria were prevented per 1,000 vaccinees (Malaria Vaccine Initiative PATH, 2013).

Final results of the trial are anticipated for 2014 and some hope to publically distribute the vaccine by 2015. In January 2010, GSK announced that the RTS,S pricing model will cover the cost of manufacturing the vaccine together with a small return of around 5 percent, which will be reinvested in research and development for second-generation malaria vaccines or vaccines against other neglected tropical diseases (Malaria Vaccine Initiative PATH, 2013).

Although this represents a great scienctific breakthrough and has major implication for African and global health, Malaria prevention is far from being achieved. Funding the price and delivery of this vaccine to the masses will pose several unique public health challenges. Countries will have to consider the logistics of delivery in their vaccine programs and most likely extend them. Setting schedules for vaccine administration may also be a large source of debate. Nonetheless, the RTS,S vaccine appears to be promising and may be a case study for future international health students.

Bibliography

CDC. (2013). CDC's Malaria Program. CDC Center for Global Health.

Malaria Vaccine Initiative PATH. (2013). Fact Sheet: The RTS,S malaria vaccine cadidate. GSK, MVI PATH.

 

nodding syndrome

Nodding Syndrome

Over the past few years there have been many reports coming out of Uganda and Sudan about the emergence of a strange disease in children. Parents and local health officials describe the gradual development a mental disease characterized by a physical nodding of the head. Those suffering from the disease often appear to be losing attention and nodding off to sleep, despite feeling awake and alert. This unexplained condition has been the focus of many epidemiology, infectious disease, toxicology, and health specialists since the turn of the decade (GHFN, 2013) (GHFN).

The World Health Organization began to investigate this strange disease in 2001, but much in still unknown. In 2009, the Uganda Ministry of Health requested that the United States CDC develop a tasks force to learn more about the growing disease. Investigators and researchers have examined and document thousands of children presenting symptoms in order to learn more of the disease. Interestingly, the disease only seems to affect a small age range of children, typically around 15 years old. The syndrome has been confirmed as a neurological disorder associated with other seizure activity, neurologic and cognitive impairment, delayed puberty, and growth retardation.

Although research has confirmed the disease as an impairment of the brain, there is still now known definitive cause. Patients suffering from nodding syndrome have been associated with malnutrition, and a parasitic infection called onchocerciasis. The CDC and other research organizations have ruled out several potential associations such as trypanosomiasis, cysticercosis, loiasis, lymphatic filariasis, cerebral malaria, measles, prion disease, or novel pathogens; or deficiencies of folate, cobalamin, pyridoxine, retinol, or zinc; or toxicity from mercury, copper, or homocysteine. Although there is association with onchocerciasis, many countries in Africa have numerous cases of this infection, but do not report any cases of nodding syndrome. Experts continue to examine specimens and search for an underlying cause to this mysterious and horrible affliction.

 Currently there are no known cases of children improving from the disease, but some have died as a result of the disease of opportunistic infections. Epileptic medications show mild improvement of symptoms but do not treat the disease. In addition to the obvious symptoms, the disease put the children at risk for many other dangers.  These children are very vulnerable to injury and accidental death due to the frequent seizure like states the can incapacitate the control of their body.

The burden of the disease is also extended upon the family of the children who must constantly monitor their mental and physical state to avoid such injuries or accidents. Parents often have to accompany the child and watch as they gradually lose mental capacity.

Reports of the disease have only been found in Uganda, Sudan, Tanzania, and Liberia, but the prevalence appears to be rising. It is a major priority for researchers to learn more about the debilitating disease and find treatment solutions. Public health solutions must be developed and implemented in order to increase detection of this disease. Additionally if a treatment or underlying cause is found, methods of prevention and treatment delivery will also be a major concern for local health officials.

 

Works Cited

Dowell, S., Sejvar, J., Reik, L., Vandemaele, K., Lamuna, M., Kuesel, A., et al. (2013, September). Nodding Syndrome. Emerging Infectious Diseases.

GHFN. (2013). Nodding Disease Kills and Confounds. Retrieved December 6, 2013, from Global Health Frontline News: http://www.ghfn.org/

GHFN. (n.d.). Nodding disease baffels experts. Retrieved from http://www.youtube.com/watch?v=5S7QLocaS0M

 

 

Rural Alcohol Misuse and Pregnancy

Alcohol misuse is a large issue in many countries across the world.   The World Health Organization reports that there are an estimated 140 million alcoholics around the globe.  A recent study found that 1 in 25 deaths around the world can be attributed to alcohol in one way or another.  Alcoholism is especially prevalent amongst rural youth. It is relevant to this class because there is much to be done regarding policies and funding related to law enforcement and resources available for people seeking treatment. Rural residents often have to travel far distances to seek help in hospitals or health facilities that are frequently understaffed.

Strategies for targeting alcoholism would vary depending on each specific rural community. The interventions would need to be specific and target the major issues of each area. I learned from a previous course in public health design and analysis, that engaging local communities in program design will generate a program that meets local needs, but will also establish greater community support. Strategies may include establishing various recreational activities that could replace alcohol use or even developing a community wide initiative with education and treatment services provided.

 Alcoholism presents many public health challenges not only here in America, but around the world.  It is an underlying cause of disease, injury, violence, disability, and mental health.  It contributes to both social and health inequalities.  Underage drinking is becoming a major issue around the world and is an issue that needs addressed.  Globally, 320,000 young people aged 15-29 years of age die annually from alcohol-related causes, resulting in 9% of all deaths in that age group.  Enforcement of underage drinking is sometimes lacking with lack of resources as a main cause.

Another public health concern regarding alcoholism is the amount of women who have babies born with fetal alcohol spectrum disorders.  Fetal alcohol spectrum disorders are a serious public health concern because it not only affects the mother, but their children are left with permanent consequences such as physical and mental defects. These children do not have the opportunity for a normal life. There is no cure for these disorders, only treatment, which many children go without due to lack of resources available to them. Given the addictive power of alcohol, many women still drink heavily during pregnancy despite knowing the consequences. I see this as a major issue. You can give people all of the knowledge on a topic, but you can’t make them change their behaviors. I would like to see mothers being prosecuted and charged for knowingly disabling their children. However, this would spark another public health issue because the children would be left without a mother.

Improvements in FASD prevention, identification and care can be enhanced through systematic efforts to educate medical and allied health students and practitioners about these issues.  These efforts will contribute toward the goals of better alcohol screening and care for women at risk for an alcohol-exposed pregnancy and identification, diagnosis, and referral to treatment for individuals with prenatal alcohol exposure. 

WHO.  Global Status Report on Alcohol and Health 2011.  http://www.who.int/substance_abuse/publications/global_alcohol_report/en/index.html.

Centers for Disease Control and Prevention.  Fetal Alcohol Spectrum Disorders (FASDs).  December 2013.  http://www.cdc.gov/ncbddd/fasd/index.html.

Mandela and the African Renaissance

The former South Africa’s president and Nobel Peace Prize laureate, Nelson Mandela, passed away yesterday at the age of 95. As British PM David Cameron said, “A great light had gone out”, the world is mourning his death. It seems a pity that not only South Africa and around the world lost a symbol of peace, humility, and forgiveness, but also it reflects the hopes of the African renaissance, to whose attainment Mandela dedicated his whole life, have faded. I mean, despite tremendous amount of foreign aids toward the continent for nearly half of a century, Africa’s fortunes have been improved? From what I’ve learned from our class so far, it is still difficult to say “yes” to the question.

There’s a slightly different story of another Africa leader at the western tip of Africa in Dakar, Senegal. Have you guys ever heard of “The African Renaissance” statue? Surprisingly, it is Africa’s tallest statue with a gigantic 52-meter high bronze Stalinist-style monument, even bigger than the Statue of Liberty^[1] in New York and Christ the Redeemer in Rio de Janeiro. In April 2010, then president Abdoulaye Wade unveiled this mammoth, celebrating Senegal’s 50 years of independence from France. The statue is supposed to represent the vigor of the African continent as it breaks the chains of colonialism. Most critics, however, call it the work of power-drunk president, with some rumors suggesting its male face was crafted to resemble Mr. Wade. Unfortunately, the monument continues to drain money from the national budget today, with only a handful of daily visitors. More troublingly, Mr. Wade allegedly announced that he would collect 35% of the revenue generated by the monument as a royalty for designing it.

 

With 54% of his countrymen living below poverty level, Mr. Wade has chosen to build the monument despite wide criticism as a huge waste of money. The estimated costs range from $28 to $70 million, which is paid for Mansudae Overseas, a company from North Korea. Yes, the company’s primary task has been to churn out propaganda paintings, posters, billboards, and Soviet-style monuments to praise the Kim family dynasty (you can see more about this from Businessweek article^[2]). But the amount was estimated a proportion of 0.2% of its national income, so if same thing happened in richer country, the total cost would have skyrocketed. Sadly, the statue symbolizes how little has changed in the last decades and corruption, nepotism, mismanagement, and decay still abound in the ‘motherland’.

It is no wonder that world opinion to pour resources into Africa has changed. In the G8’s 2006 Gleneagles Summit, world leaders promised for more aid, but it turned out the trend is downward in the very next year’s Heiligendam Summit.^[3] One of aid critics from Africa, Zambian economist Dambisa Moyo, also known as best-selling book author of “Dead Aid”, claim that most aid to Africa should be stopped because it feeds dependency and corruption, actually hurting the continent.^[4] In the 1980s, many celebrities paid attention, for example, Live Aid concert and popular song “We are the world” by USA for Africa. But aid to Africa is no longer chic, except Bono.

Surely the direct blame lies with corrupt leaders. Unfortunately, however, corrupt regimes were at the heart of the continent’s postcolonial problems and without any reformation the true African renaissance will never come. Mandela criticized bad governance in Africa at the Organization of African Unity in 1994: “we … must face the matter squarely that where there is something wrong in the manner in which we govern ourselves, it must be said that the fault is not in our starts, but in ourselves that we are ill-governed.^[5]” Rest in Peace

1. http://www.theglobeandmail.com/news/world/in-senegal-an-african-edifice-on-the-precipice/article11952317/

2. http://www.businessweek.com/articles/2013-06-06/mansudae-art-studio-north-koreas-colossal-monument-factory

3. http://www.stwr.org/aid-debt-development/international-aid-and-economy-still-failing-sub-saharan-africa.html

4. http://online.wsj.com/news/articles/SB123758895999200083

5. the entire speech http://www.anc.org.za/show.php?id=4888

"The 3 Fives"

The 3 Fives concept was jointly developed by the World Health Organization’s Departments of Food Safety and Zoonoses, Nutrition for Health and Development and Health Promotion.  It was initially tailor-made for major sporting events because the particular combination of food safety, nutrition and physical activity has a special resonance in combination with athletes.  However, it also has a general appeal because it works for all people all over the world.  The 3 Fives concept was launched in 2008 at the Beijing Olympics to raise awareness on food safety, nutrition and physical activity benefits among the population of Beijing to promote healthy lifestyles during the Olympic Games.   It is recognized that global sporting events have the potential to reach mega-populations.

 

So what exactly are the 3 Fives?

Five Keys to Safer Food

1.      Keep Clean

2.      Separate raw and cooked

3.      Cook thoroughly

4.      Keep food at safe temperatures

5.      Use safe water and raw materials

 

Five Keys to a Healthy Diet

1.      Give your baby only breast mild for the first 6 months of life

2.      Eat a variety of foods

3.      Eat plenty of vegetables and fruits

4.      Eat moderate amounts of fats and oils

5.      Eat less salt and sugars

 

Five Keys to Appropriate Physical Activity

1.      If you are not physically active, it’s not too late to start regular physical activity and reduce sedentary activities.

2.      Be physically active every day in as many was as you can.

3.      Do at least 30 minutes of moderate-intensity physical activity on 5 or more days each week.

4.      If you can, enjoy some regular vigorous-intensity physical activity for extra health and fitness benefits.

5.      School-aged young people should engage in at least 60 minutes of moderate- to vigorous-intensity physical activity each day.

 
Under each specific category, there were also specific suggestions on how to best accomplish each task or behavior.  For example, under being physically active every day in as many ways as you can, suggestions were to walk to local shops, take the stairs instead of the elevator, and getting off the bus early and walking the rest of the way.  These key behaviors were chosen because they are universally relatable and are important for health no matter a person’s age or where they live in the world.

There were no foodborne disease outbreaks in the 2008 Olympics, which suggest that food safety management was successful.  WHO staff took the opportunity during the Beijing Olympics to retrieve reactions and comments from specactors, athletes and their coaches.  The 3 Fives concept and messages was generally extremely well perceived as being an excellent tool to encourage and promote healthy behaviors.  Because of the success in the 2008 Olympics, the 3 Fives concept was also implemented in the 2010 FIFA World Cup which was hosted in South Africa.  Because of the success with this program in sporting events, the WHO is now considering partnerships to promote these same messages in other contexts such as school settings.  It will be interesting to follow this program to see the impact it may have on improving these health behaviors globally. 
 
http://www.olympic.org/Documents/Commissions_PDFfiles/Medical_commission/The_Health_Legacy_of_the_2008_Beijing_Olympic_Games.pdf
 
http://www.who.int/foodsafety/consumer/3Fives_flyer.pdf

http://www.who.int/foodsafety/consumer/3_fives_Beijing/en/index.html

No Condom Culture

It’s a topic that adolescents are preached to about in many health classes and sexual education programs in schools:  condom use.  Aside from recommending abstinence as the best form of contraceptive, condoms are considered the least expensive type of contraceptive and the easiest to obtain.  Although the education and knowledge of condom use is evident and the access to condoms is high, the percentage of young people that are using condoms has stalled, which is inevitably raising the STD rates.  The Centers for Disease Control and Prevention reports the percentage of American students using condoms hit its peak at around 60% a decade ago.  The Sex Information and Education Council of Canada also reports in a recent study that nearly 50% of sexually active college students aren’t using condoms.  It is found that teenagers are likely to use a condom the first time they have sex, but their condom use becomes inconsistent after the initial time. 

 

This is an alarming issue as we are seeing STD infections rise.  The CDC estimates that half of the new STD infections occur among young people.  Chlamydia and gonorrhea are contracted at four times the rate for individuals 15 to 24 years of age compared to the general population.  People in their 20s have the highest reported cases of syphilis and HIV. 

 

I personally think much of the decline in the use of condoms could be due to an “untouchable” mentality that many youth have these days.  By this I mean adolescents do not think that they would or could contract a disease and even if they do, they know that there are many types of treatments to help manage specific STDs.  Now that the hype of the HIV/AIDS epidemic is not as prominent as it was in the ‘80s and ‘90s, I feel we are losing sight of this issue as a country.  I would hate to see another spike in the transmission of HIV just because there aren’t as many large scale national campaigns keeping it in the forefront of people’s minds. 

 

There are also other factors that could be playing into the reason condom use is declining.  There have been setbacks in public institutions and budget cuts have led to many STD clinics and resources closing their doors.  It is a fact that people won’t stop having sex just because of a bad economy.  Other societal factors could be to blame also.  Demographics is seen as an influencing factor.  For example, African-American youth have parents that are less educated and have lower incomes compared to the population as a whole.  Both of these factors have been linked to sexually risky behaviors, including not using a condom. 

 

As individuals about to embark in the public health sector, it is important to help keep this topic relevant and in the public eye.  It is also imperative to recommend being tested for STDs on a regular basis.  I think there is much stigma that some individuals feel about being seen going to such a clinic.  We need to get rid of this mentality as a nation.  Prevention is always better than treatment. 

 

 

Time Magazine.  Steinmetz, Katy.  (No) Condom Culture:  Why Teens Aren’t Practicing Safe Sex.  November 12, 2013.

 

http://www.theprovince.com/health/Just+half+Canadian+university+students+condom+during+alarming+survey+finds/9074213/story.html

Education and Obesity

As I have studied this relatively new area to me, international health, one of the most fundamental obstacles to the achievement of public health worldwide seem to be widespread ignorance against the target disease. I think this causes an adverse reaction to some medication or vaccination among the patient in endemic area and makes it important to know about the ethnic and cultural background beforehand. Although “Education is Ignorance” Noam Chomsky once declaimed (well… here the term, education was used to criticize standardized education system), without doubt education is a way to help people get out of their intellectual confinement.

According to Chomsky’s interview in his Class Warfare book in 1995, educational system “…is designed to prevent people from being independent and creative.”^[1] However, education may prevent people, or at least women, from obesity, finds a series of recent studies. (I know guys, Chomsky meant educational system and here it means educational status.)

A study, recently published in BMC Public Health^[2], found that women with no formal education who were working in sedentary occupations have twice high-risk of central obesity, here defined by measuring waist circumference more than 80 cm, compared to women with no education working in agriculture. Conversely, for women with at least some degree of formal education, here they asked interviewee any education including primary (equivalent of elementary in the US), there was no such association. Educated women in sedentary occupations were no more likely to be centrally obese than educated women with agricultural occupations. The study used a sample of 2,465 women aged 60 years and over who had lived in the Chinese Four Provinces. So, more precisely speaking, education is a key factor in reducing the negative impact of obesity on elderly women in low- and middle-income country in Asia.

But similar pattern was observed here in America. Recent new government research conducted by the Centers for Disease Control and Prevention showed^[3] that women in college graduates are less likely to be obese compared to those with less than a high school diploma, here obesity was defined as BMI of 30 or above and they used NHANES data. Interestingly, there was no significant trend between obesity and education men. One more lament over women’s misfortune in health context.

One more evidence added to previous studies showing an inverse association between BMI and SES (socioeconomic status) ^[4]. This time, the researchers used a sample of 4065 women, ages from 18 to 45, living in low-income towns and suburbs in Victoria, Australia. The study revealed that women with higher education had statistically significantly lower BMI value, while no differences observed between income categories. In other words, education is particularly crucial for women’s health over income.

These studies tell us same thing and it make sense because education level might be associated with one’s capacity of accessing to more health information. But one final question: why not for men? Even education cannot cure the men’s ignorance? My guess is because women are more sensitive to their appearance and highly educated women are more likely affected by this motivation, whereas men are relatively dull about their appearance.

1. You can see this dialogue from chomsky.info, http://www.chomsky.info/books/warfare02.htm

2. http://www.biomedcentral.com/content/pdf/1471-2458-13-769.pdf

3. http://www.cdc.gov/nchs/data/databriefs/db50.pdf

4. http://www.ajhpcontents.org/doi/abs/10.4278/ajhp.120316-QUAN-143 Sorry guys, they open the abstract only.

The Implications of (Mis)Information

A recent NPR blog written by Mark Memmott drew attention to a potentially devastating WHO error that mistakenly attributed the rise in HIV/AIDS in Greece to self-infliction.  The WHO report explicitly stated, “HIV rates and heroin use have risen significantly, with about half of new HIV infections being self-inflicted to enable people to receive benefits of €700 per month and faster admission on to drug-substitution programs.”  A later correction by WHO stated, “What is accurate to say is that slightly more than half of the Greece's new HIV cases are among those who inject drugs.”  Despite the retraction, the misstatement remains in the WHO’s publication: Review of the Social Determinants and the Health Divide in the WHO European Region Final Report.

The offending statement, according to Memmott, appears to have resulted from the synthesis of two different reports and a subsequent conflation of drug use and ostensible intentional self-infection.  Although intravenous drug users do experience much higher risk for the contraction of HIV/AIDS and other diseases transmitted through blood, it is a far stretch to presume that these individuals would choose infection if it meant financial gain or more expedient treatment for their drug dependency.  As disturbing as this published assumption is, it is more disturbing that it made it past revisions and into a final report. 

Rather than using this opportunity to further raise awareness about the specific risks of intravenous drug use or the structural factors and mental health issues that often contribute to both drug use and STI/STD, WHO sidestepped these issues in its retraction.  Insteaf of taking advantage of the opportunity for more explicit education or even accepting responsibility for their mistake, the WHO reiterated the fact that the new HIV cases are more prevalent among people who choose to inject drugs.  It seems rather preposterous, in my opinion, to even entertain the notion that an individual would choose to contract a potentially life threatening (and definitely debilitating or life altering) disease in order to receive social service benefits. 

The potential deleterious impact of an official edict such as this is potentially devastating to the already marginalized populations of the addicted and infected.  Yes, the WHO did issue an official statement denying the claim, but the original claim remains in the official report.  If an average person reads a final report from the largest health organization in the world, what is the likelihood that they will presume any portion of it is wrong.  If the statement is taken as fact, it will lend credence to existing stereotypes about these and other marginalized populations, thus reifying the systemic inequities and violence to which they are already exposed.  

Consider the fallout if such a report was released about infected populations in the U.S.  There is already a push to enforce drug testing for social program beneficiaries due to the stereotype that marginal populations in need are unilaterally abusing the system and must be using drugs.  An added association between need, drug use, and disease necessitating long-term care funded by taxpayers or government programs could hold the potential to encourage the eradication of such programs via an intensive political rhetoric emphasizing the marginal and allegedly deviant standing of these people.

Links to the NPR blog and WHO report are below:

http://www.npr.org/blogs/thetwo-way/2013/11/26/247346881/whos-error-leads-to-misguided-meme-about-greeks-and-hiv

http://www.euro.who.int/__data/assets/pdf_file/0006/215196/Review-of-social-determinants-and-the-health-divide-in-the-WHO-European-Region-final-report-Eng.pdf  (page 112)

Other discussions of the topic linked to in the original blog: 

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961556-0/fulltext

http://www.aljazeera.com/news/europe/2013/11/greeks-self-inject-hiv-claim-benefits-2013112681147419888.html

http://ewsd.wiv-isp.be/Rapid%20communications%20%20extra%20information/Report%20of%20the%20Greek%20FP%20expert%20group%20-%20AIDS.pdf

A Great Public Health Humanitarian – Nelson Mandela

With the recent passing of Nelson Mandela, it is a good time to discuss how influential a single leader can be regarding the health and development of a country.  Mandela passed away December 5 at the age of 95 from complications of a lung infection.  He has had an immense impact on the lives of many South Africans through his political and humanitarian efforts and his work in ending the apartheid.  He is considered South Africa’s symbol of freedom with his struggle against racial oppression.  He was imprisoned for 27 years due to his strong political will and was convicted of conspiracy to overthrow the government.  He was released from prison in 1990 after an international effort lobbied for his release.  He was later elected South Africa’s first black president where he formed a government of national unity in an effort to defuse racial tension in the country.  He also was successful in creating a new constitution and created the Truth and Reconciliation Commission that investigated past human rights abuses.  His administration introduced measures to encourage land reform, combat poverty, and expand healthcare services.  After his presidency he focused on causes such as human rights, world peace, the fight against AIDS, rural development and school construction.

It is reported that four out of five South Africans depend on the public health care system that Mandela championed.  Free healthcare was introduced in 1994 for children under six and pregnant women.  This was extended to all people using primary level public sector health services in 1996.  Although this was a great accomplishment, access to healthcare services still remains vastly unequal between blacks and whites. 

One of his legacies that he leaves behind in South Africa is a special train that has helped bridge the health care gap in the country.  Mandela was instrumental in the development of a train called Phelophepa (meaning good, clean health) that cuts through South Africa’s countryside.  It runs nine months throughout the year and delivers low-cost medical care to the rural poor.  The train treats 1,500 patients a week on average.  The poor health of individuals in rural South Africa under apartheid was due to lack of access to health services.  There was only one doctor for every 40,000 black South Africans.  The numbers have since improved to 1 in 4,000.  This service is affordable to the population because it is mainly run by volunteers.  Student doctors live on the train and provided the services.  A second train has since been launched in 2012 that now allows doctors to reach 100,000 people a year. 

Throughout this course and our class discussions, we often mentioned the marginalized individuals and the disparities that they face.  I found this “healthcare train service” system that South Africa has implemented a great effort in trying to reduce those disparities and allowing more opportunities to access of health services for the rural poor.  This is a creative and innovate solution that I feel could be implemented in countries similar to South Africa.  I have not heard of such a service offered anywhere in the world and would love to see if such benefits would be gained in other areas of public health services.

CBS News.  Nelson Mandela’s Legacy:  Train of Hope Bridges Health Care Divide in South Africa.  December 6, 2013.

Nelson Mandela Foundation.  The Life and Times of Nelson Mandela.  http://www.nelsonmandela.org/content/page/biography. 

One Health

Chad Swanson’s YouTube video that we watched in our last class addressed the concept of transformational change and encouraged individuals to consider the concept of health from a more holistic perspective; specifically he explored his concept of “systems thinking for capacity in health.”  Despite the fact that this concept holds considerable promise for beginning to address the inherently symbiotic relationships present in both good and ill health, many public health strategies continue to address health issues vertically. 

The One Health Initiative attempts to shift the public health paradigm to be more inclusive, and thus ostensibly more efficacious.  One Health considers not only a holistic approach to global human health, but also a more holistic approach to environmental and animal health.  The Initiative recognizes that vaccination and treatment efforts hold relatively little value unless the space surrounding the target populations in question has the capacity to support them.  It also addresses the potential for zoonotic illnesses and degraded environment to impact human health on multiple levels.  Unless these issues are addressed collaboratively, public health measures will in effect be contradicted by re-emergent diseases that may have become less salient at some point. 

One Health’s vision of improving the lives of all species through collaborative efforts focuses on seven primary goals[1]:

• 1. Joint educational efforts between human medical, veterinary medical schools, and schools of public health and the environment;
• 2. Joint communication efforts in journals, at conferences, and via allied health networks;
• 3. Joint efforts in clinical care through the assessment, treatment and prevention of cross-species disease transmission;
• 4. Joint cross-species disease surveillance and control efforts in public health;
• 5. Joint efforts in better understanding of cross-species disease transmission through comparative medicine and environmental research;
• 6. Joint efforts in the development and evaluation of new diagnostic methods, medicines and vaccines for the prevention and control of diseases across species and;
• 7. Joint efforts to inform and educate political leaders and the public sector through accurate media publications.

These concepts have been embraced and supported by the CDC as well through the establishment of a One Health Commission and a growing body of research considering the efficacy of such an epistemology.[2]

Interestingly, this approach is not a particularly novel idea to much of the global indigenous population and other “traditional” societies.  Indigenous populations, particularly those that have retained hunting and gathering traditions recognize the necessity of respecting and caring for the surrounding natural environment.  Is “one health” simply another example of the western medicine co-option of indigenous medical practices; or, is it recognition of a failure of current system and how critical it is to build more sustainable systems?   

---

[1] http://www.onehealthinitiative.com/mission.php

[2] https://www.onehealthcommission.org/en/resources/centers_for_disease_control_cdc/

Rabinowitz PM, Kock R, Kachani M, Kunkel R, Thomas J, Gilbert J, et al. Toward proof of concept of a One Health approach to disease prediction and control. Emerg Infect Dis [Internet]. Dec 2013. http://dx.doi.org/10.3201/eid1912.130265

http://www.youtube.com/watch?v=8vnPgEP-Ids#!