Week 11 (Mar 29, 2007) - Heathcare Financing and Health Outcomes in the Global Context

How will we address the disparity in the amount of health care dollars spent in developing countries versus the amount in spent in developed countries? There really is no way to justify the fact that 84% of the world's population inhabits LMICs, yet we only spend 12% of worldwide health care dollars on the people in LMICs.

Unfortunately, large modifications in the global distribution does not appear to be on the horizon. Indeed we, global public health professionals should work towards that goal. In the meantime we are left with major public health problems from both communicable and non-communicable diseases in these countries and we have to find ways to address these now with the limited resources that are available.

Cost-effectiveness is a tool that can be used to make policy decisions on how to best allocate health care dollars to maximize effective therapies and avert the most DALYs possible. Until there is a more equitable distribution of global health care dollars, cost-effectiveness can help address global health disparities now. It's not perfect and contextual factors need to be considered along with cost-effectiveness data. Let's not throw the baby out with the bath water, it seems to me that in countries with limited resources, cost-effectiveness should be used by policy makers. What do you think ?

Week 7 (Feb 22, 2007) - Environment, Sustainability and Global Health

Dignity. That is the concept that stood out most for me as I reviewed the materials for week 7. There is no dignity when a person does not have access to clean water and sanitation. Once again it seems we have an issue that primarily affects poor people in developing countries and is not addressed as fully and passionately as it should be. If I were someone living in the conditions that we read about this week, I would feel like the world forgot me.

The case study opened my eyes further to the far reaching impact of the lack of access to clean water. Seeing that the pursuit of clean water can consume time that girls might otherwise use getting an education, addressing the issue of clean water in these populations can help us meet two of the MDGs. If we are serious about the MDGs, why aren't more efforts and resources being put toward acheiving them, especially when the answers are right in front of us. Hmmmmm.

I'm Back !!

Hello MPH classmates,

I am happy to be back on my blog after being out for a bit for my back problem. I can't believe I have not had a blog entry in a month. Well, the next couple of entries will be my attempt to catch up. There have been so many interesting things discussed while I was out. I look forward to your insight and comments on my catch-up entries. Cheers !

AC

Week 5 (Feb 8, 2007) - Nutrition, Food Security and Health

The week 5 class discussion was a lively discourse on how to address hunger and malnutrition in the midst of rapid global increases in obesity rates. In addressing these issues I really believe it is important to keep in mind that obesity does not exempt a person from being malnutritioned. As we go forward with long term solutions to address hunger, we will have to make sure that those solutions are nutritionally balanced - not inexpensive, processed or fast foods.

RUTF as discussed by Liyan in her oral presentation looks like a promising solution to the acute problems with hunger and can save lives. It also provides a mechanism for providing jobs to the people in the areas where factories are constructed to manufacture the product. Perhaps this could indirectly contribute to a long-term solution to hunger by increasing the resources available to the people who work at the factory.

Week 4 (Feb 1, 2007) - Changing Trends in Non-Communicable Diseases: Implications for Global Health

Even those of us in public health struggle with how to priortize the double burden of disease. The perspective that I hope we can all come to agree upon is that there is enough resources to go around. If we can come to a more equitable distribution of resources, than perhaps we don't have to decide if we are going to address communicable or non-communicable diseases (NCDs) in countries where both are pressing problems. Since we know that NCDs are rapidly replacing infectious diseases as the leading cause of death, we cannot only focus our public health efforts on infectious disease. With that said, the unfortunate truth is that some of the most disadvantaged people in the world are the ones who continue to be at the greatest risk for communicable disease. So, in order not to further marginalize the people of sub-saharan Africa, we have to continue to view communicable diseases as a threat to global health, despite the rapid increase in NCDs. Any other thoughts ?

Week 3 (Jan 25, 2007) - Changing Trends in Communicable Diseases: Implications for Global Health

This week we are exploring changing trends in mortality and morbidity associated with infectious diseases, neglected diseases, emerging and re-emerging infectious diseases, and epidemics and pandemics. I will not be able to attend class tomorrow night because of a family commitment. Here are my thoughts on some of this week's background resources:

Backgrounder Video: Epidemics and Pandemics - Early Detection, Early Response (27 minutes) (available at: http://tedblog.typepad.com/tedblog/files/larrybrilliant.html )
Larry Brilliant gave a great presentation highlighting where we went right in winning the battle against smallpox. As stated in his presentation, it basically boiled down to a door-to-door surveillence campaign. I was struck by the magnitude of the campaign when it was put into perspective as being the largest in UN history until the Iraq war. This statement made me think about the current AIDS epidemic. If I am understanding Dr. Brilliant's statement correctly, this means the UN is putting more into the Iraq war campaign than AIDS. The injustice of this hit home even more when I watched the background video on AIDS orphans (available at: http://video.google.com/videoplay?docid=7678580226115493904&q=AIDS+orphans&hl=en ).It is my sincere hope that in my lifetime we will come together as a global community and decide enough is enough with regards to the AIDS epidemic and put the same magnitude of effort into AIDS that was put into the successful elimination of smallpox. Perhaps Dr. Brilliant's vision for INSTEDD can be adapted in include AIDS.

Case study: Avian Flu - Preparing for a Pandemic
It is clear from the readings and 1918 Spanish flu video (available at: http://video.google.com/videoplay?docid=7423997674238499075&q=1918+influenza&hl=en ) that pandemic avian flu is a real threat. We know that the devastating Spanish flu of 1918 was also a bird flu, so we already have precendence for human-human transmision of an avian flu. Dr. Brilliant also commented on pandemic bird flu in his presentation, stating that avain flu can be all-over the world within 3 weeks because travel is getting better. However, we don't know how long it will be until the threat of a avian flu becomes a reality. I agree that we need to put resources towards being prepared so that we detect and respond early to avian flu, but the amount of resources put into avian flu needs to be balanced with public health issues that are claiming lives today - like AIDS, childhood diarrhea, malnutrition, etc. What do you think ?

I look forward to hearing our added insights to my thoughts based on tomorrow nights class discussion.

BMJ 15 Medical Milestones since 1840

This BMJ article published on-line this month is an engaging discussion of major medical progress since 1840. If you're interested in what the article has to say, here's the link : (http://www.bmj.com/cgi/content/full/334/suppl_1/DC3) . The 15 milestones noted in the article are:
Anaesthesia
Antibiotics
Chlorpromazine
Computers
Discovery of DNA structure
Evidence-based medicine
Germ theory
Immunology
Medical imaging (x-rays, etc.)
Oral contraceptive pill
Oral rehydration therapy
Risks of smoking
Sanitation (clean water and sewage disposal)
Tissue culture
Vaccines

While all of these represent incredible medical advances, personally I would replace EBM with aspirin. This is not to minimize the value of EBM, in fact Dickersin, Strauss, and Bero make some great points in the article about the contributions of EBM to modern medicine. My reason for counting aspirin in the top 15 are based on the well-documented, profound effects of aspirin on reducing cardiovascular disease morbidity and mortality. This is particularly important when we consider the current and future relevance of ischemic heart disease, which is projected to be the #1 cause of death worldwide by 2020. Aspirin costs pennies, but saves lives.

Week 2: Globalization, Development and Health

This week our discussion focused on the impact of globilization and development on health. The economic benefits of globilization and a free market economy need to be balanced with the potential negative impacts on health. Once again we see that the people affected most by the potential negative consequences are the poor, who are at risk of becoming further marginalized through the process of globilization. Privitazation of health and education seem to be major contributors to the marginalization of poor populations by limiting their access to basic, essential health services and a quality primary education. To further compound the issue, as people beocme more marginalized, they become less and less powerful - their voices are not heard - their problems become "their problems". It's unfortunate, but true. As discussed this week in a another class, if we want to improve the health stauts of a country, start with the poor populations. So the reality is, their problems are not "their" problems, they are "our" problems. Fair and equitable health/education for the poor have to be part of the globilization discussion.

To that end, while the background video - "Globalisation is Good - Johan Norberg on Globalization" (available at http://video.google.com/videoplay?docid=5633239795464137680&q=globalization&hl=en ) does a great job of showing the positive outcomes related to globilization, I think the video falls short by failing to discuss the potential negative consequences. We cannot just focus on the positive benefits and ignore the negative. We have to talk about and plan for both in order to realize maximal benefits from globilization. What do you think ?

Additional Thoughts on the "Big Picture"

This week's class discussion on the "Big Picture" took a macro view at the issues facing modern day global health. This view reinforces the importance of a multi-disciplinary approach to public health. The issues are overwhelming when you look at everything that needs to be addressed. There is no one discipline that can solve the issues alone. We need expertise AND leadership in the areas of finance, medicine (communuicable and non-communicable disease), social policy, human psychology, community development, etc in order to really address the challenges that face us. What do you think ?

Emerging Trends in Global Health - The Big Picture

This week we had the course overview and introduction. The next 15 weeks are going to be intense. We watched 2 videos this week. The first one by Hans Rosling of the Karolinska Institute actually made epidemiologic data interesting. The animation in the slides brought the data to life. The second video about the Milenium Development goals was moving. I recommend checking it out at: http://video.google.com/videoplay?docid=-8153215241403626500&q=development+and+health&hl=en . It was a reminder to me about why I have chosen Global Health Leadership as my focus area for my MPH. I'd love to hear your thoughts on the video.