Racism is an ongoing public health crisis that needs our attention now

Statement from APHA Executive Director Georges Benjamin, MD

“I can’t breathe.”

With those last words, George Floyd, an unarmed, handcuffed black man, died after being pinned down by a white Minneapolis police officer, an atrocious action that has sparked outrage throughout the nation.

We raise our voices, too, horrified, stunned and angered.

We are appalled but are not surprised by the despicable way Floyd was killed. We weep for the man, his family and a country that continues to allow this to happen. We also join in the chorus for justice and ring the alarm to all Americans. Racism is a longstanding systemic structure in this country that must be dismantled, through brutally honest conversations, policy changes and practices.

Racism attacks people’s physical and mental health. And racism is an ongoing public health crisis that needs our attention now!

We see discrimination every day in all aspects of life, including housing, education, the criminal justice system and employment. And it is amplified during this pandemic as communities of color face inequities in everything from a greater burden of COVID-19 cases to less access to testing, treatment and care.

Americans cannot be silent about this. As Martin Luther King, Jr. observed, “The ultimate tragedy is not the oppression and cruelty by the bad people but the silence over that by the good people.”

We refuse to be silent, and we call for you to join us in our advocacy for a healthier nation. At the American Public Health Association, every moment of our waking hours is poured into finding better, more healthful lives for all, so everyone has a chance to breathe. It’s our life-blood.

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APHA champions the health of all people and all communities. We strengthen the public health profession. We speak out for public health issues and policies backed by science. We are the only organization that combines a nearly 150-year perspective, a broad-based member community and the ability to influence federal policy to improve the public’s health. Visit us at http://www.apha.org.


APHA’s Racism and Health Resources

APHA’s Racism and Health page: 

https://www.apha.org/topics-and-issues/health-equity/racism-and-health (you can tweet/share the Alias, which is apha.org/racism

APHA’s new webinar series, Advancing Racial Equity: 

https://apha.org/events-and-meetings/webinars/racial-equity (also has an Alias you can share, which is apha.org/racial-equity)

APHA’s Health Equity page: 

https://apha.org/topics-and-issues/health-equity

APHA’s COVID-19 and Equity page:

 https://apha.org/topics-and-issues/communicable-disease/coronavirus/equity

Public Health Newswire health equity posts: 

http://publichealthnewswire.org/?cat=health-equity

Lend your voice to the IH Section’s Communications Team!

The IH Section’s communications team is currently looking for volunteers who want to get involved in our section’s communications activities.

This is a great opportunity for self starters interested in engaging with the global health community through our communications channels by drawing attention to relevant global health topics, encouraging public support and action on pressing global health issues, preventing the spread of misinformation, and providing transparency into the work of the APHA and the International Health section. Applicants must maintain current membership in APHA’s International Health section.

Social Media Associates

We are seeking individuals with social media skills. The volunteer will:

  • Routinely share relevant content on social media and engage followers on Facebook, Twitter, and Instagram
  • Share content from Social Media Subcommittee leadership within 2-4 hours or receiving it, during the hours of 8 am-5 pm in a U.S. time zone. Content may have to be changed to an appropriate format in order to share effectively to social media pages
  • Participate in social media subcommittee meetings
  • Assist with special projects as needed

Those who can serve as an associate for 4 months or more will have priority.

Please contact: ihsection.communications@gmail.com for more information.

COVID-19 Guest Contributors for IH Connect

COVID-19 contributors will write up an original analysis or commentary on COVID-19 for our blog. We do not accept applications from contributors wanting to promote a specific product, brand, or organization. 

Please contact: ihsection.communications@gmail.com for more information.

Regular Contributors for IH Connect

Regular contributors write up original analysis, commentary, or education on global health topics for our blog once a month. Regular contributors will also help to regularly maintain the IH website by posting relevant section news, events, webinars, workshops, etc. We do not accept applications from contributors wanting to promote a specific product, brand, or organization. 

4+ hours per month, 6 month minimum commitment.

Please contact: ihsection.communications@gmail.com for more information.

News Round Up

Politics & Policies

The World Health Organization’s annual oversight convention was held by teleconference recently, as the worst pandemic in modern history continues around the globe.

https://www.npr.org/sections/goatsandsoda/2020/05/17/857206256/unprecedented-world-health-assembly-convenes-online-as-pandemic-rages

World Health Organization (WHO) member states have agreed to set up an independent inquiry into the global response to the coronavirus pandemic. The resolution, approved without objection by the WHO’s 194-member annual assembly meeting virtually in Geneva, also allows for the inquiry to look into the health body’s own role.

https://www.bbc.com/news/world-52726017

Domestic travel restrictions and a general lack of coordinated funding — not shortages of personal protective equipment — are the biggest constraints to accessing the world’s most vulnerable communities in the midst of the coronavirus pandemic, humanitarian leaders said Monday.

https://www.devex.com/news/travel-restrictions-funding-gaps-a-bigger-problem-than-ppe-humanitarian-leaders-say-97217

As parts of the United States and Europe consider reopening, most of the world’s population remains susceptible to the coronavirus. We look at new efforts to stop the deadly spread of COVID-19 with contact tracing.

https://www.democracynow.org/2020/4/23/dr_joia_mukherjee

Loyce Pace, current president and executive director of Global Health Council, releases an opinion piece on Devex titled “The end of global health advocacy as we know it”

https://www.devex.com/news/opinion-the-end-of-global-health-advocacy-as-we-know-it-97302

President Trump has threatened to withdraw funding from the World Health Organization, accusing it of mismanaging the coronavirus pandemic, particularly in its early stages as it emerged in China. This BBC article looks at some of the charges President Trump has levelled against the WHO and the health body’s responses.

https://www.bbc.com/news/world-us-canada-52294623

Programs, Grants & Awards

At this month’s meeting of the 73rd World Health Assembly —its first-ever to be held virtually—delegates adopted a landmark resolution to bring the world together to fight the COVID-19 pandemic.

https://www.who.int/news-room/detail/19-05-2020-historic-health-assembly-ends-with-global-commitment-to-covid-19-response

The DGHI, established in 2006, is working hard to keep current students going, and some classes have shifted to focus on the coronavirus pandemic. Meanwhile, the institute is looking ahead to a possible increase in applications.

https://www.dukechronicle.com/article/2020/05/duke-university-how-global-health-institute-adapted-pandemic-coronavirus

Research

International experts have advised the World Health Organization (WHO) to work to identify the animal origins of the virus behind the COVID-19 pandemic and its transmission to humans, the UN agency said.

https://news.un.org/en/story/2020/05/1063072

One prominent research group, Harvard’s Global Health Institute, proposes that the U.S. should be doing more than 900,000 tests per day as a country.

https://www.npr.org/sections/health-shots/2020/05/07/851610771/u-s-coronavirus-testing-still-falls-short-hows-your-state-doing

While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food.

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30229-1/fulltext

Enrollment in several clinical trials of chloroquine and hydroxychloroquine — including two by the University of Washington — has been anemic so far. Fewer than 260 volunteers, out of a target of 2,000, have signed up for a $9.5 million UW study being conducted in Seattle and six other sites across the country. Another multi-site project coordinated by the UW has only about 30 patients enrolled.

https://globalhealth.washington.edu/news/2020/05/11/clinical-trial-enrollment-plummets-volunteers-are-scared-coronavirus-drugs-promoted

In most of the world, the Aedes aegypti mosquito is notorious for biting humans and spreading dengue, Zika, and other viruses. But in Africa, where the mosquito is native, most Aedes prefer to suck blood from other animals, such as monkeys and rodents. A new study suggests, though, that their taste for humans may rapidly expand—and with it their ability to spread disease.

https://www.sciencemag.org/news/2020/05/mosquitoes-taste-human-blood-may-grow-african-cities-expand

Toddlers with congenital Zika syndrome have severe developmental delays, researchers report.  In a study that covered a five-year period, researchers found that children in Brazil with congenital Zika syndrome who had microcephaly at birth suffered severe mental delays.

https://consumer.healthday.com/diseases-and-conditions-information-37/zika-1007/zika-virus-tied-to-profound-developmental-delays-757407.html

An herbal tonic developed in Madagascar and touted as a cure for COVID-19 could fuel drug-resistant malaria in Africa, scientists warn. Several African countries have said they are placing orders for the brew, whose efficacy has yet to be shown.

https://www.sciencemag.org/news/2020/05/unproven-herbal-remedy-against-covid-19-could-fuel-drug-resistant-malaria-scientists

For the first time in the post-war history of epidemics, there is a reversal of which countries are most heavily affected by a disease pandemic. By early May 2020, more than 90% of all reported deaths from coronavirus disease 2019 (COVID-19) have been in the world’s richest countries; if China, Brazil, and Iran are included in this group, then that number rises to 96%.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31089-8/fulltext

Diseases & Disasters

Italy was the first European country to be hit hard by the pandemic — its intensive care units inundated and its elderly dying in droves before the tsunami reached Spain, France, the United States or Britain. And so Italy is also ahead in coming to grips with the long duration of the illness and the lasting consequences for some survivors.

https://www.nytimes.com/2020/05/10/world/europe/coronavirus-italy-recovery.html

For the first time in over 100 years, people all over the world are fighting a common public health enemy: COVID-19. Yet, even as we pour resources into fighting this new pandemic, there is an urgent need to keep up the fight against an age-old enemy: malaria, which continues to cause immense suffering and death among some of the world’s most vulnerable populations.

https://www.globalhealthnow.org/2020-04/malaria-services-must-be-maintained-amid-covid-19-pandemic

Technology 

As coronavirus vaccines hurtle through development, scientists are getting their first look at data that hint at how well different vaccines are likely to work. The picture, so far, is murky.  On 18 May, US biotech firm Moderna revealed the first data from a human trial: its COVID-19 vaccine triggered an immune response in people, and protected mice from lung infections with the coronavirus SARS-CoV-2. The results — which the company, based in Cambridge, Massachusetts, announced in a press release — were widely interpreted as positive and sent stock prices surging. But some scientists say that because the data haven’t been published, they lack the details needed to properly evaluate those claims.

https://www.nature.com/articles/d41586-020-01092-3

Landmark review of the role of artificial intelligence (AI) in the future of global health published in The Lancet calls on the global health community to establish guidelines for development and deployment of new technologies and to develop a human-centered research agenda to facilitate equitable and ethical use of AI.

https://www.sciencedaily.com/releases/2020/05/200519165844.htm

Environmental Health

Air pollution exposure has been linked to coronary heart disease.  This prospective cohort study aimed to investigate associations between long-term exposure to air pollution and MI incidence, adjusting for road traffic noise.

https://ehp.niehs.nih.gov/doi/full/10.1289/EHP5818

Equity & Disparities

On April 29, UNICEF published a discussion paper comparing the probable downstream effects of COVID-19 in developed and developing countries. High-income and upper-middle-income countries have borne the brunt of deaths associated with COVID-19 so far, and they are now seeing diminishing mortality rates. Countries across the world are easing lockdown restrictions. But, as this UNICEF paper outlines, for populations least affected by the disease itself, but for whom food insecurity, hunger, and malnutrition are already prevalent and critical problems, the worst might be yet to come.

https://www.thelancet.com/journals/langlo/artcle/PIIS2214-109X(20)30228-X/fulltext

The number of older people in lower income countries is growing. These countries’ health systems are not designed to care for people with chronic conditions. They are more focused on single, acute diseases. This may need to change towards more individual-based health care for chronic conditions. This is why it’s important to establish if multi-morbidity is also an issue in lower income countries.

https://qz.com/africa/1860255/people-in-poor-countries-are-living-longer-but-with-more-diseases/

In nearly half a million American homes, washing hands to prevent COVID-19 isn’t as simple as soaping up and singing “Happy Birthday” twice while scrubbing. In many of those homes, people can’t even turn on a faucet. There’s no running water.

https://khn.org/news/millions-stuck-at-home-with-no-plumbing-kitchen-or-space-to-stay-safe/

Women, Maternal, Neonatal & Children’s Health

The decision to close schools was among the first action that many states took to stave the impending pandemic and was based on a strong theoretical foundation. Children are typically at greatest risk of infectious diseases, and they transmit them to each other and their families with considerable speed.

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2766113

There are reports that the coronavirus lockdowns around the world are leading to a catastrophic rise in domestic violence.

https://www.theguardian.com/global-development/2020/may/12/we-wrap-services-around-women-brazils-innovative-domestic-violence-centre

Doctors have described children with covid-19 coming into emergency rooms in bad shape with a kind of inflammatory shock syndrome affecting multiple organs.  Some were screaming from stomach pain. Others had bubbles, or swelling, in the arteries of their hearts.

https://www.washingtonpost.com/health/2020/05/06/kawasaki-disease-coronavirus/

The UN Children’s Fund (UNICEF) estimates that 116 million babies have been born since the onset of the COVID-19 pandemic, and on Thursday called for governments to maintain lifesaving services for pregnant women and newborns that are under increasing threat from strained health services and supply chains.

https://news.un.org/en/story/2020/05/1063422

 

The Intersection of Climate Change and COVID-19 Resource Guide now available!

The IH section’s Climate Change and Health working group has released a new resource guide on the intersection of climate change and COVID-19. Included are reports, articles, and webinars.

To learn more about the Climate Change and Health working group or to volunteer, please visit their website here: https://ihandcc.wordpress.com/

Global Mental Health Initiatives and COVID-19

This is the third part of a IH Blog series, Global Mental Health: Burden, Initiatives and Special Topics.

Part III – Global Mental Health Initiatives and COVID-19

Mental health issues pose a significant public health burden and in the context of COVID-19 this burden is growing substantially. In low- and middle-income countries, 76%-85% of people with mental disorders do not receive needed treatment. Many countries do not have the infrastructure, resources and/or political support to adequately ensure that all persons have access to high quality mental health services. Therefore, there is a large gap between the need for mental health treatment and available services.

One important indicator of a country’s capacity to address the growing mental health burden is the availability of adequately trained personnel to provide treatment and care. In 2010, the World Health Organization (WHO) released the results of a study that found that low- and middle-income countries in the African Region and the South-East Asian Region reported fewer mental health professionals than the Americas or the European Region. According to the 2017 Mental Health Atlas country profiles, this trend still exists. For example, India reported 1.93 total mental health workers per 100,000 population, Rwanda reported 2.01, and China reported 8.75, whereas Germany reported 144.87, France reported 173.63, Finland reported 250.55 and the United States reported 271.28. In order to meet the increasing demand for mental health care globally adequately trained mental health care providers are critically needed.

One initiative aiming to reduce the burden of mental health issues globally is the Mental Health Gap Action Programme (mhGAP) which was launched in 2008. This program uses evidence-based tools, training, and interventions to expand mental health service provision in resource-poor, low-income countries around the world. The original 2010 mhGAP Implementation Guide has been used in over 100 countries and translated into more than 20 languages. The program directs its training towards health-care providers who do not have specialized training in mental health. For instance, in 2017, to address the mental health needs of persons affected by conflict in Borno State, in northeastern Nigeria, the Federal Neuro-Psychiatric hospital and governmental authorities launched the mhGAP program. This program trained primary care workers to identify and provide care for persons with mental disorders. The story of Aisha, a girl directly impacted by this conflict who received mental health treatment through mhGAP can be found here.

In the World Health Organization’s (WHO) most recent global targets and goals (Sustainable Development Goals (SDGs)), mental health was explicitly included as a part of SDG Target 3.4. In December 2019 WHO held a meeting to accelerate progress on SDG Target 3.4 on Noncommunicable Disease and Mental Health in Oman. The goal of this meeting was to have countries come together to share success stories and challenges in order to develop innovative ideas on how to scale up national interventions to reach SDG target 3.4 by 2030. There were sessions titled: “Mental health and psychosocial support in emergencies” and “Story-telling and mass media for mental health.” Video of panels held during the meeting can be viewed here

As part of their QualityRights Initiative, WHO has developed training and guidance modules that are meant to empower all stakeholders to promote mental health recovery and human rights in mental health facilities, improve service delivery, and change mindsets around mental health. The modules are designed to be used in low, middle, and high-income countries. Updated modules were introduced in November 2019. QualityRights has been introduced into 31 countries, with Ghana being the first to introduce the program country-wide in early 2019. A total of 22 member states of the European Region formally agreed to carry out mental health related activities during 2018-2019, and a majority stated they would use WHO QualityRights toolkit and guidance materials. 

Another WHO initiative, WHO MiNDbank, is a free online platform that contains a wide variety of international and country-specific resources covering behavioral health. MiNDbank is a part of WHO’s QualityRights campaign and aims to facilitate dialogue, advocacy and research surrounding human rights violations against people experiencing mental health challenges and disabilities. 

Current Initiatives Focused on COVID-19

Global Initiatives

New global initiatives are being implemented to address the mental health burden of the COVID-19 pandemic. Many initiatives are focused on disseminating educational resources out to the public. In direct response to the COVID-19 pandemic, WHO released a list of mental health and psychosocial considerations for different groups, such as people in isolation, carers of children, and healthcare workers. To support research efforts on behavioral insights related to COVID-19, the WHO Regional Office for Europe developed a survey tool for European Member States to use. 

On March 17, 2020, the Inter-Agency Standing Committee (IASC), a humanitarian coordination forum created by the United Nations, published an interim briefing note titled, “Addressing Mental Health and Psychosocial Aspects of COVID-19 Outbreak.” Like WHO’s list of considerations, this briefing note summarizes important mental health and psychosocial support considerations in relation to the COVID-19 outbreak. The document includes 14 recommended activities and six interventions that can be globally implemented as part of the COVID-19 mental health response. The briefing note is available in over 15 different languages. 

Initiatives in the United States 

The United States is implementing several initiatives that aim to address the mental health burden of the COVID-19 pandemic. Information about some of these initiatives is provided below:

Centers for Disease Control and Prevention (CDC)

  • The CDC webpage – Stress and Coping. This page provides general and population specific recommendations.

National Alliance on Mental Illness (NAMI)

Substance Abuse and Mental Health Services Administration (SAMHSA)

  • A web page dedicated to COVID-19, with SAMHSA resources and information, guidance for opioid treatment programs, and additional federal guidance 
  • A list of SAMHSA COVID-19 funded grants organized by state

Mental Health America

  • Information and resources on mental health and COVID-19. Includes tips for social distancing, quarantine, and isolation, resources for financial support, tools and information on anxiety, links to webinars and workshops, and information for parents, older adults, domestic violence survivors, and more. 

American Psychiatric Association (APA)

Harvard University

National Child Traumatic Stress Network (NCTSN)

ThriveNYC

About the Authors:

Screen Shot 2020-03-31 at 7.52.50 PMElena Schatell MPH (c) MMS (c)

Elena Schatell is a current student at Arcadia University enrolled in the Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. She aims to promote public health in underserved communities as a future physician assistant. Her current public health interests include access to mental health services, stigma surrounding mental illness, and the relationship between faith and mental health. She has interned at the National Alliance for Mental Illness (NAMI) national office in Arlington, Virginia, working closely with the Advocacy and Public Policy team on conducting research on service barriers and state mental health policy. During her time at NAMI, she also authored articles for the Advocate magazine and blog.

McClintock.PictureDr. Heather F. McClintock PhD MSPH MSW

Dr. McClintock is an IH Section Member and Assistant Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.