Very interesting thoughts on the goals of Western medicine. Should medicine be about alleviating suffering? Totally eradicating disease through industrializing medicine (thing drug companies)? If global health is indeed largely affected by socioeconomic factors, should medicine drive policies?
The massive collaborative project known as The Global Burden of Disease Study 2010 (GBD 2010) has just been published. The GBD is a comprehensive assessment of mortality and loss of health due to diseases, injuries and risk factors in all regions of the world.
From the Executive Summary:
The Global Burden of Disease Study 2010 (GBD 2010) is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors.
Maternal Health and the Status of Women
Both globally and domestically, maternal health and the standing of women are inextricably linked. If women do not have the means and access to give birth safely, with trained and educated midwives, physicians and nurses, with appropriate prenatal education and care, it is often indicative of the standing of women in their communities and countries overall. Women’s inequality is also linked to the soaring population growth in developing countries, which will pose a range of new challenges for the next few generations.
Some may point to the United States as an anomaly, citing women’s increasing economic and financial independence, education, and leadership roles in America, while in terms of maternal health rankings, we remain pathetically far down the line for our resources (49 other countries are safer places to give birth than the U.S. – despite us spending more money on healthcare than anywhere else). Of course, the recent and incessant attacks on allowing women to access credible, accurate, up-to-date and comprehensive sexual and reproductive health education and services makes this statistic not entirely…surprising, shall we say.
So, I found the incredibly detailed and visually impressive infographic by the National Post, pulled from spectacular data and research done by Save the Children to be particularly fascinating. What they did was combine information on the health, economic, and education status of women to create overall rankings of the best and worst countries for women, splitting the countries into categories of more developed, less developed, and least developed, and the countries were ranked in relation to the other countries in their category (the divisions were based on the 2008 United Nations Population Division’s World Population Prospects, which most recently no longer classified based on development standing). While these divisions and the rankings can certainly be contentious and may incite some disagreement (nothing unusual there, these kind of rankings usually are), I thought the results were interesting. Some highlights – Norway is first, Somalia is last. The United States was 19th, and Canada was 17th (Estonia fell in between us and the Great White North) in the most developed. Israel is first in the less developed category, and Bhutan is first in the least developed category. The full report with data from Save the Children is also available, if you want to learn more about the information combined to make this image. Take a look:
A Woman’s Place – Courtesy of the National Post
One thing that I thought was particularly great was that the researchers combined women’s health and children’s heath data to create rankings specific to being a mother, when that category is sometimes only assessed based on access to reproductive care.The specific rankings of maternal health highlights largely mimics the overall standing of women, as seen here – Norway is number one, again, and Niger falls into last place:
Mother’s Index, Courtesy of Save the Children
I think these images and graphs are particularly moving given one of the top health stories coming out of the New York Times today, which showed that a recent Johns Hopkins study indicated meeting the contraception needs of women in developing countries could reduce maternal mortality (and thereby increase the standing of women in many of the nations doing poorly in the above ranking) globally by a third. When looking at the countries in the infographic that have low rates of using modern contraception and the correlation between that and their ranking in terms of status of women, it’s not surprising what the JH researchers found. Many of the countries farther down in the rankings have rates below 50%, and for those countries filling the bottom 25 slots, none of them even reach a rate that is a third of the population in terms of contraceptive use – which of course in most cases has to do with availability, not choice. Wonderfully, the Gates Foundation yesterday announced that they would be donating $1 billion to increase the access to contraceptives in developing countries.
Also of note, and in relation to maternal and newborn health, is a new study recently published by Mailman researchers that showed PEPFAR funded programs in sub-Saharan Africa increased access to healthcare facilities for women (particularly important for this region, as 50% of maternal deaths occur there), thereby increasing the number of births occurring in these facilities – reducing the avoidable (and sometimes inevitable) complications from labor and delivery, decreasing the chance of infection and increasing treatment if contracted. This has clear implications for children as well (and why I think this study relates to the National Post infographic and the NY Times article), since newborns are also able to be assessed by trained healthcare workers and potentially life-threatening conditions averted – including HIV, if the newborns have HIV+ mothers and need early anti-retroviral treatment and a relationship with a healthcare worker and system. And it goes without saying that if a new mother is struggling with post-delivery healthcare issues, including abscesses and fistulas, or was dealing with a high-risk pre-labor condition like preeclampsia, the child will have an increasingly difficult early life, perhaps even a motherless one.
- The Best And Worst Places In The World To Be A Woman (fastcoexist.com)
- Maternal health: India likely to miss milennium goals, says UN (thehindu.com)
- Contraceptive Use Averts 272,000 Maternal Deaths Worldwide (jflahiff.wordpress.com)
- Mothers lose out (thehindu.com)
- 100,000 Women’s Lives Could Be Saved By Expanded Access To Contraception (thinkprogress.org)
- Rich countries pledge $2.6bn for family planning in global south (guardian.co.uk)
- Melinda Gates challenges Vatican by vowing to improve contraception (guardian.co.uk)
- Fulfilling Contraception Needs Could Lower Maternal Mortality Drastically, Study Says (nytimes.com)
- Maternal Mortality Rates Could Tank If We Meet Contraception Needs in Developing Countries [Contraception] (jezebel.com)
The 2012 Environmental Performance Index (EPI) (99 page pdf, Yale Center for Environmental Law and Policy, Yale University, Center for International Earth Science Information Network, Columbia University, 2012)
Also discussed here: New Rankings on Environmental Performance (The Dirt, ASLA, Jun. 5, 2012)
The Environmental Performance Index assesses the relative progress of 132 countries with 22 performance indicators. The 2012 ranking showed Switzerland, Latvia and Norway at the top, Canada in 37th position and the USA, 49th.
The journal PLoS Medicine has begun to publish a series of articles - “a multidisciplinary approach to exploring the role in health of Big Food, which we define as the multinational food and beverage industry with huge and concentrated market power.” Excerpt of an editors’ note:
“The time is ripe for PLoS Medicine to shine a light on Big Food. Foremost, large food and beverage companies now have an undeniably influential presence on the global health stage. Whether it’s food company executives providing expertise at major conferences and high-level UN meetings or major global health funders lecturing on what nongovernmental organizations can learn from Coca-Cola, the perspectives and experiences of Big Food are shaping the field of global health. At the same time that their expertise is elevated in global health debates, food companies are rebranding themselves as “nutrition companies,” offering business acumen and knowledge in food science and distribution, and asserting authority over solutions to problems not just of food production but of malnutrition, obesity, and even poverty. The legitimization of food companies as global health experts is further fueled by the growing number of private-public partnerships with public health organizations, ostensibly designed to foster collaborative action to improve people’s health and wellbeing. And yet food companies’ primary obligation is to drive profit by selling food. Why does the global health community find this acceptable and how do these conflicts of interest play out?
Indeed, while problems of obesity and associated disease are dominating discussions and debates in health around the world, there’s a concomitant gulf of critical perspectives on the food industry’s role and competing interests. Despite PLoS Medicine‘s longstanding interest in the tobacco, pharmaceutical, and other industries in health, for example, we have paid relatively little attention to the activities and influence of food and beverage companies.”
Here are links to two pieces:
- Food industry needs more scrutiny from the public health community (eurekalert.org)
- Food Industry Needs Closer Monitoring By Public Health Authorities (medicalnewstoday.com)
- Food industry needs more scrutiny from the public health community (medicalxpress.com)
- Does Big Food Contribute to Bigger Bodies? (blogs.plos.org)
- Soda pop ad campaigns called misleading (cbc.ca)
- Soda Marketing Campaigns Undermine Public Health (medicalnewstoday.com)
- How should public health advocates engage with Big Food? (blogs.plos.org)
- New PLoS Medicine series will focus on best practice in global mental health (eurekalert.org)
- Soda companies’ PR campaigns are bad for health (eurekalert.org)
- Grasping and even celebrating uncertainty ( How Journalists Can Aid Critical Thinking in Healthcare Decisions) (jflahiff.wordpress.com)
- PR Campaigns By Soda Companies Are Bad For Health (medicalnewstoday.com)
6 JUNE 2012 | GENEVA - Millions of people with gonorrhoea may be at risk of running out of treatment options unless urgent action is taken, according WHO. Already several countries, including Australia, France, Japan, Norway, Sweden and the United Kingdom are reporting cases of resistance to cephalosporin antibiotics – the last treatment option against gonorrhoea. Every year an estimated 106 million people are infected with gonorrhea, which is transmitted sexually.
Dwindling treatment options
“Gonorrhoea is becoming a major public health challenge, due to the high incidence of infections accompanied by dwindling treatment options,” says Dr Manjula Lusti-Narasimhan, from the Department of Reproductive Health and Research at WHO. “The available data only shows the tip of the iceberg. Without adequate surveillance we won’t know the extent of resistance to gonorrhoea and without research into new antimicrobial agents, there could soon be no effective treatment for patients.”
Correct use of antibiotics needed
In new guidance issued today, WHO is calling for greater vigilance on the correct use of antibiotics and more research into alternative treatment regimens for gonococcal infections. WHO’s Global Action Plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoea also calls for increased monitoring and reporting of resistant strains as well as better prevention, diagnosis and control of gonococcal infections.
Health implications are important
Gonorrhoea makes up one quarter of the four major curable sexually-transmitted infections1. Since the development of antibiotics, the pathogen has developed resistance to many of the common antibiotics used as treatment, including penicillin, tetracyclines and quinolones.
“We are very concerned about recent reports of treatment failure from the last effective treatment option – the class of cephalosporin antibiotics – as there are no new therapeutic drugs in development,” says Dr Lusti-Narasimhan. “If gonococcal infections become untreatable, the health implications are significant.”
Antimicrobial resistance is caused by the unrestricted access to antimicrobials, overuse and poor quality of antibiotics, as well as natural genetic mutations within disease organisms. In addition, gonorrhoea strains tend to retain genetic resistance to previous antibiotics even after their use has been discontinued. The extent of this resistance worldwide is not known due to lack of reliable data for gonorrhoea in many countries and insufficient research.
Untreated gonococcal infection can cause health problems in men, women and newborn babies including:
- infection of the urethra, cervix and rectum;
- infertility in both men and women;
- a significantly increased risk of HIV infection and transmission;
- ectopic pregnancy, spontaneous abortion, stillbirths and premature deliveries; and
- severe eye infections occur in 30-50% of babies born to women with untreated gonorrhoea, which can lead to blindness.
Gonorrhoea can be prevented through safer sexual intercourse. Early detection and prompt treatment, including of sexual partners, is essential to control sexually transmitted infections.
For more information please contact:
Mobile: +41 793 676 214
Telephone: +41 22 791 5099
Better urban planning is essential to improve health of the 60 percent of the global population that will be living in cities by 2030
The proportion of the world’s population that lives in cities has been steadily rising, so that three in five of all people globally will live in a city by 2030. The University College London/LancetCommission on Healthy Cities explores the many issues other than health services that contribute to population health in a city environment.
The Commission has been prepared by lead author Professor Yvonne Rydin, UCL Bartlett School of Planning, and colleagues at UCL and worldwide. The authors address issues that apply globally and use specific examples from cities as diverse as London, Bogota, Accra, and Toronto to illustrate the issues.
Just as London’s first modern, large-scale, urban sewage treatment system resulted in a 15-year increase in life expectancy between the 1880s and the 1920s, so other large-scale planning initiatives can radically change the health outcomes of city-dwellers – especially for the poorest. In this report the authors recommend focussing on the delivery of a variety of urban projects that have a positive impact on health.
Examples from the report include community-led sanitation infrastructure programmes in the slums of Mumbai, India; action for urban greening to protect against heat stress in London summers; and transportation initiatives that encourage physical activity in Bogota, Colombia….
The Commission authors looked at cities as complex, interactive entities in which changes in one part of the system can have impacts on others. They use five case studies to illustrate important themes for healthy cities.
Each case study supports the argument for a new way of planning for urban health. Planners need to recognise that conditions of complexity make it difficult to capture all the necessary information about the links affecting urban health in one plan or strategy. Unintended consequences of policy action are likely to persist. Instead planners should be working with all urban health stakeholders, including local communities, particularly vulnerable communities.
Professor Rydin says: “There should be an emphasis on experimenting with and learning from diverse urban health projects. This can mean supporting communities in their own urban health projects, as with community latrines in Mumbai slums or urban food projects in London and Detroit.”
The Commission concludes with five recommendations:
- City governments should build political alliances for urban health.
- Governments need to identify the health inequalities in cities.
- Urban planners should include health concerns in their plans, regulations, and decisions.
- Policy makers need to recognise that cities are complex systems and urban health outcomes have multiple causes.
- Experimentation and learning through projects involving local communities is often the best way forward….
- How cities can become healthy places (bbc.co.uk)
- Urban parks offer breath of fresh air for improved health (cbc.ca)
- Public Health + Urban Planning (planforthepublic.com)
- Detroit plans to shrink by leaving half the city in the dark [Urban Planning] (io9.com)
- U.N. project looks to organize urban planning (dailystar.com.lb)
- Better urban planning essential to improve health of 60% of global population that will be living in cities by 2030 (medicalxpress.com)
- What is Urban Planning? (planforthepublic.com)
- The urban age: an interview with P.D. Smith (3ammagazine.com)
- How Urban Farming Can Transform Our Cities – And Our Agricultural System (ecowatch.org)
- Sprawling cities pressure environment, planning (reuters.com)
- Let immigrants come and Britain will boom (blogs.telegraph.co.uk)
- How Urban Farming Can Transform Our Cities – And Our Agricultural System (thinkprogress.org)
- Pacific Challenges: Urbanization Brings Change and Opportunity to Island Nations (newswatch.nationalgeographic.com)
WEDNESDAY, May 9 (HealthDay News) — One in six cancers worldwide is caused by preventable or treatable infections, a new study finds.
Infections cause about 2 million cancer cases a year, and 80 percent of those cases occur in less developed areas of the world, according to the study, which was published online May 8 in The Lancet Oncology. Of the 7.5 million cancer deaths worldwide in 2008, about 1.5 million were due to potentially preventable or treatable infections.
“Infections with certain viruses, bacteria and parasites are one of the biggest and most preventable causes of cancer worldwide,” lead authors Catherine de Martel and Martyn Plummer, from the International Agency for Research on Cancer in Lyon, France, said in a journal news release. “Application of existing public-health methods for infection prevention — such as vaccination, safer injection practice or antimicrobial treatments — could have a substantial effect on future burden of cancer worldwide.”…
- Infection Causes 1 in 6 Cancers Worldwide: Study (news.health.com)
- Infection Causes 1 in 6 Cancers Worldwide (health.usnews.com)
- One in Six Cancers Are Caused By Treatable Infections [Medicine] (gizmodo.com)
- One in six cancers worldwide caused by infections that are largely preventable or treatable (medicalxpress.com)
Epidemiology: What Is It and Why Should Adult Children Know About It? With Link to a Related Supercourse
It happens over and over again as I listen to the radio or read the news. I hear about an aging parent issue or a disease that is increasing in magnitude. Or sometime it’s a health issue that is affecting certain groups of people or a new bit of research the describes problems with an intervention — one that I thought was working well. Invariably these stories make me ask why? Sometimes I ask a more personal question, “If that seems to work for me, how come researchers say is isn’t effective?”
In just about every case, I answer my question by learning more about the study of epidemiology — a field that explores and collects data about how diseases specifically and health issues in general occur and affect people and in certain places. Epidemiology measures by some period of time. This short video from the Centers from Disease Control explains more.
Epidemiology can be difficult to understand, especially because people, including me, tend to personalize the issues. Here are just a few questions to illustrate this personalization.
- What risk factors for exposure to hazards contribute to aging parent falls as individuals age (in fact we are talking here about people over 60)? Why don’t people worry environmental health problems and do things early on to prevent falls?
- How come after years and years, I’m suddenly told that yearly mammograms are less important?
- Why are men being cautioned to reconsider using prostate tests for routine cancer screening?
- Why are older seniors now being told to consider getting fewer screening tests such as colonoscopies as they age?
Supercourse is a repository of lectures on global health and prevention designed to improve the teaching of prevention. Supercourse has a network of over 56000 scientists in 174 countries who are sharing for free a library of 5050 lectures in 31 languages.
- 10 (strongly suggested yet humorous) commandments for physicians when prescribing treatments (jflahiff.wordpress.com)
- New guidelines for reporting epidemiological studies that involve molecular markers (eurekalert.org)
- Geographical Epidemiology (danielgillis.wordpress.com)
- Epidemiology: Type 2 Diabetes – Rising obesity and aging populations are driving diabetes trends (onlineindustryresearch.wordpress.com)
Transcending Borders Towards Global Health is a thought stimulating conference, convening leaders, changemakers, and participants from all areas of global health. The conference is set to engage stakeholders through a critical and integrated assessment of the state of global health as well as the policies and actions taken to reduce disparities in global health and unacceptable levels of poor health framed within five key themes: international health, ecohealth, marginalized communities, education, and advocacy and activism.###
The conference is sponsored by the Office of Global Health in the Schulich School of Medicine & Dentistry at The University of Western Ontario. It takes place April 27-29, 2012 at the London Convention Centre in London, Ontario, Canada.
The agenda, speakers list and registration details can be found at http://www.transendingborders.ca .