Should the physician be aware of what happening globally?

I asked myself this question a lot, how could global health improve the performance and optimize the role of medicine? And how medicine can benefit the global health as well?  I was trying to find how could global health help me in my future decisions and it is impact of my career as a physician. The emergency doctor who first receive Mr. Duncan as a patient in the emergency and treat him with some flu and diarrhea medicine then discharged him, would he treat him in a different way if he knows about what’s going on in West Africa at that time?  I assume that patient’s health related to national and global health. The experiment proves that whatever is going on globally affects the individual health and the individual health affect public and global health. We cannot just say polio are no longer here so, we can stop polio vaccination, for example.

The question about how much knowledge the physician should know regarding global health? Global health workers would benefit from the medical doctor by knowing biomedical basis of the disease and risk factors, causes and pathogenesis. On the other hand the medical doctor will benefits from knowing about global health in disease history, distribution, other hidden behavior, cultural, and socio-demographic risk factors.  Globalization of health makes it necessary for the medical doctor to know about organizations and different health systems in the world. To apply the medical knowledge to real practice it needs more than training nowadays. Economics, social sciences and politics has a lot of impact nowadays on health and disease process. Global health makes it easy and possible for physician to see the problem from different aspects rather than the biomedical basis. Many medical school curriculums give that attention to the role of importance of international health studies in medicine.

Diseases do not stop at countries borders. We should concerned as a doctors for other diseases that are in Africa, Asia, and worldwide.  In addition to that there is an ethical concern to decrease pain in people who suffers more especially if there is a defect in their medical system and lack of physician. AIDS would not be here if we cared enough about what was going on in Africa then. Global health will broaden the knowledge of medical doctors in the matter of disease causality and relations with others diseases or risk factors. Global health well rich the knowledge of medicine. Through understanding about what is going in outside, by comparison, we can better estimate and understand about what is going on in inside.

Inequality regarding breast cancer morbidity and mortality rates in US

Breast cancer inequality and  races:

Death rates among White American is 28.3/100.000 compared to death rates in African American which is 36.4/100.000. ( Cary et al 2006). Higher mortality and morbidity rates of Breast cancer are found in different ethnic groups among US population (Shing-Giwa et al 2004). Most of ethnic rates other than Whites showed a late stages on first diagnosis. The CDC showed that rates of cancer incidence among women  in USA is  one of the highest despite that it is some what decreasing, breast cancer incidence among other races was less but nowadays it is increasing.  Morbidity and late stage at diagnosis leads to worse prognosis and higher mortality rates. in minorities and other races. The preventive measures also showed less participation from hispanic and Asian in relation to whites.

Breast cancer inequality and Socioeconomic Status:

The lower socioeconomic status showed a relation to lower screening rates. ( Lantz et al 2006). lower socioeconomic status leads to lower attention to preventive measures or seeking early help. it is also correlated to lower education and lower  health care.  Unemployment and uninsured people are higher in lower socioeconomic status. other problems and priorities than health is also found to be one of the  outcome of lower socioeconomic status,. All these factors associated with the lower income may be  the reason of this dip-arities found in breast cancer incidence and mortality as well as prevention.

Decreasing disparities and health inequality is one of the main goals of WHO and other organizations and  it is one of the human rights .The  American cancer society put  a main goal to decrease the breast cancer prevention inequality  around US.

Could Saving the Environment also Improve Global Health??

I am not sure if anyone recalls, but Purdue University had a program called the Common Read Program.  The program was developed for fall incoming undergraduate students.  Every year, a committee of current students, faculty and staff would form a committee and select a book that introduced topics and themes that could be discussed further in the classroom.  At the student orientation, every incoming first-year student was given a copy of the selected book.  The students were then asked to read the book over the summer to prepare for class discussions and assignments. 

I thought it was a great program.  The books raised interesting questions on social and environmental issues, as well as concerns about technology, and health.  These questions fueled a number of conversations inside and outside of the classroom.  I realize now, that most of these books explored topics related to global health.  One example is the Common Read: No Impact Man.  The book was turned into a documentary in 2009.  In the book, Colin Beavan (author) shares his reflections, challenges, and epiphanies as him and his family attempt to have no impact on the environment.  Beavan brings up two major themes that relate to global health: exercise and food sustainability.

One of the first changes that Beavan and his family make is to stop relying on modern forms of transportation, which release emissions.  The Beavan family stops driving and using public transportation.  They begin walking and riding bicycles and manual scooters to get around.  After doing this for just a little while, Beavan has an epiphany.  He realizes the increase in physical activity is improving his physical health.  He even reflects on and laughs about the days when he had to run in place on treadmills to get his exercise.  I think this speaks to some of the theories on what caused the obesity epidemic.  The increased number of vehicles traveling on the roads has lead to increased pollution, especially in heavily populated cities (e.g., New York, Beijing).  Interestingly, the same factors that are spawning environmental challenges are also negatively impacting our health.  I am not arguing that everyone should get rid of his or her vehicles or avoid using public transportation. I am arguing that it is interesting to consider how cultural norms and structural factors are affecting our health, as well as the environment.

Another topic that Beavan addresses is food sustainability.  Beavan and his family stop purchasing and consuming foods that are packaged and not grown or raised in their community.  The packaged food created waste, while the foods that were grown and raised outside of the community required shipping, which caused emissions.  Beavan and his family used their own, reusable containers when they purchased foods.  Additionally, they ate locally grown fruits and vegetables. Beavan finds that these foods are actually more healthful than the packaged processed foods that they had grown accustomed to eating.  This relates to the rising global concerns about the increased consumption of processed foods, fats, and sugars.

I think No Impact Man offers an interesting perspective on and evaluation of health, Western culture, and the environment.  It seems as though many of the factors that are having a negative impact on the global environment are also negatively affecting global health.

Reference:

Beavan, C. (2009). No impact man: The adventures of a guilty liberal who attempts to save the planet, and the discoveries he makes about himself and our way of life in the process. New York: Farrar, Straus and Giroux.

One Big Global Culture

Is globalization good or bad? Even after our great discussion on this topic yesterday, I am still not sure there is a clear answer.  I recently read an article by Napier (2014) that identified another challenge related to globalization and health.  In the article, Napier (2014) states, “But as globalization continues, cultural diversity decreases, denying us not only the benefits of genuine differences, but also the different kinds of knowledge that characterized humanity in former times.”  Napier (2014) goes on to say, “what constitutes culture in a globalized world where differences are often only annoyances to be ameliorated and leveled?”  In other words, through globalization we are becoming more and more homogenous.  Additionally, difference is no longer a welcomed part of humanity.  It is a barrier or challenge. 

How do these thoughts relate to global health?  I think this prospective on globalization closely aligns with global health and raises some valid questions and concerns.  In fact, I think if Napier’s (2014) prospective is accurate globalization may have a major impact on global health. 

First, let’s consider what diminishing difference across people looks like and means.  Napier’s (2014) argument implies that we are moving from being uniquely distinct people with richly different cultures, to being one culture.  We are slowly evolving into one people.  I cannot deny that in some ways, this seems like an easy solution to some of the social issues that we are facing.  However, I am not sure that is an accurate prediction.  I will save my thoughts on that for another blog.  Instead, I think it presents some interesting challenges, especially related to global health.  Jacobsen (2013) provides some possible evidence of this evolution when she discusses the concepts of  “New World Syndrome”, “McDonaldization”, and “Coca-colonization” (Jacobsen, 2013, p 320).  More and more cultures around the world are adopting diets that consist of processed foods, fats, and sugars (Jacobsen, 2013).  Additionally, globalization has influenced the sharing of attitudes and perceptions about body image and breastfeeding (Jacobsen, 2013).  For example, the prevalence of eating disorders like anorexia and bulimia has increased in non-Western societies (Jacobsen, 2013).

Second, what are the future implications of this idea of diminishing difference?  This could possibly result in fewer diseases that have a greater global impact, causing a shift in global health resource allocation.  In other words, preventing and controlling epidemics would become a major priority rather than diseases that affect just one particular part of the world.  A further consequence of this issue is that more diseases may become neglected as the focus shifts.

I return to my original question.  Is globalization good or bad?  I am not sure it can be classified in such black and white terms.  I think there are definitely some benefits that have resulted from globalization.  However, I think globalization may have some unintended consequences to global health.  As we become one global culture, who will be left out of this evolutionary process?  What will happen to the cultures that adopt these new habits? More importantly, what happens to the ones that do not?

Jacobsen, K. (2013).  Introduction to global health.  Jones & Bartlett Publishers.

Napier, A. D., Ancarno, C., Butler, B., Calabrese, J., Chater, A., Chatterjee, H., & Woolf, K. (2014). Culture and health. The Lancet, 384(9954), 1607-1639.

      

Implementing Global Health Interventions

At last night’s dinner, we questioned how we will pursue global health efforts and equality of health for all. Lobbying policy makers, leading large activist groups, and publishing our findings were some ways we discussed about addressing various issues. Simply being active in efforts to achieve global health will begin the process.

It seems that our president, Mitch Daniels, is also pursuing global health efforts. He currently co-chairs the Council on Foreign Relations’ Independent Task Force on Noncommunicable Diseases, according to this article in the Exponent:

http://www.purdueexponent.org/campus/article_c2fe035b-2d02-5f0a-a120-2d4f827a89e2.html

First of all, I applaud President Daniels on addressing global health, especially noncommunicable diseases, which receive such little attention on a global scale. Daniels says in the article “While we don’t prescribe any level of this or that, we do point out the rather stunning opportunity that’s here in a situation in which the U.S., which is only spending 0.2 percent of its budget on the whole global health picture, is only spending a little over 0.1 percent of that on NCDs.” The article also mentions that Daniels believes that U.S. international aid should be increased. While I agree with him, I was surprised that a conservative like himself who focuses on cutting costs would support increasing costs. How great is it that he believes in reducing the cost of tuition for higher education and promotes spending on issues such as global health?

However, I would also like to critique one aspect of President Daniels views. He believes in implementing cost-effective interventions in low-infrastructure settings. While this may be helpful in the short term, these sorts of interventions will not be sustainable in the long term. Focus must be concentrated on improving infrastructure. This could be done in the diagonal approach, as described in our RIG text, where disease states are targeted, which ultimately strengthens health infrastructure. However, Mitch Daniels seems to be in a neo-liberal mindset. He speaks of “$21.3 trillion loss in developing countries over the next two decades.” In addition to cost-effective interventions, this is not the mindset that should be used in expanding global health resources.

On the other hand, President Daniels suggested in the article to improve infrastructure in ways that it has already been improved relating to diseases such as AIDS. This seems to be similar to the diagonal approach that is described in our RIG text (Farmer, 2013, p. 304). President Daniels’ talk of cost-effectiveness seems to conflict with his ideas of improving infrastructure. In a way, I do not think that this is wrong. He is promoting expanding resources for global health and is trying to get the most out of the resources that are available. However, it has also been noted that “When global health is understood as a zero-sum game—when practitioners and policymakers are socialized for scarcity—some priority always loses when another wins” (Farmer, 2013, p. 336). Because of this, I struggle with President Daniels’ conflicting views of increasing equity by expanding resources and using cost-effectiveness strategies to implement global health interventions.

Farmer, P., Kim, J. Y., Kleinman, A., & Basilico, M.  (2013). Reimagining global health an

            introduction. Berkeley: University of California Press.

U.S. Breastfeeding.

 

There have been improvements in U.S. rates of exclusive breastfeeding. Some change in specific states has been rapid-- Tennessee jumped about 10% in one year. That is amazing. I also saw that The First Lady's Let's Move! Child Care initiative has a breastfeeding component that focuses on encouraging and supporting mother's that breastfeed. There also is an education component. I also found information on some community initiatives that aimed to provide a space for information and dialogue on breastfeeding. One of these community initiatives is called the African American Breastfeeding network (AABN)

The AABN is breastfeeding support group operating out of a Milwaukee YMCA (CDC, 2014). They host monthly meetings called Community Breastfeeding Gatherings (CBG) that bring together pregnant and breastfeeding mothers, their families, and International Board Certified Lactation Consultants. After a family style meal, organizers initiate an informal “community dialogue” in which fathers and mothers are introduced to key messages on how to support breastfeeding. AABN co-founder Dalvery Blackwell describes their purpose: “To move towards normalizing breastfeeding at the community level, we need to involve the entire family, not just mothers. Everybody has a responsibility in breastfeeding”. The ABBN have plans to replicate these CBG at other YMCAs in the Milwaukee area. This program clearly aims at increasing the knowledge and confidence of mother’s and their families. Further, they provide a community space for dialogue on issues facing the members of the community. 

I love this community focus. That people can bring their families and eat and it is more than strict information provision. From everything I have read, if breastfeeding is to be really encouraged or rates increased, than structural and societal conditions will need to be addressed and changed. Breastfeeding requires more than knowledge—it requires understanding. This understanding can only come through changing the public discourse on the topic. There are movements now and I believe women are more able to feed in public (legally). The degree to which OTHER people are comfortable with feeding in public will surely affect women more than any legal ramifications. Legal protections are more important in the work place, where the return to work is a major obstacle to practicing exclusive breastfeeding. Hourly workers have fewer protections—if they need to break to express, these breaks do not have to be paid for. So while you can take breaks, you will not be paid. If you work at Wendy’s, how are you going to be able to take the breaks you need? These issues of legality and comfort can’t be changed without strong advocacy and additional protections for women’s rights. I would imagine Joe Wall Street wouldn’t want his coworker next door to take frequent breaks, or bring her baby or infant to work. Women also report the need for additional support from the male figures in their life—be it the father of the child or grandfather or their father. Like I began with, there has been real increases in both the rates of exclusive breastfeeding and breastfeeding in general in the United States. We know this is best for the baby, but structural conditions need to catch up in order for that number to continue to increase.

Disease Burden of Urban Air Pollution

The greatest environmental health risk around the globe isn't toxic waste, oil spills, nuclear radiation, heavy metals in drinking water or vector-borne diseases, such as malaria. It's the air in our cities and homes, according to a 2012 World Health Organization study. Diseases including acute lower respiratory disease, chronic obstructive pulmonary disease, strokes, lung cancer and ischemic heart disease that can be attributed to ambient air pollution and household air pollution exposure cause an astonishingly high number of premature deaths each year, the 2012 estimate is about 8 million deaths per year. Many of these deaths are the result of multiple risk factors, both smoking and inhabiting a city with a high concentration of air pollutants can result in lung cancer. Studies finished in 2013 by WHO show that air pollution, indicated by small particulate matter between 10 and 2.5 microns (PM10 and PM2.5), can be carcinogenic.

The presence of PM10 and PM2.5 is the result of poor environmental policy at the municipal, national and international level in most of the world. Industry, transportation, power generation and waste management are the primary perpetuators of PM10 and PM2.5 generation and can all be found occurring at high rates in the world's growing urban areas. Other pollutants of concern include ozone (harmful to asthmatics), as well as nitrogen oxide and sulfur dioxide (the primary causes of acid rain). Indoor smoke exposure resulting from cooking by burning solid biomass puts about 3 billion people at risk of disease, the majority of which are women.

The World Health Organization maintains international standards for acceptable levels of ambient air pollution, however there is no strong compliance enforcement mechanism in place. Of the 1600 cities that report their air quality to WHO, only 12 percent have levels of pollution deemed acceptable. Gaps in monitoring exist in cities that lack the capacity to do so. Most of these cities are located in the Eastern Mediterranean  region and Africa, although the US does not report its air quality information to WHO despite having extensive monitoring programs in place. Individual cities within the US publish their own air quality data, which can be easily compared to other reporting regions of the world in this graphic.

There certainly appears to distinct difference between regions of the world in terms of air quality. I think it is important to reflect on how much of the world's industry and manufacturing occurs in cities around the world that don't have environmental policies in place that are as strong as the US and EU. Decreasing emissions of pollutants and increasing energy-use efficiency can be expensive, and while many business owners and corporations in the US bemoan the environmental regulations they operate under, I certainly appreciate having cleaner air as a result of policy. I say that with a twinge of guilt, knowing that much of what I own was manufactured somewhere near one of those red dots on the map, and that the pollution that resulted from my possessions was passed on to someone else, in another part of the world.

Here is a link to an interactive graphic produced by the WHO showing which regions and nations have exceptionally high levels of air pollution, and shows how many nations don't report data at all:

http://gamapserver.who.int/gho/interactive_charts/phe/oap_exposure/atlas.html

*All information for this post was gathered WHO's "Public health, environmental and social determinants of health" webpage or my previous coursework

Smoking and my family

Well, I need a couple more blogs and I need to write something about this. I don't mind oversharing-- it is for me to write something but also because I know people get something out of hearing about other peoples experiences. Jill, does this count as some weird auto ethnography? I also think about how our measures of disease and disability are unable to factor in the real cost to families and communities. It also made me think about Tasha's post on the reasons people smoke. You get much more intricate and nuanced responses to issues when you ask for more detail or a history. I found this when I talked to my brother's ex-girlfriend that works in the baby unit of a hospital.

My aunt died last night from a complication related to lung cancer. My parents were already driving to Texas in an attempt to be with her in the hospital before the passed. This was sudden-- from finding the tumor to complications to this point has only been about 2 weeks. The speed is shocking. She is 63, my mom's younger sister. She smoked almost her entire life and had previously beaten another kind of cancer. Other decades of smoking, my mom claims that she took pretty good care of herself. But she and I both know that smoking will catch up with you. You will eventually pay the price. Both her mom and my dad's mom died from complications related to smoking. In fact, my mom's mom snuck cigarettes into the hospital during her last days. My mom's other sister has gone through chemo several times and I believe continues to smoke. I started smoking (I do not smoke now) while teaching English in Seoul, South Korea. It began as social smoking and continued to deal with stress at the work place. I smoked when back in the U.S. until my then girlfriend basically said she wouldn't deal with it. I chewed the gum for like 8 months. The gum was easy and relaxing, no smell. But 8 months is way too long. When that relationship ended, I went back to smoking. This is all while studying health communication. This was just because it felt good and the cute neighbor girl that lived in the apartment next door also smoked. So we would hang out and smokes cigarettes.I stopped again with my current girlfriend because she wouldn't have any of it. Plus, her nose is amazing-- she can smell clogged pores.

So, why do people smoke? A lot of different reasons that have nothing to do with anyone else or their own health. I knew smoking was bad for me, but the consequences were so distal that it didn't change my behavior. I often wonder whether I would smoke again if Rachel and I were not together. I am not sure. But I don't want my older brothers to bury me at 63, that is for sure. That shit is just too hard. it breaks my heart to see my mother lamenting that she waited until my dad retired to start planning more things with her sister. Now it is too late.

Alcoholism on a College Campus

Before freshman start classes every fall, it is required for them to complete the alcohol education program called AlcoholEdu. According to the website, the program is "designed to challenge students' expectations about alcohol while enabling them to make healthy and safe decisions." (http://www.purdue.edu/alcohol/alcoholedu/index.shtml). 

I applaud Purdue's efforts to address the fact that alcohol is largely seen on a college campus. However, I do not see much information provided to students about alcoholism. Ever since coming to college, I have seen a lot of people increase the amount of alcohol that they consume and alcohol consumption has become normal for people of all ages (including those under-age). It is common for students to binge drink at parties and the standard serving size for an alcoholic drink is largely ignored. Therefore, in my opinion, I believe that college students are at an increased risk to develop alcoholism before they graduate. 

If students are at an increased risk to develop alcoholism, I think that universities throughout the US should put a larger effort to educate their students about the risks of becoming an alcoholic and common signs and symptoms. 

An important thing to note about alcoholism and that substance abuse experts have made a distinction between alcoholism and alcohol abuse. They state that, "Unlike alcoholics, alcohol abusers have some ability to set limits on their drinking. However, their alcohol use is still self-destructive and dangerous to themselves or others." (http://www.helpguide.org/articles/addiction/alcoholism-and-alcohol-abuse.htm). Some students that I have talked to would adamantly refuse that they are alcoholics, "I do not need to drink every day and I can stop when I want to." As the experts listed above, large consumptions of alcohol is dangerous and it could cause harm in the future. 

I think that there should be a large effort to educate students about the signs of a drinking problem:

• "Feel guilty or ashamed about your drinking.
• Lie to others or hide your drinking habits.
• Have friends or family members who are worried about your drinking.
• Need to drink in order to relax or feel better.
• “Black out” or forget what you did while you were drinking.
• Regularly drink more than you intended to"

Source: http://www.helpguide.org/articles/addiction/alcoholism-and-alcohol-abuse.htm

After reading through that list, it made me think about how many times I see friends drink after exams, the black-out stories, and people complaining that they drank too much the night before. 

There should also be a push to explain the signs and symptoms of alcohol abuse:

• Repeatedly neglecting your responsibilities at home, work, or school because of your drinking. 
• Using alcohol in situations where it’s physically dangerous.
• Experiencing repeated legal problems on account of your drinking. 
• Continuing to drink even though your alcohol use is causing problems in your relationships. 
• Drinking as a way to relax or de-stress.

Source: http://www.helpguide.org/articles/addiction/alcoholism-and-alcohol-abuse.htm

I have discovered that there have been times that I have abused alcohol and I didn't know it until I have read through this list. I believe that I am not the only college student that has abused alcohol, which is why I think education on this matter is very important. 

Finally, there are the signs and symptoms that you are an alcholic:

1. Increased tolerance to alcohol: Considered the first major warning sign
2. "Withdrawal: anxiety, trembling, sweating, nausea, insomnia, depression, fatigue, irritability, headache, and others"
3. Alcohol has begun to cause problems in your life, yet you continue to drink
4. Alcohol takes up a lot of you time and focus
5. You give up other activities to drink
6. You cannot control how much you drink.

Source: http://www.helpguide.org/articles/addiction/alcoholism-and-alcohol-abuse.htm

When signs and symptoms get this bad, it is necessary for the person to go to a healthcare provider to seek treatment. It is not an easy addiction to quit and support from family, friends, and others is important to prevent health problems later on in life. 

I think that it is important to educate college students about the dangers of alcoholism, because it is easy to start losing control over your drinking when you are on a college campus. In order to prevent students from becoming addicted, I think it is important to educate them more about the signs and symptoms so they can prevent themselves from abusing alcohol and they could also help others that may be developing a drinking problem. 

Any thoughts?

The Benefits of Stretching

There is a lot of information about the benefits regular exercise has on a person's health and it has become a huge push in the healthcare field for people to get active. However, I have not seen much information about the benefits of stretching.

A family nurse-practitioner wrote a brief article on the benefits seen with stretching in regards to a person's health. Among them, she has listed: "increased flexibility, enhanced coordination, better posture, improved circulation and stress relief."
Source: http://www.healthreachchc.org/news/healthTip.php?IDT=114%20

While stretching should not replace aerobic or strength-training exercise, it is something that people should incorporate into their daily routines.

One researcher wrote an article analyzing the effects of regular yoga practice. The results from the study showed that "yoga practices enhance muscular strength and body flexibility, promote and improve respiratory and cardiovascular function, promote recovery from and treatment of addiction, reduce stress, anxiety, depression, and chronic pain, improve sleep patterns, and enhance overall well-being and quality of life" Woodward, C. (2011). "Exploring the therapeutic effects of yoga and its ability to increase quality of life." International Journal of Yoga, 4(2): 49-54.

Other research has been accomplished that proves the benefits of stretching related to one's health. However, I have not seen stretching prescribed much in the medical field. Has anyone else seen stretching prescribed?

Flu Vaccine---Should You Get One?

Every year, it is required of me as a nursing student to get a flu shot. It will also be required for me to get one every year when I work as a nurse (unless I get a religious exception).

A huge push is made by medical professionals for people to get a flu vaccine every year. This year, however, the flu vaccine has shown to be very ineffective at the strain of flu that is going around.

"Officials say the vaccine does not protect well against the dominant strain seen most commonly so far this year. That strain tends to cause more deaths and hospitalizations, especially in the elderly."

Source: https://www.yahoo.com/health/flu-vaccine-may-be-less-effective-this-winter-104349275592.html

The article listed above goes on to say that in general, a "relatively good" effectiveness of a flu shot vaccine is 50-55% Which means, that even though you get your flu shot, you still have a 50/50 chance of getting ill. 

I remember learning this a couple years ago and I was complaining to a friend about getting the vaccine. Why should I spend money to get poked if it won't work?

My friend, of course, being a good nurse told me that I should get the vaccine in order to prevent spreading the flu to an immune-compromised patient in the hospital. 

However, the shot would not ensure that the patient would acquire the infection regardless of whether or not I had the shot. A nagging question came to mind--> What if the patient acquired a strain of the flu that is not protected by the shot. 

Is there something else that I could do to ensure that I do not get sick and thereby preventing the spread of the disease? According to Harvard Medical School, there are other ways to boost your immune system. 

A publication by Harvard Health Publications states that "Your first line of defense is to choose a healthy lifestyle." This can be accomplished through: eating a diet high in fruits and vegetables, whole grains and low in saturated fat; not smoke; control blood pressure; get adequate sleep each night; exercise regularly; wash my hands and drink alcohol in moderation. 

Source: http://www.health.harvard.edu/flu-resource-center/how-to-boost-your-immune-system.htm

Hospitals do a fantastic job of requiring their employees to wash their hands and use hand sanitizer. However, I do not see hospitals endorsing the other recommendations of the Harvard article. 

Time and time again, I see patients frustrated with their overweight physicians telling them to lose weight. I have witnessed multiple nurses smoking and chewing tobacco during their breaks. With the stress of residency and requiring doctors to work a 24-hour shift, I doubt that they are getting adequate amounts of sleep. 

Along with getting the flu shot, do you think that hospitals should also push these interventions in order to boost the immune system of their staff?

Food for thought. 

Depression Caused by Disease

While I was doing research for my term paper, the subject of depression caused by physical illness came up.

It is proven that certain illnesses can cause a patient with that illness to develop depression. Therefore, the patient is now experiencing both a physical and mental illness.

I want to focus this blog post on depression that is seen specifically in patient's with multiple sclerosis (MS).
"Studies have suggested that clinical depression, the severest form of depression, is more frequent among people with MS than it is in the general population or in persons with other chronic, disabling conditions."

The article I am getting the information for this blog post states that there are many reasons why a patient with MS develops clinical depression.

1. The depression may be a reactive response to the diagnosis
• The depression comes as a result of the stress associated with the disease. MS is a chronic disease, that does not have a cure, and can gradually progress to point of permanent disability. 
2. Depression may be caused by the disease itself
• MS is a demyelinating disease, which means that the myelin sheath that surrounds neurons to aid in signal transmission is destroyed over time. If MS destroys the myelin sheaths in the neurons located in the portions of the brain that control emotions, behavioral changes occur. 
3. Depression may be a side effect caused by medications. 
• Corticosteroids are the most commonly prescribed drug in MS when the patient is experiencing an exacerbation of the disease. This occurs in what is called "relapsing-remitting" MS--the most common type of the disease. 
• Corticosteroids are known to cause emotional changes as one of the side-effects.

I am bringing this up, because I have a question.
           --> Should information about mental health that is included in a global campaign distinguish between chronic mental illnesses and mental illnesses that develop as a result of diseases? Is it necessary to educate the public about the differences between them?

My second question is: Should the treatment between the typical depression and depression caused by MS be the same? Or should people with MS have different treatments/interventions?

Any thoughts?

SOURCE: http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Depression

What to do with informal health providers?

While writing my term paper, which was about water and hygiene (who would've guessed that I'd pick that topic, right?), a theme that kept coming up in review publications was the role of informal water providers. Populations in urban areas that don't have access to a well or improved water source will sometimes rely upon informal water providers to meet their needs. Informal water providers can be mobile or have established distribution points, and may not be subject to any form of quality or pricing regulation. As urban population density continues to increase, it is expected that reliance on these sources will increase as well (1). This is an obvious example of a private enterprises filling in gaps in the public sector's ability to distribute water to urban citizens. While this is necessary for people to gain access to water in some urban areas, there are some potentially negative outcomes of small-scale, private distribution. For example, plastic waste generated from sachet (safety-sealed, plastic bags of water for sale) usage contributes to the physical waste issues experienced in many urban areas. By filling canals and gutters, discarded sachets increase localized flooding and transmission of waterborne diseases during heavy rain events (2). Another example, Informal providers are not necessarily regulated for pricing or quality and there is no guarantee of continual distribution, they can move locations or fold operations at any time. They're not great, but they work.

What about informal health providers? In many low and middle-income countries, informal providers (IPs) cover healthcare provision for significant segments of rural, poor and undeserved populations. Just like in my water provision example above, this is the result of a response to an unavailability of access to formal services. In India, a 2007 survey counted 24,807 qualified doctors (77% worked in urban areas) and 89,090 IPs (90% worked in rural areas). That, to me, indicates a strong presence in healthcare provision and an important standing as the primary source of healthcare provision and consultation in rural areas. In two rural India communities (one in northern and one in southern India) a survey of IPs found that the majority that were practicing had received some state-sponsored training and had apprenticed under a doctor. There appears to have been some professional assocations to supplement state-sponsored training and many IPs maintained relationships with doctors working in the formal sector. It appears that in this particular case the formal and informal providers have reached a working arrangement where they are complementary to one another. Of course there is an open debate on whether IPs should be allowed to practice bio-medicine. Some see IPs as necessary and worth investment in improving their quality of care, and some see them as a public health danger that need to have their practices terminated (3).

What do you guys think, what magnitude of difference in quality of care is allowable while striving to reach a global state of "health for all"? I'm sure I wouldn't be alone if I said that ideally IPs would be replaced by formal providers that were fully accessible to everyone, but we've seen in the course that there is a significant amount of international and state-specific policy work that needs to be done before that could ever become a reality. For now, I think further investment in IPs in low and middle-income nations is important as the rate of urbanization increases across the world. Increasing population densities in major urban areas reduces some of the geographic challenges to reaching everyone who needs healthcare, but the increasing population densities will continue to stretch existing urban infrastructures and resources. State-directed training and certification programs could go a long way towards improving the care received by people who seek out IPs and increase the healthcare provider to patient ratio in urban areas that will be increasing over the coming decades.








Citations:

1. Srinivasan, V. (2013). The impact of urbanization on water vulnerability: A coupled human-environment system approach for Chennai, India. Global Environmental Change, 23, 229-239.
2. Stoler, J., Fink, G., Weeks, J., Otoo, R., Ampofo, J., & Hill, A. (2011). When urban taps run dry: Sachet water consumption and health effects in low income neighborhoods of Accra, Ghana. Health and Place, 18, 250-262.
3. Guatham, Meenakshi, KM Shyamprasad, Rajesh Singh, Anshi Zachariah, Rajkumari Singh, and Gerald Bloom. "Informal Rural Healthcare Providers in North and South India." Health Planning and Policy 29 (2014): 20-29. Web.

Snowpiercer, the Hunger games, and global health (SPOILERS)

POTENTIAL SPOILERS FOR SNOWPIERCER. Also, the views talked about here do not necessarily reflect my feelings on the matter. Just food for thought and something to discuss. I consider myself pretty liberal:

All right, I figured I'd try something a little more fun for this blog post. I recently watched the 2014 movie Snowpiercer. Amazing movie, one of the best reviewed films of 2014, and immensely enjoyable. My favorite movie of the year (I am way behind on this years films).

The basis premise is that humanity froze the Earth when their attempt to reverse global warming backfired. The remnants of humanity survive on a perpetual motion train that travels the globe. Right away, you see that humanity is decided into a North-South dynamic-- the back of the train live in dire circumstances, filthy and malnourished. The front of the train is where the well off dwell. Without ruining the film, which is a truly creative and original, it is enough to say that if you have seen or read the Hunger Games you will be familiar with the films premise-- in order to for humanity or society to function, there must be those that toil for less and with less in order for the rest of us to enjoy some semblance of comfort. Basically, the class system is in place in order to have a functioning society. Somebody has to clean toilets or prepare food or work with their hands. Just not us or our children! (HEAVY SARCASM THERE).

As very little under the sun is new, there is plenty of class politics and modes of production and means of production and the idea of sacrifice to keep humanity moving or humming. I guess I found it interesting for global health because we talk about health for all. If we subscribe to what they discuss in these movies, then health for all is really a way to keep workers healthy and producing. Again, not a very novel argument. But the argument is really that not all lives are equal or deserve access to the same things. I imagine many of us would hold a similar attitude to a degree-- working any job should only give you access to the most basic things. The more "difficult" the task or responsibility you hold, the more you should be compensated. In fact, we had a mini version of this discussion in class when talking about miners being paid marginally more because their work is more risky and the possibility for serious harm is higher.

Health for all appears to mean that we should sever the tie between income and health. The poorest should not suffer from treatable disease. The healthcare system should not be dependent on the ability to afford or access needed services. This really undercuts a lot of what we have discussed this semester from pharmaceuticals to treatable disease. How can we put the combined contribution of society toward those that would benefit-- advances in healthcare deserve to be enjoyed by all. If the argument is that this takes care of those doing work, is that such a bad argument to make?

Men, breastfeeding, and values.

Provocative title, right?

I thought I would take some time to reflect on my last paper on exclusive breastfeeding. Plus, I get to speak from my favorite position: ME!

Two items have me examining both my motivation and reason for writing on that subject:

1) In our COM 600 class, a former critical-scholar-trying-to-go-good-by-being-more-quantitative asked a question whether good research involving a specific population can be done by researchers outside the population. Or, is it more difficult to really help a community when you are an outsider.

2) I told my brother I was writing a paper on exclusive breastfeeding. His response:

So did you just decide to pick a topic you know nothing about and where you have no right to talk about it?

 Hilarious. But it did get me thinking about values and voices in research. Do I think great research can be done from the outside? Of course. But let me pose some questions to get people thinking:

1) What would you say about an all female research team conducting research into men and prostate cancer? About the experiences of men living with prostate cancer?

2) How about an all male team conducting interviews into the lived experiences of women who have had an abortion?

Do you find any issues? Is it about the values or axiology we take into the research? Is research value neutral? Is great research simply great research, regardless of gender, race, or number of arms? (except 3 arms, 3 arms would be suuuuuper weird). I would assume yes. As long as there is an attempt to understand or take on the position of the interviewee or "subject". Think about the word subject, the very word connotes a difference or distance being investigator and the people you are speaking to or studying. In fact, I believe we have moved away from using the word subject to refer to participants in a study.

I speak from an extremely privileged position-- white, well off, male. That is indisputable. If I actually did anything with exclusive breastfeeding research, I absolutely would expect that I would have to work reflexively. That I would need to constantly question my assumptions and the purpose of the research. I wrote the paper and of course there are a million things I still don't understand and a million ways to experience or think about the issue. I asked my friend Lori, who is a nurse that works in the prenatal unit, about exclusive breastfeeding. She said that they always try to have the baby nurse within the first hour, but sometimes the baby won't latch or the mother is simply too tired. She also said that there is a ton of pressure on mothers to breastfeed, that this can result in a lot of guilt. I absolutely had not thought about this last point whatsoever. There always is something new to learn and something that you can't understand from an outsiders perspective. Are any of us in this class mothers? Suffer from mental illness? Abused drugs or sought treatment for it? Something to think about.

Sickle Cell Disease: Babies, Migrants, & Mental Health

Imagine that you have been experiencing frequent episodes of excruciating pain since the age of six. Imagine having a condition that not many people, including physicians, understand.  Imagine not expecting to live to see your 50^th birthday.  Unfortunately, these are realities for many people living with sickle-cell disease (also known as sickle-cell anemia).  Based on the limited literature and data available on the disease, it seems to be an understudied and often misunderstood condition that has serious health consequences.  Globally, nearly 5% of the population carries the trait genes for haemoglobin disorders like sickle cell anemia (World Health Organization (WHO), 2011).  Sickle-cell disease is linked to a variety of global health concerns, including: infant and child mortality, migration, and mental health.  

Sickle-cell disease causes the disfigurement of the red blood cells, resulting in restricted blood flow and blockages to all parts of the body (WHO, 2011).  Individuals living with sickle-cell disease are susceptible to chronic pain, tissue death, and serious bacterial infections (WHO, 2011).  The life expectancy for an adult with sickle-cell disease is 42 to 48 years of age (Platt, Rosse, Milner, Castro, Steinberg, & Klug, 1994).  Sickle-cell disease can only be cured by a bone marrow transfusion (Chakrabarti & Bareford, 2004).  Unfortunately, for a variety of reasons, this is not a feasible option for many sickle-cell disease patients (Chakrabarti & Bareford, 2004).  

 

Infant & Child Mortality

Infant and child mortality continues to be a major global health concern, especially in low- and middle-income countries (see WHO, 2014).  More than 300,000 babies are diagnosed with serious haemoglobin disorders like sickle-cell disease every year (WHO, 2011).  Most of these babies are born in low- and middle-income countries (WHO, 2011).  According to WHO, 50% to 80% of the infants in low- and middle- income countries who are born with sickle-cell disease die before they reach 5 years of age.

Migration

Even though sickle-cell disease is most prevalent in tropical regions, it is estimated to affect 90,000 Americans.  It is most common in Black or African-Americans.  In fact, 1 out of 500 Blacks or African-Americans are born with sickle-cell disease (Centers for Disease Control and Prevention (CDC), 2011).  It is said that the disease was spread to most countries by migration (WHO, 2011).  I think this is interesting based on our class discussions on migration.  This seems to be a unique example of how migration can affect subgroups within a host country.  Sickle-cell disease could be a result of forced migration from the slave trade or voluntary migration.

Mental Health

Similar to other chronic conditions, sickle-cell disease not only affects an individuals physical health, it can also greatly affect his or her mental health.  Studies have found that sickle-cell disease causes painful episodes, deteriorated vision, anemia, and depression (Jenerette, Funk, & Murdaugh, 2005).  One major reason for this is that others often stigmatize individuals living with the illness, including physicians (Jenerette, Funk, & Murdaugh, 2005).  I think sickle-cell disease offers us another illustration of why patients would benefit from the integration of physical and mental health.

There seems to be a great opportunity to build on the research on sickle-cell disease.  As I mentioned earlier, this appears to be a very understudied topic.  Additionally, it raises questions about who decides which health conditions are important.  I think it also provides evidence that a focus on global health is essential because health issues can breach geographic boundaries and international borders.

Works Cited

Centers for Disease Control and Prevention. (2011, September 16). Sickle Cell Disease (SCD). Retrieved December 4, 2014, from Centers for Disease Control and Prevention: http://www.cdc.gov/ncbddd/sicklecell/data.html

Chakrabarti, S., & Bareford, D. (2004). Will developments in allogeneic tranplantation influence treatment of adult patients with sickle cell disease? Biology of Blood & Marrow Transplantation , 10 (1), 23-31.

Jenerette, C., Funk, M., & Murdaugh, C. (2005). Sickle cell disease: A stimatizing condition that may lead to depression. Issues in Mental Health Nursing , 26, 1081-1101.

Platt, O. S., Rosse, D. J., Milner, W. F., Castro, P. F., Steinberg, M. H., & Klug, P. P. (1994). Mortality in sickle cell disease. Life expectancy and risk factors for early death. New England Journal of Medicine , 330 (23), 1639-1644.

World Health Organization. (2011, January). Media centre: Sickle-cell disease and other haemoglobin disorders. Retrieved Dec 4, 2014, from World Health Organization: http://www.who.int/mediacentre/factsheets/fs308/en/