Okay. I’ll admit it’s not news that violence against women is a major cause of the AIDS pandemic, and that women bear the largest burden in new infections and total prevalence. But the specifics of the UNAIDS conference had me interested.
First, it’s always good to remind ourselves of the developments of AIDS, especially in hard-hit areas, like Africa and South/Southeast Asia. In Africa, women account for 60% of infections and in Asia the proportion of HIV-positive women to HIV-positive men is increasing.
But next, the conference intends to focus on specific differences that might underlie the differences in prevalence and incidence. Today, for example, the conference focused on violence.
Up to 70% of women face violence in their lifetime–in South Africa a woman is raped every minute.
I will try to keep up with this conference over the next week and a half, and I urge you to do the same.
Yesterday The Lancet, a peer-reviewed medical journal, retracted its report on the connection between vaccines and an increased risk for autism. According to NPR, Dr. Andrew Wakefield authored the study 12 years ago after he found 12 patients who had taken the Measles-Mumps-Rubella (MMR) vaccine, 8 of whom had diagnosed with autism. From the NPR article:
It later emerged that Wakefield had been taking money from a lawyer suing vaccine makers. The results of his study couldn’t be replicated… In the retraction today, the Lancet editors wrote that it became clear parts of the paper are “incorrect.”
I view this retraction as a major success in transparency of medical research, and I can only hope that its effects are reflected in public health and health prevention. The fear of autism has lead to a small–but significant–decrease in child vaccinations. This reflects a poor understanding of how well the MMR vaccines have changed the world in which we live. In America, because of effective vaccination programs, these diseases are almost nonexistent:
In America, vaccine usage has all but wiped out these once-devastating diseases.
I can only hope that vaccinations continue as they have in the past–before Dr. Wakefield’s work. There are many more discussions we can have about research funding and biases, but I’ll save those for later. Similarly, I’ll postpone discussion of the need for large-scale vaccination programs in developing countries. For now, I’ll just end with the reminder than Measles, Mumps, Rubella, and other diseases were once regular epidemics–occurring every couple of generations–that would wipe out huge segments of several societies throughout history. It is the hallmark health and medicine of the last century that we are no longer subject to these kinds of regular plagues and destruction, and we largely have vaccines to thank for this peace. So, it’s refreshing to see some honesty about the risks of vaccination.
Hi everyone! My name is Prasanth Pattisapu. I’m first year medical student at Baylor College of Medicine and a new blogger with SGHE. I’m going to upload my bio soon, but till then, I figure I’d put up a quick post on Haiti. I welcome any feedback/criticism.
Moving to the recovery stage ... a man builds floorboards for a tent in a makeshift camp at a golf course in Port-au-Prince. Photo: AFP/UN/Marco Dormino. Linked from Brisbane Times
As we try to move past the devastation in Haiti, all eyes are on the aid effort. To Americans, stories of FEMA during/after Hurricane Katrina leave us with bitter memories of aid mismanaged. To Haitians–as with many developing countries–unfulfilled promises for foreign aid from the U.S. and other wealthy nations have been all too common. With this acute awareness of the limitations of disaster assistance, the transition to a more sustainable form of aid is urgent.
Aid projects can be divided roughly into relief projects and development projects (and those in between). Relief projects tend to include building refugee camps and medical missions. They are concerned with the short term goals of disaster assistance. Development aid include education projects and infrastructure development. These projects focus on the long term, and helping sustain a higher standard of living. Ideally, the aftermath of a disaster sees relief aid slowly transform into development aid, in the aim of bringing the country to a new–and better–standard of living.
In Haiti, we’re seeing the beginnings of the short term relief process. Admittedly, there are shortfalls. The New York Times outlined how delays in food aid and monetary support have affected the people of Port-au-Prince. One can blame these shortfalls on infrastructure and governance, but this is an unsatisfying answer when history points the blame equally upon previous aid efforts and economic/political intervention in Haiti. At the Senate Committee on Foreign Relations Meeting this past Thursday, Dr. Paul Farmer described the disaster as an “acute-on-chronic” situation, alluding to Haiti’s troubled history with previous disasters, including hurricanes and political upheavals, before the earthquake even hit.
The current emphasis, as one Senator in the committee mentioned, is to “get it right this time,” to plan relief aid with development aid in mind.
It is instructive to look at previous aid efforts in other countries to learn from their lessons. First, I highly recommend reading Carol Lancaster and Samuel Wangwe’s book, Managing a Smooth Transition from Aid Dependence in Sub-Saharan Africa. The book takes a very brute-force analysis of aid to Africa, looking at those nations that have achieved aid independence and those that haven’t, and asks, “what’s the difference?” The central finding of this work is that countries are most likely to achieve aid dependence when external organizations work within the development plan and resource allocations of the government leadership. This places the responsibilities for managing aid on two sets’ of shoulders: NGOs/donors to follow the rules and the recipient leadership to set the rules.
Key examples here are countries like Burundi and Rwanda. As Dr. Farmer notes in the video above, Rwanda essentially told all NGOs that if they could not work within the framework of development that the government had set, they would not be allowed to work in the country. It seems harsh, but it prevents NGOs from becoming disorganized, overextending certain areas of the public works’ budget while leaving others lacking. The net effect is that the government authority is undermined, a phenomenon Haiti has seen in the past.
There will be a lot to watch for in the coming weeks in Haiti. But I urge readers to keep an eye out for the transition to local management of the relief effort. In my opinion, that will be the key to effective aid.
Residents walk past earthquake-damaged buildings on January 12, 2010, in Port-au-Prince, Haiti. Photograph by Lisandro Suero, AFP/Getty Images. Linked from National Geographic.
Not only is the earthquake that devastated Haiti yesterday the strongest of it’s kind in over 200 years, it’s a health worker’s nightmare. A CNN World article reported that the death toll is feared to be over 100,000, with countless more injuries. President Obama has already verbally committed expeditious support for Haiti, and aid groups on the ground have already sprung to action.
It may seem odd to do so on this blog, but in saying that the earthquake is a health worker’s nightmare, I am referencing my mother’s reaction to the news. Being a nurse, she made the observation that in a situation such as this in which the health infrastructure is devastated as deeply as the population, psychological problems such as Posttraumatic Stress Disorder can debilitate not only victims but the deliverers of aid and healthcare. To be so helpless in the ability to fulfill the primary purpose of a career in aid or health work in the face of such destruction can be monumentally discouraging.
Following such disasters we generally see an outpouring of support from the international community, and many wonder how to filter through the organizations and venues for monetary aid. I think it is important to research organizations that already had a well-established presence on the ground and thus would not only need more immediate support but are also better versed in the local issues and people. My “vote” of confidence and support goes to Partners In Health. The briefing on their website is a testimony to the sensibility and ingenuity with which Partners In Health runs their organization:
Over the past 18 hours, Partners In Health staff in Boston and Haiti have been working to collect as much information as possible about the conditions on the ground, the relief efforts taking shape, and all relevant logistics issues in order to respond efficiently and effectively to the most urgent needs in the field.
To support their efforts in Haiti, please consider helping to fund their need for medical supplies and personel: https://donate.pih.org/page/contribute/haiti_earthquake. Sometimes, the least we can do to help is what is needed most.
Following Victor’s lead, I’d like to do some reflecting myself, but on a more personal level. Recently, I’ve been filling out applications for a variety of internships, fellowships, summits, and conferences. They have all asked me the difficult question that often leaves me speechless and pensive for a time. Why?
It’s a difficult question to answer, because it implicitly asks us to convince people of the priority we place on health equity above so many other pressing issues. We tend to focus so much on the discussions we have amongst those of our own kind, celebrating things like the top global health developments in the past decade. But for those who don’t read our blog, those who aren’t members of FACEAIDS or GlobeMed, or those who haven’t heard of PEPFAR, the question still remains: Why should I care?
Since the New Year quickly approaches, I’m making finding my answer to this question my New Year’s resolution. I’ve already started on something based on my recent readings of contemporary philosopher John O’Manique and Horace Mann, the man credited with starting the public education movement in America in the 1830’s.
O’Manique uses common sense to define a right per se:
A right is a claim to something that is needed for the development of an individual human being. Its moral foundation is the virtually universal belief that, since development is good, one ought to develop and have or do what is required to develop. This is the transcendent human articulation of the propensity found in all organisms, to develop.
Many of us in the bidness argue for health as a human right. And, because of this expanded sense of “rights,” I agree. I see access to the basics of health as the condition for human development. Lacks of access to the most basic care, along with access to preventative measures for HIV/AIDS, TB, and Malaria, keep afflicted populations in the undeveloped world living defenselessly as victims instead of as productive members of our new global society. And thus “global health equity” is a means for allowing people to achieve betterment.
But to me, it is more than a human right; it is a necessary condition for helping people lift themselves out of their poverty. This is where adopting Horace Mann works nicely. In a speech on his inauguration as Secretary of the Massachusetts Board of Education, Mann states plainly that education for the poor can have economic motivations, too:
The greatest of all the arts in political economy is to change a consumer into a producer; and the next greatest is to increase the producing power,—and this to be directly obtained by increasing his intelligence.
Our arguments for better access to care in impoverished areas need not be simply moral; they can be economic.Providing better access to health for the poor in the world’s undeveloped regions is analogous to providing education for the poor in Masachusetts in 1837. It can start the gears which turn stagnation into productivity. A man afflicted with AIDS cannot till what little farmland he has. And if he cannot till, he cannot be expected to grow food for his children. And if they are malnourished, how can they hope to develop their father’s land? The lack of access to health care is the initial step in a vicious cycle.
And so, global health equity is necessary for all the right reasons, ones that I know need expansion and probably warrant discussion. So now I pose the same questions to you: Why global health equity above everything else? Why should I care?
It’s that time o’ year. Time for rankings, lists, and summaries of all that’s happened in the past year. Except this year, we’re also staring at the end of an entire decade! Yeah, some say the decade ends next year, but heck, a lot’s happened since Y2K! Inspired by Newsweek’s recap of the “decade in 7 minutes“, I figure all of us motivated by global health equity could also all use a bit of reflection this time of year.
It’s been a busy busy decade, with tons of developments. Here are a few to chew on. This list is by no means comprehensive….so throw out other moments, people, and events that you think shaped global health over the past decade.
1. The launch of PEPFAR and the Global Fund to Fight HIV/AIDS, TB, and Malaria: Since 2003 and 2002, respectively, these two financing/aid programs represent major scale-ups in the pool of resources available for global health. They’ve provided much needed hope to millions across the world, from the destitute sick to those working on their behalf. While both programs have faced criticism and challenges in disbursing their funds, they signify the prominence that global health, often driven by HIV/AIDS, has gained on the world stage.
2. The emergence of the Gates Foundation as a major global health player: Since they first stepped up their efforts in global health around the turn of the century, the Bill and Melinda Gates Foundation has become a major influence on global health. On an annual level, their budget for global health now mirrors that of the World Health Organization! Their philanthropy has added a significant boost to research efforts for diseases that affect the poor around the world, though some are wary of accountability and transparency issues. Nonetheless, Bill and Melinda Gates hold major clout, and are trying to use that clout to attract more and more attention to global health, recently even taking time to lobby Washington officials to sustain high levels of foreign aid and also appealing to the American public through an appearance on Meet the Press.
3. University students get active: Student activism and engagement around global health played critical roles in increasing political will for addressing HIV/AIDS at the turn of the century, and a proliferation of new groups during this decade, such as GlobeMed and FACEAIDS, promises to sustain student energy for years to come. With more young people realizing that the challenges of global health demand their attention and present opportunities for action (certainly one book about a doc’s work in Haiti had some thing to do with this), a new generation of young leaders will surely change the landscape of the ways in which organizations – from universities, businesses, governments, to NGOs – respond to global health inequity. This 00s will be remembered as a decade when this energy fomented on college campuses.
4. The health MDGs - In 2001, the global community rallied around the Millenium Development Goals - targets around key development metrics that the world has promised to realize by 2015. While global goals by nature are challenging tools to use, the health MDGs (focused on reducing child mortality, maternal mortality, and HIV/AIDS) laid a foundation around which many programs and initiatives mobilized political will and support for global health.
5. Who rules in global health? - As this decade draws to a close, the debates around governance in global health – who makes decisions and how – are under increasing scrutiny. With the proliferation of new initiatives and organizations, it’s often confusing as to how the global health agenda and priorities are set. Debates about whether we should move away from disease-specific funding, increase investment in prevention versus treatment, etc seem to have a chaotic way of being addressed, with many global health actors flocking in the direction of the crowd. The heightened importance of these debates signifies, however, the ways in which global health has ascended as a political priority in the course of the decade. To get a snapshot, see the Foreign Affairs debate that Laurie Garrett kicked off in 2007.
These are just a few of the major things that have emerged and happened over the past 10 years in global health. Coming from the 90s, when global health policy-makers often spent most of their time arguing how to ‘manage’ health systems on pennies, the 00s saw a paradigm shift towards arguing instead about how a new infusion of resources could be best used to tackle major global health emergencies, like the AIDS pandemic. With so many grave health inequities continuing to plague our world, the focus on effective health delivery is certainly welcome, but maintaining high(er) levels of commitment will still be a necessary challenge into the coming decade.
In a busy, busy 10 years however, there are plenty more developments I’m missing on this short list. Throw ‘em out there for discussion!
The media, as well as experts, have had us scrambling to get vaccinated against the H1N1 influenza virus, but experts are now saying that the pandemic may not be as severe as originally predicted. Rob Stein of the Washington Post explains:
Experts warn that the flu is notoriously unpredictable, but several recent analyses, including one released late Monday, indicate that the death toll is likely to be far lower than the number of fatalities caused by past pandemics.
Historically, flu pandemics have killed tens of thousands, the worst being the Spanish Influenza pandemic of 1918 with a death toll of between 20 and 50 million worldwide. Experts say that the best estimate of deaths from the 2009 H1N1 outbreak will fall between 10,000 and 15,000.
Have we finally realized that preventative measures are worth investing in? Or is the virus simply less vicious than previous outbreaks? I am inclined to side with the former. While I do believe many people overreacted, it seems that the general paranoia was enough to prompt governments worldwide to take preventative action and vaccinate as many people as possible. But is there a better way to instigate this sort of change than scare tactics?
Interesting clip from AlJareeza showing the impact of the H1N1 pandemic on drug companies:
As one Oxfam representative refers to in this clip, the H1N1 pandemic, and subsequent need for vaccines, reminds us of the huge impact the profit motives of drug companies around the world makes on the health of so many.
Donors haven’t stepped up to the plate for the Global Fund for HIV/AIDS, TB, and Malaria, creating a significant funding shortfall in their upcoming grant cycle of about $5 billion dollars. In the face of these broken promises, the Global Fund, coming out of their recent Board meeting, is having to resort to perverse bureaucratic management techniques. As the CGD blog’s David Wendt describes, GFATM is using “creative” ways to address the funding gap, by forcing developing country governments to propose increased “efficiency”. I might term the measure “brutal” more than “creative”. It must be difficult for an NGO leader or Ministry of Health member in Haiti, say, to figure out how to distribute and spend their few pennies in the best way possible. Wendt points out that:
Efficiency cuts assume that countries are asking for more than they need or that they could do more with less. According to resources needs estimates by folks like UNAIDS and Roll Back Malaria, many developing countries need far more than what they are asking for. Claiming these cuts will help poor countries “trim the fat” might be viewed as condescending. Whether they can do more with less is probably a moot point.
More than “condescending”, its shameful that donor governments continue to fall short of their responsibilities. The Global Fund here is just the messenger for these broken promises, trying to do the best with what they’ve been given. I know I’m living in utopia, but indulge me atleast in wondering….will there ever be a day where developed countries go beyond the call of duty, instead of falling short? Why is the US or the UK asking instead Rwanda or Haiti or Ethiopia, countries beset with pandemics and poverty, to “trim the fat”? When I read the headlines about the US government failing to trim their own bloated and mal-distributed health care budget or bigger-than-the-entire-world-combined defense budgets, I can’t but wonder how unfair this all really is.
So my last post dealt mainly with posing the question: How can we rebrand our social change to increase perceived value?
I ignorantly tried to answer my own question by stating something to the effect of “we need to make the idea of affecting social change easier to handle”. While I still think this is a worthwhile goal, I think it deserves another look.
I’ve been reading up on an interesting idea called system justification theory. A recent article in the online Miller-McCune e-journal has a really good overview of the theory. Basically is a jargony term for explaining one of the biggest barriers to convincing people that a specific attempt at social change is, in fact, change for the better. As John Jost, a psychologist who helped coin the phrase, summed it up:
people are motivated to justify and rationalize the way things are, so that existing social, economic and political arrangements tend to be perceived as fair and legitimate
Thus, most people tend to justify the current state of things. People pushing for global health equity, however, are calling for change. I think you can see the confrontation that will arise…
But what can we do to turn this confrontation into inclusion? One of Jost’s more recent studies on system justification theory, in regards to environmental degradation, might give some insight into a viable answer. Jost writes that “system-sanctioned” campaigns for change actually help convince people to live greener lives.
Now, though, I wonder how we make global health equity campaigns “system-sanctioned”? That’s a pickle I’ll try to get out of next time…
