Public health and internationalism

A new website had been created, based at Birkbeck, University of London: The Reluctant Internationalists: A History of Public Health and International Organisations, Movements and Experts in Twentieth Century Europe.  A central concern of The Reluctant Internationalists is the role played by debates about public health and (real or imagined) crises in the formation of international structures, mechanisms and organizations in twentieth century Europe.
The Reluctant Internationalists is a four-year project funded by a Wellcome Trust Investigator Award and led by Dr Jessica Reinisch. The core research team comprises Ana Antic, Dora Vargha and Johanna Conterio-Geisler (postdoctoral researchers), and David Bryan (PhD student). You can find more information about the project, its participants, along with updates on upcoming workshops, events, fellowships, blog posts and news on the website

New from the National Academies Press: Including Health in Global Frameworks for Development, Wealth, and Climate Change

From the NAP:

Including Health in Global Frameworks for Development, Wealth, and Climate Change is the summary of a three-part public webinar convened by the Institute of Medicine Roundtable on Environmental Health Sciences, Research, and Medicine and its  collaborative on Global Environmental Health and Sustainable Development. Presenters and participants discussed the role of health in measuring a country’s wealth (going beyond gross domestic product), health scenario communication, and international health goals and indicators. The workshop focused on fostering discussion across academic, government, business, and civil society sectors to make use of existing data and information that can be adapted to track progress of global sustainable development and human health. This report examines frameworks for global development goals and connections to health indicators, the role for health in the context of novel sustainable economic frameworks that go beyond gross domestic product, and scenarios to project climate change impacts.

Read, download, or by the workshop summary here.

Light-bulb moments for a nonprofit

From the New York Times:

No baby should die or be disabled because a light bulb can’t be replaced. Yet during visits to hospitals in India and other countries, Krista Donaldson often saw lifesaving phototherapy systems, used to treat infant jaundice, languishing in dusty corners because of burned-out bulbs and other seemingly simple problems.

Often, the real issue was that these donated Western systems weren’t designed for local conditions.

As chief executive of a nonprofit organization called D-Rev, Ms. Donaldson had a mission: to design first-rate medical equipment better suited to developing countries, then license it to for-profit distributors in those areas. That way, she reasoned, the market would allow sales and production to grow to meet full demand.

Or that was the plan. It hasn’t exactly worked out that way. “We thought if you design a good product, it will scale on its own,” Ms. Donaldson said. “That works in efficient markets, but most developing communities don’t have efficient markets.”

To read the complete article, click here.

Inequality at the core of high health care spending: A view from the OECD

From the Health Affairs blog:

It is commonly said that the US spends more than twice as much on health care as other developed countries, yet its outcomes are worse. The inference is that too much care is provided, to no good end.

Such international comparisons are drawn from the Organization of Economic Cooperation and Development (OECD), a group of 34 developed countries. Analyzing these data is a multi-step process, like peeling an onion, and the truth resides deep within its core.

The process starts by adjusting health care spending for “purchasing power parity” (PPP) and expressing it in US dollars. By that measure, per capita spending in the US is 160 percent more than the OECD mean (Panel A, left bracket), and this is the basis for the notion that the US spends more than twice as much. But it is only the first layer.

The second layer is the economy. The US spends more principally because it is wealthier (Panel A, right bracket), but even in proportion to its gross domestic product (GDP), the US spends more, about 60 percent more. But that is only the second layer.

The third layer is price. Health care prices are inordinately high in the US and inordinately low in many other countries, particularly those that exercise price controls. Therefore, to understand how much care is given, comparisons of health care spending must be adjusted for the purchasing power parity of health care (HC-ppp). When so adjusted, spending in the US is still higher relative to its GDP, but by only 31 percent (Panel B). This represents the core difference in services. Some are administrative, but most are health care services.

What explains this 31 percent? A large body of evidence suggests that it results from poverty and income inequality, which are more prevalent in the US than in any other OECD country except Chile, Mexico and Turkey. And poverty is associated with substantial increments in spending. For example, the poorest decile of Medicare beneficiaries spends 30-40 percent more than the wealthiest; overall hospital utilization rates in large urban areas are 25-35 percent more than in their wealthiest Zip codes; and hospital readmissions are most prevalent from poor neighborhoods and in safety-net hospitals.

Read the complete post here.

Lecture today: Global Water Issues and U.S.-Japan Cooperation

Kazunari Yoshimura will provide a general overview of global water issues and discuss the possibility of U.S.-Japan cooperation in terms of water treatment, water security, and disaster prevention. Mr. Yoshimura will also go into detail on waste water treatment technologies in both the United States and in Japan. He also will describe his experience as a technical advisor to the U.N. and Japan’s official development assistance and provide insight into his work within the international community.

Sponsored by the Center for Japanese Studies and the Consulate General of Japan in Detroit.

  • Date:  10 October, 2013
  • Time:  12:00-1:00pm
  • Location:  1636 School of Social Work Bldg

Mold toxins tied to AIDS epidemic

From the New York Times:

Aflatoxins — poisons produced by fungi that grow on moldy peanuts and corn — may be worsening Africa’s AIDS epidemic by helping suppress the immune systems of newly infected people, a new study has found.

The study, by researchers at the University of Alabama at Birmingham and published recently in the World Mycotoxin Journal, measured blood levels of aflatoxins and H.I.V. in 314 Ghanaians who had never taken antiviral drugs.

The more aflatoxins they had, the more likely they were to have high blood levels of H.I.V. — even those with higher levels of CD4 blood cells, meaning they had not been infected long and were not yet eligible for triple-therapy cocktails under the latest World Health Organization guidelines.

The toxins, produced by aspergillus fungi that grow on damp grains, nuts and beans, are so common as to be almost unavoidable in humid climates, but so dangerous that federal law limits concentrations in food to 20 parts per billion. American peanut-butter makers are always on the watch for them. Ground peanuts are a staple food of West Africa.

In high doses, aflatoxins can be deadly. A 2004 outbreak in Kenya killed 125 people; samples of moldy corn had up to 8,000 parts per billion. Regular exposure to low doses can cause liver cancer.

The authors suggested that aflatoxins either contribute proteins that help H.I.V. reproduce or somehow lessen the numbers of the white blood cells that the virus targets, making its attack on the immune system more potent.

Talking female circumcision out of existence

From the Fixes blog at the New York Times:

Like every other girl of her era in her part of southern Ethiopia — and most girls in the country — Bogaletch Gebre was circumcised. In some regions girls are circumcised as infants, but in her zone it happened at puberty. It was around 1967, and she was about 12. A man held her from behind, blindfolded her and stuffed a rag in her mouth, and with his legs held her legs open so she could not move. A female circumciser took a razor blade and sliced off Gebre’s genitals.

Gebre nearly bled to death. She stayed at home for about two months, and after she healed, she was presented to her village, ready for marriage. . . .

Today, however, cutting has vanished from Kembata-Tembaro, as have bride abduction and widow inheritance. A study (pdf) done for the Innocenti Research Center, a research arm of Unicef, found that cutting had only 3 percent support in 2008 — down from 97 percent in 1999. This is a remarkable achievement. There is nothing more difficult than persuading people to give up long-held cultural practices, especially those bound up in taboo subjects like sex.

The change happened because of an organization that Gebre and her sister Fikrte started called Kembatti Mentti Gezzima-Toppe, which means “women of Kembata working together.” It is now known simply as KMG-Ethiopia.

Read the complete post here.



Improving health, health systems, and health policy around the world

New from the National Academies Press:

The roots of health literacy can be traced back to the national literacy movement in India under Gandhi and to aid groups working in Africa to promote education and health. The term health literacy was first used in 1974 and described as “health education meeting minimal standards for all school grade levels”. From that first use the definition of health literacy evolved during the next 30 years with official definitions promulgated by government agencies and large programs. Despite differences among these definitions, they all hold in common the idea that health literacy involves the need for people to understand information that helps them maintain good health.

Although the United States produces a majority of the research on health literacy, Europe has strong multinational programs as well as research efforts, and health literacy experts in developing countries have created successful programs implemented on a community level. Given these distinct strengths of efforts worldwide, there are many opportunities for collaboration. International collaboration can harness the United States’ research power, Europe’s multilingual and multinational experience, and developing nations’ community-based programs to create robust programs and research that reach people—not based on language or nationality but on need and value.

Read or download the PDF of the 2013 workshop summary here.

Pollution leads to drop in life span in northern China

From the New York Times:

Southern Chinese on average have lived at least five years longer than their northern counterparts in recent decades because of the destructive health effects of pollution from the widespread use of coal in the north, according to a study released Monday by a prominent American science journal.

The study, which appears in The Proceedings of the National Academy of Sciences, was conducted by an American, an Israeli and two Chinese scholars and was based on analyses of health and pollution data collected by official Chinese sources from 1981 to 2001.

The results provide a new assessment of the enormous cost of China’s environmental degradation, which in the north is partly a result of the emissions of deadly pollutants from coal-driven energy generation. The researchers project that the 500 million Chinese who live north of the Huai River will lose 2.5 billion years of life expectancy because of outdoor air pollution.

“It highlights that in developing countries there’s a trade-off in increasing incomes today and protecting public health and environmental quality,” said the American member of the research team, Michael Greenstone, a professor of environmental economics at the Massachusetts Institute of Technology. “And it highlights the fact that the public health costs are larger than we had thought.”

Read the complete story here.

An investment strategy in the human interest

From the always interesting Fixes blog at the New York Times, a new idea for funding aid projects:

You are a health official in Uganda, and you’re watching a crisis unfold. Your people have long suffered from epidemics of sleeping sickness, one of Africa’s biggest killers. There is no vaccine and the only treatment is protracted and painful. Sleeping sickness, transmitted by the tsetse fly, is carried by cattle and also kills cattle, destroying the livelihoods of families who keep them.

There are two strains of sleeping sickness that affect humans; one is in West Africa and one in East Africa. Uganda is the only country that has them both. Worryingly, they are moving closer together as their cattle carriers move, and will likely meet in a decade. Once that happens, the disease will become even harder and more expensive to screen for and diagnose.

Their meeting can be prevented, and sleeping sickness can be controlled, by treating cattle and then periodically spraying them with an insecticide. But treating 3.5 million cattle, and then tracking them for smaller campaigns of re-spraying, would cost some $30 million. Uganda doesn’t have that money. So it will pay a lot more later — in money, in the lives of animals, and in human health and productivity.

Governments and international aid donors sometimes like to call the work they do to improve people’s lives “investing.” Uganda’s problem is an example. In a figurative sense, treating those cattle is an investment — a very good one. A small amount of money put in now will bring large rewards later. Of course, it’s not literally an investment.

But what if it were?

What if this project were treated like a business startup? You’d get people to put up the money. If the “business” doesn’t work, the investors are out of luck. But if it succeeds — if the cattle are treated and sprayed, and the gains are maintained — international donors would repay the investors with interest, using part of the money saved by reducing sleeping sickness.

If this idea sounds familiar, it should. The Development Impact Bond is almost exactly the same as the Social Impact Bond, the hottest idea in social-service provision (an oxymoron if ever there was one) of the last few years. One difference is who repays investors if the program succeeds. With a social impact bond, the government does. With a development bond, payment would fall to international donors such as foundations or government agencies such as Britain’s Department for International Development or the U.S. Agency for International Development.

Read the complete post here.