Category Archives: Global Health
Several weeks ago, the Harvard School of Public Health celebrated its Centennial with fanfare, fundraising and a panel discussion featuring world health leaders who are graduates of the school. Following the centennial, NewPublicHealth spoke with the School’s Dean, Julio Frenk, MD, MPH, PHD, who has a joint appointment at the Harvard Kennedy School of Government. He is also a former health minister of Mexico and a former senior fellow in the global health program of the Bill and Melinda Gates Foundation.
NewPublicHealth: What do you think have been the key changes in public health efforts since the Harvard School of Public Health was founded 100 years ago?
Julio Frenk: The 100 years that have passed since the School of Public Health was founded are not just any 100 years—they’re the 100 years with the most intense transformations in health in human history. We have seen a more than doubling of life expectancy since the school was founded. Around 1900, the global average for life expectancy was 30 years. At the end of the century, the global average was about 65 years. It more than doubled in the 20th century, and that increase has continued with some setbacks, most notably the AIDS epidemic in Saharan Africa. And we have had a qualitative shift not just in the level of mortality, but in the causes of death. So we went from a preponderance of acute infections to now a predominance of mostly chronic non-communicable diseases, and that’s an incredible transition.
A critical change is that the experience of illness became very different starting from the beginning of the 20th century. Before then, illness was mostly a succession of acute episodes, from which one either recovered or died. If you recovered, you went on to get your next acute illness. Now, illness is more a condition of living. People live with cancer. People live with AIDS. So that’s a big transformation of the patterns of health, disease and death.
Another big change is the emergence of complex health systems, and that’s—again—a process that started at the beginning of the 20th century. Before the 20th century, the social function of the sick was mostly trusted to undifferentiated institutions, such as the family or religious institutions, and it’s not until the 20th century when you see this incredible explosion of specialized institutions and specialized human resources, doctors, nurses and other health professionals. In the 20th century, healthcare is 10 percent of the global economy and employs millions of people, including eight million doctors. These are all profound transformations.
NPH: How has the training of students of public health changed in the last 100 years?
Frenk: There has been profound change. What happened at the beginning of the 20th century was the emergence of public health as a field of action. The practices of engineering emerged in Europe, especially with the rapid urbanization there starting around the 17th century, but then greatly expanded in the 18th century. Engineering allowed for access to clean water and taking care of waste, which resulted in some diseases coming under control. In the 19th century the discovery of microbiology gave rise to the abolishment of the germs as causes of illness. That is the junction that gives birth to public health, along with the idea of social policy, of social activism that actually changed social conditions. It’s in that mix that public health gets shaped.
NIH to Direct Additional $100M Toward Research in an HIV Cure
The National Institutes of Health (NIH) has announced plans to invest an additional $100 million over the next three fiscal years in research directed toward a cure for HIV. Over the past three decades, NIH-funded research has led to the development of more than 30 antiretroviral drugs and drug combinations targeting HIV. Anthony S. Fauci, MD, director of the NIH’s National Institute of Allergy and Infectious Diseases, said that growing knowledge about HIV, along with the development of new treatment strategies, makes the moment “ripe to pursue HIV cure research with vigor.” “Although the HIV/AIDS pandemic can theoretically be ended with a concerted and sustained scale-up of implementation of existing tools for HIV prevention and treatment, the development of a cure is critically important, as it may not be feasible for tens of millions of people living with HIV infection to access and adhere to a lifetime of antiretroviral therapy,” he said in a statement. Read more on HIV/AIDS.
Hong Kong Announces First Human Case of H7N9 Avian Flu
H7N9 avian flu appears to have spread from mainland China, with Hong Kong reporting its first human case of the deadly avian flu strain. A 36-year-old Indonesian domestic helper is in critical condition after travelling to Shenzhen and buying, slaughtering and eating an apparently infected chicken. Earlier this year a report of human infection in Shanghai was quickly followed by the confirmation of more than 100 cases. While closing down live poultry markets in the area caused the number of new cases to drop, the World Health Organization has confirmed a total of 139 cases and 45 deaths. Ko Wing-man, Hong Kong's secretary for food and health, said Hong Kong has raised its level of preparedness for an avian flu pandemic to "serious," and the city has suspended the importation of live chickens from certain Shenzhen farms as it also investigates its own stock. Read more on infectious disease.
Study: ‘Benign’ or ‘Healthy’ Obesity May Not Exist
Despite what some health professionals believe, “benign obesity” may not exist, according to a new study in the Annals of Internal Medicine. People who are overweight or obese without health issues such as high blood pressure, diabetes or other metabolic issues are still at increased risk of major health problems when compared with metabolically healthy, normal-weight people. The researchers looked at the results of eight studies covering more than 61,000 people, finding that in follow-ups of at least 10 years later the people who were overweight but without the risk factors were still at an increased risk of 24 percent for heart attack, stroke and even death. One explanation could be that these overweight people without the risk factors actually do have the risk factors, only at low levels that are difficult to detect, and that then become gradually worse. The results indicate that physicians should look at both body mass and metabolic tests when determining a patient’s health. Read more on obesity.
Study: U.S. Graphic Warning Labels Could Get 8.6M Smokers to Quit
A new study out of Canada indicates that the U.S. Food and Drug Administration may have underestimated the potential impact of graphic warning labels on tobacco products. From 2000 to 2009, the warning labels cut Canada's smoking rate somewhere between 12 and 20 percent, which would be the equivalent of between 5.3 million and 8.6 million U.S. smokers. That's also 33 to 53 times larger than the FDA's estimates when they pushed for the warning labels--and when the tobacco industry successfully challenged the measure, with the court pointing to the low impact as one of the reasons for the ruling. "Our analyses corrected for errors in the FDA's analysis, concluding that the effect of graphic warnings on smoking rates would be much stronger than the FDA found," said Jidong Huang, MD, the study's author. "Our results provide much stronger support for the FDA's revised proposal for graphic warnings, which we hope will be forthcoming in the near future." Read more on tobacco.
Expanding Nurse Practitioner Abilities Could Save Patients $472M by 2015
Expanding which health services nurse practitioners at retail health clinics can provide could save at least $34 per visit, or as much as $472 million in health costs by 2015, according to a new study in the journal Health Affairs. The estimated 6,000 retail health clinics, often found in chain pharmacies or "big box" stores, provide walk-in care for minor health problems. The rules for nurse practitioners vary from state to state, with some allowing them to prescribe medications and practice independently of a doctor's supervision. Researchers looked at insurance claims from 2004 through 2007, finding that the state's that grant wider latitude also tend to see lower costs for the patients:
- $704 -- Average cost of treatment in the 14 days after a traditional doctor's office visit
- $543 -- Average cost of care during and after a retail visit in states where nurse practitioners had no independence and could not prescribe medication
- $484 -- Average cost of care during and after a retail visit in states where nurse practitioners were allowed to practice without the supervision of a doctor
- $509 -- Average cost of care during and after a retail visit in states where nurse practitioners were allowed to practice without supervision and prescribe medication
Read more on access to health care.
New Estimate Puts 2009 Swine Flu Global Death Toll at More than 200K
The death toll from the 2009 swine flu epidemic was likely far higher than previously believed, according to a new study in the journal PLoS Medicine. Previously, the total stood at about 18,500 laboratory-confirmed deaths, though experts considered that to be a low estimate because it only factored in confirmed cases of H1N1. A new study, bringing together 60 researchers in 26 countries, now places the toll at as many as 203,000 global deaths--or 11 times higher than the previous estimate. "This study confirms that the H1N1 virus killed many more people globally than originally believed," study lead author Lone Simonsen, a research professor in the department of global health at the George Washington University School of Public Health and Health Services. "We also found that the mortality burden of this pandemic fell most heavily on younger people and those living in certain parts of the Americas." Read more on global health.
Study: Children, Teens Exposed to Far Too Many Alcohol Ads on Television
Children and teens continue to see too many television ads for beer, wine and other alcoholic drinks, with the industry failing to follow its own voluntary standard covering the number and frequency of ads, according to new research from the Johns Hopkins Bloomberg School of Public Health in Baltimore. The voluntary standards call for alcohol companies not to advertise during programs when more than 30 percent of the viewing audience is likely to be younger than 21. However, using data from 25 of the largest markets in 2010, the study found that nearly one in four of the alcohol ads on the most popular programs for viewers aged 12-20 violated the voluntary standards. Alcohol contributes to an estimated 4,700 deaths among underage youth in the United States each year, with studies showing that exposure to alcohol marketing increases the likelihood of underage drinking. "Underage drinking harms teens, their families and their communities," CDC Director Tom Frieden, MD. "Exposing teens to alcohol advertising undermines what parents and other concerned adults are doing to raise healthy kids." The findings appeared in the latest CDC Morbidity and Mortality Weekly Report. Read more on alcohol.
Kaiser Family: Most Americans Support Global Health Efforts, Although Don’t Fully Understand It
A new survey from the Kaiser Family Foundation finds that while the majority of Americans support the current U.S. efforts to improve public health in developing countries, there remain misconceptions about the levels of U.S. spending and how it is allocated. The 2013 Survey of Americans on the U.S. Role in Global Health was conducted in August 2013, through a random phone survey of 1,507 adults. According to the survey, 31 percent of Americans says we spend too little and 30 percent say we spend enough. However, the average American also believes foreign aid accounts for 28 percent of the federal budget, when in reality it is approximately 1 percent. Most people polled also don’t realize that most of the aid goes toward specific program areas, and is not simply a blank check to be allocated by the recipient country. Read more on global health.
About 10 Percent of Americans, 25 Percent of Adults Suffer from Arthritis
About 10 percent of Americans have arthritis, with half of them so severely affected that they can’t perform normal daily activities, according to the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. The report found that about 52.5 million adults—or about one quarter of all U.S. adults—had some form of arthritis; experts expect that number to climb to 57 million by 2030 as the population grows older. However, there are other possible explanations for the increasing problem. "The increase in arthritis definitely has to do with the aging of our population, but it's also potentially linked to the obesity epidemic," said the study's lead author, CDC epidemiologist Kamil Barbour. Read more on aging.
The celebrations earlier this month for the Harvard School of Public Health’s centennial included galas, world leaders and a $450 million fundraising campaign, about a third of which is already completed.
But the most poignant moments may have been watching former graduates, many who are now in key health leadership positions across the globe, in quiet conversations with current students, answering questions about how to get the most out of their time in Boston to help improve population health when they hit the field. Kelechi Ohiri, MD, senior adviser to the Nigerian Ministry of Health, who got his Harvard Master of Public Health eleven years ago, sat out some of the formal Centennial lunch to speak to a current student from his country whose excitement at meeting Nigeria’s top health official bubbled over.
“Meeting him makes me believe I’ll be able to use what I’m learning to help make a difference at home,” she said.
Ohiri said that a critical focus should be “networking to improve skills and create contacts,” which he said is often underutilized by students of public health, and contrasted that with networking as an “explicit goal” of the Harvard MBA program.
Several graduates who are now world health leaders convened for a panel discussion moderated by Institute of Medicine President Harvey Fineberg (who received all his degrees, including his MD, from Harvard) about their experiences in the field of public health. In addition to Ohiri, participants included:
- Gro Harlem Brundtland, MPH ’65, the former Prime Minister of Norway and former Director-General of the World Health Organization
- Suraya Dalil, MD, MPH ’05, the Minister of Public Health of Afghanistan
- Howard Koh, MD, a former professor at the Harvard School of Public Health and currently the U.S. Assistant Secretary for Health
- Pradit Sintavanarong, MD, MPH ’89, the Minister of Public Health of Thailan
More than 10,000 public health officials, academics and students will gather in Boston next week for the 2013 American Public Health Association Meeting in Boston. This year’s theme is “Think Global, Act Local,” drawing critical attention to the increasingly global world of health where events across the globe—from food safety, to infectious disease outbreaks, to innovative public health solutions—can impact every local neighborhood.
>>NewPublicHealth will be on the ground at the APHA Annual Meeting, with speaker and thought-leader interviews, video perspective pieces and updates from sessions, with a focus on what it takes to build a culture of health. Follow our coverage here.
Ahead of the annual meeting, NewPublicHealth spoke with Georges Benjamin MD, APHA executive director.
NewPublicHealth: Why is the theme “Think Global, Act Local” so important?
Georges Benjamin: We’re in a world in which everything is global. There are no boundaries anymore. Rapid transit through planes, the fact that our borders are so porous...public health has always been a global enterprise, but even more so today. Our food comes no longer from a single farm but from multiple farms and sometimes multiple countries, so foodborne risks for disease and illness are global. We’ve seen that terrorism disasters are global. We’ve seen that obesity, particularly with corporations that sell certain products globally, is a big issue, and tobacco has always been a global issue. So, public health is global, and the idea is that if we can learn from people around the world and then utilize those learnings within our local communities, we’ll be stronger
NPH: What are some of the meeting sessions you’d highlight?
Benjamin: Our opening session will feature Professor Sir Michael Marmot, Director of the International Institute for Society and Health and Research Professor of Epidemiology and Public Health at University College, London, who spoke at our meeting five years ago on the social determinants of health and is going to give us an update. In the closing session, we’ll hear from actor/physician/public health doctor, Evan Adams, MD, the deputy provincial health officer for British Columbia, who will speak about improving the health of native people. So in both our opening and closing sessions we’re looking globally, as well as emphasizing what happens locally. We’ll also hear from the minister of health of Taiwan, who will talk about universal health care as well as violence prevention. And we’ll also be holding sessions that track the many public crises that we’ve already had this year.
In honor of World Polio Day, the U.S. Centers for Disease Control and Prevention (CDC) will highlight polio eradication work around the globe on Twitter and Facebook. Development of the polio vaccine has reduced the disease worldwide by 99 percent, with only Afghanistan, Nigeria and Pakistan as the remaining polio endemic countries in 2012.
But both in endemic countries and in countries where polio was thought to have been vanquished, cases persist. According to the Global Polio Eradication Initiative, just this week eleven new wild poliovirus (WPV) cases were reported, including one from Afghanistan, two from Ethiopia, four from Pakistan and four from Somalia. The total number of WPV cases for 2013 is now 296, with 99 from countries that have not yet been able to eradicate the disease and 197 from countries that have seen outbreaks. In Israel, for example, while no cases of paralytic polio have been reported, environmental surveillance suggests that virus transmission (first detected in February 2013) continues in parts of the country’s southern and central regions. A vaccination campaign for children under age ten is ongoing.
On December 2, 2011, CDC Director Thomas R. Frieden, MD, MPH, activated CDC’s Emergency Operations Center (EOC) to strengthen the agency’s partnership engagement through the Global Polio Eradication Initiative (GPEI). Activation of the EOC has provided enhanced capacity for CDC’s polio eradication support program, which trains public health volunteers in the United States and globally to improve polio surveillance and help plan, implement and evaluate vaccination campaigns.
Additional EOC activities include:
- Publication of several joint World Health Organization Weekly Epidemiologic Record/CDC Morbidity and Mortality Weekly Reports (MMWR) highlighting polio eradication progress.
- Collaboration with GPEI partners on detailed country-plans for expanded technical and management support, including assistance with outbreak responses, surveillance reviews, vaccination campaign planning and monitoring, and data management.
- Provision of operational support to Nigeria for the country’s FY 2012 Polio Eradication Emergency Response Plan. The plan focuses on enhancing management and leadership skills to improve program performance.
- The development of indicators for monitoring polio vaccination campaign performance in the areas of planning, implementation and evaluation.
- Review of WHO-proposed outbreak response protocols for all polio-affected countries.
“If we fail to get over the finish line [to fully eradicate polio],” says Frieden, “we will need to continue expensive control measures for the indefinite future…More importantly, without eradication, a resurgence of polio could paralyze more than 200,000 children worldwide every year within a decade.”
Study: Top Athletes Endorse Junk Food More Often Than Healthy Food
A new study of professional athletes’ food and beverage endorsements found that more often than not their paid support is given to products that are energy-dense and nutrient-poor, according to a new study in the journal Pediatrics. The study looked at 512 brands endorsed by 100 different athletes, finding that “Seventy-nine percent of the 62 food products in athlete-endorsed advertisements were energy-dense” and “93.4% of the 46 advertised beverages had 100% of calories from added sugar.” Denver Broncos player Peyton Manning and Miami Heat player LeBron James had the most endorsements for the energy-dense, nutrient-poor food and beverages. "I hope this paper inspires some reflection on the part of America's athletes and professional sports leagues, as well as all other celebrities for that matter,” said Center for Science in the Public Interest Executive Director Michael F. Jacobson, in a statement. Read more on nutrition.
U.S. Task Force Recommends Against Blood Pressure Screening for Kids, Teens
Despite recommendations from several expert groups, the U.S. Preventive Services Task Force is not recommending that health care professionals respond to the growing obesity crisis by screening children and teens for high blood pressure. The panel concluded that more study into the issue is needed, and that in the mean time there are other, known avenues toward lowering youth obesity and improving cardiovascular health. "We don't know if lowering blood pressure in youth leads to improved cardiovascular health in adulthood,” said panel member Kirsten Bibbins-Domingo, MD. “We also don't know the long-term benefits and harms for children and adolescents who initiate blood pressure medications when they are young. While there is much we don't know, we do know that eating a healthy diet, being active, and maintaining a normal weight are ways children and teens can improve their cardiovascular health." Read more on heart health.
Study: Tobacco Advertisements Connecting with Young Kids in Many Low-, Middle-income Countries
The global pervasiveness of tobacco advertisements means that most very young children in many low-and middle-income countries are familiar with cigarette brands, and nearly 70 percent of kids ages 5 and 6 can identify at least one cigarette logo, according to a new study in the journal Pediatrics. The study is from the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health. The findings demonstrate the significant steps countries and public health organizations still need to take to limit the influence of tobacco ads. “Evidence-based strategies exist to reduce the ability of tobacco companies to market their products to children, such as implementing and enforcing bans on tobacco advertising, promotion and sponsorship,” said Joanna Cohen, PhD, co-author of the study and director on the institute. “Putting large picture warnings on the front and back of cigarette packs and requiring plain and standardized packaging, as Australia has done, also helps to reduce the attractiveness of cigarette packs among young children.” Read more on global health.
New NIH Study to Look at House-to-House HIV Testing, Other Measures, to Reduce HIV Burden in Africa
A study in South Africa and Zambia is assessing whether house-to-house voluntary HIV testing and prompt treatment of HIV infection, along with other proven HIV prevention measures, can substantially reduce the number of new HIV infections across communities. The trial is funded primarily by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), administered by the Office of the Global AIDS Coordinator. “Through this new study, we aim to learn whether the treatment of HIV-infected individuals as a form of HIV prevention, an approach previously tested in roughly 1,800 heterosexual couples where one partner was infected, will be just as effective when implemented across an entire adult population,” said NIAID Director Anthony S. Fauci, MD. “The study also will tell us whether this method of delivering population-wide HIV treatment as prevention is feasible and cost-effective.” The trial is being conducted in South Africa and Zambia because the HIV prevalence in those countries is among the highest in the world. An estimated 12.5 percent of adults in Zambia and 17.3 percent of adults in South Africa are infected. The study team will measure the impact of the two HIV prevention packages by determining the number of new HIV infections among a representative sample of 52,500 adults drawn from the 21 study communities and followed for three years. The study is expected to end in 2019. Read more on AIDS.
Study: Better Awareness Likely Reason for Increase in ER Visits for Youth Concussions
Improved awareness of the signs and symptoms of traumatic brain injuries (TMI)—such as concussions—is likely the cause of a noticeable increase in TMI-related emergency department visits by children, according to a new study from doctors at the Cincinnati Children's Hospital Medical Center. The study appeared in the journal pediatrics. Visits for these types of injuries climbed about 92 percent from 2002 to 2011, while the overall severity of the injuries decreased and the hospitalization rate remained at around 10 percent. "We are doing a better job at educating ourselves and educating the public about concussion," said Dr. Holly Hanson, lead study author and an emergency medicine fellow. "People and doctors are recognizing sports-related concussions more. People are recognizing the signs and symptoms. People are more aware of the complications. So people are coming in more." According to the U.S. Centers for Disease Control and Prevent, each year TMI accounts for about 630,000 emergency department visits, 67,000 hospitalizations and 6,100 deaths in children and teens annually. Read more on injury prevention.
HHS Developing New Burn Treatments to Improve Disaster Response, Daily Care
Through its Biomedical Advanced Research and Development Authority (BARDA), the U.S. Department of Health and Human Services (HUD) is working to develop five new types of burn treatments for disaster response and daily emergency medical care. The thermal burn medical countermeasures—which could take the form of drugs, vaccines or medical products—will be for chemical, radiological or nuclear incidents. Developing new measures is critical, because with only 127 burn centers in the country, a mass casualty event could quickly overwhelm the public health response. “Sustainability of these medical countermeasures for thermal burns is critical for their availability when they are needed most,” said BARDA Director Robin Robinson, PhD. “Our repurposing and multi-purpose strategy facilitates development, ensures availability, and reduces overall costs for thermal burn medical countermeasures.” Read more on disasters.
Report: U.S. Poverty, Uninsured Rates Remain Stagnant
Despite an improving economy that included the creation of more than 2 million jobs last year, the U.S. poverty rate in 2012 remained relatively equal to the previous year, according to a new report from the U.S. Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2012. About 46.5 million people lived at or below the poverty line in 2012, or about 15 percent of the nation. That’s about 2.5 percentage points higher than 2007, right before the economic recession. About 48 million people were without health insurance in 2012, only slightly lower than the 48.6 million in 2011. While the recession seems to have leveled out, the fact that poverty rates have yet to truly rebound has many experts concerned. “We’re supposed to be in recovery,” said Austin Nichols, a researcher at the Urban Institute. “Poverty rates should be falling because long-term unemployment is falling. And they're not.” Read more on poverty.
Economic, Mental Toll of Economic Crisis Likely Responsible for Global Jump in Men’s Suicide Rates
The economic and mental toll of the 2008 global economic crisis was likely a major contributor to the surprising increase in the U.S. and global male suicide rates in 2009, according to a new study in the journal BMJ. There were about 5,000 more suicides than expected that year. The male suicide rate in the United States climbed almost 9 percent in the United States in 2009; the overall global rate climbed 3.3 percent, with the largest increases seen in the European Union and North and South American countries. Depression and stress can lead to increased alcohol and drug abuse, which are also suicide risk factors. The study concluded that immediate action, such as job-creation programs, may help prevent a continued increase in suicides. "Unemployment appears to lead to an increase in anxiety and depression -- two psychiatric symptoms that might be intermediate steps toward suicide," said Robert Dicker, MD, associate director of the division of child and adolescent psychiatry at North Shore-LIJ, in New Hyde Park, N.Y., who was not a part of the study. "More unemployment, more family distress, more losses [of status and friends] also most likely are involved." Read more on mental health.
Study: Two Simple Questions on Mobility Can Help Assess, Treat Older Adults’ Physical Declines
Two simple questions about mobility could help doctors more accurately assess and treat an older adult’s physical decline, according to a new study in the Journal of the American Medical Association:
- For health or physical reasons, do you have difficulty climbing up 10 steps or walking a quarter of a mile?
- Because of underlying health or physical reasons, have you modified the way you climb 10 steps or walk a quarter of a mile?
The answers could help determine whether physical therapy or mobility-assistance devices are needed. The findings emphasize the importance of increased physical activity and exercise in health aging, according to Cynthia Brown, MD, of the division of gerontology, geriatrics and palliative care at the University of Alabama at Birmingham. "With an increasing older population in the United States, it is incumbent on us to find ways to help older Americans continue to live well and independently,” she said. “The major barriers—lack of physical activity, obesity and smoking—are all risk factors that can be successfully overcome with appropriate treatment and assistance." Read more on aging.