Author: Jean Armas

Public health nerd excited about how technology and data are transforming health and health care worldwide. Avid collector of travel postcards.

The Dire State of Reproductive Rights Worldwide

by Jean Armas, posted in APHA IH Section, Family Planning, Policy and Advocacy, Women's Health

Each day, an estimated 830 women die of preventable causes related to pregnancy and childbirth. Disproportionately affected are adolescent girls and women living in rural and impoverished areas. Providing women with universal access to family planning is one important and cost-effective way to help reduce maternal deaths. Doing so would decrease maternal deaths by a third. In developing countries, investing in family planning would lead to 2.4 million fewer unsafe abortions (one of the top causes of maternal deaths worldwide according to the WHO) and 5600 fewer maternal deaths related to unintended pregnancies. In addition, it would decrease infant mortality by anywhere from 10 to 20%.

Availability of family planning services has clear benefits in protecting the health of women and children, but it also offers so much more than that. When women can plan the timing and spacing of their pregnancies, women are more likely to attend and finish school; achieve higher levels of education; gain access to better job opportunities; contribute positively to her community; and improves the chances that she will invest in her children’s health, education, and well-being. In short, when women do better, societies do better.

This is all at grave risk now. As part of Trump’s first executive order, he reinstated the global gag rule which when implemented, states that the US can withhold family planning foreign assistance to any foreign non-governmental organization that so little as provides information on abortions, and that’s even if the organization receives funding from other sources. It’s important to note that the US already prohibits any foreign assistance from funding abortions under the Helms Amendment, which has been in place since 1973.

The re-enactment of the global gag rule comes as no surprise, as historically it has been re-enacted by every Republican president since Reagan then overturned by every Democratic president. Ironically although it has been argued that the gag role was put into place to decrease the number of abortions, a Stanford study found that abortions actually increased in years that the gag rule was in effect. It has also been shown that cutting off family planning funding to these organizations severely limits and in some cases, completely ceases, their ability to provide contraceptives and reproductive health services, thus increasing unintended pregnancies and unsafe abortions and further worsening maternal health outcomes.

The newest reinstatement of this rule however, extends far beyond the scope of the original rule and withholds all US global health assistance, not just family planning foreign assistance, to organizations that perform or provide any counseling, referrals, information, or advocacy on abortions. This revision of the global gag rule will not only hurt the millions of women in some of the poorest areas of the world who heavily rely on US-funded organizations which provide family planning services like contraception, but now impacts vulnerable men, women, and children alike. That’s because many of these organizations provide so much more than reproductive health services. Many of these organizations are hospitals and clinics, which in addition to reproductive health services, provide the full spectrum of medical care including life-saving childhood vaccinations, treatment for survivors of gender-based violence, HIV prevention and care, prenatal and postnatal care, and play a vital role in preventing the spread of infectious diseases like Zika and Ebola.

This is an unprecedented setback for the global health community and a huge threat to the advances that we have made in the fight against emerging infectious diseases, HIV/AIDS, and maternal and child mortality to name a few. We cannot let the progress we’ve worked so hard for be eradicated. Let us always remember that progress is something we must work for everyday, a call to action that is becoming more imperative in the precarious times ahead of us.

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US support for family planning foreign assistance currently stands at $575 million to 40 countries. With the institution of this new rule, $9 billion of global health assistance to 60 countries is currently at stake.

Here are a few ways to get involved:

Read APHA’s statement opposing reinstatement of the global gag rule.

 

Attacks on Health Care Workers in Syria and the Weakening of the International Community

by Jean Armas, posted in APHA IH Section, Conflict and Health, Human Rights

Before the conflict began, Syria’s health care system was one of the most advanced in the Middle East with chronic diseases ranking as the most common health concern, vaccination coverage rates at 95%, and their pharmaceutical industry producing over 90% of the country’s medicines. Five years later, the conflict has nearly decimated the health care system and today nearly half of the country’s public hospitals and primary health care systems are closed or only partly functioning, almost two-thirds of health care workers have left the country, domestic production of medicines is down by two-thirds, and the vaccination coverage rate has dropped by half. Correspondingly, life expectancy has dropped by nearly 14 years.

Since the Syrian conflict began in 2011, Physicians for Human Rights has documented 382 attacks on 269 different medical facilities and 757 deaths of medical workers. The patterns of attacks clearly demonstrate that health care facilities and workers are being deliberately targeted. When health care workers are attacked, innocent civilians are deprived of the life-saving interventions needed for both routine and emergency care. In Aleppo alone, a health care facility is targeted every 17 hours and a health care worker every 60 hours. These alarming statistics make Aleppo one of the most dangerous places in the world to be a health care worker. APHA Executive Director Dr. Georges Benjamin noted the dire state of the Syrian health care system in a letter to the UN Security Council last December, but the situation has only worsened since then.

According to a recent report in September of this year, there were only 30 doctors serving the estimated 250,000 residents trapped in rebel-held eastern Aleppo. There are currently no more hospitals functioning at full capacity in eastern Aleppo. With the huge upswing of Syrian military activity these past few days, it is likely there are far less doctors or hospitals left. To make matters worse, humanitarian aid to eastern Aleppo has been severely restricted. Since humanitarian operations started over two years ago, the UN has conducted 420 convoys to deliver medical supplies and food to eastern Aleppo however as of late, they have not been able to make their deliveries. Health care cannot exist without health care workers, supplies, and facilities.

International humanitarian law and medical neutrality have been established to protect health care facilities and workers to ensure that they can continue to provide care during armed conflict and not be prosecuted for providing services to protesters or opposition fighters. But when health care facilities and workers are purposefully targeted and humanitarian aid is withheld, there is a clear violation of international humanitarian law that should be punished accordingly as a war crime. Though the violations in Syria are some of the most flagrant, these deliberate attacks on health care facilities and workers, used as a weapon of war, occur in many other parts of the world as well. In Yemen, over 600 health facilities have been targeted since fighting began in 2014. Médecins Sans Frontières (Doctors Without Borders) has gone so far as to call attacks on health care facilities and workers during times of war as the new normal. Additionally, health workers in Bahrain were arrested, imprisoned, tortured, and charged with crimes for caring for protesters and documenting police brutality in response to the Arab Spring uprising in 2011.

Although news outlets and humanitarian organizations worldwide have brought a lot of attention to these tragedies, bringing awareness to these atrocities is not enough to stop it. It is the responsibility of the international community to help put an end to such blatant threats to human rights. The UN’s Responsibility to Protect gives permission to the international community to intervene and protect populations when a state fails to prevent and halt genocide and mass atrocities. However, the operationalization of this doctrine has proven to be disappointing. Although most actors in the international community agree that something should be done, they have been unable to agree on exactly what must be done. No-fly zones have been suggested and temporary ceasefires have been adopted to ensure delivery of humanitarian aid but both are merely stopgap measures. These are not enough to put a stop to such unnecessary human suffering and should not be the final solution.  

As the war approaches its sixth year, the future of Aleppo looking bleak, and current estimates of the death toll in Syria surpassing 470,000, the need for for the international community to help put a permanent end to the war could not be more dire. However, given the international community’s long track record of ineffectual measures, it is unclear how they will proceed. One thing is for certain, it’s about time for the international community to ask themselves whether the decisions (or indecisions) they’ve made with Syria and other conflicts have been consistent with the principles of the Responsibility to Protect doctrine. Human lives are at stake and from a human rights standpoint, this should take precedence over any personal or state interests.

Health Literacy in the Viral Media Age

by Jean Armas, posted in APHA IH Section, Information and Social Media, Technology

October is Health Literacy Month. And even though we only have a few days left in the month, I thought squeezing in a communications related post would be a fitting first blog post for the newest addition to the Communications Committee.

According to the World Health Organization, health literacy is defined as “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Health literacy means more than being able to read pamphlets and successfully make appointments. By improving people’s access to health information and their capacity to use it effectively, health literacy is critical to empowerment.”

With health literacy playing a critical role in empowering individuals to make positive health choices, it should come as no surprise then that low levels of health literacy are associated with poor health outcomes. As such, it is our responsibility as public health professionals to promote health literacy by ensuring that the health information we disseminate is accurate, accessible, and actionable. In many ways we are already experts at this, from presenting information either orally or through pictures in low literacy settings to adapting messaging to the local culture. We understand the value of delivering contextually relevant health information.

Although many individuals still rely on health professionals for trusted health information, we cannot ignore the influence of communities on health literacy and in particular the rising role of digital communities. Digital communities have helped individuals with similar health concerns share information and support each other and have enabled the growth of viral media campaigns that raise awareness on health topics and reinforce key health messages. And while digital communities have certainly helped advance health literacy by making information more readily accessible, they have also had a detrimental effect.

In the viral media age, inaccurate health information can easily diffuse to a large number of people at lightning speed in digital communities. On top of that, social networks yield incredible power in influencing health behaviors even while taking into account individual characteristics such as income and education. This combination of factors should raise some alarms.

A recent article in The Atlantic discusses the challenges created by the spread of health misinformation and criticism in digital communities during epidemics. From the 2014 measles scare in Vietnam to SARS in China example after example demonstrates the potential harms of digital communities. Whether through exacerbating individual fears or creating mistrust between health professionals and the public, digital communities can negatively impact health literacy.

Although the author notes this is most evident in the Asia Pacific region, where the confluence of Internet users, smartphones, and infectious diseases has created the perfect storm, the problem of health misinformation among digital communities isn’t limited to epidemics or geography. The problem of health misinformation exists anywhere the Internet does. It is a problem that isn’t going away anytime soon and will only continue to grow. In 2015, over 3 billion people worldwide were using the Internet compared to 738 million in 2000. Of those users, 2 billion live in developing countries compared to only 100 million in 2000.

Projects focused on increasing global Internet access, like Facebook’s Internet.org which has brought free basic mobile Internet service to over 25 million people from India to Zambia, are gaining traction. In addition, data and mobile phones are becoming more affordable. These factors are driving the ubiquity of the Internet. Thus, it is imperative that we think about ways to limit the spread of health misinformation by staying ahead of the conversation in the days, months, and years ahead of us.

As we think about how to accomplish this, here are a few ideas to start with: