Category: APHA IH Section

Looking Ahead: Global Health Threats in 2019

by Yara Asi, posted in APHA IH Section, News, Policy and Advocacy

The past year felt turbulent across many facets of life- global health included. Between threats to health from climate change, infectious disease outbreaks, the opioid crisis, threats to healthcare in war zones, and the ever-present health risks of noncommunicable diseases, global health resources are stretched thin. The coming year promises to be just as challenging.

Many global health organizations, such as the World Health Organization and IntraHealth, release reports on health risks to look out for at the start of each year. Between these lists, there is significant overlap, suggesting that the problems in global health are not a matter of lack of data or direction, but poor prioritization and lack of resources. Pollution and climate change rank high on almost all such lists; the WHO reports that 90% of people breathe polluted air on a daily basis. As a result, the WHO considers air pollution the greatest environmental threat to health for 2019- a significant step considering the threats of water pollution and other environmental contaminants. As with most global health issues, the world’s poorest people are hit the hardest. Nearly nine in ten of global deaths due to inhaled pollutants are in low- and middle-income countries (LMIC), due to entirely preventable causes like poor regulation of transport emissions and using gas-powered cookstoves in homes.

Another problem heavily featured in the forecasting reports for 2019 include health risks due to conflict. More than 1 in 5 people across the globe (22%) live in a conflict-affected environment. These are the populations least likely to meet health and development targets, like the Sustainable Development Goals. Specific conflicts are high on the radar of global health officials, especially Yemen and Syria. Both countries have experienced heavy destruction of their existing health infrastructure, brain drain of medical personnel, and tangential struggles that bode poorly for health, such as food insecurity and poor sanitation. Dogged efforts by both local and international humanitarian workers have been able to stave off many public health disasters in such environments, but as wars proliferate and donor attention drifts, only the most pressing issues can be addressed. For example, in Yemen, an unprecedented multi-wave cholera outbreakled to more than 1 million cases of cholera. Of these cases, 30% were children. An effort by many international and local NGOs to distribute vaccines to these cases likely decreased the death toll, but the existing malnutrition of the population coupled with factors like destroyed water supplies exacerbated the outbreak and accelerated the need for resources and personnel.

Risks from infectious disease are typically present throughout global health forecasts, and this coming year was no different. In fact, for the first time, the WHO considers vaccine hesitancy, which they define as the reluctance or refusal to vaccinate despite the availability of vaccines, to be a public health risk that threatens to undo decades of work eradicating diseases that, until quite recently, affected people around the world. Vaccine hesitancy is thought to be one of the factors that has led to a 30% increase in global measles cases. Outbreaks of Ebola have shown how dangerous and fast-moving an infectious disease can be, even with the health workers tasked with treating ill patients. Resurgence of polio in war-torn Syria was only dissipated through a massive vaccination effort. The growing threats from influenza, Dengue, Zika, MERS, SARS, and many other diseases have raised the alarm as to how well global public health processes are able to deal with a potentially catastrophic pandemic. Unfortunately, another global health risk identified by the WHO is antimicrobial resistance for the types of antibiotics that, for decades, have saved the lives of millions. This could cause currently treatable infections like pneumonia, gonorrhea, and salmonellosis to be as dangerous as in times before antibiotics were available. One such infection, tuberculosis, affects 10 million people per year and kills almost 20% of those afflicted. In 2017, almost 500,000 cases of tuberculosis were classified as “multi-drug resistant.”

It’s not all bad news. Overall, global health trends are moving in a generally positive direction. Global life expectancy has increased by 5 years since 2000. Every day, more people will be able to access clean water, electricity, and the internet. Global child mortality has fallen by almost 15% since 1960, while global extreme poverty has fallen to less than 10%, an almost 30% decrease from just three decades ago. Almost 90% of children receive the DTP vaccine before their first birthday. However, progress is uneven, and for many is too slow. Many experts believe that some of the long-simmering global health concerns of the past few decades may be coming to a head as 2019 begins.

For anyone concerned with global health, these risk forecasts can seem dire. Even under the best of conditions, most initiatives set to tackle these risks can at best hope to minimize, and not completely eradicate, the threats from these challenges. The MDGs and SDGs are an important first step in setting a global agenda that puts the social welfare of populations at the front and center, and such efforts must continue. Yet, policymakers cannot ignore the many countries around the world that continuously fail to meet minimum standards of health and well-being. We cannot decouple the political and economic circumstances that lead to failures in global health progress. Short-term aid packages are a necessary salve, but not a sustainable solution. Many global health advocates contend that putting health and well-being at the center of state strategic planning would cascade into positive indicators in all aspects of life, such as food security, education outcomes, economic development, and inter-state diplomacy and coordination. To ensure that we are poised to meet the known and still unknown risks that may come in the coming years, global health must be a primary consideration.

High-Level Perspectives for this Epidemiologist: Exploring Global Disease Control Policies and Strategies

by scanyatonwu, posted in APHA IH Section

I just returned from participating in a Disease Control Strategies and Policies short course at the University of Heidelberg’s Institute of Global Health. It was a great opportunity for me to spend some time learning about high-level disease control and prevention efforts that have been made on a global scale to tackle communicable and non-communicable diseases. Additionally, it was a different experience for me to have to take a step back and reflect on the amount of work and time that is required to build public health infrastructure, strengthen health systems, and empower communities across the globe. At times, I have to admit, I was a bit discouraged as I listened to how easily politics, corruption, misinformation, poor communication, and a lack of cultural awareness can so easily reverse significant progress that has been made toward eradicating high-impact diseases. Overall, however, I came away with a deep understanding that there will always be work that needs to be done by versatile public health professionals. I would recommend this course to passionate individuals who are considering leadership roles in global health or have been practicing full-time in the field of public health (or at least a health-related field) for at least 3 years.

It was very stimulating to participate in this course with professionals from all over the world. One thing that was especially satisfying was that many participants were able to speak about how public health (we also had some pharmaceutical and economics/policy development perspectives) is practiced in their specific countries/regions. I found myself constantly learning as I compared and contemplated how different interventions mentioned by my peers could (or could not) be applied to my setting- I even gained better perspective on some of the public health activities that are undertaken and sustained even though they don’t appear to be very effective at preventing or limiting disease. Of course, I took time to acknowledge the different cultural and political factors that come into play and influence public health policies in different countries. Something I did not expect was that I would have the opportunity to represent the U.S., Texas (the state I worked in as an epidemiologist before taking my fellow position), and Zambia (a little knowledge goes a long way) on various topics. There were 3 or 4 of our lecturers that are doing work in Zambia so I also had the opportunity to learn more about their projects and see whether or not they were connected to any of the partners that our CDC office works with.

On to the highlights! My favorite part of this course was an interactive lecture where we got to role play that we were members of the WHO Strategic Advisory Group of Experts (SAGE) on Immunization deciding why we should or should not recommend a Dengue vaccine (there was also a group that had to role play being a country that had to decide on whether to introduce the vaccine). Dr. Annelies Wilder-Smith (WHO Advisor and Consultant) led the activity. This vaccine had caused many political, social, and public health challenges in the Philippines that made my jaw drop and emphasized how delicate public health support from the public is (especially during an election year). Ultimately, we learned that there are many different factors that are considered before a vaccine is recommended for public health use and that ministries of health have to use all available information to choose whether or not to introduce certain vaccines into their communities. The process we went through was very full-circle for me because it answered questions that I have had about where to find the most comprehensive information on public health vaccines so that I can serve as a better resource to those in my spheres of influence. Another assignment we had was to give presentations on Hepatitis A, B, C, and E. In my group, I focused on the epidemiology and global burden of Hepatitis E. This was an interesting topic for me because I had started seeing a few Hepatitis E lab reports being submitted to the health department I worked at in Texas. As a result of this assignment, I learned that the risk factors differ between developed vs. developing countries (undercooked meat consumptions vs poor sanitation) and that there are also different genotypes seen in developing vs. developed countries. Our last main assignment was to choose a prompt to write an essay on. I debated between The large Ebola outbreak in West Africa has been controlled by an effective vaccine and The HIV/AIDS pandemic will be ended by 2030. I was tempted to write on the first topic but then I decided that, since the majority of my office focuses on HIV (and my current role focuses on other diseases), this would be a great opportunity to better understand the work that they do. I was not disappointed! Overall, I concluded that the HIV/AIDS pandemic will not end by 2030 because, even though there is knowledge about how to protect against HIV and an effective treatment exists, cases continue to increase by millions each year. Additionally, men are underrepresented in the data and there are many community-level interventions that need to be implemented in diverse cultural settings (particularly in sub-Saharan Africa) in order to see the 90-90-90 goals reached by 2030.

Other lectures that stood out to me included presentations on Tobacco Control (Presented by Dr. Volker Winkler), Vector Control/Control of Arboviruses (Presented by Dr. Norbert Becker and Dr. Annelies Wilder-Smith, respectively), Global Diabetes Control (Presented by Dr. Florian Neuhann), and an exercise focused on ranking an individual’s risk of getting infected with Ebola virus based on varying exposures to an Ebola Virus Disease patient (Presented/Facilitated by Dr. Sabine Geis).

I thoroughly enjoyed my experience and hope that I can attend another course in the future! Feel free to see if there are some courses you may be interested in as well
Short Courses at Heidelberg Institute of Global Health!

Sophia Anyatonwu, MPH, CPH, CIC
Epidemiologist
Global Epidemiology Fellow | PHI/CDC Global Health Fellowship Program

Call for Proposals: Health and Climate Solutions due 2/8

by ihsection, posted in APHA IH Section, Climate Change and Environment, Climate Change and Health Group

Posted on behalf of the Climate Change and Health Working Group
———————————
 Application Deadline: February 08, 2019, 3:00 p.m. ET

Purpose

Through this funding opportunity, Robert Wood Johnson Foundation (RWJF) seeks to develop and amplify the evidence around a set of approaches that improve community health and well-being and advance health equity, while also addressing climate change adaptation or mitigation. Eligible, local approaches can focus on one or more of a range of determinants of health—including, but not limited to: air quality; energy sources; transportation or mobility design; food and water systems; housing; and health systems. Proposals should specify the determinants of health that the given approach is addressing, and the expected impact on health and well-being. Grant funds will support research and evaluation activities to develop the best possible evidence highlighting what is working well with the select approach and why; where there have been opportunities and challenges; and how other communities may learn from this approach to tackle similar challenges. *All interventions eligible for this funding must have been implemented and active for at least one year as of the date of the application.

Eligibility and Selection Criteria

·      Proposals must discuss approaches focused in one or more geographically defined communities.
·      The community or organization implementing the approaches to address the health impacts of climate change, while improving health equity, must serve as the primary applicant (Project Director), and will be the prime recipient of funds. Individuals from collaborating organizations (e.g. research partner) can serve as the co-Project Director.
·      Eligible applicant organizations include public and private nonprofit organizations, federally or state-recognized Indian tribal governments, indigenous organizations, local government, and academic institutions.
·      Preference will be given to applicant organizations that are either public entities or nonprofit organizations that are tax-exempt under Section 501(c)(3) of the Internal Revenue Code and are not private foundations or Type III supporting organizations. The Foundation may require additional documentation.
·      Applicant organizations must be based in the United States or its territories.
·      Only one proposal may be submitted per applicant organization.

RWJF encourages applicant organizations representing diverse geographic areas, first time-applicants, and communities that are most vulnerable to the effects of climate change to apply.

Key Dates

Monday, January 7, 2019 (3:00 – 4:30 p.m. ET)
The first of two optional applicant webinars to provide an overview of the program and an opportunity to ask questions that are general in nature. The second webinar (see below) will be a repeat of the first. Registration is required; please register here for the January 7th webinar.

Tuesday, January 15, 2019 (8:00 – 9:30 p.m. ET)
A repeat of the first optional applicant webinar to provide an overview of the program and an opportunity to ask questions that are general in nature. Registration is required; please register here for the January 15th webinar.

February 8, 2019 (3 p.m. ET)
Deadline for receipt of brief proposals.

March 6, 2019
Selection of semi-finalists; notification of invitations to submit full proposals.

April 3, 2019 (3 p.m. ET)
Deadline for receipt of full proposals.

May 2, 2019
Selection of finalists; notification of invitation to participate in a site visit interview.

May 6, 2019 – May 20, 2019
Site visits conducted.

May 31, 2019
Selection of recommended grants; notification of decisions.

July 15, 2019
Approximate grant start date.

Total Awards
·      Up to eight awards will be made through this funding opportunity.
·      Proposals may request a budget of up to and including $350,000 each, for a project duration of up to and including 24 months.
·      Grant funds will support only research and evaluation activities and some communication and dissemination efforts; funds may not be used to develop or implement a new intervention, program, or approach.

For more information and to apply:
https://www.rwjf.org/en/library/funding-opportunities/2018/health-and-climate-solutions-hub.html

The Developing World & Non-Communicable Diseases: A Pandemic of Drug Shortages & Inequitable Access

by pragmaticsolidarity, posted in APHA IH Section, Chronic Disease, Health Equity, Pharmaceuticals

Throughout the developing world, health demographics are rapidly shifting from communicable diseases to non-communicable diseases (NCDs) due to urbanization, lifestyle changes, and introduction of processed food. Although still retaining a significant portion of their communicable disease burden like tuberculosis and malaria, the prevalence of hypertension, diabetes, and cancer in developing countries has increased dramatically and is expected to cause every 7 out of 10 deaths by 2020. With the rise of these health ailments, the global health community has highlighted the importance and severity of these diseases through UN High-level meetings, incorporating relevant indicators in the Sustainable Development Goals (SDG’s), and forming interagency coalitions within countries to address the barriers of NCD prevention and treatment. However, NCD medication supplies have remained an underappreciated barrier that humans affected by global health inequalities confront each day. The complications of drug supplies range from common medications being out of stock to not having a vital class of medications available at the health facility. The medication shortages that plague developing nation states often have a more pronounced effect on underserved populations – essentially causing an impossible barrier to treating their chronic condition and preventing morbidity/mortality.

Last month on November 20th, The Lancet Diabetes & Endocrinology revealed predictions in the year 2030 regarding the world’s insulin supply that stunned health care professionals around the globe. From data gathered recently, the number of individuals diagnosed with Type 2 diabetes is estimated at 405 million people. Although some patients can be treated with oral or injectable diabetic medications like metformin or GLP1 inhibitors, there are approximately 63 million people on earth today that require the use of insulin to manage their diabetes. However, only 30 million individuals use insulin due to availability, affordability, and inequitable access to this essential class of medications. Although these numbers provide a clear indication of the necessity for change in regards to access to insulin globally, the scientists at Stanford that conducted the aforementioned study in The Lancet predicted that the number of individuals diagnosed with Type 2 diabetes will increase to 510 million in 2030 – 79 million of those will need insulin to proper manage their health disorder with only 38 million having equitable access to insulin. These statistics exhibit that, in 13 years, less than half of the people on this planet will be able to access insulin, a medication developed 97 years ago. Though over half of the world’s diagnosed Type 2 diabetics will reside in China, India, or the United States, the study continued and stated that the insulin supply shortage will distress those inhabiting Africa and Asia most significantly. The reasons formulated to explain this health disparity include the fact that three pharmaceutical industries control almost 100% of insulin being manufactured in the world, the complexity of insulin which is a hormone produced by living cells, and generic companies’ lack of interest in producing a biosimilar at an equitable price.   

Cardiovascular diseases (CVDs) pose an implausible health burden on the global society with 30% of all deaths worldwide being attributed to these ailments. Of this mortality caused by CVDs, it is estimated that 80% occurs in the developing world with projections suggesting a steady increase in this percentage. However, with equitable access to cardiovascular medications, approximately 75% of recurrent CVDs can be prevented causing a decrease in both mortality and morbidity for humanity. To determine the access to common cardiovascular medications like atenolol, captopril, hydrochlorothiazide, losartan, and nifedipine, the BMC Cardiovascular Disorders journal published findings in 2010 of a survey within 36 countries. The findings revealed that the drug shortages transcended more complex medications like insulin and affected the access of medications that are considered ubiquitous in the developed world. The analyzed data revealed that of the abovementioned medications in the 36 countries, only 26.3% was available in the public sector and 57.3% in the private sector. The study also stated that in several nations, the wages earned within one working day was insufficient to meet the cost of one day of purchasing treatment. When considering situations where monotherapy is inappropriate, this finding would disclose that treatment would be particularly unaffordable.

When considering access to NCD medications generally, wealth has been a substantial determinant of inequitable access to treatment of hypertension, asthma, cancer, and others classified as NCDs. In many low-income to middle-income countries (LMICs), a wealth gradient has even been observed. In order to gather information to disprove or support this theory, the BMJ Global Health Journal published a study conducted in Kenya in August 2018. The study administered surveys to patients prescribed hypertension, diabetes, and asthma medications and collected data on those medications available at their home, including location and cost of the service. When analyzing the data, the results clearly indicated a wealth gradient for each of the three diseases included in the study in terms of access. As household income increases, so does the likelihood that a family has an opportunity to obtain proper medication. In addition, the results showed that poorer patients had to travel further to obtain treatment than those with a higher income. Finally, and most meaningfully, poorer patients paid more for their medications than their fellow humans inhabiting other parts of the country.  

These global health inequalities are unjustifiable in a global society where the quantity and quality of medications on the market is incredible. The drug shortages and inequitable access differ between the developed world and developing world, but also by socioeconomic stratifications within countries themselves. In order to provide compassionate care to every human suffering from any of these ailments, governments need to begin initiatives to make insulin, losartan, albuterol, and every vital NCD medication available to every citizen in their country. Heads of states, pharmaceutical industries, ministries of health, and health care professionals need to accompany their citizens and patients with a health mindset moving away from health as a commodity to health as a right. Most urgently, universal health care coverage needs to be at the forefront of every national health agenda to properly address this pandemic of drug shortages and inequitable access.

Mark your calendar for WORLD AIDS DAY – December 1st!

by publichealthtalks, posted in APHA IH Section

The first global health day ever recognized, World AIDS Day, is observed on December 1st every year. This day is an opportunity for people all over the globe to support those living with HIV, support the fight and research against HIV, and remember those who have died because of AIDS-related illnesses.

Since the beginning of the AIDS epidemic in the 1980’s, over 70 million people have acquired the infection and an estimated half have died from AIDS related complications. Today, there are over 37 million across the globe that live with the disease. Twenty-two million of the 37 million are currently on treatment.

Today, an HIV diagnosis is not a death sentence. There are many different treatment and prevention options (such as PrEP) and services for those in vulnerable populations. Still, access to care and treatment remains a significant problem, especially in developing nations, and more needs to be done to address this issue and increase access. There is also still a general gap in awareness. This year’s theme is “Know Your Status” because one in four people with HIV are unaware that they have the disease. Unfortunately, this may be due to barriers to getting tested.

The WHO recommends the use of self-tests for HIV in areas where there is a lack in availability of HIV tests. This is where a person can collect their own specimen, typically oral fluid or blood, and perform the test in a private setting such as their home. Currently, 59 countries have started using HIV-self tests.  The largest HIV self testing programs have been implemented in six countries in south Africa by the WHO with help from international organizations such as Unitaid.

The UN has a target of diagnosing 90% of all people with HIV by year 2020 and the world has committed to ending AIDS by 2030. Self tests are a huge step in getting vulnerable populations and communities access to testing and knowing their status. Knowing your status and getting on antiviral treatment as soon as possible are the consequential steps to ending AIDS. However, it all begins with awareness and access to testing.

What are some ways YOU can spread awareness and recognition for World AIDS Day and contribute to the goals for 2020 and 2030?

  1. Rock the RED Ribbon to show everyone you support the movement – this symbol became part of the AIDS awareness movement in 1991 when New York artists created it. Fun Fact:  It was the first disease-awareness ribbon made and was later adopted by other health awareness causes, such as breast cancer awareness and mental health awareness.
  2. Print out #ROCKTHERIBBON posters or share them on social media to spread the message. Find these images here!
  3. DONATE to organizations that support AIDS research. Be sure to do your own research to make sure the organization’s mission aligns with your motivations.
  4. Volunteer at a World AIDS Day event near you!
  5. GET TESTED & KNOW YOUR STATUS!