Category Archives: Global Health
Yale Report Finds U.N. Responsible for Haiti Cholera Outbreak
A new report from the Yale University Schools of Public Health and Law finds that the United Nations (U.N.) inadvertently caused a deadly cholera epidemic in Haiti. The report confirms prior accounts that U.N. peacekeepers inadvertently but negligently brought cholera into Haiti, causing one of the largest epidemics in recent history. Because of inadequate water and sanitation facilities at the U.N. base in the Haitian town of Méyè, sewage from the base contaminated the Artibonite River, the largest river in Haiti and one the country’s main water sources. By July 2011, cholera spread through the country, infecting one new person per minute. The epidemic continues, and public health experts estimate it will take a decade or more to eliminate the disease from Haiti. Prior to this outbreak, cholera had not existed in Haiti for more than a century. The report calls for setting up a claims commission, as well as providing a public apology, direct aid to victims, infrastructural support, and adequate funding for the prevention and treatment of cholera. Read more on global health.
Eyes May be a Window to Stroke Risk
Retinal imaging—easily done in many ophthalmology practices and clinics—may alert practitioners to patients at higher risk of a stroke by providing information on the status of blood vessels in the brain, according to a new study in the journal Hypertension. Worldwide, high blood pressure is the single most important risk factor for stroke, however it is still not possible to predict which high blood pressure patients are most likely to develop a stroke. Researchers tracked stroke occurrence for an average of 13 years in close to 3,000 patients with high blood pressure who had not previously experienced a stroke. At baseline, each had photographs taken of the retina; damage to the retinal blood vessels was scored as none, mild or moderate to severe. During the follow-up, 146 participants experienced a stroke caused by a blood clot and 15 by bleeding in the brain, but even after adjusting for stroke risk factors such as age and cholesterol levels the researchers found that the risk of stroke was 35 percent higher in those with mild hypertensive retinopathy and 137 percent higher in those with moderate or severe hypertensive retinopathy. And risk remained high for patients with photographic evidence of retinopathy even if they were had good blood pressure control through medication. Read more on vision.
NIH Releases Online Alcohol Screening Course to Help Detect Problems in Young Adults
The National Institute on Alcohol Abuse and Alcoholism has released a new online training course to help health care professionals conduct fast, evidence-based alcohol screening and brief intervention with young adults. According to the Institute, underage drinking is widespread and a major public health problem. Over the course of adolescence, the proportion of youth who drink more than a few sips escalates from 7 percent of 12-year-olds to nearly 70 percent of 18-year-olds. Heavy drinking is common. Having five or more drinks on one occasion is reported by half of 12 to 15-year-olds who drink and two-thirds of 16 to 20-year olds who drink.
“Some may see underage drinking as a harmless rite of passage, but when you look at the risks, it is a big deal,” said Vivian B. Faden, PhD, associate director for behavioral research, director of the Office of Science Policy and Communications at NIAAA, and co-author of the course. “We developed the guide and the continuing medical education (CME) course to help health care professionals reduce underage drinking and its risks in a way that fits easily into their practice.”
Each year, about 190,000 people under age 21 visit emergency rooms for alcohol-related injuries and about 5,000 die as a result of underage drinking. And young adults who drink also have an increased risk of developing alcohol dependence later in life. The new course includes a two-question screening tool. One question asks about the drinking habits of an adolescent’s friends and the other question asks about the adolescent’s own drinking frequency. Read more on alcohol.
The United Nations Foundation believes that, for the biggest public health obstacles facing the world, it will take all nations and all sectors working toward solutions to succeed. So the Foundation works to make that a reality, bringing together partnerships, growing constituencies, mobilizing resources and advocating policies that can help everyone—in both the developing and developed world.
NewPublicHealth recently spoke with Kathy Calvin, President and Chief Executive Officer of the United Nations Foundation, about the organization’s many efforts to improve health both globally and locally—and how these two goals can support each other.
NewPublicHealth: What changes have you seen in global health during your time in the field?
Kathy Calvin: The number of nonprofits dedicated to health issues has quadrupled it seems, and real progress has been made, which is the most important point—that we’re actually seeing a reduction in maternal deaths and newborn deaths and preventable diseases such as measles and diarrhea and pneumonia. I mean, there’s just been enormous progress, with still much more to happen. But it’s been an exciting time after what I think has been a pretty discouraging period where no amounts of foreign aid seemed to be making a difference. I attribute that partly to some innovations in research and financing, but also to the fact that a lot of governments in Africa actually have prioritized women and prioritized health in some pretty significant ways. And I think we’ve had a very enlightened government in the last five years here, too, in terms of what we’re doing overseas.
So, it’s been exciting to see it. Health is not my background. I’ve really been privileged to see both how serious and significant the challenges are, but also how much good can be done with just a little bit of organized effort.
NPH: When you talk about enlightened government, what are some examples? What is making the difference now?
Calvin: Well ironically it isn’t all that political. In fact, some of the biggest shifts took place under President George W. Bush’s administration with his creation of the President’s Malaria Initiative—until then, there had been zero real depth of interest and progress on malaria—as well as PEPFAR, which some people criticized because it was so bilateral, but it had a huge impact in allowing the current administration to really set some ambitious goals for reducing and eliminating parent-to-child transmission and setting that audacious goal of an AIDS-free generation.
Even as the global population continues to grow, technological and societal advances mean that our world is constantly getting smaller. Or at least that we are becoming more interconnected.
Understanding this—that a person in a Midwestern U.S. state is better off when a person on the other side of the world has access to quality health care—the U.S. Department of Health and Human Services’ (HHS) Global Health Strategy is working with partners across the globe to improve the health of everyone.
"Although the chief mission of [HHS] is to enhance the health and well being of Americans, it is critically important that we cooperate with other nations and international organizations to reduce the risks of disease, disability, and premature death throughout the world," said HHS Secretary Kathleen Sebelius.
One of the most powerful initiatives has been the push toward greater immunization rates. Immunizations alone saved 3 million children’s lives in 2011. Over the past decade, premature deaths from measles have been cut by 71 percent and from tetanus by more than 90 percent. And polio is closer and closer to complete eradication.
Still, vaccine-preventable diseases still account for approximately one in four global deaths of children under the age of 5. And of the 22 million children who go without the full benefits of vaccines each year, it is often the poorest that are most affected.
Among the greatest continuing obstacles are the persistent myths surrounding vaccinations, such as the false and repeatedly debunked belief that they cause autism.
“Overcoming these mistaken beliefs has become an integral part of our work towards global vaccine access. Until we reach the day when no lives are lost to vaccine-preventable diseases, we will aggressively continue to develop new and improved vaccines and ensure they are available to everyone in every country.”
>> Read the full “Beyond our borders: Why the U.S. Department of Health and Human Services invests in global efforts” at DefeatDD.org.
The final plenary session at this year’s NACCHO Annual included a talk by Christopher Murray, MD, DPhil, director of the Institute for Health Metrics and Evaluation at the University of Washington on how data is used to measure health, evaluate interventions and find ways to maximize health system impact. Dr. Murray was a lead author on three pivotal studies published last week that used data to assess the state of health in the United States compared with 34 other countries and county level data on diet and exercise. One of the key findings is that Americans are living longer, but not necessarily better—half of healthy life years are now lost to disability instead of mortality; and dietary risks are the leading cause of U.S. disease burden.
NewPublicHealth spoke with Dr. Murray about the study findings, their impact and upcoming research that can add to the data public health needs to improve the health of all Americans.
NewPublicHealth: Tell us about the three studies that were published this week using the Institute’s research.
Dr. Murray: The study in JAMA [Journal of the American Medical Association] is an analysis of a comprehensive look at the health of the United States in comparison to the 34 OECD [Organisation for Economic Co-operation and Development] countries. The study looks at both causes of death and premature mortality through over 290 different diseases and puts them all together in a comprehensive analysis of what the contributors are to lost healthy life. That study also looks at the contribution to patterns of health in the U.S., from major environmental, behavioral, and metabolic risk factors. In each of those categories, there are important findings:
- The U.S. spends the most on healthcare but has pretty mediocre outcomes and ranks about 27th for life expectancy among its peer countries.
- For many large, important causes of premature death, the U.S. does pretty poorly. And we also see a big shift towards more and more individuals having major disability—from mental disorders, substance abuse, and bone and joint disease.
- On the risk factor front, the big surprise is that diet is the leading risk factor in the U.S. It is bigger than tobacco, which is second and then followed by obesity, high blood pressure, high blood sugar, and physical inactivity. Diet in this study is made up of 14 subcomponents, each analyzed separately and then put together.
CDC: Youth Homicide Rate at a 30-Year Low
The youth homicide rate reached a 30-year low in 2010, though a slowing of the decline since 2000 indicates the increased need for youth violence prevention strategies, according to a new data in the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR). The 2010 rate was 7.5 per 100,000 U.S. youth, ages 10 to 24. Higher-risk youth, including males and non-Hispanic black youth, have seen slower declines in the homicide rate. “We are encouraged to see a decline in the homicide rate among our youth but unfortunately, homicide continues to rank in the top three leading causes of death for our young people,” said Linda C. Degutis, DrPH, MSN, director, CDC’s National Center for Injury Prevention and Control. “Our youth represent our future and one homicide is one too many. Comprehensive approaches that include evidence-based prevention strategies are essential to eliminate homicide as a leading cause of death of young people.” Read more on violence.
FDA Proposes Arsenic Limit for Apple Juice
The U.S. Food and Drug administration has proposed a limit of 10 parts per billion of inorganic arsenic in apple juice, which is about the same levels permitted in drinking water. Inorganic arsenic, which is both naturally occurring in the environment and a product of arsenic-containing pesticides, is a known carcinogen linked to skin lesions, developmental effects, cardiovascular disease, neurotoxicity and diabetes. The non-profit Consumer Reports called the proposal a "reasonable first step in protecting consumers from unnecessary exposure to arsenic." Now that the FDA has released its proposed guidance, we look forward to analyzing the agency's risk assessment, submitting comments, and continuing the dialogue on this important public health issue," said Urvashi Rangan, Director of Consumer Safety and Sustainability at the organization. Read more on food safety.
Study: Air Pollution Kills 2.1 Million People Each Year
As many as 2.1 million people die every year because of global air pollution, according to a new study in the journal Environmental Research Letters. About 470,000 of those are linked to human-caused increases in ozone, although climate change is only a small factor. Fine particulate matter air pollution can get into the lungs, causing cancer and other respiratory illnesses. "Our estimates make outdoor air pollution among the most important environmental risk factors for health," study co-author Jason West, of the University of North Carolina, said in a release. "Many of these deaths are estimated to occur in East Asia and South Asia, where population is high and air pollution is severe." Read more on environment.
Study: Americans Living Longer…But Not Necessarily Healthier
A new study in the Journal of the American Medical Association paints a broad, sweeping picture of life expectancy and health in the United States, finding that while people are living long in general, they’re also spending more of their lives in poor health as illnesses that used to lead to early deaths have been replaced with chronic conditions. The overall average U.S. life expectancy in 2010 was 78.2 years. The new findings are part of the Global Burden of Disease Study, which is a collaboration of 488 researchers in 50 countries. "It's rare these days that you get information or studies that give you the big picture," said study author Christopher Murray, MD, director of the Institute for Health Metrics and Evaluation at the University of Washington, in Seattle. "It's pretty uncommon to step back and say, 'What does all the evidence tell us about the most important health problems, and where does the U.S. fit in that landscape?'" While the United States has been making improvements, they’ve not been coming as quickly as they have in other countries. The main causes of earlier death in the country are heart disease, lung cancer, stroke, chronic obstructive pulmonary disease and road injuries, and the top causes of disability are lower back pain, depression and other musculoskeletal disorders. Read more on global health.
Five Daily Servings of Fruits, Vegetables Tied to Longer Lives
Eating plenty of fruits and vegetables is directly tied to living a longer life, according to a new study in the American Journal of Clinical Nutrition. Researchers found that consuming fewer than five servings a day—the recommended amount by many public health organizations—was tied to a higher chance of early death. They did not find that people who consumed more than the recommended level saw greater returns. They also found that while people who ate fewer fruits and vegetables were more likely to smoke, to eat more red meat, to eat high-fat dairy products and to be undereducated, the overall study results did not change even after accounting for gender, smoking, exercise, alcohol consumption and body weight. Read more on nutrition.
Red Cross: Emergency Call for Blood, Platelet Donations
A recent drop in blood donations has led the American Red Cross to issue an emergency request for more donors of all blood types. Donations were down about 10 percent in June and more is needed to ensure enough blood and platelets for the summer months. "We're asking for the public's help now to prevent a more serious shortage," said spokesperson Stephanie Millian in a release. "Each day donations come up short, less blood is available for patients in need. It's the blood products on the shelves today that help save lives in an emergency." To see if you are eligible to make a donation or to make an appointment either call 1-800-RED CROSS (1-800-733-2767) or go to RedCrossBlood.org. Read more on preparedness.
American Institute of Architects, Others Launch Ideas Competition to Rebuild Sustainable Communities
The American Institute of Architects (AIA), Make It Right, St. Bernard Project and Architecture for Humanity have launched a new “Designing Recovery” ideas competition to help rebuild sustainable, resilient communities in areas hit by natural disasters. The announcement came at the annual Commitment to Action at CGI America. "The cities of New Orleans, New York and Joplin are all stark reminders of the emerging threat of severe-weather disasters brought on by a changing climate,” said Eric Cesal, Director of Reconstruction and Resiliency at Architecture for Humanity. “Every city can learn from the successes and failures of these three cities and their response to disaster. Designers and architects have a responsibility to do more — and to do better. We hope this competition will draw out the best and brightest new ideas for a world of new risks." Read more on disasters.
On World Blood Donor Day, HHS Highlights Need for More Resources
Today is World Blood Donor Day. The United States is one of only 62 countries that collect 100 percent of their blood from voluntary, unpaid donors; the World Health Organization has this goal for all countries by the year 2020. About 8 million people donate blood in the United States each year. While this number is substantial, the U.S. Department of Health and Human Services (HHS) says even more donations are needed to help surgical patients, cancer patients, victims of natural disasters and people who suffer battlefield injuries.
According to HHS:
- Forty or more units of blood may be needed for a single trauma victim
- Eight units of platelets may be required daily by leukemia patients undergoing treatment
- A single pint of blood can sustain a premature infant’s life for two weeks
Read more on global health.
Supreme Court Rules Naturally Occurring Human Genes Cannot be Patented
In a unanimous decision, the U.S. Supreme Court ruled that naturally occurring human genes cannot be patented, although synthetically produced genetic material can be. The ruling struck down Myriad Genetics Inc.’s patents on the BRCA1 and BRCA2 genes linked to breast and ovarian cancer. Robert Darnell, MD, president and scientific director of the New York Genome Center, said the ruling "sets a fair and level playing field for open and responsible use of genetic information" and that “it does not preclude the opportunity for innovation in the genetic world." Read more on research.
Kaiser Family Foundation Report Highlights U.S. Engagement in Global Health: A NewPublicHealth Q&A with Josh Michaud
The increasing globalization of the world circles back to health as well. That’s a key tenet in a new report, The U.S. Government Engagement in Global Health: A Primer, from the Kaiser Family Foundation. The report describes the U.S. agencies and programs involved in global health and the federal budget supporting these efforts. Following the release of the primer, NewPublicHealth spoke with Josh Michaud, a Principal Policy Analyst at the Kaiser Family Foundation focused on the U.S. government’s role in global health.
NewPublicHealth: Why did the Kaiser Family Foundation create the global health primer?
Josh Michaud: The Kaiser Family Foundation has produced primers for other health issues on which we work, including Medicare and Medicaid. We felt that global health was an area in which we’ve built up some good data and analysis and we wanted to put it together in a format accessible to as wide an audience as possible. There has also been a growing interest at universities among young people in global issues, in particular global health issues.
Another critical reason to produce the primer is to set out a baseline for discussions, whether it is for different sides of a policy debate, student’s writing papers or people just getting started in the field. We don’t come at this with a particular recommendation, it really is meant to be a portrait of all the different parts of the U.S. government that are involved in global health. In the final section of the primer, we pulled together some policy issues that are of particular importance right now.
NPH: What trends or changes does the report note?
Michaud: The major trends have been increased levels of funding and an engagement by many different parts of the U.S. government in global health. The budget has increased significantly. In fiscal year 2001 the global health budget was about $1.5 billion. In fiscal year 2012 it was $8.8 billion. And while the United States is the most important and largest donor to global health, contributions from other governments have also grown significantly.
Much of the increased funding has been driven by increases for HIV/AIDS programs worldwide, and in particular, the PEPFAR program that the United States funds, as well as U.S. funding in support of Malaria. Earlier in the decade, there were significant increases year by year. That’s now leveled off and we don’t know what will happen in the future.
Update on 2011 UN Meeting on Non-communicable Diseases
Last year the United Nations held a High-Level Meeting on Non-communicable Disease. CEOs from the American Cancer Society, the American Diabetes Association and the American Heart Association have issued a statement on the one-year anniversary and stating that the meeting helped to elevate the importance of non-communicable diseases, or NCDs—including cancer, diabetes, cardiovascular diseases and chronic respiratory diseases—on the global health agenda. Progress from last year’s meeting includes a declaration in May by U.N. Member States for a global target of achieving a 25 percent reduction in premature mortality from NCDs by 2025. Read more on global health.
Obesity Rates Higher in U.S. Rural Areas
Obesity is more prevalent in rural areas of the United States than in urban areas, according to a new study by researchers at the University of Florida College of Public Health and Health Professions. The researchers found that 40 percent of rural residents are obese, compared with 33 percent of urban residents. The study was published in the Journal of Rural Health. Read more on obesity.
U.S. Pediatricians Warn Against Trampoline Use
Despite safety measures such as nets and padding added in the past several years, trampolines should still not be used by kids at home or on playgrounds, according to the American Academy of Pediatrics. The added measures have not changed the types of injuries caused by trampoline, according to Susannah Briskin, MD, a sports medicine specialist who helped craft the new recommendation. While the number of trampoline-related injuries dropped from 111,851 in 2004 to 97,908 in 2009, the total number of trampolines has also decreased. Read more on pediatrics.
Quebec will be the host city of the 12th HIA International Conference this week, the first time the meeting will be held in North America.
Quebec is a strong choice as host city. In 2001, the province of Quebec institutionalized health impact assessments (HIAs) by requiring that all laws and by-laws that could have an effect on health be evaluated for their impact. To help develop effective strategy, internal procedures were created at the Ministry of Health and Social Services to respond to requests, as well as HIA guidelines, a research program, and communication tools to help disseminate the HIA outcomes. Over 500 requests for advice have been generated since the requirement was put in place.
NewPublicHealth recently spoke with Alain Poirier, MD, chairman of the HIA meeting’s local organizing committee and the former National Public Health Director and Assistant Deputy Minister in Quebec’s Ministry of Health and Social Services.
NewPublicHealth: How did the 2001 law come about?
Dr. Poirier: The Health Minister at the time had been an official with the World Health Organization and so was well acquainted with the work being done in some European countries on evaluation the impact of laws on health. Our Public Health Act said the health minister “shall” be consulted, not “should” be consulted on any measures resulting from a new law or by-law that could have an impact on health.
And just saying that is not enough. I was made the person in charge in the Ministry of Health and Social Services of taking responsibility for the evaluations with the help of different groups, including academia. We also have a public health institute, the Institute National de Santé Publique du Quebec, which also has a mandate to help evaluate public policies and counsel the health minister about the impact of public policy.
We’ve had a lot of demand to evaluate new proposals, in part because every five years all the ministers in Quebec are required to issue a report on strategic planning. So when we screen the strategic planning we could foresee in advance what is going to be worked on in other ministries.
NPH: What is an example in Quebec of an HIA that was done that has resulted in a change in policy?