Category: Guest Blog

The Severity of Racial Health Inequities

by internationalhealthstudents, posted in Guest Blog

Guest Blogger: Tiffany Gilliam

African American women are more likely to succumb to negative health outcomes than any other race or ethnicity. Health inequities are classified as the differences in health status between one disadvantaged population and a group of advantaged. Numerous social determinants of health are related to health inequities, such as:

  • Socioeconomic status
  • Education
  • Age
  • Sex
  • Race and ethnicity
  • Lack of access to quality healthcare

These factors also increase the risk of cardiovascular disease, high blood pressure, diabetes, strokes and healthcare inequity. Nearly 50,000 African American women die each year from cardiovascular diseases. There is a significant gap in life expectancy for African American women compared to white women.

Research has shown that larger populations, like those found in metropolises, correlate to wider gaps in life expectancy. The county of Philadelphia is one of the most racially diverse counties in the United States. That same county contains one of the most racially segregated cities in terms of access to quality healthcare and positive health outcomes. The Philadelphia population is estimated at 1,560,006 residents: 44.2 per cent of which are African American. A recent study conducted by the University of Pennsylvania examined the patient ratio to primary care physician (PCP) in low socioeconomic neighborhoods. The study revealed a PCP ratio of 3,000:1  in underserved areas of Philadelphia. Given this PCP a question is raised regarding the level of care provided to patients. The patient to primary care physician ratio is high due to several reasons such as shortage of primary care physicians, increased amount of Affordable Care Act-covered patients, and the high density of elderly and chronically ill in underserved areas.

In a recent conversation with Sheila, my esthetician, she stated a previous diagnosis of ovarian cancer. The physician immediately advised a treatment of chemotherapy, without any willingness to answer questions or provide additional information.

Before that treatment occurred, however, Sheila received a second opinion from another physician, which revealed that she suffered from endometriosis, not ovarian cancer. After this conversation, numerous questions were raised.  How many other African American women were misdiagnosed and treated for illnesses they did not have? Why was it so difficult for the doctor to make an accurate diagnosis? How often are doctors encouraging participatory medicine when interacting with patients?

How can public health clinicians improve negative health outcomes amongst underserved African American women populations? It is crucial that health polices are created to enforce the overall well-being of African American women of disadvantaged populations. Health policies that promote affordable education, employment opportunities, and adequate accessible health promotion programs are needed in order to improve fair and equal treatment, along with disease prevention and detection.

 Tiffany Gilliam is a first year masters student in Public Health at La Salle University, with a focus in Maternal and Child Health, Social and Behavior Sciences and Health Equity. Her academic interest includes Global Health, Reproductive and Sexual Health and Public Health Policy. For the past three years, Tiffany has worked as a Behavioral Health Worker at Northeast Treatment Center, providing coping strategies, social skills, methods to reduce impulsive behavior at school to children with Attention Hyperactivity Deficit Disorder (ADHD), Oppositional Defiant Disorder (ODD)/Conduct Disorder and Mood Disorder.

Guest Blog: Second Annual Global Social Service Workforce Alliance Symposium at the US Institute of Peace

by ihsection, posted in Guest Blog

Guest Blogger: Amanda Hirsch

The SSW symposium provided a forum for practitioners, government representatives, academics, and other experts from around the world to discuss current efforts (3) being undertaken internationally to expand the social service systems for the health and safety of children and families. The presentation was broken into three parts, each part discussing one component of the stride to strengthen the social service workforce.

  1. Planning: Dr. Jini Roby, a professor in the Department of Social Work of Brigham Young University along with Ms. Joyce Nakuta, Deputy Director of the Namibia Ministry of Gender Equality and Child Welfare spoke on the topic of planning the social service workforce. Planning the workforce, they agreed, “takes a system”- a calculated outline of each potential worker and their respective responsibility. To be most effective, social service must work on a network basis from workers on the ground (ie child health workers who raise and mentor orphaned children) to policy makers that have the capacity to encourage funding of child health worker training programs- all positions are necessary for the job to effectively get done.
  2. Robin Sakina Mama, Dean of Monmouth University School of Social Work and Ms. Zenuella Sagantha Thumbadoo, Deputy Director of National Association of Child Care Workers, South Africa discussed developing the social work force. This component of the process deals with educating and training social service workers. Dr. Robin Sakina Mamma spoke about the issue of certification and degrees. Today, many countries in need of social service work are left at a disadvantage because they lack existing institutions that provide proper degrees for social work or do not yet have a place in  the workforce for professional social workers. With that, many do not receive enough of an education in social work to be effective and many do not have a chance to practice and/or use their degrees in their home countries of need.
  3. Natia Partskhaladze of UNICEF and the Georgian Association of Social Works discussed the issue of supporting the workforce. Dr Partskhaladze spoke about worrisome recruitment and retention rates that are particularly high in developing countries, such as her home country of Georgia. The social work profession was non-existent in Georgia as of fifteen years ago. After establishing a study program and professional network for social work in the year 2000, an organization of social workers has since been formed. Centered on retention and development, the organization strives to keep social workers in the workforce while encouraging Georgians to get involved in the field of social work through the development of academic and professional programs and support groups. This organization of social workers now boasts 600 members, making Georgia an example of what committed recruitment and retention efforts can do to create or revive a supply of social workers within a country in need.

In her opening remarks Deputy of the Child Protection Section of UNICEF, Dr. Karin Heissler, noted that social work uses data and lessons learned in order to make decisions about the social service workforce and influence policy- a concept that is very familiar in public health.

Public health is entirely driven by data and “lessons learned”- both are at the base of nearly all interventions and both are necessary when public health professionals must have a voice at the community or policy levels.

The process of “planning the workforce” described is similar to the process of planning an intervention in public health. Both require assessing an issue; anticipating the immediate, medium, and long-term needs to be addressed; and creating a system with which to achieve a goal at all anticipated levels.

twitter photoAmanda Hirsch is a summer Global Health intern for APHA. She is starting her final undergraduate year at the GWU Milken Institute School of Public Health. Her passion for global health began in rural Honduras, and she is particularly interested in disparities in healthcare systems that affect the Latino community. She intends to pursue an MPH degree with a dual concentration in Community-Oriented Primary Care and Global Health. You can follow her on Twitter at @amandahirsch12.

Disney, measles, and parents’ choice not to vaccinate: Who’s to blame?

by ihsection, posted in Guest Blog

Guest bloggers: Brittany Seymour and Rebekah Getman

The recent challenges surrounding childhood vaccinations in the United States have received notable attention in both popular and scientific press, illustrating a spectrum of parental concerns and resultant attitudes ranging from vaccine hesitancy to outright refusal. The current measles outbreak traced to Disneyland has contributed to the highest number of US measles cases in fifteen years and resulted in the Centers for Disease Control and Prevention’s release of an official CDC Health Advisory in January this year. Over half of the individuals who have come down with the illness are unvaccinated; of those, more than 80% are old enough to receive the MMR vaccine but have not, leading many states to reevaluate their personal belief exemption policies. Unsurprisingly, this now multi-state outbreak has reignited the emotional debate over vaccine safety, efficacy, and policy in mainstream and social media. While vaccinations are likely one of the most prominent health debates in the United States right now, health officials are increasingly battling unfounded controversy regarding several of public health’s greatest achievements.  The field that is tasked with controlling global disease epidemics is now up against what have been dubbed “digital pandemics:” the far-reaching, rapid spread of unrestricted, scientifically inaccurate health information across the Internet through social networks.

Researchers at Harvard University recently studied this phenomenon over another common public health intervention: community water fluoridation. A lobby to end fluoridation pushes on in communities across America, despite more than 3,000 studies confirming its safety and benefits. The researchers’ findings indicate that, similar to the anti-vaccination community, a small but vocal and very tightly knit network is driving the anti-fluoridation lobby. A well-known social theory describes individuals in the world as connected by six degrees of separation, and Facebook’s one billion users are four degrees separated; the study found that individuals in the anti-fluoride community are separated by a mere two degrees. Often, highly connected networks develop a strict set of norms and values, and any person or information in violation of those norms, such as scientifically accurate pro-fluoride information, will be quickly rejected, making rational discourse nearly impossible. The researchers also traced online social conversations about fluoride through the network. Members of the anti-fluoride network frequently shared and cited scientific studies to back their arguments; however, in more than two-thirds of conversations, the actual study cited was buried two or three links away from the online discussion, or was not reachable at all. This is concerning because, under these circumstances, the risk of evidence becoming misrepresented or misinterpreted likely increases with each link that takes readers further away from the source.

The researchers’ findings support the theory that highly connected social networks, and not science or evidence, are driving digital pandemics of health information on openly accessible Internet sites. In the digital information age, scientific fact is only one piece of the complex health decision-making process. When capable, intelligent parents encounter the sea of voices online while researching how to make optimal decisions for their children’s health, of course they become concerned with what surfaces to the top of their Google search. The Harvard study suggests that perhaps we need to stop blaming parents for choosing not to vaccinate their children or for lobbying to end fluoridation in their communities, an approach that only alienates parents with questions and shuts down dialogue. Moreover, corrective scientific information inserted into existing social communities without respect for norms and values, even if in response to misinformation, runs the risk of insulting those not readily convinced solely by the prevailing science, an ultimately detrimental approach.  Rather, additional research is needed to discover new, social health communication strategies that are more inclusive and acknowledge social networks’ differing belief systems. Digital pandemics are a part of our current, connected reality. Rather than fight against this trend (which may prove impossible), public health communication approaches must empower and partner with parents so that the voices of expertise, evidence, and experience are the ones they trust, and share within their networks, once again.

Getman HeadshotRebekah Getman is the Senior Program Manager for Education at the Harvard Global Health Institute, tasked with creating and implementing multi-disciplinary curriculum for students that supplements their in-classroom learning. These curricula combine global health knowledge with other disciplines to provide students with a broad lens through which to study and assess global health interventions.

SeymourHeadshotBrittany Seymour is an Assistant Professor of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine’s Department of Oral Health Policy and Epidemiology and the Inaugural Harvard Global Health Institute Fellow. Her research includes interdisciplinary global health curriculum development and pedagogy, capacity strengthening for oral health delivery systems in resource-challenged regions, and digital information transfer and impacts on health.

World Mental Health Day Forum by the Global Mental Health Advocacy Working Group: A Review

by ihsection, posted in Guest Blog

photo (2)Guest blogger: Socorro Lopez

Mental illness has proven to be one of society’s greatest invisible burdens, accounting for 4 of the 10 leading causes of disability worldwide. The Global Mental Health Advocacy Working Group recently honored World Mental Health Day by hosting a forum to discuss mental health needs amongst people in humanitarian crises, an extremely vulnerable group in terms of developing and dealing with mental illness.

The event’s panelists included Kelly Clements, the U.S. Department of State’s Deputy Assistant Secretary of the Bureau of Population, Refugees and Migration, Dr. Inka Weissbecker, the Global Mental Health Psychosocial Advisor for the International Medical Corp (IMC), and Dr. James Griffith, the Chairman in the Department of Psychiatry and Behavioral Sciences at the George Washington University School of Medicine and Health Sciences.

The discussion touched on three important themes in relation to mental health in emergency settings: the vulnerability of people suffering from mental illness, the critical gap in mental health services, and the detrimental social isolation that the mentally ill are frequently subjected to.

While approximately 10% of a population is traditionally at risk of developing a mental disorder under normal circumstances, this rate has the potential to double during a humanitarian crisis, meaning more people must deal with these disabilities in highly unstable environments. Furthermore, mentally ill individuals are more susceptible to stigma, discrimination, violence, abuse, and human rights violations in these circumstances.
Although there is a vast need for mental health services in emergency settings, there is a significant lack of access to quality care. The number of health professionals who can implement psychosocial interventions that effectively address mental illness is minimal during crises.

“There is a treatment gap between the people who need care and those who receive it,” said Dr. Weissbecker, who has monitored IMC’s mental health and psychosocial programs in countries such as South Sudan, Ethiopia, Sierra Leone, Syria, and Afghanistan.

A lack of healthcare professionals and mental health services often means that the burden of care for a mentally ill individual is placed on their families. Unfortunately, mental disorders are still fundamentally misunderstood around the world, causing many communities to be ill equipped to properly care for a portion of their citizens. In the absence of related health services, families resort to harmful traditional health practices that stem from local beliefs. These practices regularly call for extreme measures, such as chaining the mentally ill to trees or institutionalizing them in inept facilities, to isolate people dealing with mental disorders from the rest of the community.

By acting as natural buffers to instability and prejudice, Dr. James Griffith discussed the vital role that local caregivers, families and communities can play in treating mental illness. In accordance with this line of thought, IMC programs have integrated community involvement into their programs by hosting educational seminars that utilize local volunteers to raise awareness and social consideration for mental illness.

The panelists also addressed how this knowledge could be applied to two topics that have been making recent headlines: Ebola and the Islamic State in Iraq and Syria (ISIS). In terms of treating mental illness within extremist groups such as ISIS, the panelists were quick to correct the misconception that violence can commonly be associated with mental illness, a stereotype creating stigma and driving discrimination. According to the American Psychiatric Association, “the vast majority of people who are violent do not suffer from mental illness.”

In relation to Ebola, preventing and treating mental illness proved to be more applicable. In order to diminish emotional and psychological trauma, Weissbecker discussed the need to provide more education to people who contract the disease and their families, in order to decrease debilitating fear and prevent transmission. Reintegration services should also be offered to survivors who may be treated differently once they return to their communities. Finally, it is important to find ways to safely bury the dead, while ensuring that burials are still culturally significant.

Addressing mental health in emergencies is undoubtedly a multifaceted and complicated health challenge. Nevertheless, increased rates of mental disorders and the potential social ramifications of having such illnesses illustrate that mental illness in humanitarian crises is an urgent issue for global health. Reducing the current treatment gap and increasing communities’ understanding of mental disorders are two of the most promising tactics to improve the health status of the mentally ill in these situations. In doing so, devastating disability and demoralizing hardship can be prevented in populations that have already experienced immeasurable adversity in their lives.

Socorro Lopez is an undergraduate at the George Washington University, majoring in environmental studies and minoring in public health and geographic information systems. Her interests include environmental, reproductive, and global health. Prior to working at the American Public Health Association (APHA) as a Global Health Intern, she was part of the Collegiate Leaders in Environmental Health (CLEH) program at the Centers for Disease Control and Prevention (CDC). Socorro is originally from Roatan, Honduras and recently returned from Tanzania, where she was studying coastal ecology and doing research on water quality.

Opportunities Lost — Could Ebola Have Been Better Contained?

by ihsection, posted in Guest Blog, Health Systems

This blog post, by IH Section member Mary Anne Mercer, originally appeared on Huffington Post. It was co-authored by Scott Barnhart and Amy Hagopian.

In a desperate attempt to contain the highly contagious Ebola virus in Liberia, 50,000 people were recently quarantined in a slum neighborhood of Monrovia, whether they were sick or not. Imagine being trapped in an open-air prison without any sense of when you would be released. And if you get sick inside that slum, there is no organized system to take care of you.

Quarantining 50,000 poor slum dwellers is far different from quarantining a household, a plane, a bus or a boat. Why would Liberia feel driven to take such a drastic move when only a few of the residents in the area had Ebola? Such is the desperation of a country with a health system so weak that it has no other way to cope with an epidemic of any serious threat, let alone one this virulent.

Francis Omaswa, who led Uganda’s successful effort to control an Ebola epidemic in 2000, said last week, “Controlling the epidemic is about early detection, isolation, treatment of new infections, contact tracing, and safe handling of body fluids and the remains of those who die.” These routine infection-control procedures are not hard to implement, but doing so requires basic public health infrastructure. When a country has no capacity to perform these functions, desperate measures such as quarantining a whole slum can seem reasonable.

How did Africa’s health systems come to be so weak? Didn’t the United States and other major donors just spend billions of dollars on global health in Africa? In the process of providing all that care for diagnosing and treating HIV, preventing malaria and distributing vaccines, didn’t we build clinics and laboratories and train health workers and create medical records systems? Well, not exactly.

Recent major global health initiatives have been aimed almost exclusively at specific diseases such as HIV, TB and malaria, while strengthening the health system is typically an afterthought. Funding generally favors the private sector, particularly faith-based non-governmental organizations, and views with skepticism the role of public institutions such as ministries of health. The private health organizations proliferating across Africa lure health workers away from their jobs in public clinics and hospitals, usually offering higher salaries than governments can pay. Yet the over-riding responsibility to care for an entire population, including the poorest, resides with governments, which remain under-resourced and struggle to keep up with the needs of their citizens.

When the choice was made to invest in single-disease programs that were walled off from government health systems, we missed an opportunity. We could have developed the capacity to address other emerging health problems by building infrastructure: facilities, information systems, the work force, logistics and supply chains. Some donors hoped their disease-specific initiatives would “spill over” in a way that would strengthen the health system. Unfortunately, recent research shows this did not occur.

When the funds stop flowing to private organizations that implement these single-disease programs, the work stops. Weak health systems limp along until the next emergency, when another cycle of global health programs sweeps through.

Meanwhile, the routine burden of illness from malaria, pneumonia, diarrhea, TB, malnutrition and, increasingly, diabetes and other chronic diseases, continues to shorten life expectancy in Africa. Weak systems can’t effectively keep up with those problems, let alone the sudden shocks imposed by emerging diseases like Ebola.

What will help? For one thing, we must stop focusing on disease-specific initiatives implemented primarily through the private sector. Donor funding should go through ministries of health whenever possible, and flow from there to health facilities and staff. Health workers funded by external donors must be paid at the same salary scale as the public sector.

Finally, as Ebola has shown, feeble ministry of health surveillance systems must be bolstered. Better surveillance is a large part of why wealthier countries are at much lower risk of major epidemics than are nations with scant public health resources. Ebola would not be the crisis it is today if it had been recognized earlier, with contacts traced, quarantined and cases treated. But for that to happen, the essential elements of functioning health systems in the affected countries would have to be in place. When we hear stories of nurses dying because they didn’t have the simple protective equipment needed to care for Ebola patients, the gaps in those health systems become clear.

The expanding Ebola epidemic underscores the urgency of making investments in the health systems of African governments. Global health initiatives of the last decade largely missed an opportunity to strengthen health care capacity in Africa. Will we have another chance with the next epidemic? Let’s make Ebola the last one to trample across the continent because there are no health systems to contain it.

Mary Anne Mercer began life in rural Montana and recently returned to her Montana roots, where she is rehabilitating a small ranch near Red Lodge. She holds a doctoral degree in public health and is on the faculty of the University of Washington in Seattle, where she teaches global health. She has worked or studied in 15 developing countries, lived in rural Nepal and Thailand, and currently supports maternal and newborn care projects in East Timor for a nonprofit organization, Health Alliance International. In addition to academic publications, Mary Anne co-edited a book on the health effects of globalization, “Sickness and Wealth: the Corporate Assault on Global Health.” She was a silver Solas Award winner for Travelers’ Tales in 2012. During the academic year she also sings and studies writing in Seattle.

Scott Barnhart, MD, MPH, is Professor of Medicine and Global Health at the University of Washington. He has worked on health system strengthening in Haiti, Southeast Asia, and several countries in Africa.

Amy Hagopian, PhD, is Associate Professor of Public Health at the University of Washington. She has studied the migration of doctors and nurses from poor countries to rich ones, including Uganda, Nigeria, and the Philippines.