Category Archives: Global Health
For “Outbreak Week” we’ve already covered the deadliest pandemics in human history. But which outbreaks could be around the corner? Outbreaks: Protecting Americans from Infectious Diseases, 2013, the new report from Trust for America’s Health and the Robert Wood Johnson Foundation, lays out a few possibilities on which infectious diseases may pose the more serious threats in the future. Here are the greatest threats to the United States, according to Tom Inglesby, MD, Chief Executive Officer and Director of the UPMC Center for Health Security.
Middle East Respiratory Syndrome (MERS)
Spread across 12 countries, the virus has killed almost 40 percent of the people it’s infected. And while it may currently be confined to one region of the world, the high level of air travel between the Middle East and the United States increase the chance that it could find its way into the country, according to Inglesby, who said “we still don’t have a good handle on how it spreads, and there is no treatment for it or vaccine against it.”
Novel influenza virus
A new flu strain that, like the seasonal flu, is far reaching, but which would have a “far higher mortality rate.” Recent examples of major flu pandemics include the 2009 H1N1 outbreak; recent studies indicate the swine flu may have killed more than 200,000 people. The new H7N9 is also notable because of its high mortality rate.
Accident involving a lethal engineered virus
With scientists experimenting on viruses — enhancing their lethality or ability to spread — the risk grows of an accident releasing an engineered virus into the population.
It’s the most common infectious disease in the world and drug-resistant strains are only making the matter worse. “The level of drug resistance is growing and coping with this needs to be a real priority,” said Inglesby.
Not a pathogen, but a reason why pathogens could become even more dangerous. The U.S. Food and Drug Administration is taking steps to combat this growing issue, including new regulations on antimicrobial use in food animals and new restrictions on antibacterial soaps.
Deliberate biological threats
A biological attack, whether from another nation or as a terrorist act, could cause not only severe illness and death, but also communication problems that would hinder the ability of public health departments to respond.
Climate change is making this already existing problem even greater—with the regional climate shifts, places that haven’t had to deal with mosquito-based threats are now seeing them swarm in because of the warmer weather. Notable examples include the West Nile Virus and Dengue Fever. “We need to reinvigorate our strategy for mosquito control and the infectious diseases that come with mosquitoes.
While it has been decades since polio was a critical threat for much of the developed world, the disease—a virus that can spread from person to person and affect the brain and spinal cord with the potential for paralysis—still causes disease and death in the developing world. Earlier this year cases were reported in Syria, while in Israel the polio virus was found in soil likely from human waste infected with the disease, prompting a revaccination campaign among children age 5 and under. Polio has continued to spread in Afghanistan, Nigeria and Pakistan, and has been reintroduced and continues to spread in Chad and in the Horn of Africa after the spread of the virus was previously stopped. Other countries have seen small numbers of cases recently after no cases for decades.
Because even a small spread of the disease could reach the United States if infected individuals carry the virus here, the U.S. Centers for Disease Control and Prevention (CDC) several years ago made polio one focus of their Emergency Operations Center. CDC staff work with the World Health Organization and foreign health departments on vaccination campaigns aimed at fully eradicating the disease.
>>Bonus Content: View the CDC's infographic, "The Time to Eradicate Polio is Now."
NewPublicHealth spoke recently with Sona Bari, senior communications officer at the World Health Organization about the efforts underway to eradicate polio globally.
NPH: How are you able to detect polio outbreaks?
Sona Bari: We have a global surveillance system for polio and know from it that since 1988 the reduction of the disease has been over 99 percent. Polio is now endemic, which means indigenous polio virus transmission has never been stopped in parts of three countries: Nigeria, Afghanistan and Pakistan. So the surveillance is important because you can get polio down to very low levels like you do now, but it can reemerge. To completely eradicate polio you have to have an effective intervention, which is largely by vaccination. And you can be bring polio under very tight control by massive vaccination, but the virus is very good at finding children who are unvaccinated or under-vaccinated, and in Nigeria, Afghanistan and Pakistan we still have large groups of unvaccinated children. So the reason that polio transmission has not been stopped in these areas is that not enough children are vaccinated.
NPH: Why is there insufficient vaccination in those countries?
Bari: The basic reason is the quality of vaccination activities. Do these countries have decent health systems—strong routine immunization systems where children are regularly taken to a medical facility for their immunizations? When there are mass vaccination campaigns, are we reaching all children? Then there are, on top of that, layers of political complexities. In one part of Pakistan, for example, there is a ban on polio vaccinations by the local warlords. So there are access and security issues, layered on top of the difficultly of reaching all who need vaccines in countries such as Nigeria or Pakistan. That said, we know that these circumstances are not unique. They may differ from country to country, and each country does have a unique combination of the obstacles, but polio has been eradicated in countries that are far poorer than Nigeria or Pakistan, that have had worse conflict and that have perhaps much worse health systems. So it can be done.
Youth Smoking Rates Reach Record Lows in 2013
Overall youth smoking declined significantly in 2013, and smoking rates fell to record lows for all three grades surveyed (grades 8, 10 and 12), according to the Monitoring the Future survey released annually by the National Institute on Drug Abuse and conducted by researchers at the University of Michigan’s Institute for Social Research. For all three grades combined, the percentage of students who reported smoking cigarettes in the past month fell from 10.6 percent in 2012 to 9.6 percent in 2013. The data is based on annual surveys of 40,000 to 50,000 students in about 400 different secondary schools. Read more on tobacco.
WHO and UNICEF Vaccinating Millions of Children in the Middle East Against Polio
The World Health Organization (WHO) and UNICEF are mounting the largest-ever immunization response in the Middle East, with a goal of vaccinating more than 23 million children against polio in Syria and neighboring countries over the next few weeks. The campaign is in response to an outbreak of polio in Syria, where 17 cases have so far been confirmed, and to the detection of the virus in sewage in other parts of the Middle East.
The campaign plans to vaccinate all children under age 5 in the targeted areas in the next few months, whether they are living at home or displaced by conflict. The vaccinations will be given at set sites or by workers going house to house, and the campaign will be carried out by national and local health authorities supported by UNICEF, WHO, the Syrian Arab Red Crescent and other partners. The total cost to UNICEF and WHO through April 2014 will be $39 million.
Prior to this outbreak, no polio cases have been recorded in Syria since 1999. The risk of spread to countries in the region and beyond is considered high, and health authorities from 21 countries have declared a public health emergency. Genetically-related polioviruses, which originated in Pakistan, were found in sewage samples in Egypt in December 2012 and in Israel in the West Bank and Gaza earlier in 2013. According to WHO, immunization activities have been significantly constrained in Syria in the past few months by the ongoing conflict, which has led to 500,000 to 700,000 children missing vaccinations.
Editor’s Note: NewPublicHealth also spoke with Sona Bari, WHO's senior communications officer, about the efforts underway to eradicate polio globally. The interview will run later today.
Read more on global health.
CDC Expects TB Test Shortage to Ease
Supplies of tuberculin skin tests are expected to return to normal in January, following shortages that health providers have been experiencing since 2012, according to the U.S. Centers for Disease Control and Prevention (CDC). Two tests are approved by the U.S. Food and Drug Administration to detect tuberculosis and diagnose active illness: Tubersol, made by Sanofi Pasteur Limited; and Aplisol, produced by JHP Pharmaceuticals, LLC. Shortages were first reported for Tubersol, which was out of production from late 2012 through April 2013, increasing the demand for Aplisol. In August, a CDC survey found 29 of 52 U.S. jurisdictions were reporting a shortage of at least one of the tests. Read more on the Centers for Disease Control and Prevention.
Epidemic of E. coli Infections Traced to One Strain of Bacteria
In the past decade, a single strain of E. coli, has become the main cause of bacterial infections in women and the elderly by invading the bladder and kidneys, according to a study published in the American Society for Microbiology's journal mBio. Besides becoming more resistant to antibiotics, the H30-Rx strain gained an unprecedented ability to spread from the urinary tract to the blood, leading to sepsis and posing a threat to the more than 10 million Americans who annually suffer from urinary tract infections. The study authors say the new findings could help trace the history of the “superbug” and possibly lead to the development of a vaccine. Read more on infectious disease.
CDC: Measles Remains a Threat to U.S. Health Security
Fifty years after the creation of the measles vaccine, the disease continues to be a very real public health threat both in the United States and globally, according to the U.S. Centers for Disease Control and Prevention (CDC). While a recent study in JAMA Pediatrics confirmed U.S. measles elimination starting in 2000 and sustained through 2011, international travel means people from countries where the disease persists could still bring it to the United States. Approximately 158,000 globally died from measles in 2011, with an average of 430 children dying each day. These facts illustrate the need to be vigilant in reporting suspected cases to public health departments. “The steady arrival of measles in the United States is a constant reminder that deadly diseases are testing our health security every day,” said CDC Director Tom Frieden, MD, MPH. “Someday, it won’t be only measles at the international arrival gate; so, detecting diseases before they arrive is a wise investment in U.S. health security.” Read more on infectious disease.
HHS: $55.5M to Strengthen Training of U.S. Health Professionals, Especially in Nursing
The U.S. Department of Health and Human Services has announced the planned investment of millions to strengthen training for health professionals and add more professionals to the U.S. health care workforce, with a clear emphasis on nursing workforce development. About $45.4 million of the $55.5 million in FY 2013 will go toward nursing, including adding to the number of nurse faculty ($22.1 million), improving nurse diversity ($5.2 million), promoting interprofessional collaborative practice ($6.7 million) and supporting nursing education ($9.2 million). The more than 270 grants will also deal with overall public health, behavioral health and dentistry. Read more on nursing.
Switching to a Healthy Diet Adds About $1.50 Daily to Food Costs
Switching to a healthier may lighten your wallet a bit, but not so much that it isn’t worth it, according to a new study in the journal BMJ Open. Looking at 27 studies in 10 countries, researchers found that a diet that emphasizes fruits, vegetables, nuts and fish will add about $1.50 per day, or $550 per year, to an individual’s food budget. Healthy proteins such as boneless, skinless chicken breast were behind most of the additional costs. While this difference could be an issue for low-income families, middle-class families shouldn’t see much of a problem in making the healthy switch, according to study author Mayuree Rao, a junior research fellow in the department of epidemiology at the Harvard School of Public Health. "$1.50 is about the price of a cup of coffee and really just a drop in the bucket when you consider the billions of dollars spent every year on diet-related chronic diseases." Read more on nutrition.
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.