White House Takes a Stand on Climate Change and Public Health

“Climate change is making an impact on our public health.”
-President Obama

We know that climate change threatens our air, food, water, and homes but earlier this month at a round table discussion, President Obama spoke about the effects of climate change on public health. In this video he says the temperature of the planet is rising and that not only comes with adverse weather and environmental consequences, but also a “whole host of public health impacts.”

Accompanied by Surgeon General Dr. Vivek Murthy, President Obama put a spotlight on increased heat-related deaths, severe asthma, extended allergy seasons, and the spread of tropical or insect-borne diseases as some possible consequences of climate change. He also spoke about the need to focus on prevention and action and the costs associated with inaction.

This is the beginning of a big push from the White House to better understand and deal with the health effects of climate change and this statement outlines their plan to do so. This is such a great step in the right direction and a big win for the public health field. Here’s to hoping it all leads to a long-term commitment with the necessary funding and policies to make significant changes!

Putting People First

“If we’re going to create resilient health systems, we have to move away from just focusing on commodities, abstract interventions. We have to remember that health is about people. It’s about protecting our populations and creating a workforce that serves those populations. So let’s think about how we build a people-centered health system.”
-Richard Horton, Director, The Lancet

The quote above is from a Global Health Workforce Alliance video which uses key stakeholders such as Richard Horton and WHO Director General Dr. Margaret Chan to make the case for a global strategy on human resources for health – the current Health Workforce 2030 campaign that you may have heard about.

So why the 2030 date? Well, based on current trends in low- and middle-income countries, it’s estimated that by the year 2030 there will be a major shortage of health workers due to country capacity to produce and retain qualified workers. At that point, the workforce (supply of health professionals) will not be able to match the need (provision of essential services).

The Ebola outbreak in West Africa has clearly demonstrated the importance of looking at a health system through the lens of people. Affected countries have lost almost 500 health workers to date (including my aunt) and these are countries that were already suffering from health worker shortages and brain drain. It’s clear that a focus on human resources is critical for these countries and others to strengthen their health systems and become resilient. Having the best supplies and medicines, cutting-edge innovations and interventions, and state-of-the-art facilities without a strong health workforce is not going to advance positive health outcomes.

The Health Workforce 2030 summary brochure is available here on the WHO’s website and the full strategy will be completed by May 2016 for consideration at the 69th World Health Assembly.

It will be interesting to see how this “people focus” plays out and influences the post-2015 development agenda.

If you’d like to learn more about the global workforce crisis in more general terms, check out this TED Talk from human resources expert Rainer Strack. It’s not about health workers or low- and middle-income countries, but he tells a good story.

Band Aid 30: Celebrities Strike Again

Over the weekend the song These Days by UK pop group Take That made it to number one on the UK Official Singles Chart. So why is that good news? Because the song took the number one spot from Band Aid 30’s Do They Know It’s Christmas?

Do They Know It’s Christmas? was first released in 1984 to raise money for the famine in Ethiopia. It was re-recorded twice (first in 1989 and then again in 2004) to raise more money for famine relief. The latest version was released last month and has undoubtedly caused a lot of controversy as it aims to respond to the Ebola outbreaks in West Africa.

While the celebrities involved may have had good intentions, their delivery is shoddy and the result is a condescending attempt at charity. Do They Know It’s Christmas? portrays West Africa as a single, poverty-stricken country in peril. The sensationalist message the title, imagery, and lyrics send is that Westerners need to save Africa because it is a place of famine and disease without any joy or hope. The lyrics read:

There’s a world outside your window and it’s a world of dread and fear
Where a kiss of love can kill you
And there’s death in every tear
And the Christmas bells that ring there are the clanging chimes of doom
Well tonight we’re reaching out and touching you
Bring peace and joy this Christmas to West Africa
A song of hope where there’s no hope tonight

The lyrics alone are insulting and erroneous, but coupled with the video, the whole thing is so patronizing. I’m utterly appalled that the producers of the music video decided to show footage of a female Ebola patient being removed (practically dragged) out of her house as the opening scene. How is that okay? Did they get her consent? Was her family involved? Also, the lack of transparency around donations and proceeds is problematic. Money is being kept in the Band Aid Charitable Trust, but the website doesn’t provide any information on exactly how the money will be disbursed and used.

As someone who has suffered a heartbreaking personal loss to Ebola I support all awareness, aid, and relief efforts, but I cannot comprehend how this whole thing came together and I’m quite disappointed in all the celebrities involved. They had the potential to do much better. They could have used their fame and influence to create something like Africa Stop Ebola which provides accurate educational information and gives all proceeds to Medecins Sans Frontieres (an organization that has been on the front lines of the Ebola outbreaks since March). But then again, celebrities and development don’t usually mix well, right? Share your thoughts below.

P.S. – check out this Band Aid 30 spoof created by the Norwegian Students’ and Academics’ International Assistance Fund

Making Social Justice the Ultimate Goal

In the global health field, we generally understand that investing in health is critical for a nation to prosper. But would you consider a lack of investment in health to be a social injustice?

The United Nations’ Under Secretary-General Michel Sidibe thinks so. In this short interview with CCTV News, he talks about how the Ebola outbreaks in Guinea, Liberia, and Sierra Leone have exposed global health failures and explains why health is an investment, not an expenditure.

Prior to watching his interview I’d never really labeled a weak health system as a social injustice in my mind. But health is a right and a shortage of health workers, the inability to provide basic health services, and lack of infrastructure – all of which have become very apparent in the Ebola outbreak – are in fact social injustices. So I think this is a very apt way to label the current situation as it puts a broader lens on the issues and ties everything into the bigger picture of the role of health in society.

His interview made me think of universal health coverage (UHC) because the definition of UHC requires social justice. It addresses the issues of access, equity, and capacity. I wonder if there will be an increased focus on moving towards UHC for the three Ebola-affected countries as part of their rebuilding efforts.

What do you think will be the biggest social justice issues coming out of the Ebola outbreaks? And how do you think we can best address them?

Remembering My Aunt, Dr. Ameyo Adadevoh, Who Stopped Ebola in Nigeria

This blog post originally appeared on the Management Sciences for Health (MSH) blog and was authored by Video Editor Niniola Soleye. This reposting does not convey an endorsement of MSH from the IH Section.


L to R: MSH staffer Niniola Soleye and her aunt, Dr. Ameyo Adadevoh 

My aunt, Dr. Ameyo Adadevoh, identified and contained the first case of Ebola in Nigeria.  She paid with her life because the health system was not ready to deal with Ebola.  The system has since caught up, and is today a model for other countries.  But the loss of such a gifted doctor and family anchor is incalculable.

Ebola arrived in Nigeria at a time when doctors at all federal government hospitals were on a labor strike (my aunt worked in a private hospital).  After ongoing negotiations with the government failed to meet their demands, the doctors – desperate to see significant changes in the health system and seeking improved salaries, positions, and titles – reached their breaking point.  So they went on an indefinite strike.

Patrick Sawyer – the index case – left quarantine in Liberia and collapsed at the airport in Lagos, Nigeria.  He was trying to travel to a meeting of the Economic Community of West African States (ECOWAS) in Calabar, Nigeria.

When he arrived at my aunt’s hospital, another doctor diagnosed him with malaria.  My aunt first encountered him during her ward round the following day and once she saw him she suspected Ebola even though she had never seen an Ebola patient before.  She questioned him and he denied being near anyone suffering from the virus but she immediately contacted the Lagos State and Federal Ministries of Health and got him tested.  While waiting for the test results to come back, the pressure on my aunt began.  Liberian government officials (and the patient himself) insisted that she discharge him so he could attend the ECOWAS conference.  She held her ground and resisted his release.  They even threatened to sue her for a violation of human rights (holding him against his will) but she remained steadfast for the greater public good.  Though she didn’t have the proper protective gear or protocols, she created an isolation area in her hospital to continue his treatment and protect her staff.  The patient couldn’t be moved because there was no isolation facility available in Nigeria at the time —the infectious diseases hospital in Lagos wasn’t functional.

The test results came back.  Patrick Sawyer’s Ebola diagnosis was confirmed, and he died in her hospital.

My aunt became ill ten days later and was taken to a makeshift isolation ward that had been set up for all the Ebola cases in the infectious diseases hospital.  The conditions of the facility were so poor that she and other patients were eventually moved to a former tuberculosis ward that had been donated by the USG.

Between the doctors’ strike and the lack of preparedness, the Ebola outbreak in Nigeria could have been a thousand times worse.  My aunt’s actions helped prevent a major spread of the virus across the country.  Because she raised the necessary red flags quickly and refused to discharge the patient, all Ebola cases in Nigeria can be traced to a single path of transmission originating with the index case. That’s no small feat in a country of more than 170 million people.

The events leading to my aunt’s death were a clear result of the larger health system troubles in Nigeria.  That said, today, Nigeria is Ebola-free.  In fact, other countries – including the US – are now looking to Nigeria to share best practices for the response and containment of Ebola.  This demonstrates that the health system eventually did catch up to Ebola, but the response was too late for my aunt and several others who were on the front lines.  If the index patient had ended up in another hospital under the care of another doctor, the delayed response from the health system may have been much more costly.

There are so many lessons to learn from the current Ebola outbreak in West Africa.  For me, the most obvious one is the importance of health system strengthening as a means to not only improve overall quality and access for all, but also to give countries the ability to properly respond to unexpected health challenges like Ebola.  If any of the affected countries had stronger health systems before this outbreak, the number of fatalities would have been significantly reduced.  We must learn from this outbreak and focus on health system strengthening as a crucial part of the rebuilding process.

One of the biggest challenges in the Ebola current outbreak is a shortage of health workers.  The high fatality rates in this Ebola outbreak reflect that.  Health workers at all levels of a health system need to be properly supported, incentivized, and protected.  They shouldn’t have to go on strike in order to improve their health systems so they can provide higher quality care.  My aunt and the more than 200 other health workers in West Africa who also lost their lives in the battle against Ebola shouldn’t die in vain.

I’m so proud that MSH is developing a solid short-term and long-term response to the Ebola outbreak in West Africa.  As part of my role at MSH, I’m supporting the Ebola response team and I see that as my way of continuing my aunt’s legacy through my job and helping to prevent other families from experiencing what my family has gone through in the last two months.

For me, the inability of the Nigerian health system to adequately prepare and quickly respond to the Ebola outbreak was an agonizing, first-hand example of the need for MSH and it reinforced the importance of the work we do.  My aunt’s death is still very painful but it comforts me to know that I am part of an organization that’s truly committed to saving lives (in everyday practice, not just in theory) and is dedicated enough to step into a crisis situation and mobilize the expertise and resources that are so desperately needed.