Positive Youth Development Programs: PALS

After our discussion in last night's class I felt that it would be interesting for some of you to learn a little bit more about Positive Youth Development (PYD) and PYD programs. PYD refers to intentional efforts put forth by other youth, adults and communities for youth to enhance their interests, skills and abilities in throughout life and into adulthood. There are many programs that could be considered PYD's: Girl and Boy Scouts of America, Young Life Programs, NFL Play 60 and many more. "Positive youth development is a philosophy of child and adolescent development that holds that all people have strengths and the potential for positive change (Benson, Scales, Hamilton, 2006). PYD programs are structured to build assets such as self-esteem, competence, and prosocial behavior rather than focusing on reducing deficits such as antisocial behavior (McDonough, 2013). PYD programs have potential to promote positive change in the lives of many youth, but evidence has shown that they may have a particular potential to promote positive outcomes in low-income populations. This is possibly due to the fact that these individuals have limited access to material and social resources, physical activity, lower academic achievement, and greater incidence of health problems such as being overweight, obese, or depression (McDonough,2013). There is growing evidence suggesting that a positive relationship between youth and program staff and having a caring climate in physical-activity based PYD programs predict emotional regulation, empathetic self-efficacy, and prosocial behavior (Catalano et al.,2004).

Purdue University has it's very own PYD called PALS- Purdue Athletes Life Success Program. PALS is offered to those youth and adolescents aged 8-14 that reside in Tippecanoe County that are at or below federal poverty guidelines. We access these individuals through the surrounding school corporation's list of those who receive free or reduced lunches. PALS is provided free of charge to the camper, and breakfast, lunch, and a snack is served throughout the day. The staff is comprised of Purdue Students and Purdue Student Athletes. The mission of PALS is to provide positive growth and character development experiences and empower youth and adolescents to stay in school, set life goals, and learn successful life skills. The program runs during the summer and is a month in duration. The curriculum includes activities such as sports, health and nutrition, American Sign Language, Judo, financial literacy (taught by PEFCU), careers, and gang avoidance. Currently in Tippecanoe county there are 43 documented gangs. One of the very interesting findings that our research on the program has found is that many children are unaware of the fact that they are able to make friends without joining a gang. PALS works to provide a safe and caring environment where youth and adolescents can make friendships. This past summer our program enrolled 565 youth and adolescents. 38% Hispanic, 29% White, 18% Multiracial, 12% African American, 3% Asian. The average age was 10 years old with a pretty even split of males and females.

I believe that programs such as PALS would be incredibly beneficial not just in other locations in America, but worldwide. As we have discussed and learned in class, education is one of the surest ways to prevent many of the current issues that the world is facing. By having youth and adolescents spend their summer days on a college campus we are showing them what they are able to attain if they work hard and stay in school As Nelson Mandela quoted "Education is the most powerful weapon which you can use to change the world." Through PYD programs we are educating today's youth and adolescents about the fundamental lessons that it takes to become a successful and productive member of today's society.

If PALS sounds interesting to you and sounds like something you would like to get involved with, please email me for more information: GQuattro@Purdue.edu!

Sources:
(1) McDonough M, Ullrich-French S. Social Responsibility among Low- Income Youth in Physical Activity- Based Positive Youth Development Programs: Scale Development and Associations with Social Relationships. Journal of Applied Sport Psychology. 2013
(2) Catalano R. Positive Youth Development in the United States. Annals of the American Academy of Political and Social Science, 591, 98-124. 2004

Health care system and dilemma in North Korea

Health care system and dilemma in North Korea

For the past half-century, after the war in 1953, South and North Korea has been divided and South Korea has grown to become one of developed countries, with an average annual income of more than $31,950 per person (compared with $18,000 in North Korea). North Korea, on the other hand, has been in severe poverty due to economic decline or even collapse, which causes public health problems. Economic depressions and public health problems combined with natural disasters in the early 1990s (1). A ‘snowball effect’ of economic downturn was initiated with an inordinate number of natural disasters like foods, malfunction and drought and it aggravated overall public health infrastructure in the country. 

In North Korea, states manage and control public health system adopted from Soviet model (2). The state-oriented health care system manages public health care facilities with delivery of care at no direct cost to people. The system was once considered to be exceptional among developing countries, and United Nation ranked it highly on the health assessments (2). While the basic healthcare infrastructure that was developed in the 1950s continues to exist today, the extent of the medical services available has been a major source of uncertainty and concern. The economic and health decline has been constrained the operation of healthcare system with a lack of medications, resource deficiencies and limitations of clean water and food provision since 1990s (3).

The economic and health declines of the 1990s created a considerable strain on the present healthcare system. Specifically, resource deficiencies, a lack of medications, vaccines, power and heat, and limitations of clean water and food severely diminished the quantity and quality of available services.8 From 2001 to 1994, rate of vaccination coverage for under one year old children decreased 63% for combined diphtheria, 23% for polio and 95% for a two-dose tetanus toxoid. Moreover, the case of infectious diseases like tuberculosis (TB) and malaria has steadily increased (3). Many people in North Korea have a daily diet with substitute foods like noodles and cakes, made from a mix of plants and brasses such as soybeans, potatoes, grasses and corn husks. North Korea’s officials say one person takes around 600g per day from such foods administered by public distribution system. But in reality, the amount of foods is only 40% of total food intake (4).

In the past several years, North Korean Government has shown their willingness to involved in outside world, which shows the increasing number of international supports from NGOs have been entered into the North Korea. After the wide spread flood, which damaged lots of lands, farms and mines, The North Korea got helped from United Nations (UN) food emergency program. According to the close observers of North Korea, the number of death caused by natural disaster and malnutrition is approximately between 800000 and 1·5 million (3). Hoverer, North Korea is still make themselves be isolated and they are against to release health statistics, which makes them being with international community uncertainty of the precise extent of the public health devastation.

1. Sigal L. Disarming strangers: nuclear diplomacy with North Korea. Princeton University Press; 1998, p. 1–254.

2. Eberstadt N, Banister J. The population of North Korea. University of California: Berkeley; 1992, p. 38–62.

3. Davies J. North Korea’s public health tragedy. Lancet 2000; 357:628–30.

4. Macfarlane S, Racelis M, Muli-Musiime F. Public health in developing countries. Lancet 2000;356:841–6.

In class we talked about the role of government in stepping in when violence arises in other countries. I brought it up because of one of the required readings for this week focused on violence and its implications. Violence can become huge public health issues such as suffering injuries directly from the violence or even from being a refugee stuck in an overcrowded, low policed refugee camp. Pedersen (2002) wrote: "It seems paradoxical that there are effective international mechanisms in place for monitoring and possible preventing economic or financial crisis in the world markets, but there is no set of indicators directed to monitor conflict and crises in the political sphere nor a system that will detect potential deadly conflicts in the world today. Ethnic conflicts leading to massive killing and retaliation, such as the one experienced in Rwanda, could have been easily prevented. Security must be framed within an effective global system of advanced conflict warning, independent from official state bodies and based on accurate databases to track the stage at which conflict begins to take shape (1)." 

When I first read this it sounded great in theory but the ideas was not well thought out.  In practice, I do not see how this would ever happen. First, Pederson calls for a system that is independent from official state bodies. I feel that state bodies have the resources to great such a system if it was possible and I don’t know how you could make it completely independent from governments. If there was such a system who would be in charge of it? If a crisis was indicated who would handle it, an independent body or a specific country or government body? Would that government trust the information? I think these questions would need to be very well thought out when pursuing trying to create such a system.

The second thing that I have issue with is even if such a monitor system was in place how effective would it actually be. While the hypothetical system may have indicated that there was unrest in the Middle East (which I think most already knew that to some extent), I don’t think it could have predict that a frustrate man setting himself on fire in Tunisia would have started the Arab Spring or how wide spread the protests would have become (2). A year after it had started, presidents and leaders have been removed from Egypt, Tunisia, Yemen and Libya. I don’t know if a model or system could have predicted the outcome of one localized action.

While the Arab Spring example may not be what Pedersen had in mind of what to monitor, I think it shows just how fast something can occur. The Rwanda genocide was given as an example of a situation that could have benefited from a monitoring system. However, with the increased globalization and increases in social media one would think that a similar situation would receive much more global attention. Perhaps social media is our current monitoring system.

(1) Pedersen, D. (2002). Political violence, ethnic conflict, and contemporary wars: broad implications for health and social well-being. Social science & medicine,55(2), 175-190.

(2) http://www.npr.org/2011/12/17/143897126/the-arab-spring-a-year-of-revolution

My experiences with the American Red Cross

Last summer I had the opportunity to work with the American Red Cross to fulfill my practicum requirements for my master’s program.  I gained great insight as to their overall mission and their role in helping with global public health issues.  I was astonished to hear how much of an impact the Red Cross has and has had for over a century.  The Red Cross is the largest humanitarian network in the world with a presence and activities in almost of country around the world.  It is an excellent example of how a non-profit organization and non-governmental organization can be successful and ever-present in the most dire times that people need them. 

The Red Cross focusses on helping people affected by disasters, supporting members of the military and their family, health and safety education and training, blood collection, processing and distribution to as many as 3,000 medical facilities across the United States, and international relief and development.  In 2012, the Red Cross provided 96,380 overnight stays, 9,159,888 meals and snacks, and 6,594,597 relief items for hurricane and tropical storms in the United States alone and over 155 million people were helped through disaster response, community based programs and vaccination campaigns.  They also were able to vaccinate 1.1 billion children against measles and rubella internationally (Red Cross, 2012).  These numbers are enormous and have had an enormous impact on public health internationally.  What is striking about this organization is that a majority of the work is done by volunteers.  These individuals I have great respect for and look up to as I begin my career in the public health field.  Not only have the volunteers helped the impact of the Red Cross, but their efforts would not be possible without the financial supporting of corporate and individual donors. 

Although my experiences were local and not international, I was still able to gain an appreciation for the work that they are doing globally.  As discussed many times throughout this semester in this course, non-governmental organizations can be just as successful as government sponsored programs.  Their use of partnerships is a great example of what can be done when organizations with different resources come together with one goal in mind:  to prevent and alleviate human suffering. 

I worked locally to develop disaster relief plans for large scale apartment complexes and nursing homes.  I was responsible for developing a plan in case disasters, such as a fire, were to displace a large amount of people at once in a specific area.  I located local resources that would be capable as acting as “canteen” services for affected individuals.  These included many churches and community resources that had space to accommodate basic needs of people.  It was great to be able to form these partnerships for the local Red Cross and hopefully my efforts will be of use in the future.  Although my project was small scale, this is a great example of what the Red Cross is doing nationally to help people around the world.  I greatly advocate for many of you in this class to sign up to be a Red Cross volunteer.  With your interest and knowledge of public health, you all would be great assets to this organization.

 

American Red Cross.  2010 Disaster Response Statistics.  Retrieved from http://www.redcross.org/nj/camden/about-us/disaster-response-statistics.

Nike: Still Doing It?

Recently, we discussed companies, such as Nike, that manufacture clothing in factories where the conditions are rife for employee abuse.  One of the comments made was that we as consumers feel powerless.  What difference does it make to a conglomerate like Nike if one person or group boycotts their products?  I did a little browsing into Nike and have discovered that not only has Nike has made an effort to clean up its image, but  we as consumers can also influence retail companies.

On average, Americans buy 64 garments per year, and the majority of these are made overseas .¹ Research has shown that consumers actually want to purchase clothing that was produced ethically: 94% of respondents in one survey indicated that how workers are treated in factories is important to them.¹   So, the intent to purchase ethically made items is there, and we would like to ensure that those who make these items are being treated fairly. The problem is that even though the consumer intent is there and supported by corporations, there is not much we can do without governmental help.  Earlier in 2013, six major apparel companies (including Nike) requested that the Peruvian government strengthen its labor laws-which are less strict than the standards the companies even impose-but the Peruvian government has not taken any action.  So, while these companies have in fact taken action to try to ensure that overseas employees are treated fairly, unless the governments enforce stricter standards, not much can be done.  It should be explained that corporations contract factories to produce their products; these contractors are not actually part of the corporations, so while Nike can (and does) try to enforce standards as much as it wants, whether or not the contractors actually follow them is up to the individual contractor.   To give Nike credit, it has gone from denying abuse of employees to actively attempting to ensure fair treatment.  In 1991, there was an uproar when it was revealed that Nike cut costs by manufacturing in less than ideal conditions in Indonesia and spent the savings on aggressive marketing companies.²  After the consumer backlash (which will be discussed in a bit), Nike now continues to post its commitments, standards, and data (including the location of each factory utilized) publicly.  While abuses of their workers are still undoubtedly occurring daily, they have come far from where they used to be.

As previously mentioned, we (even as graduate students) can have an impact on these companies!  We have a unique environment on a college campus that we can leverage.  Student groups exist and have previously been able to pressure universities to force suppliers to change their ways. The best example is from 2009, when Russell Athletic rehired 1,200 workers they had fired for unionizing after students campaigned to suspend Russell’s contracts.²  Again in 2011, Penn State threatened to terminate its licensing agreement with Adidas for not paying severance pay to 2,600 workers after the factory unexpectedly closed.¹  Being students on a campus gives us a better platform to organize and more leverage.  If you consider Purdue’s contract with Nike, just imagine what would happen if we got enough people to boycott?  This might be an idealistic dream, but I just want to point out that we have more power than we think!

1: http://www.salon.com/2013/03/21/sweatshops_still_make_your_clothes/

2: http://www.businessinsider.com/how-nike-solved-its-sweatshop-problem-2013-5

Complementary and Alternative Medicine

Complementary and Alternative Medicine (CAM) is becoming increasingly popular in the United States. Americans are starting to seek a more holistic approach to health, and are supplementing conventional Western Medicine with natural products and services that are considered to help promote wellness and prevent diseases. CAM can be defined as “a set of medical and healthcare systems, practices, and products that are not part of that country’s own tradition and are not integrated into the dominant healthcare system” (NCCAM 2002).

The kind of people in the United States that are most likely to use CAM are women (Barnes et al. 2004), people with higher household income ethnic minorities (Barnes et al. 2004), and people with chronic health problems such as anxiety, back pain, and headaches (Astin 1998). Studies have shown that people aren’t necessarily dissatisfied with US medicine, but are starting to use CAM as a means to take control of their own health, increase their options for treatment, and not rely solely on conventional medical care (Eisenberg et al 2001).

The top 10 CAM treatments in the United States are (Barnes et al. 2004):

 1) Prayer for one’s own health 

2) Prayer for someone else’s health

3) Non-vitamin, nonmineral, natural products

4) Deep Breathing Exercises

5) Prayer Group

6) Meditation

7) Chiropractic Care

8) Yoga

9) Massage

10) Diet-based therapies.

What is interesting about CAM, and how it is used and perceived in the United States, is that in many developing countries, CAM practices and treatments are considered traditional medicine that have been used for hundreds of years. Any given practice can simultaneously be traditional or alternative depending on the location of its use. Some countries (China, North and South Korea, and Vietnam) have also fully integrated traditional medicine into their healthcare systems (WHO 2003). For example, in China, traditional herbs constitute 30-50% of total medicinal consumption. About 80% of the world’s population uses traditional systems of medicine for health care with plants as the dominant component (Mukherjee & Wahile 2006).

Certain diseases and conditions have also sparked a disproportionate use of complementary and alternative treatments. Cancer, for example, due to its expensive and extensive treatment regime, has caused the afflicted individuals to resort to other methods of treatment as well such as prayer, diet, and meditation. In Brazil, up to 89% of cancer patients use CAM (Holtz 2008). Current research efforts are also trying to evaluate the effectiveness of immune modulation or enhancement, which if successful, could help enhance or inhibit the immune system’s responses (NCCAM 2002). This could be particularly helpful to those afflicted with HIV/AIDS in countries all over the world.

As CAM increases in popularity, and more evidence-based research emerges on different treatments, public health officials should consider implementing certain CAM techniques into policy and interventions. Based on a nation’s resources (natural and economic), it might be a more viable option to integrate alternative medicine into the traditional mode of healthcare delivery. Overall, people are finding different methods that they believe will help benefit their health, and I think this is a good opportunity to bridge the gap in cultural differences in the practice of medicine.

Astin, J. A. 1998. “Why patients use alternative medicine.” JAMA 279:1548-1553.

Barnes et al. 2004. CAM use among adults: United States, 2002. Advance data from vital and health statistics. Retrieved from http://www.cdc.gov/nchs/data/ad/ad343.pdf.

Eisenberg D.M. et al. 2001. “Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey.” Annuals of Internal Medicine 135:344-351.

Holtz, Carol. 2008. Global Health Care: Issues and Policies Sudbury, MA: Jones and Bartlett Publishers.

Mukherjee, P.K, & Wahile, A. 2006. Integrated approaches toward drug development from Ayurveda and other Indian system of medicines. Journal of Ethnopharmacology 103:25-35.

NCCAM. 2002. Get The Facts: What is Complementary and Alternative Medicine (CAM)? Retrieved December 4, 2013 from http://nccam.nih.gov/health/whatiscam/

WHO. 2003. Traditional Medicine. Retrieved December 3, 2013 from http://www.who.int/mediacentre/factsheets/fs134.pdf .

Wacky Tobacky: Which is more “wacky,” the drug itself or the tobacco industry?

Wacky Tobacky: Which is more “wacky,” the drug itself or the tobacco industry?

In our brief discussion of global corporations and their influence on health, tobacco immediately came to mind. The Tobacco industry affects health globally in several different ways, namely tobacco-related morbidity and mortality and the economic deprivation of impoverished tobacco users. The annual mortality experienced worldwide is estimated to account for three million deaths. It is projected that this number could reach up to ten million deaths annually within 30 to 40 years (From 2000), 7 million of which will occur in low income countries.¹ Mortality, however, is but the end result of the ensuing morbidity caused by years of loyal tobacco consumption and its negative health effects, namely: a 2 to 4 –fold increase in coronary heart disease and stroke, a 230% increase in lung cancer among men (130% for women), and increased mortality from chronic obstructive lung disease by 120-130%. In the U.S. the effects of cigarette smoking cause an estimated 443,000 deaths annually (nearly 1 out of 5 deaths).³ Although smoking has declined in higher income countries, tobacco consumption has increased approximately 46% in countries classified in the medium development category. If trends continue, the proportion of increase/decrease in high and low development countries tends to favor an overall increase in the consumption of tobacco (from 30% to 35% globally).² Thus, one could surmise that an increase in smoking prevalence in less developed countries might subsequently result in increased mortality rates as the fledging health systems become overburdened treating tobacco-related diseases.

The effects of tobacco consumption on health extend well beyond its direct effects. The economic effects of tobacco consumption may have a significant effect upon the impoverished – exacerbating state of malnourishment and hunger. In Bangladesh, the consumption of cigarettes increased approximately 33% from 1992 to 1996. Had not the increase from 1992-1993 to 1994-1995 occurred, residents in Dhaka Bangladesh could have saved enough to purchase 15% more meat, 14% more milk or 79% more eggs.⁴ This trend is especially concerning considering that the prevalence of smoking is inversely related to the monthly household income with the poorest (<$24/month) having a smoking prevalence of 58.2%. To put this into perspective, men in Bangladesh who smoke cigarettes spend five times as much on cigarettes than house rent, 18 times as much as health, and 20 times as much as education.  It is staggering to think of what the money wasted on tobacco could have accomplished had it not been for the greed of tobacco companies.⁴

The greed of the tobacco industry seems to have no regard for life or restraint. Their promotion and advertisement strategies unabashedly target susceptible populations such as youth⁵, and those in low income countries.⁶ Tobacco companies target these populations by: denying that their product results in negative health outcomes, pouring millions of dollars into deceptive advertising, interfering with national public health laws, spurring trade policies benefiting tobacco growing nations, and political efforts to keep tobacco taxes low.⁶ These efforts do not go unrewarded. The consumption of tobacco through cigarettes is increasing in Eastern European and Asian countries while simultaneously decreasing in North America and West Europe.⁶ It seems as if the tobacco company’s unfettered greed seems not be content with coercing the health and wealth out of developed countries but, after aggressive policy measures are put in place, rather to pursue and take advantage of the most vulnerable and impoverished. These people may have little say in regards to their own tobacco-related health. Some papers have even advocated for tobacco cash crops in these areas to stimulate economic growth. This may initially seem like a good idea but it would only act to contribute to the wealth and power of the tobacco companies whose economic power may be much greater than the countries whereby it profits. The wealth garnished from destroying the health of others is then used to further spread the disease and to lobby against aggressive policies and trade regulations. Although this industry is not the only one to take advantage of the vulnerable and impoverished, it certainly seems to do so with the utmost disregard for human well-being.

11       Peto R, et al. Mortality from smoking worldwide. British Medical Bulletin.1996;52:12-21

22    Corrao M, Guindon G, Cokkinides V, and Sharma N. Building the evidence base for global tobacco control. Bulletin of the World Health Organization. 2000;78:884-890.

33  Centers for disease control. Smoking and tobacco use. Centers for disease control and prevention.  http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/ . Updated August 1, 2013. Accessed 12/5/2013

44   Efroyson D, Ahmed S, Townsend J, et al. Hungry for Tobacco: An Analysis of the Economic Impact of Tobacco Consumption on the Poor in Bangladesh. Tobacco Control. Sept. 2001;10:212-217. BMC Public Health. 2008;8:

55     Chen P, Chiou H, Chen Y. Chinese version of the Global Youth Tobacco Survey: cross-cultural instrument adaptation. BMC Public Health. http://www.biomedcentral.com/1471-2458-8-144. Published 4/30/2008. Accessed 12/5/2013.

66   Dagli E. Are low income countries targets of the tobacco industry? International Journal of Tuberculosis and Lung Disease. 1999;3:113-118

http://luckyironfish.com/lucky-iron-fish-background-video/#!

The video is an example of what many of us can do to advance global health in our own "small" way!! And what is important here is knowing the situation/ context, living it; being open to possibilities and listening to communities...Inspiring video!!

The goal of eliminating health Disparities from rich and poor: Is it possible?

A plan for a “grand convergence” in health suggests that by increasing funding in research and development to invest in new medications, vaccinations and technology could get rid of the disparities between rich and poor nations. Not only does it claim that by focusing these investments towards AIDS, malaria and tuberculosis will get rid of disparities but that it is possible to get rid of them within one generation. I found this very surprising. The prevalence of these diseases is nothing new or unheard of by those in the health field. The former US Treasury Secretary Larry Summers stated “For the first time in human history we are on the verge of being able to achieve a milestone for humanity: eliminating major health inequalities so that every person on earth has an equal chance at a healthy reproductive life.” Now after being in international health this year and other previous classes this rose several issues for me. First I’m skeptical that by addressing just the health of nations that we will be able to eliminate health disparities. We have mentioned in almost every class that health is the influenced by many other things, for example structural violence, the environment and human rights. I do agree that it is the right for everyone to have an equal opportunity for a healthy life but I think it may be a bit naive to think that by addressing the actual health outcome (AIDS, TB ect.) that it will result in riding the health disparities. For example just because we now have medications to treat this illnesses does not mean that we solved the problem of the number of women being raped and therefore have HIV/AIDS, the number of people who now have access to clean water, shelter, sanitation, food, healthcare and the list goes on.  The article then goes to explain that the report recommends taking preventative bold steps such as heavy taxing on sugar, alcohol and of course tobacco. This made me think of the number of people who would throw a fit because their human rights were being comprised because the government has too large of a role in the decisions they should be making for themselves. Bio politics or the influence the government has on a population’s health is definitely going to be discussed due to this type of situation. The investment for research and development will have to double from 3 billion to 6 billion dollars by 2020 to save approximately 10 million lives in low and middle income countries. I do agree that international assistance is important and we do need to focus on minimizing the gaps between low and high income nations, I just think that 6 billion dollars would be better spent and would save more lives if we focused on the factors that lead to these health outcomes in the first place rather than the health outcome themselves. However, these types of factors would also be more difficult to address and I’m sure arguments could be made that they would be a riskier investment. I believe this brings up a lot that was mentioned last night by some of you.

Leadership and Health Management in Developing Countries

Despite all of the financial aids and resources that many organizations like WHO, UNISEF, philanthropic foundations have provided for developing countries to improve their public health issues and achieve the health-related of  Millennium Development Goals(MDGs) still most of these countries are not on track of MDGs. People in such countries still suffer from burden of infectious diseases, health inequality and discrimination. Global Health system has well defined the strategic plans by providing evidence-based preventive and therapeutic intervention to reduce health problems in low income countries but less attention is paid on how to deliver those interventions so they can be effective. There are many factors that impede the success of interventions such as complexity of the programs, lack of human resources, health system capacity, lack of engagement of the local implementers, inadequate integration of research and the most important one lack of management and leadership.

In order to strengthen health care system in developing countries special attention should be paid on the role of leadership and management in such system. Global health should study how to define intervention plans and simplify its programs for public health systems in developing countries, and put in place programs to train leaders in health care systems to use their resources properly. A leader in health care system should know how to use the resources, scale up health workers, reach and engage communities; match the best delivery strategy to the specific health problem.  A health manager should know how to involve civic society and the voluntary private sectors who can help on proper decision making which are vital in progressing health equity. This function requires strong leadership from government Ministries of Health and World Health. I refer to one of the challenges that global health organization encounters in health care systems especially in low income countries which has great impact on the health indicators.

There are significant disparities in developing countries in terms of distribution of health professional, and levels of care. One of the most important reasons is lack of strategy plans of human resource management for attraction and retention factors to keep health professionals in rural areas which have caused many health professional to work in urban areas while most of the population in such regions are living in rural areas. The impacts of such misdistribution of professional health workers in primary health care can cause resistance of infectious diseases, increasing risk of environmental health issues, people are not receiving clinical preventive health services, and as a result raising the rate of mortality especially among children. The success of strategies within a health sectors depends on management skills, for instance someone who realizes the personal characteristics like age, gender, marital status, and other factors which could have an impact on an individual's decision. Also, experience manager who knows how to work with international partners, stakeholders, political parties and institutional organizations in order to influence and shape general living conditions as well as national policies, and socio-economic status in remote and rural areas. These general living conditions are including staff accommodations, schools and qualified teachers, safe drinking water, electricity, roads and transportation which could influence staffs attraction and retention.  

Ultimately, in order to improve public health issues and achieve the health-related Millennium Development Goals, WHO and its partners should consider designing a framework containing a guidance and support in leadership and management development , such as developing negotiating skills, support systems, money management, staff distribution, monitoring information, supplies, and create comparative environments in health care management among developing countries to encourage them to enhance their performance.

 

1)Staffing remote rural areas in middle- and low-income countries: A literature review of attraction and retention  Uta Lehmann^1*, Marjolein Dieleman² and Tim Martineau³

2)Working paper - World Health Organization www.who.int/management/working_paper_10_en_opt.pdf‎ 2007

3)Health equity: challenges in low income countries

4)www.ncbi.nlm.nih.gov. Afr Health Sci. 2009 October; 9(Suppl 2): S49–S51.

5)What are the barriers to scaling up health interventions in low and middle income countries? A qualitative study of academic leaders in implementation science.
Gavin Yamey

 

Waste In Global Health

Waste In Global Health

While reading through some of the global health literature, I was surprised at the staggering amount of waste in global health efforts. Resources are finite and should be spent to their utmost potential especially when considering the importance of reducing health inequities among the disenfranchised, the marginalized, and the impoverished.

Although, as we recently discussed in class, globalization has had many negative effects on health globally, it has contributed to increased global health funding through global/international organizations: mostly from wealthy, egalitarian entities. However, one must consider the effectiveness of such organizations. Funding from outside sources are seldom aware of the difficulties faced by the beneficiaries of their funds. Often, funds must be allocated according to the donor’s wishes which may be driven by emotional responses to issues faced in the donor country; and the donor’s priorities, politics, and values.¹ This effectively silences the voice of needy and impoverished populations leading to programs lacking sociocultural, economical, political, and health-related awareness. Thus, waste can be seen as misappropriated, although well-intentioned, funds and resources for services and diseases that miss the underlying causes of global health inequity. A common example can be seen in how organizations commonly “stovepipe” funds in a vertical fashion to predetermined services or diseases as Garret illustrates that, “a government may receive considerable funds to support, for example, an ARV-distribution program for mothers living in the nation’s capital. But the same government may have no financial capacity to support basic maternal and infant health programs.”¹

Cultural competence is another factor that can be overlooked and lead to waste. In Vietnam, a program was developed to treat tuberculosis that failed to take into account: cultural perceptions about the common side-effects of the regimen, that many perceived western medicine as being too strong, and that family, peer, and community support (particularly from family leaders) is essential for maintaining long-term treatment compliance. The failure to incorporate these sociocultural aspects into the program led to widespread medication non-compliance resulting in the waste of program funding, TB-medication, and time. Moreover, the program may have done more harm than good as widespread TB medication compliance fosters an environment from which multi-drug resistant (MDR) strains of TB can emerge and spread. This, in effect, would lead to higher mortality rates and increased cost of treatment as the cheaper, first-line treatment for TB is no longer efficacious for treating TB. ²

Beyond the waste involved with the utilization of funds at the interface of programs and health inequities, the underlying framework and structure of how funds are appropriated and distributed are fraught with corruption, and greed. A 2006 World bank report estimated that “about half of all funds donated for health efforts in sub-Saharan Africa never reach the clinics and hospitals…[and that money] leaks out in the form of ghost employees, padded prices for transport and warehousing, the siphoning off of drugs to the black market, and the sale of counterfeit – often dangerous – medications.” Moreover, in areas where corruption is widespread, “an amazing 80 percent of donor funds get diverted from their intended purposes.”¹ One would suspect that these areas also have the greatest need for funds. Governments appropriations also play a significant role in the waste of global health funds. Economist Paul Collier has estimated that “something around 40% of Africa’s military spending is inadvertently financed by aid.”³ The inappropriate use of foreign aid by governments is not only wasteful, it has been shown to be linked with negative health outcomes as one study indicated that “Life expectancy at birth is reduced by between 3 and 6 months for each 1% of GNP spend on military programs…[and that] this association is three times stronger in the poorest countries compared with middle-income and more affluent nations.”⁴ The most disappointing news to this story is that this problem is perpetuated through the same bodies who ostensibly pledge to fight against global health inequities but yet are “complicit in this process through the global arms trade…[as] permanent members of the United Nations Security Council together account for 80% of the world arms exports, much of it flowing to developing countries.”⁴

These issues cause me to speculate about the progress that could have been made in the absence of this waste. The truth is that waste seems to be widespread and can also be seen in: duplications in parallel health systems causing increased transport costs and increased labor demand,⁵ loss of water  and contamination of water through leaking water distribution systems resulting in 40 to 70% of wasted water (that could have been used for hygiene and sanitation) and 30% of waterborne outbreaks.⁶ It seems that much of the research and international focus rests on the clinical and program implementation strategies and not enough emphasis is put on the underlying systems that result in widespread waste. Imagine the progress that may occur if governments and organizations are held accountable for their use of health aid monies. Imagine if those funds could be used in a manner that not only represents the needs of the impoverished, but was also sensitive to their political, economical, and sociocultural context. Imagine if funds could be used to create sustainable sources of water that reduces waste and creates opportunities for increased personal hygiene and sanitation. Imagine if global health efforts were based on rigorous application of scientific approaches and informed by local knowledge and resources. In medicine they have a saying “Primum non nocere” meaning “first, do no harm.” Should global health adopt this as well? Should waste and inefficiency (as I have demonstrated a couple of times) worsen the health outcomes of the purported beneficiaries and further drive the impoverished and needy into the pit of health disparities? One could only wonder the progress that could have been made had these issues not held us back.

Sources:

1.       Garret L. The Challenges of Global Health. Foreign Affairs. Jan/Feb 2007. www.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-global-health.html?mode=print . Accessed 12/3/2013

2.       Ito K. Health Culture and the Clinical Encounter: Vietnamese Refuges’ Responses to Preventative Drug Treatment of Inactive Tuberculosis. Medical Anthropology Quarterly, New Series. Sept.1999; Vol. 13: 338-364

3.       Schrecker T. Globalization and health: the need for a global vision. Lancet. 2008;372:1670-76

4.       Chapter 1 Globalization and Health: Challenges and Prospects Ichiro Kawachi and Sarah Wamala

5.       Phyllida T, Bennett S, Haines A, et al. Overcoming health-systems constraints to achieve the millennium development goals. Lancet. 2004;346:900-9006

6.       Moe C. Rheingans R. Global challenges in water, sanitation and health. Journal of Water and Health. 2006;0.4 suppl:41-57

In addition to obesity, nutrition, clean water and sanitation, a new issue is emerging as a public health threat, Fake medications. Fake medicine is a concern in every region of the world, affection low, and middle and high income countries. This is absolutely an issue that needs to be addressed. As we all know medications have can react with one another and other foods and dietary supplements, and this happens when the consumer is aware that of what they are taking. These fake medications may contain wrong ingredients or doses that could results in harm to the person buying them. In Africa one third of all TB medication is thought to be fake and about 35% of all malaria medications were found to be failed chemical analysis in Southeast Asia and sub-Saharan Africa. It gets worse, the World Health Organization also predicts that anywhere from 25%-60% of the entire medicine supply in developing countries could be substandard or counterfeit.  If we do not address this on an international scale we will be creating more problems, deaths and illnesses than what we are already trying to control. An organization called Fight the Fakes is making an effort to promote public awareness about this problem. They are using social media sources such as twitter and Facebook to reach as many people around the world to join them. The World Health Organization predicts that counterfeit and substandard medicines constitute over a 400 billion dollar market, which has increased by 300% since the year 2000. Selling fake medication is even now being called “the new face of organized crime”. These fake medications have been found to include poisons such as mercury, rat poison, paint and antifreeze. In addition to they also are assisting in drug resistance. If the number of fake medications continues to increase its result will be detrimental to global health.  More money and research will need to be invested into the development of even stronger resistant medications, which we are already struggling to develop. In addition 30% of countries have little or no regulation to prevent medications that are below standards from being distributed.  Obviously these countries are going to have an increased risk of ingesting fake medications.  Developing countries are already not receiving the care they need and it’s frustrating to think that the little amount of care they are getting may actually cause more harm than good. Usually when I hear about contamination it’s usually within dietary supplements, not prescription medications. I was shocked to read about how large of a problem this has grown into. The Fight the Fake’s website lists organizations from around the world that are joining the effort to minimize the problem. They also have posted stories of people who have been affected from fake medications. I think it’s very sad that this is happening. In the United States alone 70 percent of the population takes prescription medications. If people who do not have health insurance or simply cannot afford to pay for their prescription drugs  and stumble across a site selling what appears to be the same medication for less money they could be tempted to purchase medications.

http://www.cbsnews.com/news/study-shows-70-percent-of-americans-take-prescription-drugs/

http://www.who.int/mediacentre/factsheets/fs338/en/

http://fightthefakes.org/resources/?audience_id=23

http://www.prweb.com/releases/uspharmacopeia/fightthefakes2013/prweb11371516.htm

FOOD FOR TOMORROWS CLASS

Just a reminder that you are encouraged to bring any food or beverages into tomorrows class. Please list what you plan of bringing if you are participating.

HIV-Tainted Drugs

This story (1, 2) came out a decade ago, but I thought that I should share with the class to see your thoughts on the subject since HIV/AIDS is, with fighting other infectious diseases, one of the Millenium Development Goals.  Bayer sold Factor VIII concentrate, a crucial component in the blood-clotting cascade that is missing in individuals with hemophilia A (3, 4).  The protein was isolated from plasma donors and the drug developed prior the development of an HIV screening test.  The typically self-injected drug was a breakthrough in medicine as that meant that hemophiliacs could finally lead a normal life, some using it as much as three times a week (2).  However, amid the HIV pandemic, Bayer heat-treated, which, according to a government study, led to the virus being ''undetectable'' (1, 2).  Although the un-heated product was pulled from the shelves in America, thousands of American hemophiliacs were infected with HIV, and was exported to Asia when a distributor took interest (2).  Cutter Biological, the Bayer branch in charge of Factor VIII, “asked the distributor to 'use up stocks' of the old medicine before switching to its 'safer, better' product. Several months later, as hemophiliacs in Hong Kong began testing positive for H.I.V., some local doctors questioned whether Cutter was dumping 'AIDS tainted' medicine into less-developed countries. Still, Cutter assured the distributor that the unheated product posed 'no severe hazard' and was the 'same fine product [they had] supplied for years” (2).  Over 15 years of lawsuits led to a settlement of $600 billion paid to American families.  The NY Times article goes on to describe that when Cutter was asked by an Asian distributor for the “new” (heated” Factor VII concentrate, “Cutter replied that most of the new medicine was going to the United States and Europe, and that there was not enough left for Hong Kong, though a small amount was available for the 'most vocal patients'” (2).  But my question is, what about those families abroad who have lost their loved one and isn’t there more government regulation?

What shocks me most is that the FDA did not seem to have done much to have stopped or regulated Cutter’s actions.  By May 1985, which is when the FDA realized that the unheated product was being exported and an FDA official asked that the issue be “‘quietly solved without alerting the Congress, the medical community and the public, ‘according to Cutter documents” (2), the CDC had already established that HIV was transmitted through blood products (2).  Additionally, other countries likely had ministries of health/health departments so wouldn’t they also have an equivalent of our FDA to ensure the safety of their own people?  Last but not least, with the added heating process, wouldn’t the FDA have inquired about the safety of the old product and asked that the latter be discarded (despite the large loss of capital and material)?

(1) http://www.cbsnews.com/news/bayer-sold-hiv-risky-meds/

(2) http://www.nytimes.com/2003/05/22/business/2-paths-of-bayer-drug-in-80-s-riskier-one-steered-overseas.html?pagewanted=all&src=pm

(3) http://www.hemophilia.org/NHFWeb/MainPgs/MainNHF.aspx?menuid=180&contentid=45&rptname=bleeding

(4) http://www.qiagen.com/products/genes%20and%20pathways/pathway%20details?pwid=64

The Healthy Workplace Project for Preventing Sickness

The Healthy Workplace Project is an initiative directed by Kimberly Clark. The HWP works to prevent illness and sickness in the workplace, but many of their tips can be applied in your home, apartment, dormitory, or wherever it is that you find yourself spending a majority of your time! With the holiday season quickly approaching many people will find themselves in and out of stores to find the perfect gift for their loved ones (touching door handles), traveling by way of airplanes or other forms of transportation, and spending time with family and friends. THE HWP talks about spotting "hot zones." Hot Zones are places where the possibility of germ transmission is at it's highest. According to Kimberly Clark and the Health Work Place Project the following are considered hot zones:

1. Doors. It is recommended to wipe doorknobs and handles daily, and to use hand sanitizer while entering and exiting the building. It is important to wipe daily due to the fact that germs can live on hard surfaces for up to 48 hours.
2. Copy Stations. Did you know that adults touch their faces on average 15.7 times every hour? This makes hand washing incredibly important. If you wash and properly dry your hands you can reduce 77% of bacteria.
3. Elevator Buttons. Due to the fact that everyone has to touch the button to get where they need to go it is incredibly contaminated. This same concept goes for ATM buttons, restroom toilet handles, etc. Don't forget to use hand sanitizer especially when touching these items.
4. Stair Railings. Wipe these daily. A person with a virus on their hands can transfer those germs onto surfaces up to 7 times. 
5. Conference Tables. When large amounts of people gather it makes it especially easy to transfer germs. Wipe down tables at least every day. (just think about the desks that we sit in throughout our classes, do you think that these are ever wiped down?)
6. Lobby Areas. Viruses can live on surfaces such as chairs and tables from 20 minutes to 2 hours. 

Apart from the listed hot spots above, places on our campus that are sure to harbor many bacteria and viruses are places such as computer labs, Rec Sports center, dining halls, desks in class rooms and many more. Do yourself a favor and carry your own small hand sanitizer in your backpack or purse. It has been proven that using hand sanitizer can reduce your sick days by up to 21%, who doesn't want to do that for themselves and their employees? If people are healthy for more days out of the year they are able to be more productive and efficient in their work and studies. Three easy tips to remember are: Wash, Wipe and Sanitize! 

Keeping our hands clean is one of the best and easiest ways to prevent the spread of infection and illness! Here are some tips to ensure that you are practicing proper hand washing: 
Wet your hands, Rub your hands together (sing happy birthday from beginning to end twice in your head, or out loud if you want to be entertaining to those around you!), Rinse your hands, Dry your hands well using a clean towel or an  air dryer, whichever is available to you. 


Sources:
(1) http://www.healthyworkplaceproject.com/creating-healthy-workplaces.aspx
(2) http://www.cdc.gov/handwashing/
(3) http://www.cdc.gov/features/handwashing/