International Health Leadership

So many ingredients must go into a health initiative to ensure its success.  The money must be there. A sense of collaboration and cultural awareness. The manpower, sometimes with a particular skill set.  The technology.  But all of this must come together under a source of strong leadership.

Simon Sinek: How Great Leaders Inspire Action

This TED Talk was shared with me recently and I love how broadly it can be applied across various aspects of our lives, including work in international health.  I would highly recommend watching the full 18 minutes, but if you are short on time, he explains his main idea 1:40-4:40 (also love the beautiful analogy he makes to human brain function at 5:50).  I believe a broad definition of leadership is any way to inspire desired behavior, which is the goal of health campaigns. However, we know from countless international health examples that this often fails (remember Lala mentioned a 5% success rate among public health initiatives).  Then there are the times that the goal outcome is achieved, but by questionable means that may impinge on future progress, as was the case with forced smallpox vaccination.  Leaders of health initiatives, whether they’re directing the WHO or working on a specific case at a local level, could have a lot to learn from Sinek’s method of leadership, called the golden circle (see graphic).  

The circle asks three questions about your initiative: why, how, and what. Most communication in our day-to-day lives is rather uninspired, working from the what to the how and never touching the why. Example: “I’m exhausted and I need a coffee (what), so I am going to run to Starbucks (how).”  But why are we exhausted?  Why is Starbucks the answer? Why have we fallen into this pattern?  Now let’s take an international health example.  “HIV/AIDS is a problem in your village and people are dying (what).  We are going to treat the afflicted with this medication and we are going to teach safe sex practices (how).”  Why doesn’t this approach always work?  The facts are there, and they are indisputable.  But the approach lacks a deeper connection.  It lacks empathy.  It lacks why.  Senik points to the example of Martin Luther King Jr., whose famous line “I have a dream” did not start with what or how, but with why: his purpose was his belief, and that was what inspired so many and brought about remarkable change.  Senik’s catchphrase, if you will, is “People don’t buy what you do; they buy why you do it.”  He repeats this again and again.  Though in some cases the what/how might be enough to spur change, the why has infinitely more power to inspire.  It also necessitates deeper introspection into the cause and mission of a health initiative and how to connect it to the local people.  It turns a mandate into a mantra, a plan of action into purposeful action. 

What do you think of Senik’s model? What are other important components of public health leadership and inspiration?

Global Control of Vector-borne Diseases

Diseases like the Zika virus and the West Nile virus are evaluated and worried over by the world.  The threat of Zika making it to the United States caused great concern this past summer.  Luckily for the States we only had travel-related cases until the very end of the summer.  Vector-borne and zoonotic diseases have been emerging as great problems for the world.  This is another part of the history of disease changing.  Concern for these diseases started appearing in the past three decades (Kilpatrick & Randolph, 2012).  My experiences at the Montgomery County Health Department taught me how much effort can go into vector control programs.  In that county, we set traps to catch and identify different types of mosquitoes.  We sent these mosquitoes off to the Indiana State Health Department to be further tested for disease.  West Nile virus has been located in Montgomery County.  Using adulticide spray and larvicide dunks, we tried to control the problem before it got out of hand.  I wanted to know what new steps the world is taking at large to gain control over the vector-borne diseases.  Kilpatrick and Randolph make the argument that clinicians are just as important as epidemiologists for the control of these outbreaks.  Once the disease has been defined, it is the clinician’s job to properly and quickly identify the disease.  We are more often seeing these diseases spread from human to human hosts.  Examples of this are dengue fever and malaria.  The Zika virus has also been known to be transmitted by sexual contact.  This is why it is so important for clinicians to understand and diagnose the diseases in an efficient manner.  The clinicians and epidemiologists face the difficult task of separating out the different vector-borne illnesses because of their similar symptoms.  This is one method of vector control.  Other countries are looking more at fixing the problem at the source.  In China, they hope to prevent mosquitoes from being able to carry the diseases and thus prevent the spread.  Kilpatrick and Randolph agree that continued work needs to be done.  Developing countries are at a disadvantage because of lacking finances and technology.  Globalization is one of the reasons these vector-borne illnesses have spread.  It will take a global effort to maintain control over any more growth for these diseases.

References:

Kilpatrick, A. M., & Randolph, S. E. (2012). Drivers, dynamics, and control of emerging vector-borne zoonotic diseases. The Lancet, 380(9857), 1946-55. doi:http://dx.doi.org.ezproxy.lib.purdue.edu/10.1016/S0140-6736(12)61151-9

Open Defecation Problem in India

Last class, we had an interesting speaker who talked about the problem of open defecation in India. The speaker emphasized the cultural aspect of the problem. Although, I totally agree that understanding the cultural influence and achieving a high level of cultural competence is crucial before designing any intervention, I believe that we should deeply investigate what is behind these cultural factors. People tend to go for open defecation because they prefer the open air and for socialization especially for the females. However; they were not provided by the ideal latrine that could help modifying their deeply rooted cultural norms regarding open defecation. The latrines that they were supplied with were not well ventilated, with bad smell, dark, accessible to animals and snakes, and most importantly, from my point of view, is that such pit latrines need to be cleaned manually and without water. Such way of cleaning pits will increase Indians cultural resistance and will make their social construction of reality regarding using open defecation versus latrines more deeply rooted as such latrines will remind them with the historical caste prejudice of the colonial practices. In my opinion, such intervention by the government to combat the problem of open defecation was the worst proposed solution to the problem. The speaker emphasized that even if the ideal latrines were provided to Indians, they would not use them because of their cultural influences. However; I have some reservations on this idea. Despite, few Indians link open defecation to health, they have many other negative concerns regarding open defecation such as female embarrassment and sexual harassment, risk of robberies, risks of going out at night, slipping in feces, animal attacks, parasites, flies and mosquitoes … etc. Such negative concerns are ideal points for public health interventions to tackle this problem as they will be cultural facilitators if the ideal alternative is present. However; the main obstacle which, from my point of view, is the lack of water, will remain as the major challenge. How can we provide such ideal latrine without adequate water sources? How can we convince Indians to stop open defecation and they see it as the cleanest and best solution?

In my opinion, intervention to this issue will not be successful without directing our scope to water problems. Diarrhea is the second leading cause of death among Indians with lack of safe water being the key underlying cause. This is another incentive to tackle water problems. Water and sanitation are interrelated and influenced by one another. Cultural values and individual behavior modifications regarding open defecation cannot be attained without making the environment conductive to such modifications and this cannot be achieved without prioritizing water problems. Guaranteeing safe water is no longer a privilege, it is a right, necessity and political obligation. 

Naturopaths Without Borders: the movement toward naturopathic global health

Naturopaths Without Borders: the movement toward naturopathic global health

Naturopathic medicine is something we haven’t touched on very much throughout the semester, and having researched cultural practices when dealing with maternal breastfeeding behaviors in developing countries, I wanted to examine the profession of natural medicine and their efforts on the frontlines of global health.

Naturopathic Doctors (NDs) have found that natural medicine has been increasing in popularity in recent years as an acceptable form of treatment, speaking to the increasing “trend toward naturopathic global health” within the industry (Marchese, 2013). Organizations such as Naturopaths Without Borders have flourished and have developed intervention programs to tackle global health issues such as malnutrition. Consistent to what has been discussed in class, successful programs are those with scheduled approaches experiencing greater coverage and some built around Social Learning Theory. Coming across a narrative article by a North American ND- “Naturopathic Medicine Serving Underserved Communities” (Marchese, 2013)- on her efforts in Haiti however, questioned my advocacy for their efforts. Marchese describes her work with NWB in saying “[…] did not arrive with any expectations besides the expectations placed upon me as an experienced ND to […] supervise and teach naturopathic medical students”. How is this ND being trained by organizations such as NWB to work in developing communities with little inclination as to what she may be exposed to, and the stresses that she may be causing on their local systems? Is it wrong to not go into such communities without a purpose besides the ‘selfish’ means that come with public health professions?

 

Second, the malnutrition program as Marchese describes also teaches local parents about healthy diets and what malnutrition is. Are these practitioners being sensitive to the idea that they may be living on what may or may not be available to them as they are restricted by several underlying factors? Also, giving any regard to traditional food preparations underlined by cultural determinants? As a relatively new organization and approach to tackle global health problems, NWB from an initial investigation, has much to incorporate in terms of cultural sensitive training and even perhaps more efforts on research.

 

A final question I pose is the sustainability of this approach in the arena of global health with such intervention programs typically being more reliant on greater financing and even altercations of diet versus taking prescription medication. Would such practices be harder to change behaviors than traditional prescription medication?

 

What was promising however, was the idea that they approach global health issues based on the same principles guided by the profession such as identifying the causes and treating such causes as well as treating the whole person (Marchese, 2013).

 

I look forward to thoughts! 

Reference 

Marchese, Marianna (2013). Naturopathic Medicine Serving Underserved Communities. Natural Medicine Journal, 5(10).  

http://www.naturalmedicinejournal.com/journal/2013-10/naturopathic-medicine-serving-underserved-communities

Health of Prisoners

      More than 10 million people are incarcerated worldwide. Of these 10 million, the U.S. accounts for 2.3 million, 1.6 in China, and 0.9 in Russia and India, Thailand, Iran, Indonesia, Turkey, Brazil, Mexico, South Africa, and Ukraine with about 100,000 people (Fazel & Baillargeon, 2010). Prisoner populations have many health problems including, but not limited to, high rates of suicide and mental illness, infectious diseases, and chronic diseases. Generally, the rates of these diseases are higher inside prison walls than in the general population. I am interested in finding out if these individuals enter the prison with poor health possibly because of low SES, race, or ethnicity as the social determinants, or if the prison is a contributing factor to poor health.

      Several papers that I've read recently discuss the affect of prisoners health on population health. These are related because unhealthy, risky prisoners are released back into the community without being treating for physical or mental illness, and without have going through interventions for drug and/or alcohol abuse. When released from prison, depending our the duration of incarceration, one may have to start from ground zero. They may have no family support, most likely have trouble finding employment, and not have the resources to take care of any physical or mental illness. Because of these factors, they are very likely to go back to risky behaviors. In fact, the death former inmates is over 12 times that of other state residents 2 weeks after release (Binswanger et al., 2007). The most elevated risk (129 times that as state residents) is from drug overdose.

      It is clear that prisoners face many challenges, emotionally and physically. Some would argue that prisoners don't deserve equal healthcare and rights, but some would advocate for the opposite. In specific to public health, the health of prisoners is not only detrimental to them, but can also havea  negative effect on community members after their release. Just as culture is many times seen as a barrier rather than a strength, high prevalence of physical and mental illness in prisoners present a challenge, but also can be seen as an opportunity. Holding interventions and providing equal healthcare services in prisons can positively affect our society and hopefully reduce the rate of re-incarceration.

      Do you guys think that prisons should have these services? Do you think the health and safety of innocent community members is in jeopardy because of lack of treatment and intervention of prisoners?  Do you know of any of these services provided in the U.S. or other countries?




References
Binswanger, I.A. (2007) Release from Prison- A high risk of death for former inmates. The New England Journal of Medicine, 356. 157-165.

Fazel, S. & Baillargeon, J. (2010). The Health of Prisoners. The Lancet, 377. 956-965.

Opioid Addiction

Last night I watched “Last Week Tonight” with John Oliver, where he talked about the opioid abuse epidemic that is occurring in the United States.  The topic is heavy but he lightens it with some political humor.  I would encourage you all to watch it, because besides the humor it is unfortunately accurate:

https://www.youtube.com/watch?v=5pdPrQFjo2o

This topic hits me hard because I peronally know someone who is addicted to opioids.  Every time I hear the topic brought up I want to ignore it, pretend it’s not happening, and deny that it’s an actual problem in the States.  But the said truth is that it is a problem, a big problem.  It makes me mad to think how big pharma companies (cough Purdue Pharma) can get away with this sort of unethical, unmoral, and most importantly harmful behavior.  I couldn’t help but think about those readings on Transnational Corporations (TNCs) we had a few weeks ago.  That this business has the same rights as individuals, and that they are just running a business.  They have a product (Oxycotin), they market it (heavily), and they have become very successful.

However, fingers can’t be pointed in one direction.  I feel the issue is systemic.  Under the new healthcare system (the ACA), physicians are reviewed based on quality versus quantity (aka on number of procedures, patients, lab tests, etc.); this is referred to as “pay for performance” [1] and is better than the old system, for the most part.  The problem lies when the United States is one of only two (think about that – there are 196 countries on Earth), that allows direct-to-consumer drug ads [2].  Patients see these ads on television or in magazines or literally anywhere, with the friendly notion to “Ask your doctor about…”.  These patients enter the family practice or hospital setting and feel empowered to ask the physician for these drugs, specifically in this situation opioids, and would probably rate their experience and satisfaction as low if they did not receive these drugs that are marketed to be “life-changing” [3].  The physicians are then put between a rock and a hard place.  The patients are unknowingly in the same position as well, having to choose between living with pain or living with addiction.  In my experience in my nursing capstone in the Emergency Department, it was not uncommon for me to encounter (excuse any stereotype) drug-seekers, most commonly opioid-seeking patients.  The reality is sad, these patients are undoubtedly experiencing pain, but opioids are addictive and harmful and easily abused, and NOT the correct medication for most pains (excluding end-of-life treatment and cancer pain).

I have some recommendations of my own (for when I become president and change the world of course), but I want to hear yours.  What could or should be done to reverse this epidemic?  And since this is an international health class and not just a public health class, do you feel this is a global health issue?  Are public health students in the UK studying this epidemic in America thinking “yikes.. they have a really public health issue”?  Should international organizations become involved (i.e. WHO)?

[1] http://journalofethics.ama-assn.org/2015/07/ecas3-1507.html

[2] http://www.who.int/bulletin/volumes/87/8/09-040809/en/

[3] https://www.youtube.com/watch?v=5pdPrQFjo2o

A Sexual Health Lesson from Thailand

Because we did not have much time in class Tuesday to discuss it, I would like to take this blog post to comment more on Mechai Veravaidya’s Ted Talk, “How Mr. Condom Made Thailand a Better Place.”  There were many clear strengths in this program and it is a strong example of how to promote change in an individual behavior at a societal level.  As we discussed in class, many public health campaigns center their efforts around educating the individual on proper health behaviors, without looking at the confounding factors at the societal level that may make this behavior unpopular or infeasible.   Condom use, for example, is complicated by access to condoms, understanding of their effective use, and the consent of all involved people to use them.  Apart from these direct causes, other indirect causes affect their perception in the public sphere; these include religion, opinions about sexual behavior and sexual education dissemination, and social norms regarding sexual activity. 

The folks in Thailand clearly had a lot working against them, with a 3.3% growth rate in 1974 and a resurgence of sexual health issues when HIV/AIDS hit some years later.  Especially coming from a U.S. perspective where sex ed has been overtaken by abstinence-only programs, I must say that my single favorite part of Thailand’s program was their presence in the schools.  I believe this is a must for any public health campaign; children learn easily and can more quickly adapt their behaviors while adults may be more resistant due to lifelong habits.  As cliché as it sounds, children are also the future and even if behavior adoption is not 100% in the adult population, making an impact on the youth of a community can spell out great success later down the road, when they practice the desired health behavior and pass it on to their own children. 

The other great thing this program did was remove stigma by cementing the condom into popular culture.  They made art and t-shirts, board games and superheroes.  Condoms are available in coffee shops, not only in some corner aisle of the drug store where people are embarrassed to be seen as is the case here in the U.S.  Condoms in mini-bars at hotels is an ingenious idea, and also represent an honest perspective by acknowledging that alcohol use can lead to risky behaviors and that being prepared is a better strategy than pretending things like this don’t happen.

Because condoms are not 100% effective, I would be interested to see if Thailand has seen an increase in the use of other methods of birth control as well, such as the pill or implant, and what their policy on emergency contraception is.  It seems that since their condom program has been so effective, it may be easier to increase usage of other methods now that the stigma around sexual and reproductive health has been somewhat lifted.  I believe many other countries, including our own, have a lot to learn from this public health initiative.

Global Veterans' Health

While browsing the internet this past week, I found a picture captioned “Remember the female veterans”.  This was not a strange request, but it was the picture that truly captured my attention.  In the picture, these beautiful and strong women were all amputees.  Whether it was a single leg, arm, or both all of the women had been injured in some way.  That is what shocked me so.  I have no recollection of seeing women veterans and their permanent injuries.  Looking at female veterans would be an interesting topic of study.  But this is international health and the comparison of veteran health between countries is also fascinating.

It appears one of the biggest challenges faced by veterans returning from deployment is reintegration into the community.  The World Health Organization (WHO) has an assessment titled International Classification of Functioning, Disability and Health (ICF).  According to Resnik et al., the 2007 ICF was performed to assess to difficulties of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans reintegrating into their communities.  Veterans and caregivers alike were interviewed on the problems they face.  Open-ended questions were asked so the two groups could express what their most important challenges were.  In this study, decision making was difficult for veterans with polytrauma.  It was often the case that the Post Traumatic Stress Disorder (PTSD) victims second guess themselves.  They also could feel overwhelmed by making these decisions or not feel confident in their decision making abilities.  The veterans were also questioned on their abilities to perform everyday tasks.  Difficulties included getting distracted and working in the proper order of tasks.  I believe future research will need to be done on veterans’ health.  A more in depth comparison between different countries’ veterans would not go remiss.  Until this study is done, remember United States veterans on November 11^th for Veteran’s Day.  Australia, Canada, and Great Britain also have remembrance days on or near this date.  While not everyone may agree on governments’ military spending and other factors, veterans are still the brave and patriotic people protecting us.  They are also the ones to put their health at risk to perform their duties.

Resnik, Linda J, PhD,P.T., O.C.S., & Allen, S. M., PhD. (2007). Using international classification of functioning, disability and health to understand challenges in community reintegration of injured veterans. Journal of Rehabilitation Research and Development, 44(7), 991-1006. Retrieved from http://search.proquest.com.ezproxy.lib.purdue.edu/docview/215285969?accountid=13360

Gender Bias in Breastfeeding Behaviors in Developing Countries

Gender Bias in Breastfeeding Behaviors in Developing Countries

In diving into breastfeeding behaviors in developing countries, I have come across a few articles that have found that there are certain gender biases that exist in regions with regards to exclusive breastfeeding behaviors (Fledderjohann et al., 2014; Fujita et al., 2012; Jain, Tyagi, Kaur, Puliyel, & Sreenivas, 2014). Can this be attributed to particular cultural ideologies and if so, should public health interventions approach the topic of breastfeeding with simply this in mind, or should there be an intervention of its own on female equality?

 Countries such as India have been investigated and researchers have found that in some of these areas, there was over 10% difference in males being breastfed more often in Delhi, and 21% lower breastfeeding rates among females in other regions (Fledderjohann et al., 2014; Jain et al., 2014). In Sub-Saharan Africa, males were breastfed for a longer duration in comparison to females (Fujita et al., 2012; Chakravaty, 2012). Jain et al, (2014) linked this gender bias difference in breastfeeding behaviors to postpartum depression and found that mothers of girls in Delhi had a higher rate of postpartum depression and less likely to breastfeed. In searching as to possible reasons as to why this can occur in communities, I came across the discussion of having the preference for boys versus girls in families. Chakravaty (2014) discussed the fact that this gender bias of breastfeeding is linked to the presence of a “son-biased fertility choice” in both India and regions in Africa, and a possible attributer to postpartum depression. These breastfeeding behaviors have of course also been linked to an 11% greater chance of dying among females before the age of five (Fledderjohann et al., 2014).  

I became torn when trying to analyze how public health professionals should approach a concept such as this. The preference for a son has been evident in these cultures, and as it is part of a cultural construct, should there be an attempt to ‘remove’ this ideology from these communities? I am largely opposed to any intervention attempting to change ANY cultural ideology; however, at the same rate, there is a large social justice issue with regards to life and death situations of females being threatened. My question to all is what is your opinion on this? How should we approach a change that needs to be made in breastfeeding behaviors among developing communities? Also, of separate programs are needed, which should be tackled first?! 

References 

Fledderjohann, J., Agrawal, S., Vellakkal, S., Basu, S., Campbell, O., Doyle, P., … Stuckler, D. (2014). Do Girls Have a Nutritional Disadvantage Compared with Boys? Statistical Models of Breastfeeding and Food Consumption Inequalities among Indian Siblings. PLOS ONE, 9(9), e107172. https://doi.org/10.1371/journal.pone.0107172

Fujita, M., Roth, E., Lo, Y.-J., Hurst, C., Vollner, J., & Kendell, A. (2012). In poor families, mothers’ milk is richer for daughters than sons: A test of Trivers–Willard hypothesis in agropastoral settlements in Northern Kenya. American Journal of Physical Anthropology, 149(1), 52–59. https://doi.org/10.1002/ajpa.22092

Jain, A., Tyagi, P., Kaur, P., Puliyel, J., & Sreenivas, V. (2014). Association of birth of girls with postnatal depression and exclusive breastfeeding: an observational study. BMJ Open, 4(6), e003545. https://doi.org/10.1136/bmjopen-2013-003545

Chakravarty, A. (2012). Gender Bias in Breastfeeding and Missing Girls in Africa: The Role of

Fertility Choice. Mimeo.

Health AND Human Sciences

This past week on Monday night, I had the amazing opportunity to meet the man, the myth, the legend, Dr. Paul Farmer.  He has been my biggest idol for many years, and is one of the many reasons I chose to pursue a career in public health.  At his lecture, he spoke mostly about Hurricane Matthew and MDR-TB.  At the end of his lecture however, audience members were allowed to go up to the microphone and ask questions.  I did not get the opportunity to ask him how he is so awesome (sorry guys) but a professor (this was held at IUPUI) in sociology asked Dr. Farmer an important question: how has your anthropology background helped you in your medical career?  Dr. Farmer answered poetically, and I’m paraphrasing, “Every time I go to a field or see a patient, I am an anthropologist first and a doctor second; I appreciate learning about cultures, and it has made me a better doctor.” 

This question and Farmer’s answer sparked in my mind again when I read the D. D. Mara’s article “Water, sanitation and hygiene for the health of developing nations” for this next week.  In it the author writes, “Rural water supply and sanitation is essentially simple engineering but much less simple sociology, and there needs to be a good and sustained programme of hygiene education so that people with an improved water supply and improved sanitation know how to use them to maximize the benefits to their health” (p. 454).

So clearly this week has really got me thinking about how critical the social sciences (anthropology, sociology, etc.) are to the medical sciences.  I do not think I could be a nurse without taking the anthropology, public health, and ethics courses that I did and continue to take.  Like Farmer said, I think a lot more credit or emphasis needs to be given to these courses and this type of human science.  I know a lot of students who have not taken courses like these but want to work in the field of medicine.  What do you all think?  Should health professional students be required to take social sciences courses?  How critical is it to medicine?

Vaccination between personal choice and epistemic violence

Last class Chris raised the ethical concern regarding vaccinations and how obligation is totally non-acceptable. Although I, personally, totally agree with that, I believe that the debate in this issue will remain for a long time. During my study as a dental student, I learned about the code of ethics for a dentist which is based on five main principles which are: patient autonomy, non-maleficence, beneficence, justice and veracity. However; when I was studying for my boards a couple of months ago, I realized that a new concept was added which is: avoid paternalism (do not act as if you are the parent of the patient and take his own decision). Although, I thought that this concept is a further explanation of the concept of autonomy, I believe that such an addition spots a light on the essentiality of the freedom of choice. Your role, as a dentist, is to provide all information, then let the patient take his own decision. Do not go for paternalism, otherwise this will be some sort of epistemic violence.

Actually, I argue for vaccination in a similar way. We, as public health professionals, should have the proper communications with the public to target their concerns regarding vaccination. We should work hard to provide all information in a way that they can understand well. If we fail, we should be brave enough to return to ourselves and look for the cause not just blame the people behaviors, cultures or levels of intelligence. We should apply this reflectivity in order to identify the problem, know how to deal with it and avoid epistemic violence. However; regarding vaccinations, there is usually an argument about the validity of being a complete personal choice especially during times of outbreak or for health care workers. During periods of outbreak, herd immunity is broken and there is a national or even a global threat. Should vaccines still be a respectful personal choice or we should move to protect the whole population? In the same context, health care workers are considered as reservoirs for infectious diseases. They act like a vehicle transmitting diseases among patients and even to people outside the medical field. That is why; if they are not taking care of their own health by deciding not to take vaccines (personal choice), they must care about others’ health. I read before that Johns Hopkins has an obligatory policy with their health care workers regarding taking the flu vaccine in order to protect patients and the whole community. Such a policy maybe ethically offensive to some but totally acceptable for others. Explicitly, the personal choice should be always respectful. However; vaccination debate will continue in some situations in which the clear vision of whether it is a complete personal choice or it is more about the community right to survive and keep healthy is still hazy.

Safe Drinking Water

According to the CDC and USAID Water and Development Strategy approximately 800 million people do not have access to improved dependable clean drinking water source, with about 2.5 billion lacking access to modern sanitation. The disease burden associated with unsafe drinking water and sanitation is great. Diarrheal disease is one of the leading causes of morbidity and mortality especially among children under age 5. The concept of clean water and safe sanitation is essential to health, as water and sanitation services have significantly improved health and engendered many secondary benefits.

The adverse health impacts attributable to lack of water and sanitation are significant. Reliable safe water at home prevents not only diarrhea but guinea worm, waterborne arsenicosis, and waterborne outbreaks of diseases such as typhoid, cholera, and cryptosporidiosis. Girls are more likely to be responsible for collecting water for their family, making it difficult for them to attend school and thus forgo potential opportunities to engage in small business endeavors. Initiatives such as tricycle carts generally encourages boys to collect the water, thus freeing time for the women to engage in more productive uses.

Researchers should focus on the sustainability of water and sanitation services by developing strategies that holistically address the influence of the environment, culture, and economics on the implementation and long-term maintenance of treatment systems. For interventions to be effective in reducing risk and blocking pathogen pathways, they must consider the environmental, cultural, and economic conditions of a particular community. Interventions should consists of these steps: point-of-use treatment of contaminated water, safe water storage, improved hygiene, behavior change techniques.

The majority of people who die due to lack of access to clean and dependable drinking water as well as diarrheal disease are mostly children.  Access to safe water and sanitation is not a privilege it’s a right.

Influence of the Workplace on Health

        In a few classes recently, we have been talking about ecological models. As I highly support that all levels from society to the individual need to be addressed in order to make health behavior change feasible, I think it is really hard to make strong interventions at each level when using this model. This model has been used a lot with increasing physical activity, one of my biggest interests. The use of this model addresses the need for the safe environment and resources, social support, and personal values and attitudes towards physical activity. One think I was wondering is where "time", one of the most reported barriers to not engaging in sufficient PA, would fit in. This then led me to think about my internship last summer that took place at a corporate wellness company.
      I thought time might fit in at the organizational/societal level, because the norm in the U.S. is 40-hour work weeks with the addition of caring for a family and your personal life. Some companies have already adopted "personal time" into the work day for their employees. For example, Apple allows employees 30 minutes a day to meditate. Companies such as Google, Nike, and Yahoo! also have meditation spaces and group fitness classes available for employees. Fitbit, another company leading in wellness programs, provides treadmill desks and a voluntary comprehensive wellness program including incentives and competitions among employees. During college, there are so many health resources and so many influences on your health. Once you enter the workplace, I believe your primary influence is your work environment and the people you work with. That is why I beleive corporate wellness programs are so important. They allow employees to time to relieve stress and improve their health, which in turn, the ultimate goal is to have healthier. more productive employees who feel that their employer cares. Even if your workplace does not pay for you to exercise or provide treadmill desks, having a a positive health-focused environment I believe can really have an impact on one's attitudes towards adopting a health lifestyle.
     In my ideal world,  pizza & donuts wouldn't be allowed at meetings, and every employee would be provided the opportunity and the resource to exercise, meditate, etc. for 30 minutes of the work day :)

A Critical Look at the SDGs

After the Sustainable Development Goals (SDGs) were brought up in our last class discussion, I ran across an article in Lancet that attempted to quantify early progress in the health-related SDGs (GBD 2015 SDG Collaborators, 2016).  Measures from the Global Burden of Disease Study (GBD) of 2015 were used to quantify 33 SDG health indicators.  As you may know, the SDGs are composed of 17 primary goals, with 169 targets and 230 indicators, and will serve as the framework for development from 2015-2030.  In this study, an SDG index was developed to give an overall picture of health in each nation; the highest scoring included Iceland, Sweden, and Singapore, while the lowest were Central African Republic and Somalia (GBD 2015 SDG Collaborators, 2016).  Factors that could severely impact the SDG index score in a positive way included universal health care, family planning, and hygiene.  When comparing the SDG index (for health) to the Socio-demographic Index, a few countries proved surprising, either by having worse SDG progress than expected (Russia, India, and the U.S.) or better (Uruguay, Maldives, and Morocco) (GBD 2015 SDG Collaborators, 2016).

While these numbers and indices and statistics can show interesting trends, criticism abounds for the convoluted structure of the SDGs.  William Easterly suggested SDG may as well stand for “senseless, dreamy, garbled” (Easterly, 2015).  He complains that much of the content is too vague and full of wishful thinking, and that by attempting to make such a wide range of topics a “priority”, it turns out that nothing is a priority.  Another slant of criticism is articulated in Devi Sridhar’s comment in response to the Lancet article I described above.  Sridhar realizes the importance of statistically significant results for the sake of maintaining aid funding, but she challenges the notion that the numbers always spell out the answer for developing nations, who all have their own development priorities that are not always reflected in the numeric representation of their struggle.  As she beautifully articulates, “This view raises a larger question of why heavily modelled numbers exported from Seattle or Washington, DC, USA, are taken as the benchmark for what poor people require, over their own voices, and whether global health has moved to such abstraction that statistical models, imputations, and programming no longer resonate with the reality of people's lives” (Sridhar 2016).

So what do you guys think?  Do the SDGs establish a strong framework for sustainable development, or do they lack clarity or priority?  How do you feel about the reliance on indices and data?  What role do these numbers have to play in relation to the voices of local people?

References:

Easterly, W. 2015. The SDGs should stand for senseless, dreamy garbled. Foreignpolicy.com. Accessible at http://foreignpolicy.com/2015/09/28/the-sdgs-are-utopian-and-worthless-mdgs-development-rise-of-the-rest/.

Sridhar, D. 2016. Making the SDGs useful: a Herculean task.  The Lancet 388;1453-1454.

GBD 2015 SDG Collaborators. 2016. Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015.  The Lancet 388;1813-1850.