2019 World Cancer Day – “I Am and I Will”

Every year on February 4th, World Cancer Day is celebrated by bringing awareness and providing education about the disease. Many of the efforts focus on making the reduction of preventable cancer a global health priority.

In 2018, it was estimated that there were 26,000 deaths that occurred due to cancer across the globe every single day. This rate is only predicted to increase with time due to a variety of factors. To name a few: the age of the world population is increasing, there is a general lack of education about ways to prevent cancer in developing countries, and early detection methods and treatment are scarce in these same developing countries. By 2030, the rate of cancer deaths per year is expected to hit 21.6 million – this is 8.4 million more than the 2010 rate. To put this into perspective with infectious diseases, in 2015 alone, the deaths per year due to malaria was 72,000 while cancer rates met 8.9 million – with the majority of the deaths coming from developing countries.

The largest gaps in rates of cancer survival can be noticed in cancers that are more responsive to early screening and treatment (for example: breast and colorectal cancers). These rates vary greatly between developing and developed nations as well as in different racial groups in the same country.  In the United States and Australia, the 5 year survival rate for breast cancer (2010-2014) was up to 90% compared to only 65% in Malaysia for the same time frame. In the U.S. between 2004 and 2009, there was a difference in the 5 year survival for cervical cancer between whites and blacks, 64% and 56% respectively. These differences in rates can be attributed to differences in prevention and treatment programs. For example, in many developing countries, cancer patients do not have access to radiotherapy facilities near their homes. There are 60 countries across the globe with cancer patients that do not have one radiotherapy facility in the entire country. On the screening side, many developing nations do not have the health care infrastructure or funds to provide regular cancer screenings.  The same gaps in access to care and resources can be said about different areas of socioeconomic status in the United States.

Current efforts to develop prevention and treatment programs across the globe are focused on the WHO’s recommended 4 main approaches or areas of: prevention, early detection, diagnosis and treatment and palliative care… and there have been successful feats! An example of a successful cancer prevention program is in Sudan. Their program focuses on promoting public awareness of breast cancer and early detection through in-home breast exams done by trained female volunteers. Another positive program was implemented in India in 2013. This program increased breast cancer awareness in the study urban area, and a subsequent increase in early stage diagnosed breast cancer increased from 74% to 81% in 3 years (2013-2016). Most cancer prevention and reduction programs in developing nations focus on the initial stages of increasing awareness and education about cancer as they are cost efficient and effective.

To fight these discrepancies in cancer death rates, many use this day to spread social media messages about cancer prevention and early screening, attending festivals or walks that raise awareness or support and encouraging public government officials to make cancer issues a priority in their own countries through policies and research. In general, the day brings people together with a common cause and mission: getting rid of preventable cancer. This map is a great resource to find and join activities anywhere on the globe related to World Cancer Day.

In addition, 2019 introduces the start of a 3-year campaign called, “I Am and I Will”, and focuses on the personal commitments required to help decrease the global burden of cancer as a whole. The American Cancer Society highlights a few ways people can personally decrease the effects of cancer as well as support others in their circles by:

  • Making healthy life choices such as saying no to tobacco products, limiting alcohol, being conscientious about time spent in the sun and eating an overall healthy and wholesome diet
  • Knowing the signs and symptoms of cancer and seeking early treatment when identified
  • Sharing cancer experiences with decision makers in government and advocating for change and funding to go into cancer research
  • Encouraging schools and businesses to adopt healthy practices such as nutrition, physical activity and no tobacco policies to support their students and workers

Visit www.worldcancerday.org before February 4th to learn more about this day and how you can get involved in your own personal way.  Every little action makes a difference in shining a light on the importance of defeating cancer on many different scales. #IAmAndIWill

Global News Round Up

Politics & Policies

Every year, the World Health Organization puts out a list of the most pressing issues that face global health.  They change a bit each time as the WHO tries to emphasize where we need the most progress to be made, and the lists are always enlightening.

Funding to tackle 33 significant diseases has reached its highest level since figures were taken, says a survey which has tracked this for 11 years.

Programs, Grants & Awards

The health of the U.S. population can be affected by public health threats or events across the globe. Recent examples of this include the Ebola Virus outbreak that began in 2014, the 2003 SARS epidemic, and the 2009 SARS epidemic, and the 2009 spread of novel H1N1 influenza. Improving global health can improve health in the United States and support national and global security interests by fostering political stability, diplomacy, and economic growth worldwide.

Research

Results from trials of tafenoquine, a novel anti-relapse medicine for patients infected with Plasmodium vivax malaria, have shown the drug to be effective and safe, according to a pair of studies published in The New England Journal of Medicine.

Diseases & Disasters

There were just 28 reported human cases of Guinea worm disease (GWD) last year, the U.S.-based Carter Center said Thursday.  The nongovernmental organization (NGO) founded by former President Jimmy Carter said the disease is gradually moving toward eradication.

A Pakistani health official says the country has kicked off its first nationwide polio vaccination campaign for the year in efforts to eradicate the crippling disease by the end of 2019.

According to the World Health Organization, the first HIV case appeared in Yemen in 1987, and the number of people living with it was estimated to be around 9,900.  While the prevalence was only 0.2 percent of the population, most Yemenis living with either of the viruses faced stigma and discrimination, even from their families.

At least 11 people have died in Argentina after becoming infected with hantavirus, a disease carried by rats and other rodents, according to a news alert from the World Health Organization (WHO).

The number of Ebola cases recorded each day in the Democratic Republic of the Congo is expected to more than double, with concern mounting that uncertainty over how the virus is being transmitted could result in it spreading to neighbouring countries.

An estimated 1 in 10,000 people are born with hemophilia, a blood disorder caused by lack of proteins needed to stop bleeding. While those in developed countries have access to treatment that allows them to lead normal lives, that is not the case for the more than half a million people in low- and middle-income countries. For them, hemophilia can be a “curse,” a cause for stigma and financial disaster—and, sometimes, a death sentence.

Technology

Solar power is helping make universal healthcare a reality in places where unreliable power supplies regularly affect access to vital services, and can out people’s lives at risk, thanks to support from the United Nations Development Programme (UNDP).

Environmental Health

Leading climate scientists and meteorologists are banking on a new strategy for talking about climate change: Take the politics out of it.  That means avoiding the phrase “climate change,” so loaded with partisan connotations as it is.

Dried fish producers in Cox’s Bazar’s Nazirar Tek village, the largest dried fish producing village in the country, are still using toxins even though an NGO has been putting in efforts to make them switch to organic fish-processing methods.

This weekend, a crucial but barely heralded scientific mission will come to an end in a remote part of Antarctica.  A team of seven Australian and American researchers will conduct the last extraction of ancient air from ice cores drilled as deep as 240 metres.

Equity & Disparities

For her next act, Leland started a venture — called Co-Impact — designed for just such funders. It pools donors’ money and brings them into the decision-making to support proven solutions in Africa, South Asia and South America.

Women, Maternal, Neonatal & Children’s Health

For Indian airline executive ElsaMarie D’Silva, the gang rape that killed a Delhi college student in 2012 was a turning point.  Although the attack stood out for its savagery, D’Silva knew that the rape of Jyoti Singh Pandey was not an isolated event: it fit a pattern of everyday harassment and violence that Indian women endure in public places.

The mosquito-borne virus that causes Rift Valley fever may severely injure human fetuses if contracted by mothers during pregnancy, according to new research.

Looking Ahead: Global Health Threats in 2019

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

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

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