Kiran Gadani
Prioritizing the Global Health Agenda
“So much to do, so little funding!”—is probably the motto on many public health professionals’ lips these days. Looking at the tremendous global health agenda, one is forced to ask the questions: Where should we start? Where is the funding? What is priority? What country is important?—the answers to these and many other questions are very close to unanswerable. So then what do we do?
Much of the world is suffering from what is called the “double burden of disease”—meaning that there is a great prevalence of communicable diseases in addition to the epidemic of chronic non-communicable diseases (CNCDs), which disproportionately impacts the developing world. The number of deaths from these diseases [CNCDs] is double the number of deaths that result form a combination of infectious diseases (including HIV/AIDS, tuberculosis, and malaria), maternal and perinatal conditions, and nutritional deficiencies (Daar et al. 2007). With increasing globalization and urbanization, the prevalence of Type II Diabetes, cardiovascular disease, cancers, etc. have risen. In the developing world, for example, in India, the prevalence of Type II Diabetes is the highest in the world and it’s population still suffers from infectious diseases such as pneumonia and malaria. Besides their direct threat to global health, diseases such as HIV/AIDS, TB, and malaria have a disastrous impact on the development of the poorest countries (Kaul and Faust, 2001).
Developed nations also face a rising epidemic of chronic diseases. 66% of the U.S. Adult population is considered overweight or obese, which drives the rising incidence of associated chronic diseases (diabetes, CVD, hypertension, stroke, etc.). The high incidence and prevalence of these types of chronic diseases put a great deal of strain on health care systems and health care professionals. With rising medical costs and technology, comes the need for better, more sustainable health care systems. But what is the most important? Is it the annual death of 2.04 million people due to HIV/AIDS (WHO 2004)? Or the 7.20 million deaths due to coronary heart disease (WHO 2004)? Or the deaths due to other conditions such as lower respiratory diseases, diarrheal diseases, cancers, influenza, and the list goes on.
Most funding is driven by emotional, high-visibility events, including large-scale natural disasters such as the Asian tsunami; diseases that capture the public’s imagination such as HIV/AIDS; or diseases with the potential for rapid global transmission such as hemorrhagic fever, severe acute respiratory syndrome, or pandemic influenza. These funding streams skew priorities and divert resources from building stable local systems to meet everyday health needs. (Gostin 2007).
This shows that funding is lacking in many situations and most funding goes to the “high-profile” diseases. What about road traffic accidents? The obesity epidemic? Or perinatal conditions? All these question marks behind these threats to health and other threats poses the critical urgency of planning the global health agenda in the most effective way possible. As Gostin suggest, a sustainable local system of health care is definitely needed, in order to provide basic health care services, which, for the most part, will prevent many risk factors and diseases. However, merely providing health care services will not tackle all of these questions. Rather, a combination of a healthy built environment and access to sustainable health care would prevent many diseases. Although treatment of HIV/AIDS is extremely important, it is more important to build sustainable systems to prevent these types of diseases. Putting funding into more preventative programs will be more beneficial than trying to treat people. Ethically, it is not right to ignore the treatment portion of health care programs. So, in addition to treatment, preventative programs should be placed.
For example, investing funds into programs that prevent risk factors such as adiposity, high blood pressure, smoking, poor diet, sedentary lifestyle—would reduce the incidence of chronic diseases such as Type II Diabetes, cancers, hypertension, CVD, stroke, just to name a few. Furthermore, basic health goods should be in place, such as safe drinking water and sanitation regulations, which would greatly reduce the incidence/prevalence of infectious diseases and breed healthier individuals.
What is truly needed, and what richer countries (although not always adequately) do for their citizens, is to meet what can be called “basic survival needs.” Basic survival needs include sanitation and sewage, pest control, clean air/water, diet nutrition, tobacco reduction, essential medicines and vaccines, and well-functioning health systems (Gostin 2007).
“Meeting basic survival needs can be disarmingly simple and inexpensive and should rise to the top of the agenda of the world’s most powerful countries” (Gostin 2007). Gostin’s suggestions on what should be priority and what should be at the top of the global health agenda do not require extensive technology and biomedical research, they are basic survival needs, which will foster healthier individuals, and in the long-run reduce deaths due chronic and infectious disease. Furthermore, by providing these basic needs will enhance the overall health of a population, in the long run, increasing productivity and positively contributing to economic stability.
Prioritizing the global health agenda is one of great controversy about health care professionals, politicians, and citizens of all countries. As stated before, much of the funding and resources go toward diseases and other conditions that are visibly apparent and many diseases/conditions are ignored. What about mental health conditions? And road traffic accidents? Tobacco control? Gostin suggests a Framework Convention on Global Health as a model for all states (nation-states) to provide citizens with basic survival needs. He describes this framework as a bottom-up model, in which a global health governance scheme is formed to do the following: build capacity (which will contribute to building sustainable health systems), set priorities (so international assistance can be geared toward providing basic survival needs), involve stakeholders (in which relevant resources and expertise can be allocated and made us of), coordinate activities, and evaluate/monitor progress. Just as in the Framework Convention for Tobacco Control, an international treaty which takes into account global health, will be one step forward in setting priorities and effectively reducing disease burden around the globe.
Resources
Gostin, L.O. (2007). Meeting the survival needs of the world’s least healthy people. Journal of the American Medical Association; 298: 225-228.
Kaul, I., Faust, M. (2001). Global public goods and health: taking the agenda forward. Bulletin of the World Health Organization, 79 (9).
World Health Organization. (2008). The World Health Report 2008. WHO: Geneva, Switzerland.
World Health Organization. (2009). Top 10 causes of death. WHO: Geneva, Switzerland. http://www.who.int/mediacentre/factsheets/fs310/en/index.html
Thursday, April 30, 2009
Disaster Relief - Analysis of 2005 South Asian Earthquake
It’s hard to imagine a more devastating disaster than a powerful earthquake. They come without notice; completely unpredictable even in our age of technology. They last barely seconds but manage to level cities centuries old. The destruction left by earthquake is often irreparable and rebuilding of structures, restoring of power and water, etc may take months or years to complete. However, more devastating then the lack of shelter, power, etc is the disruption of health care. Those injured in major earthquakes can number in the hundreds of thousands and most likely, health care in the area is heavily disrupted if not shut down altogether. Those with minor injuries who otherwise would have received treatment may have to wait days before being seen by doctors and even longer before receiving care. Most vulnerable in earthquake disasters, or any disasters for that matter, are developing countries with poor infrastructure, remote populations, and difficult terrain. The 2005 major earthquake that shook the mountains of Kashmir was the third deadliest disaster in the last quarter century. The 7.6 magnitude quake leveled the cities of Muzaffarabad, Balakot, and Abbottabad and destroyed innumerable villages in those and neighboring regions.
The earthquake struck Northern Pakistan just northeast of the capital of Azad Kashmir district, Muzaffarabad. Muzaffarabad is a large city with a population of over 750,000, located in a river valley and surrounded by mountain villages. On the morning of the earthquake, October 8, 2005, most men were at work in the open fields, while majority of women and children were at home and school respectively. When the earthquake hit at 9 am that morning, children in their classrooms experienced their schools collapsing on them, while shelter homes in the mountains crumbled and fell. In a report put together by the Spinal Cord Injury Project for Pakistan Earthquake Rehabilitiation (SCIPPER), children reported hearing a “deafening sound and forceful shaking” which sent them tumbling down. The walls of their school collapsed, killing hundreds of children instantly and trapping the rest of them. Confusion and panic spread as they lay injured under the rubble, surrounded by dead classmates and screaming. The injured children lay for hours until they were rescued by family or community members. Many sustained spinal cord injuries which left them paralyzed from the neck or waist down. The shock of being unable to move their arms and leg was horrifying; just earlier that day they were “running and playing with their friends.” Far from being cared for or comforted, the paralyzed victims of the earthquake were left lying outside for days until helicopters came and took them to care facilities. Because of the mountainous terrain, most affected villages and cities were already difficult to access because of poor roads and weather conditions. After the earthquake, landslides essentially blocked all access to the region, making care even more difficult to access.
In addition, Pakistan was not properly prepared to manage such a huge natural disaster and didn’t have the means to respond quickly and efficiently. It took weeks to reach most of the affected villages and because of the quake, most proximal health care facilities were destroyed so victims had to be airlifted elsewhere. It was reported that of the nearly 512 healthcare facilities in the affected area, approximately 300 of them were completely destroyed while nearly 75 were seriously damaged. The lack of facilities and competent doctors was exacerbated by the landslides and road blockages which made most villages accessible only by helicopter. The condition worsened in the following days as the few health care facilities that were still open became extremely overcrowded as victims were flown in. The immediate priority of the doctors was surgical care for patients that were severely injured. However within days it became clear that lack of access to clean water, sub par sanitation conditions, and overcrowding were of greater concern. Patients who received surgical care continued to suffer from life-threatening infections due to unhygienic conditions. The overburdened care facilities could not provide follow-up care for many patients post-operatively simply due to the sheer volume, which indirectly resulted in lives lost.
The level and nature of the training of much of the medical provider was not adequate to prepare them to treat affected patients. Many senior medical students, in their fourth year, were sent to the mountain region to help the rescue efforts. Not only had they received no formal training in disaster relief medicine, they were hardly accustomed to making independent decisions without the approval of their attending physicians. When they finally arrived in the affected regions, it had been a few days since the quake and people were desperate for medical attention. The burden of having to prioritize patients by severity of condition and treating them independently was overwhelming for the untrained and unprepared medical students. In addition, the majority of them had never had to practice medicine without the facilities of a hospital or even more basic needs such as anesthesia, clean water, or proper prescription medicines. The adaptability required of those treating earthquake victims definitely hindered relief efforts and better preparation of medical students would have been invaluable in making them more efficient first responders to this disaster situation.
An unexpected crisis that arose after the quake was the outbreak of infectious disease in the shelter camps. The state of Pakistan’s development in terms of availability of water, power, and safe road conditions was unreliable even before the quake. Afterwards, approximately 144 camp settlements were established to shelter nearly 144,000 residents. The close proximity in which masses of people lived caused huge outbreaks of disease, with nearly 65% of all clinic visits being to treat infections. Generally, acute respiratory disease, such as pneumonia, and diarrhea were among the chief complaints, especially once the winter set in. The tents set up in these settlements were not meant to be used in the harsh cold of Kashmir’s winter, and the death toll continued to rise through the first winter season. Winterization of the tents became increasingly important to enable the survival of the displaced village populations. Even now, three years after the earthquake, access to food and water continue to remain unreliable, especially since the initial influx of international aid dropped steeply after the first few months. Many people are still living in prefabricated homes which are unable to protect residents from the elements and could most definitely not withstand another earthquake. Roads have not been permanently rebuilt yet either, forcing patients with lifelong conditions to travel for hours or even days to receive proper medical attention when needed.
Death caused by a natural disaster is unfortunate and unavoidable. However, every effort to reduce the number of deaths and the injuries sustained by a population must be made. The time lag in reaching the affected regions, the consistently poor access to basic needs such as clean water and the lack of disaster preparation of the medical teams all contributed to the enormous death toll of nearly 75,000 and those injured numbering 100,000. Although international aid is of invaluable help in facing these kinds of disasters, ultimately it is the responsibility of every nation to prepare themselves against disasters which pose the largest threats in their regions.
References
1. Suharwardy, Sanaa. Personal interview. 10 Apr 2009. Interview.
2. Brennan , Richard J., and Ronald J. Waldman. "The South Asian Earthquake Six Months Later - An Ongoing Crisis." The New England Journal of Medicine (2006): 1769-1771. Print.
3. Sabri, Ahmed A., and Muhammad A. Qayyum. "Why Medical Students Should be Trained in Disaster Management: Our Experience of the Kashmir Earthquake." PLoS Medicine 3(2006): 1452-1453. Print.
4. Vanek, Zeba. "SCIPPER-Medical Neuro-Rehabilitation and Creating an Ongoing Sustainable System of Medical Care." RealMedicineFoundation.org Oct 2007 1-5. Web.11 Apr 2009..
The earthquake struck Northern Pakistan just northeast of the capital of Azad Kashmir district, Muzaffarabad. Muzaffarabad is a large city with a population of over 750,000, located in a river valley and surrounded by mountain villages. On the morning of the earthquake, October 8, 2005, most men were at work in the open fields, while majority of women and children were at home and school respectively. When the earthquake hit at 9 am that morning, children in their classrooms experienced their schools collapsing on them, while shelter homes in the mountains crumbled and fell. In a report put together by the Spinal Cord Injury Project for Pakistan Earthquake Rehabilitiation (SCIPPER), children reported hearing a “deafening sound and forceful shaking” which sent them tumbling down. The walls of their school collapsed, killing hundreds of children instantly and trapping the rest of them. Confusion and panic spread as they lay injured under the rubble, surrounded by dead classmates and screaming. The injured children lay for hours until they were rescued by family or community members. Many sustained spinal cord injuries which left them paralyzed from the neck or waist down. The shock of being unable to move their arms and leg was horrifying; just earlier that day they were “running and playing with their friends.” Far from being cared for or comforted, the paralyzed victims of the earthquake were left lying outside for days until helicopters came and took them to care facilities. Because of the mountainous terrain, most affected villages and cities were already difficult to access because of poor roads and weather conditions. After the earthquake, landslides essentially blocked all access to the region, making care even more difficult to access.
In addition, Pakistan was not properly prepared to manage such a huge natural disaster and didn’t have the means to respond quickly and efficiently. It took weeks to reach most of the affected villages and because of the quake, most proximal health care facilities were destroyed so victims had to be airlifted elsewhere. It was reported that of the nearly 512 healthcare facilities in the affected area, approximately 300 of them were completely destroyed while nearly 75 were seriously damaged. The lack of facilities and competent doctors was exacerbated by the landslides and road blockages which made most villages accessible only by helicopter. The condition worsened in the following days as the few health care facilities that were still open became extremely overcrowded as victims were flown in. The immediate priority of the doctors was surgical care for patients that were severely injured. However within days it became clear that lack of access to clean water, sub par sanitation conditions, and overcrowding were of greater concern. Patients who received surgical care continued to suffer from life-threatening infections due to unhygienic conditions. The overburdened care facilities could not provide follow-up care for many patients post-operatively simply due to the sheer volume, which indirectly resulted in lives lost.
The level and nature of the training of much of the medical provider was not adequate to prepare them to treat affected patients. Many senior medical students, in their fourth year, were sent to the mountain region to help the rescue efforts. Not only had they received no formal training in disaster relief medicine, they were hardly accustomed to making independent decisions without the approval of their attending physicians. When they finally arrived in the affected regions, it had been a few days since the quake and people were desperate for medical attention. The burden of having to prioritize patients by severity of condition and treating them independently was overwhelming for the untrained and unprepared medical students. In addition, the majority of them had never had to practice medicine without the facilities of a hospital or even more basic needs such as anesthesia, clean water, or proper prescription medicines. The adaptability required of those treating earthquake victims definitely hindered relief efforts and better preparation of medical students would have been invaluable in making them more efficient first responders to this disaster situation.
An unexpected crisis that arose after the quake was the outbreak of infectious disease in the shelter camps. The state of Pakistan’s development in terms of availability of water, power, and safe road conditions was unreliable even before the quake. Afterwards, approximately 144 camp settlements were established to shelter nearly 144,000 residents. The close proximity in which masses of people lived caused huge outbreaks of disease, with nearly 65% of all clinic visits being to treat infections. Generally, acute respiratory disease, such as pneumonia, and diarrhea were among the chief complaints, especially once the winter set in. The tents set up in these settlements were not meant to be used in the harsh cold of Kashmir’s winter, and the death toll continued to rise through the first winter season. Winterization of the tents became increasingly important to enable the survival of the displaced village populations. Even now, three years after the earthquake, access to food and water continue to remain unreliable, especially since the initial influx of international aid dropped steeply after the first few months. Many people are still living in prefabricated homes which are unable to protect residents from the elements and could most definitely not withstand another earthquake. Roads have not been permanently rebuilt yet either, forcing patients with lifelong conditions to travel for hours or even days to receive proper medical attention when needed.
Death caused by a natural disaster is unfortunate and unavoidable. However, every effort to reduce the number of deaths and the injuries sustained by a population must be made. The time lag in reaching the affected regions, the consistently poor access to basic needs such as clean water and the lack of disaster preparation of the medical teams all contributed to the enormous death toll of nearly 75,000 and those injured numbering 100,000. Although international aid is of invaluable help in facing these kinds of disasters, ultimately it is the responsibility of every nation to prepare themselves against disasters which pose the largest threats in their regions.
References
1. Suharwardy, Sanaa. Personal interview. 10 Apr 2009. Interview.
2. Brennan , Richard J., and Ronald J. Waldman. "The South Asian Earthquake Six Months Later - An Ongoing Crisis." The New England Journal of Medicine (2006): 1769-1771. Print.
3. Sabri, Ahmed A., and Muhammad A. Qayyum. "Why Medical Students Should be Trained in Disaster Management: Our Experience of the Kashmir Earthquake." PLoS Medicine 3(2006): 1452-1453. Print.
4. Vanek, Zeba. "SCIPPER-Medical Neuro-Rehabilitation and Creating an Ongoing Sustainable System of Medical Care." RealMedicineFoundation.org Oct 2007 1-5. Web.11 Apr 2009.
Wednesday, April 29, 2009
Swine Flu
Introduction
There has been much media attention given to “swine flu,” a flu outbreak that began in
History
Surveillance in
Reports from
A number of press reports have asserted that the swine flue may have begun in
Naming the Flu
One interesting controversy regarding the epidemic is deciding upon the official name of the virus. Because the flu has not as of yet been isolated in any pigs, officials are questioning whether it can properly be referred to as swine flu, an idea many pork producers are strongly backing. In meetings all over the world officials have been meticulous about naming the disease anything from “Mild flu-like illness” to “H1N1” to “Mexican Flu” and “North American Flu.” The CDC has also discouraged using the name “swine flu”, although the most recent fact sheets that have been released in hospitals and airports by the institution still refer to the disease as “swine flu.” Others argue that identifying the origin of the disease and from there deciding on a proper name is a secondary concern as all efforts now should be concentrated on preventing and treating the disease (5).
National Response
President Obama recently asked congress for 1.5 billion dollars in funds for treatment of swine flu. Additionally, the FDA authorized emergency use authorizations of important diagnostic and therapeutic tools for surveillance and treatment of the disease. This action effectively declares a state of emergency and allows the FDA to approve the use of uncleared medical devices and drugs for treatment provided certain criteria are met. The CDC has also begun issuing reports to the media, to hospitals and to airports to spread awareness about the disease and try and control its spread in the
International Response
Conclusion
Responses to the epidemic have taken a global scale only very recently, but all involved parties have echoed the desire to improve surveillance and engage in early detection, early response efforts to prevent further escalation of the disease.
Works Cited
1. "AFP:
2. "The Associated Press: Scientists struggle to understand swine flu virus." Google. 30 Apr. 2009
3. "CDC - Influenza (Flu) | Swine Influenza (Flu)." Centers for Disease Control and Prevention. 30 Apr. 2009
4. "FDA Authorizes Emergency Use of Influenza Medicines, Diagnostic Test in Response to Swine Flu Outbreak in Humans." U S Food and Drug Administration Home Page. 30 Apr. 2009
5. "The Naming of Swine Flu" The New York Times - Breaking News, World News & Multimedia. 30 Apr. 2009
6. Saker, Lance, Kelley Lee, and Barbara Cannito. "Infectious Disease in the Age of Globalization."
7. "Swine flu:
8. "Swine flu continues to spread; Obama asks $1.5 billion to fight it -- baltimoresun.com." Baltimore, Maryland breaking news, sports, blogs, video, classifieds and weather | baltimoresun.com -- baltimoresun.com. 30 Apr. 2009
9. "WHO | Influenza-like illness in the
Abandoning Failed Global Health Ideologies & Practices: the Most Vital Step for a New Global Health Agenda
As the purview of global health’s mission, goals, priorities, and responsibilities is constantly being defined and redefined, we can no longer allow politics, disjointed interdisciplinary efforts, and ill-informed practices set the standards for the future global health agenda. Millions of patients’ lives in both the developing and developed world depend on the agenda-setting decisions that are often based on outdated ideologies and pressure from insincere stakeholders. In order for the future generation of global health leaders to approach global health commitments through an ethical and evidence-based lens, I have listed below what I believe to be the most necessary and yet neglected global health priorities that should define the future global health agenda.
Priority I: Global health inequities must be approached through a human rights framework that becomes fully integrated with public health ideology and practice.
Dr. Paul Farmer, MD, PhD, one of the world’s most committed prophets of social justice, argues that while the emerging global health and human rights movement has reduces many inequities that plague the disease landscape of the developing world, the orthodox lens through which we view both public health and human rights approaches are essentially flawed (2008). Today, global health policies are popularly constructed around cost-effectiveness and sustainability, which possess genuine motives, but are devoid of the commitment required to not only cease epidemics, but address social and economic inequities, such as poverty, in impoverished countries (Farmer, 2008). In terms of human rights ideology, only civil, legal, and political rights are prioritized, and the much more dire issues of food, health, and education are regarded as an after-thought (Farmer, 2008). Dr. Farmer argues that both these theoretical approaches serve a neoliberal political and economic agenda set by domineering governments and international financial institutions, rather than the public health needs of the world’s most neglected communities (Farmer, 2008). Chidi Anselm Odinkalu, one of Africa’s leading human rights lawyers, astutely proclaims, “In Africa, the realization of human rights is a very serious business indeed. In many cases it is a life and death matter. From the child soldier, the rural dweller deprived of basic health care, the mother unaware that the next pregnancy is not an inexorable fate…and the activist organizing against bad government…people are acutely aware of the injustices inflicted upon them. Knowledge of the contents of the Universal Declaration will hardly advance their condition. What they need is a movement that channels these frustrations into articulate demands that evoke responses from the political process. This the human rights movement is unwilling or unable to provide. In consequence, the real-life struggles for social justice are waged despite human rights groups, not by or because of them, by people who feel that their realities and aspirations are not adequately captured by human rights organizations and their language” (Farmer, 2008).
One of the most telling examples of the salience of prioritizing an evidence-based human rights approach to the global health agenda is that of financing AIDS treatment in the developing world. The health and human rights community has successfully framed access to life-saving medications as a public good rather than a commodity (Farmer, 2008). This has compelled public health experts to rethink their traditional funding strategies that are adopted from international financial entities, such as capping health expenditures and prioritizing cost recovery in resource-poor countries (Farmer, 2008). After it was discovered that implementing user fees and selling AIDS therapy to poor African patients who could not afford treatment, diagnosis and care transformed from commodities with a market value to rights, driven by a framework of ethics and dignity (Farmer, 2008). It is promising to note that human rights and social justice were once the roots of public health action, and now are reemerging as priorities in the future global health agenda (Farmer, 2008). G8 countries must build on these recent encouraging responses and “move toward explicit endorsement of a rights based approach, backed up by firm long-term commitments to the redistribution of resources across national borders” (Labonte et al., 2005).
Priority II: Human, information, and material resources must be responsibly delivered and monitored to developing countries whose primary health care systems are experiencing crippling shortages of both health professionals and medical supplies.
As the brain drain of health professionals and dearth of medical supplies, ranging from gloves to HIV medications, threatens the delivery of care to millions of patients in the developing world, the long-term strengthening of human and material resources seems to fall at the bottom of the global health agenda each year. In sub-Sahara Africa alone, one million more health workers are needed just to provide basic primary care to its citizens (Labonte et al., 2005). The most unacceptable tragedy is that under-resourced health systems in most developing countries are unable to retain the nurses and physicians trained by their own professional schools (Labonte et al., 2005). The medical training of these health professionals is supported not only by private financing, which includes tuition, but by the local impoverished communities, who are taxed indirectly (Labonte et al., 2005). In order to reverse the brain drain, investments must be made medical universities and hospitals, health professionals must receive sufficient salaries and benefits that will incentives them to stay in their home country, such that they not only serve as clinicians, but public health leaders as well (Labonte et al., 2005). However, salaries alone cannot convince health professionals in the developing world to commit their professional lives to communities plagued by war, genocide, and social injustice. One study found that young physicians in urban Kenya were mostly unsatisfied with their working conditions simply due to the lack of diagnostic tools and medications needed in order to treat their patients (Labonte et al., 2005). Dr. Farmer once questioned, “How long can African doctors and nurses tolerate being little more than spectators to the grisly parade of suffering and premature death within the walls of that continent’s public hospitals?” (Farmer, 2008). In addition, the training and integration of community health workers is the most promising means by which to deliver care to the most neglected and isolated patient communities who possess the smallest chance of ever seeing a health professional in their lifetime.
It has been agreed upon by the global health community that since the most affluent countries benefit the most from this brain drain, these countries should begin negotiations on the multilateral agreement on migration of health professionals (Labonte et al., 2005). In addition to holding wealthy nations accountable for their intake of health professionals from the developing world, private foundations and donors must be encouraged to prioritize health information and human-resource development in their funding considerations (Labonte et al., 2005). The enhancement of health information systems can enable developing countries to “quantify health problems, set spending priorities, improve health care delivery, and measure the effects of interventions” (Okie, 2006).
Priority III: The funding decisions made by international institutions, national governments, non-profit organizations, and private foundations must follow standards of accountability, transparency, need, and sustainability.
In terms of sustainable financing, it has been estimated that most developing nations will not be able to achieve the Millennium Development Goals by 2015 that were set by G8 countries, unless these G8 countries increase their long-term funding commitments to these countries (Labonte et al., 2005). The G8 countries account for almost half the world’s economic output and govern the agenda-setting processes of the World Bank and International Monetary Fund, and yet only provided one-third of the estimated minimum health care needs of developing countries (Labonte et al., 2005). G8 countries must also specify mechanisms to ensure the affordability and availability of any vaccines, essential medicines, and diagnostic tools developed, as well as commit to ensuring access to and reduced prices of treatments (Labonte et al., 2005).In addition, the funding of research for diseases that afflict the wealthiest populations the most, disproportionately outweigh the many more millions of people who are dying of neglected and tropical diseases in impoverished countries due to the lack of market value incentives for researchers (Labonte et al., 2005). In order to reconstruct the funding agenda for global health, development aid must not undermine equity, such that health and education expenditures are capped or user fees are required for cost recovery (Labonte et al., 2005). Patients in the developing world do not wish for “cost-effective” solutions to their problems; they simply desire effective solutions (Farmer, 2008). Shirin Ebadi, a Nobel Peace Prize winner and human rights lawyer in the Middle East, recently encouraged the United Nations to cut off its funding to all nations who spent more on their military than on health and education for their people.
Private foundations, most notably the Bill & Melinda Gates Foundation, have arguably “energized research and forged partnerships among academia, governments, and industry much more effectively than most other institutions have” (Okie, 2006). The world’s largest charitable foundation, the Bill & Melinda Gates Foundation provides approximately $3 billion, or approximately one dollar per year for every person in the poorer half of the world’s population, solely to global health innovations, projects, and campaigns (Okie, 2006). “I think people watch what the Gateses do and assume that if they’re doing it, it’s not only a smart humanitarian move, but a smart business move,” said Helene Gayle, a former official at the Centers for Disease Control and Prevention (Okie, 2006). While the size of the foundation’s grants have largely shaped the current global health agenda, critics have argued that such monopolizing power instills long-term threats to global health needs (Okie, 2006). “The foundation’s grant making may not always reflect the priorities of recipients in developing countries, and its choices may influence the decisions of other funding agencies, potentially steering money away from basic science and toward product development” (Okie, 2006). Thus, Gates Foundation advisors must become more fully integrated into the communities they serve so that funding is responsibly distributed to the issues and patients who need it the most.
Priority IV: We must resurrect the priority public health once placed on primary health care infrastructure and we must ensure that our current disease-specific approach does not undermine the sustainability of these health systems
Due to the detrimental impact infectious diseases have had on impoverished patient communities throughout the world, disease-specific initiatives have institutionalized a vertical, “stovepipe” approach to the global health agenda. This has partly been due to the relative ease of raising media attention, garnering resources, and securing financing for disease-specific actions, as opposed to the less glamorous public health issue of broad health system strengthening (Smith & MacKellar, 2007). For instance, the world’s two most largely endowed funding sources, the Global Fund and PEPFAR, are allotted specifically for HIV/AIDS, tuberculosis, and malaria. However, the impacts that funding and attention for infectious diseases are belittled by widespread health system weaknesses, such shortages of skilled personnel and insufficient resources for operating hospital vehicles (Smith & MacKellar, 2007). “Although disease-specific interventions are important, assuring real change will require attention to environmental, political, and social actions that target the root causes of disease as envisaged at Alma Ata” (Magnussen et al., 2004). As a result, the seemingly short-fix solutions to our current global health crises pose as our largest threat, as it steals the spotlight away from the long-term systemic issues that need the attention the most.
Our future global health agenda can easily prioritize primary health system strengthening alongside current disease-specific programming in such a way that the two do not cancel each other our. First, the Ministry of Health of each country must work intimately alongside leaders from their fellow departments of agriculture, housing, sanitation, education, and food distribution (Magnussen et al., 2004). Second, health care system strengthening can no longer be placed in the hands of distant policymakers and top-down officials. The Alma Ata Declaration of 1948 requires that interventions are derived from the needs of the community, and are expressed and led by community members themselves (Magnussen et al., 2004). Furthermore, it is implied from this notion that programs need to be founded and researched in the locality in which they will be applied, rather than in universities and think tanks halfway across the world (Magnussen et al., 2004). Finally, accessibility to health services and resources to rural populations in both the developing and developed world must be ensured through the creation of community clinic networks, rather than on building acute, tertiary hospitals in booming urban centers (Magnussen et al., 2004).
Works Cited
Farmer, P. (2008). Challenging Orthodoxies: The Road Ahead for Health & Human Rights. Health and Human Rights, 10 (1): 5-19. Retrieved April 19, 2009, from < class="Apple-tab-span" style="white-space:pre"> article/viewFile/33/102>.
Magnussen, L., Ehiri, J., & Jolly, P. (2004). Comprehensive Versus Selective Primary Health Care: Lessons for Global Health Policy. Health Affairs, 23 (3): 167-176.
Okie, S. (2006). Global Health- The Gates-Buffet Effect. New England Journal of Medicine, 355 (11): 1084-1088.
Ollila, E. (2005). Global health priorities- priorities of the wealthy? Globalization and Health, 1(6): 1-5.
Smith, R.D., & MacKellar, L. (2007). Global public goods and the global health agenda, problems, priorities, and potential. Globalization and Health, 3(9): 1-7. Retrieved April 19, 2009, from
Monday, April 27, 2009
Natural Disaster
Public Health during a Natural Disaster
It is amazing how we sometimes take certain necessities for granted. While I was in high school which was also a boarding school in Cape Coast, the central region of Ghana, West Africa, there was water shortage for about four weeks. The worst experience I had to face within the three years in high school. We had to walk about three miles, wait a couple of minutes in a line to fetch a bucket of water which we used for bathing, washing our utensils, washing our cloths and for cleaning the bath and restrooms. I was fortunate because my parents sent me filtered bottle water to drink, and not everyone was fortunate enough to have that privilege, but I still had to go for two to three trips before I would be able to get enough water to do all my other chores. Some of the students found other ways like cleaning their plates with tissues other than cleaning it with water and soap. It was frustrating and stressful and due to the fact that, we had to wake up very early to make our journey for water, we slept in class most of the time because we were tired. The water shortage which was caused by lack of rainfall and excessive heat dried the source from which our water came from. The water in my school’s reservoirs got finished. The experience was terrible and eventually, we were all sent home until the supply of water was restored. We had five minutes prayer session each time we met for assembly where we prayed for rainfall. In our geography class we were encouraged to plant more trees than to destroy them and were taught that these were some of the problems caused by global warming. Some students got ill, others had heat rushes on their skin due to the excessive heat, body odors and we all faced serious sanitation problems forcing the school authorities including the health department to send us all home. When we were called back to school my classmates and I decided to each bring a tree which we planted on our school property to help in the evaporation process for the future rainfall process. The experienced taught me to appreciate the flow of water in our various homes and caused me to understand some of the trouble and problems these natural disasters such as excessive heat and lack of rainfall causing drought and other social problems that individuals living in other countries face for a long time.
Many countries especially developing countries remain significantly great with impact of natural disaster such as earthquakes, volcanoes, extreme heat, famine, drought, hurricanes, tsunamis, wildfires, etc. This disasters cause about 90 percent of deaths in low and middle-income areas (1) due to the continuous lack and inadequate access to basic amenities such as running water, food, shelter and health care after the disaster strike. The poor even before the disaster strikes already live in conditions which are not very conducive making them vulnerable even before they are hit with natural environmental problems. Whether it is natural or man-made disaster, it caused damage, loss of lives, ecological destruction and major health problems (1). Before a situation may be classified as a disaster, there are not many resources available to handle the that particular situation thus expert extra support and response from outside to that particular area or country. Man-made disaster such as war can have great impact on human lives. There was 13 years of civil war in Liberia from 1990 to 2003, the country suffered an enormous amount of death and disability. It killed more than 200,000 people (3), and about 500,000 people were forced to leave their homes and became internally displaced refugees who had to flee to other countries (1). The UN High Commission for Refugees (UNHCR) who is in charge of protecting the rights of refugees reported 42, 000 Liberians living in the Budumbura Refugee Camp in neighboring Ghana, including 18,000 children and over 4,000 of these children were born in the camp. Their human rights were violated and they had to live their entire lives as refugees (3). Some of the refugees arrived in boats, canoes, helicopters and a few on cars. I remember watching the news and constantly seeing casualties and young children holding guns on the news in Liberia. One of my Liberian friend mentioned that another way to survive was to join the civil war movement and fight for that particular group, in that sense they could be able to arm and protect themselves. As he mentioned, it was just another way to survive. Perch my Liberian friend suffered cuts and a gunshot in his arm but he is now married to a Ghanaian woman, with two beautiful children. It is possible that, his initial plan wasn’t to work as a car mechanic but situation in which he found himself made him decide to do and get the best out of his life in Ghana. A lot of people who suffer from such a disaster do not always have it as Perch had; they sometimes die and mostly have psychological problems. To help the refugees who came to settle in the Buduburam Refugee Camp in Ghana, they created the Liberian Dance Troupe project which uses theatre and dance to maintain Liberian culture, and to teach the youth within the camp about HIV/AIDS, teen pregnancy and drug abuse. Adult leaders were able to train over 100 children and youth in theatre, the arts, oral and written literature, dance and music. Youth who receive cultural training carry out weekly cultural training seminars in primary schools located in the camp which have provided support to over 1000 children (3). This project has also enhanced the literacy skills of young members of the LDT and supports their psychosocial rehabilitation. They are able to raise awareness about important health and social issues while the youth are encouraged to participate in this project to build their self-confidence, acquire dignity and develop renewed sense of identity and to continue with practicing their culture even a different community and not their own country (3).
Drought another serious disaster which is mainly caused by lack of precipitation, a natural climate cycle thus causing an extended dry period (2). Drought leads to serious shortage in water and food. Shortage of water leads to shortage of food, no water to cultivate and harvest food crops to eat. In 2005, Niger suffered an agricultural problem locust outbreak and drought which lead to famine. The drought affected more than 3.6 million people and put them at risk of starvation (4) thus they seek international aid for food.
Natural and man-made disasters are all major problem to our health and to the entire environment in which we live in. It is indeed true that most of the natural disasters, we as human can not always prevent them but as little as we can such as using more green products can also help in taking little steps and trying to be rational on issues to prevent conflicts can go a long way in saving life and preventing some man-made disaster as wars. I know its not as easy as it sounds but as an African, I know in a developing country such as Ghana when there is conflicts which can spark to a major problem, the governments do not only handle the issue themselves but involves the local leaders who are mostly opinion leaders in that particular region. Involving these opion leaders are able help solve regional conflicts for example which goes a long way because they eventually after a long process compromise and then resolve the issue. It makes these opinion leaders feel important and also they serve as a better channel for the group who are dissatisfied in sometimes very minute misundersatnding. The culture of a group of people are to be respected when trying to help and bring peace among people in a particular palce or even a country. I think its best for local leader and government in most developing countries to give basic education to its people, in doing that, certain basic things that contribute to misunderstanding may be solved by knowing the facts and practicing to live a better and healthy life styles. Education goes a long way because it does not only expalin basic concepts but goes a long way by helping people become more rational on issues and open minded on things they might have not thought of and due to past expereinces they might learn to tale some approaches that other countries took to make their nation a better one. Wars pull us back especially with the health sector because it spoils a nation rather than fixes the nations. Since we all want to move forward in having better life styles and increasing our life span its important to discourage any man-made disaster and try not to pull back in increasing factors that would contribute to natural disater. There is great impact on disasters, nations suffers when thre is one, so we must all move forward by not encouraging any form of disaster among ourselves and in our various countries.
References
Skolnik R. Natural Disaster and Complex Humanitarian Emergencies. Essentials of Global Health. Sudbury, MA: Jones and Bertlett Publishers; 2008: 247-262.
World Health Organization, 2009. Retrieved
http://www.who.int/hac/techguidance/ems/drought/en/
Liberian Trauma Recovery and Cultural Awareness, 2009. Retrieved
http://www.warchild.org/projects/WC_Canada/Liberia_Ghana/liberia_ghana.html
Niger, country, African: History, 2009. Retrieved
http://www.infoplease.com/ce6/world/A0860001.html
It is amazing how we sometimes take certain necessities for granted. While I was in high school which was also a boarding school in Cape Coast, the central region of Ghana, West Africa, there was water shortage for about four weeks. The worst experience I had to face within the three years in high school. We had to walk about three miles, wait a couple of minutes in a line to fetch a bucket of water which we used for bathing, washing our utensils, washing our cloths and for cleaning the bath and restrooms. I was fortunate because my parents sent me filtered bottle water to drink, and not everyone was fortunate enough to have that privilege, but I still had to go for two to three trips before I would be able to get enough water to do all my other chores. Some of the students found other ways like cleaning their plates with tissues other than cleaning it with water and soap. It was frustrating and stressful and due to the fact that, we had to wake up very early to make our journey for water, we slept in class most of the time because we were tired. The water shortage which was caused by lack of rainfall and excessive heat dried the source from which our water came from. The water in my school’s reservoirs got finished. The experience was terrible and eventually, we were all sent home until the supply of water was restored. We had five minutes prayer session each time we met for assembly where we prayed for rainfall. In our geography class we were encouraged to plant more trees than to destroy them and were taught that these were some of the problems caused by global warming. Some students got ill, others had heat rushes on their skin due to the excessive heat, body odors and we all faced serious sanitation problems forcing the school authorities including the health department to send us all home. When we were called back to school my classmates and I decided to each bring a tree which we planted on our school property to help in the evaporation process for the future rainfall process. The experienced taught me to appreciate the flow of water in our various homes and caused me to understand some of the trouble and problems these natural disasters such as excessive heat and lack of rainfall causing drought and other social problems that individuals living in other countries face for a long time.
Many countries especially developing countries remain significantly great with impact of natural disaster such as earthquakes, volcanoes, extreme heat, famine, drought, hurricanes, tsunamis, wildfires, etc. This disasters cause about 90 percent of deaths in low and middle-income areas (1) due to the continuous lack and inadequate access to basic amenities such as running water, food, shelter and health care after the disaster strike. The poor even before the disaster strikes already live in conditions which are not very conducive making them vulnerable even before they are hit with natural environmental problems. Whether it is natural or man-made disaster, it caused damage, loss of lives, ecological destruction and major health problems (1). Before a situation may be classified as a disaster, there are not many resources available to handle the that particular situation thus expert extra support and response from outside to that particular area or country. Man-made disaster such as war can have great impact on human lives. There was 13 years of civil war in Liberia from 1990 to 2003, the country suffered an enormous amount of death and disability. It killed more than 200,000 people (3), and about 500,000 people were forced to leave their homes and became internally displaced refugees who had to flee to other countries (1). The UN High Commission for Refugees (UNHCR) who is in charge of protecting the rights of refugees reported 42, 000 Liberians living in the Budumbura Refugee Camp in neighboring Ghana, including 18,000 children and over 4,000 of these children were born in the camp. Their human rights were violated and they had to live their entire lives as refugees (3). Some of the refugees arrived in boats, canoes, helicopters and a few on cars. I remember watching the news and constantly seeing casualties and young children holding guns on the news in Liberia. One of my Liberian friend mentioned that another way to survive was to join the civil war movement and fight for that particular group, in that sense they could be able to arm and protect themselves. As he mentioned, it was just another way to survive. Perch my Liberian friend suffered cuts and a gunshot in his arm but he is now married to a Ghanaian woman, with two beautiful children. It is possible that, his initial plan wasn’t to work as a car mechanic but situation in which he found himself made him decide to do and get the best out of his life in Ghana. A lot of people who suffer from such a disaster do not always have it as Perch had; they sometimes die and mostly have psychological problems. To help the refugees who came to settle in the Buduburam Refugee Camp in Ghana, they created the Liberian Dance Troupe project which uses theatre and dance to maintain Liberian culture, and to teach the youth within the camp about HIV/AIDS, teen pregnancy and drug abuse. Adult leaders were able to train over 100 children and youth in theatre, the arts, oral and written literature, dance and music. Youth who receive cultural training carry out weekly cultural training seminars in primary schools located in the camp which have provided support to over 1000 children (3). This project has also enhanced the literacy skills of young members of the LDT and supports their psychosocial rehabilitation. They are able to raise awareness about important health and social issues while the youth are encouraged to participate in this project to build their self-confidence, acquire dignity and develop renewed sense of identity and to continue with practicing their culture even a different community and not their own country (3).
Drought another serious disaster which is mainly caused by lack of precipitation, a natural climate cycle thus causing an extended dry period (2). Drought leads to serious shortage in water and food. Shortage of water leads to shortage of food, no water to cultivate and harvest food crops to eat. In 2005, Niger suffered an agricultural problem locust outbreak and drought which lead to famine. The drought affected more than 3.6 million people and put them at risk of starvation (4) thus they seek international aid for food.
Natural and man-made disasters are all major problem to our health and to the entire environment in which we live in. It is indeed true that most of the natural disasters, we as human can not always prevent them but as little as we can such as using more green products can also help in taking little steps and trying to be rational on issues to prevent conflicts can go a long way in saving life and preventing some man-made disaster as wars. I know its not as easy as it sounds but as an African, I know in a developing country such as Ghana when there is conflicts which can spark to a major problem, the governments do not only handle the issue themselves but involves the local leaders who are mostly opinion leaders in that particular region. Involving these opion leaders are able help solve regional conflicts for example which goes a long way because they eventually after a long process compromise and then resolve the issue. It makes these opinion leaders feel important and also they serve as a better channel for the group who are dissatisfied in sometimes very minute misundersatnding. The culture of a group of people are to be respected when trying to help and bring peace among people in a particular palce or even a country. I think its best for local leader and government in most developing countries to give basic education to its people, in doing that, certain basic things that contribute to misunderstanding may be solved by knowing the facts and practicing to live a better and healthy life styles. Education goes a long way because it does not only expalin basic concepts but goes a long way by helping people become more rational on issues and open minded on things they might have not thought of and due to past expereinces they might learn to tale some approaches that other countries took to make their nation a better one. Wars pull us back especially with the health sector because it spoils a nation rather than fixes the nations. Since we all want to move forward in having better life styles and increasing our life span its important to discourage any man-made disaster and try not to pull back in increasing factors that would contribute to natural disater. There is great impact on disasters, nations suffers when thre is one, so we must all move forward by not encouraging any form of disaster among ourselves and in our various countries.
References
Skolnik R. Natural Disaster and Complex Humanitarian Emergencies. Essentials of Global Health. Sudbury, MA: Jones and Bertlett Publishers; 2008: 247-262.
World Health Organization, 2009. Retrieved
http://www.who.int/hac/techguidance/ems/drought/en/
Liberian Trauma Recovery and Cultural Awareness, 2009. Retrieved
http://www.warchild.org/projects/WC_Canada/Liberia_Ghana/liberia_ghana.html
Niger, country, African: History, 2009. Retrieved
http://www.infoplease.com/ce6/world/A0860001.html
Wednesday, April 22, 2009
The Obesity Epidemic: A Global Health Priority
Introduction to the Obesity Epidemic
The world is shifting at an alarming rate from infectious diseases to chronic non-communicable diseases. Without concerted action, 388 million people worldwide will die of one or more chronic diseases in the next 10 years (Daar et al., 2007). The number of deaths from these diseases is double the number of deaths that result from a combination of infectious diseases, maternal and perinatal conditions, and nutritional deficiencies (Daar et al., 2007). Chronic diseases will also have a huge negative economic impact. Over the next 10 years, China, India, and the United Kingdom are projected to lose $558 billion, $237 billion, and $33 billion respectively due to reduced economic productivity (Daar et al., 2007).
By 2020, it is estimated that two thirds of the global burden of disease will be attributable to chronic diseases, most of them strongly associated with diet (Chopra et al., 2002). The nutrition transition towards refined foods, foods of animal origin, and increased fats plays a major role in the current global obesity epidemic and is due to several factors: urbanization, changes in income and food price changes, modern technology, and globalization (Popkin and Mendez, 2007 and Popkin, 2006). Obesity is a precursor to many chronic diseases, including cardiovascular disease, type 2 diabetes, arthritis, and respiratory complications, which in turn have become major factors in the current healthcare crisis in the United States (Butchko and Petersen, 2004). Results from the 2002 NHANES survey indicate a doubling in obesity prevalence rates in adults and a tripling in prevalence rates among adolescents over the past two decades (Butchko and Petersen, 2004).
Because of these rapid changes, priority in a crowded global health agenda should go to addressing the forces that contribute to the obesity epidemic. It is especially important to act now as rates are increasing in developing countries since it is possible to intervene and prevent these countries from seeing levels of chronic diseases comparable to that of the United States and other developed countries. In this essay, we will review some of the main forces behind the obesity epidemic: decreases in physical activity with concurrent increases in technology, shifts in the food system, and the subsequent effects of globalization of transnational corporations. Addressing this epidemic and progressing towards possible solutions requires a multidisciplinary approach and coordinated efforts on a global scale.
Physical Activity and Technology
Technological forces at the community and individual levels that increase the level of comfort in everyday life also greatly contribute to the lower levels physical activity. The introduction of the automobile revolutionized way people traveled and extended the distances to which people can travel (Choi et al., 2005). Many children no longer walk to school, and people are able to commute longer distances for work. In China, about 14% of households acquired a motor vehicle between 1989 and 1997 and television ownership skyrocketed (Popkin and Mendez, 2007). Modern machines at home and in the workforce decrease the need for direct human efforts. Washers, dryers, and dish washers take away the opportunities of old-fashioned household physical activities (Choi et al., 2005). There is an increase of sedentary jobs due to the mechanization of the service sector (Popkin, 2006).
In addition to the luxuries that technology provides, children are influenced by the forces that they encounter in schools and in their neighborhoods. In many schools, physical education is removed from the curriculum due to budget cuts while vending machines with unhealthy snacks are still available. Due to the rise in crime rates in some neighborhoods, there is a perception that the streets are unsafe. Many parents do not allow their children to go outside and play in the parks or playgrounds and as a result, the children become hooked onto TV, games, and computers (Choi et al., 2005).
Shifts in the Food System
One of the most significant shifts in the food system relates to the marketing and sales of food (Popkin, 2006). Through advances in technology, the amount of processed foods has increased, and the subsequent fall of food prices has enabled the food and beverage industries to expand their markets abroad. The global value of food trade grew from $224 billion in 1972 to $438 billion in 1998, and this was accompanied with the consolidation of agricultural and food companies into large transnational corporations, which in turn developed global brand names and marketing strategies with adaptation to local tastes (Chopra et al., 2002). As these corporations penetrate new markets, they often use the strategy of purchasing large shareholdings in local food producers, wholesalers, or retailers (Chopra et al., 2002). For example, in China, transnational corporations significantly invested in local companies to produce, distribute, and retail both global and locally adapted products (Chopra et al., 2002). As commodity prices decrease and incomes increase, people tend to increase the diversity of their diet and shift into higher priced commodities and processed convenience foods (Popkin and Mendez, 2007).
Globalization and Obesity in Developing Countries
Until recently, obesity and the associated risk of chronic diseases have been perceived as problems of developed countries. However, the problems of overnutrition are increasing even in countries where hunger is endemic (Chopra et al., 2002). Many developing countries are experiencing shifts in food imports due to the increase in direct foreign investment in the food industry, especially through supermarkets and fast food restaurants (Popkin and Mendez, 2007). For example, between 1989 and 1998, sales by U.S.-owned food processing affiliates in Asia increased from $5 billion to $20 billion (Popkin and Mendez, 2007).
Urbanization has also played an important role in the obesity epidemic. Globalization has been associated with occupations that involve spending more time away from home, and the consumption of processed food and fast food meals have greatly increased (Popkin and Mendez, 2007). In general, people living in urban areas consume higher levels of fats and animal foods, along with lower consumption of vegetables (Popkin and Mendez, 2007). Even this, however, has begun to change as rural development increases (Popkin and Mendez, 2007). As a result of these various forces, people in the developing world are abandoning traditional diets that are rich in fiber and grain for diets that include increased levels of sugars, oils, and animal fats (Chopra et al., 2002).
Underlying the corporate expansions into and investment in developing countries is the principle of the rules of trade, set forth by the World Trade Organization (WTO). The WTO enforces and addresses these rules to facilitate increased global trade (Popkin and Mendez, 2007). The two key principles addressed are 1) a benefit that is granted to one Member State is required to be granted to all Member States and 2) the imported and domestically produced goods, services, and intellectual properties are allowed the same competitive advantages in the markets of importing countries (Popkin and Mendez, 2007). While these rules were designed to achieve non-discrimination, it inadvertently allows the WTO to assist with the market penetration and global advertising in developing countries (Chopra et al., 2002).
Future Efforts
The fundamental science behind the obesity epidemic is quite simple: dietary changes are exacerbated by a parallel decline in energy expenditure associated with reductions in daily physical activity (Chopra et al., 2002). However, what makes this epidemic so difficult to address are the additional forces that exist at various levels of society to provide the underlying currents to this epidemic. Although we are slowly becoming more aware of the magnitude of this problem, we need to act now and increase our efforts in order to address this complex yet pressing issue. Many researchers believe that since obesity is a multifaceted problem, it will take a multifaceted and long-term approach from all key stakeholders to solve it (Butchko and Petersen, 2004). However, the two most important fronts to start with include the community level and the national and international levels.
Efforts at the community and individual levels should include increasing education and awareness about the risks for obesity. People must be made aware that there is a problem in the first place before they can decide whether or not they want to change their habits. Since people generally go for the quick fix than use the approaches may require personal sacrifices and lifestyle changes, prevention and intervention programs should be customized for each individual so that they would be able to continue the different strategies long after they have completed these programs (Choi et al., 2005). For those people that are aware of the problem yet have no control over the types of food or exercise facilities available to them, that is where the policymakers come in.
Efforts at the national level are incredibly important as governments and policymakers have the largest potential to make a difference and spearhead efforts towards addressing obesity. Even though individuals have the right to make their own choices as to what they feel is best for them, they do not have control over forces such as globalization, marketing, and corporate investment. However, instead of fighting against the food and beverage industries, we would be even more efficient if we partner with them and work together. Governments should reiterate to these industries that the goal is not to take over their businesses, but instead to work towards a common goal to benefit the greater good. Governments can use subsidies or other incentives to promote corporate investment in poorer areas to ensure that fresh fruits and vegetables are affordable and help to promote healthier food choices (Popkin and Mendez, 2007). Price manipulation, public education, and clear food labeling are also effective strategies that can be implemented (Chopra et al., 2002). Governments could also work with the private sectors to focus on creating social environments that encourage physical activity, walking, and more nutritious food choices (Choi et al., 2005). This is especially relevant in the workforce where employees may not have access to healthy cafeterias or facilities to exercise in.
Since globalization is contributing to the rising rates of obesity in developing countries, efforts at the international level are crucial to prevent this epidemic from getting worse. Governments and organizations need to work together on a global scale in order to achieve national objectives for the protection and promotion of public health (Chopra et al., 2002). One way to garner support for addressing obesity is through the creation of non-binding legal documents to promote global support for this issue (Chopra et al., 2002). Non-binding legal documents, which can be classified into intergovernmental resolutions and intergovernmental codes of conduct, have the advantage of flexibility while binding legal documents have the advantage of ensuring compliance (Chopra et al., 2002). The idea is to start with non-binding legal documents and then progress to the development of binding legal commitments (Chopra et al., 2002). Currently, the World Health Organization is promoting non-binding legal instruments through the resolutions of the World Health Assembly, but it is not planning on developing binding mechanisms yet (Chopra et al., 2002). Although introducing legal documents may seem a bit extreme to some, it may just be the driving force that is needed to unite international efforts and attention toward obesity.
Even though strategies at the community and national and international levels are necessary starting points, long-term goals require a multidisciplinary approach in order to coordinate efforts to increase the progress towards solving the obesity epidemic and subsequently to slow the spread of chronic non-communicable diseases. It is predicted that countries will lose billions of dollars and millions of lives over the next 10 years due to chronic diseases, so taking immediate action to address one of the biggest risk factors of these diseases will be worth it.
References
Butchko, H. and Petersen, B. 2004. The obesity epidemic: stakeholder initiatives and cooperation. Nutrition Today 39(6):235-244.
Choi, B.C.K., Hunter, D.J., Tsou, W., and Sainsbury, P. 2005. Disease of comfort: primary cause of death in the 22nd century. Journal of Epidemiology and Community Health 59:1030-1034.
Chopra, M., Galbraith, S., and Hill, I.D. 2002. A global response to a global problem: the epidemic of overnutrition. Bulletin of the World Health Organization 80(12):952-956.
Daar, A.S. et al. 2007. Grand challenges in chronic non-communicable diseases. Nature 450:494-496.
Popkin, B.M. 2006. Global nutrition dynamics: the world is shifting rapidly toward a diet l inked with noncommunicable diseases. The American Journal of Clinical Nutrition 84:289-298.
Popkin, B.M. and Mendez, M. The rapid shifts in states of the nutrition transition: the global obesity epidemic. In: Kawachi, I., Wamala, S., eds. Globalization and Health. New York: Oxford University Press. 2007:68-80.
The world is shifting at an alarming rate from infectious diseases to chronic non-communicable diseases. Without concerted action, 388 million people worldwide will die of one or more chronic diseases in the next 10 years (Daar et al., 2007). The number of deaths from these diseases is double the number of deaths that result from a combination of infectious diseases, maternal and perinatal conditions, and nutritional deficiencies (Daar et al., 2007). Chronic diseases will also have a huge negative economic impact. Over the next 10 years, China, India, and the United Kingdom are projected to lose $558 billion, $237 billion, and $33 billion respectively due to reduced economic productivity (Daar et al., 2007).
By 2020, it is estimated that two thirds of the global burden of disease will be attributable to chronic diseases, most of them strongly associated with diet (Chopra et al., 2002). The nutrition transition towards refined foods, foods of animal origin, and increased fats plays a major role in the current global obesity epidemic and is due to several factors: urbanization, changes in income and food price changes, modern technology, and globalization (Popkin and Mendez, 2007 and Popkin, 2006). Obesity is a precursor to many chronic diseases, including cardiovascular disease, type 2 diabetes, arthritis, and respiratory complications, which in turn have become major factors in the current healthcare crisis in the United States (Butchko and Petersen, 2004). Results from the 2002 NHANES survey indicate a doubling in obesity prevalence rates in adults and a tripling in prevalence rates among adolescents over the past two decades (Butchko and Petersen, 2004).
Because of these rapid changes, priority in a crowded global health agenda should go to addressing the forces that contribute to the obesity epidemic. It is especially important to act now as rates are increasing in developing countries since it is possible to intervene and prevent these countries from seeing levels of chronic diseases comparable to that of the United States and other developed countries. In this essay, we will review some of the main forces behind the obesity epidemic: decreases in physical activity with concurrent increases in technology, shifts in the food system, and the subsequent effects of globalization of transnational corporations. Addressing this epidemic and progressing towards possible solutions requires a multidisciplinary approach and coordinated efforts on a global scale.
Physical Activity and Technology
Technological forces at the community and individual levels that increase the level of comfort in everyday life also greatly contribute to the lower levels physical activity. The introduction of the automobile revolutionized way people traveled and extended the distances to which people can travel (Choi et al., 2005). Many children no longer walk to school, and people are able to commute longer distances for work. In China, about 14% of households acquired a motor vehicle between 1989 and 1997 and television ownership skyrocketed (Popkin and Mendez, 2007). Modern machines at home and in the workforce decrease the need for direct human efforts. Washers, dryers, and dish washers take away the opportunities of old-fashioned household physical activities (Choi et al., 2005). There is an increase of sedentary jobs due to the mechanization of the service sector (Popkin, 2006).
In addition to the luxuries that technology provides, children are influenced by the forces that they encounter in schools and in their neighborhoods. In many schools, physical education is removed from the curriculum due to budget cuts while vending machines with unhealthy snacks are still available. Due to the rise in crime rates in some neighborhoods, there is a perception that the streets are unsafe. Many parents do not allow their children to go outside and play in the parks or playgrounds and as a result, the children become hooked onto TV, games, and computers (Choi et al., 2005).
Shifts in the Food System
One of the most significant shifts in the food system relates to the marketing and sales of food (Popkin, 2006). Through advances in technology, the amount of processed foods has increased, and the subsequent fall of food prices has enabled the food and beverage industries to expand their markets abroad. The global value of food trade grew from $224 billion in 1972 to $438 billion in 1998, and this was accompanied with the consolidation of agricultural and food companies into large transnational corporations, which in turn developed global brand names and marketing strategies with adaptation to local tastes (Chopra et al., 2002). As these corporations penetrate new markets, they often use the strategy of purchasing large shareholdings in local food producers, wholesalers, or retailers (Chopra et al., 2002). For example, in China, transnational corporations significantly invested in local companies to produce, distribute, and retail both global and locally adapted products (Chopra et al., 2002). As commodity prices decrease and incomes increase, people tend to increase the diversity of their diet and shift into higher priced commodities and processed convenience foods (Popkin and Mendez, 2007).
Globalization and Obesity in Developing Countries
Until recently, obesity and the associated risk of chronic diseases have been perceived as problems of developed countries. However, the problems of overnutrition are increasing even in countries where hunger is endemic (Chopra et al., 2002). Many developing countries are experiencing shifts in food imports due to the increase in direct foreign investment in the food industry, especially through supermarkets and fast food restaurants (Popkin and Mendez, 2007). For example, between 1989 and 1998, sales by U.S.-owned food processing affiliates in Asia increased from $5 billion to $20 billion (Popkin and Mendez, 2007).
Urbanization has also played an important role in the obesity epidemic. Globalization has been associated with occupations that involve spending more time away from home, and the consumption of processed food and fast food meals have greatly increased (Popkin and Mendez, 2007). In general, people living in urban areas consume higher levels of fats and animal foods, along with lower consumption of vegetables (Popkin and Mendez, 2007). Even this, however, has begun to change as rural development increases (Popkin and Mendez, 2007). As a result of these various forces, people in the developing world are abandoning traditional diets that are rich in fiber and grain for diets that include increased levels of sugars, oils, and animal fats (Chopra et al., 2002).
Underlying the corporate expansions into and investment in developing countries is the principle of the rules of trade, set forth by the World Trade Organization (WTO). The WTO enforces and addresses these rules to facilitate increased global trade (Popkin and Mendez, 2007). The two key principles addressed are 1) a benefit that is granted to one Member State is required to be granted to all Member States and 2) the imported and domestically produced goods, services, and intellectual properties are allowed the same competitive advantages in the markets of importing countries (Popkin and Mendez, 2007). While these rules were designed to achieve non-discrimination, it inadvertently allows the WTO to assist with the market penetration and global advertising in developing countries (Chopra et al., 2002).
Future Efforts
The fundamental science behind the obesity epidemic is quite simple: dietary changes are exacerbated by a parallel decline in energy expenditure associated with reductions in daily physical activity (Chopra et al., 2002). However, what makes this epidemic so difficult to address are the additional forces that exist at various levels of society to provide the underlying currents to this epidemic. Although we are slowly becoming more aware of the magnitude of this problem, we need to act now and increase our efforts in order to address this complex yet pressing issue. Many researchers believe that since obesity is a multifaceted problem, it will take a multifaceted and long-term approach from all key stakeholders to solve it (Butchko and Petersen, 2004). However, the two most important fronts to start with include the community level and the national and international levels.
Efforts at the community and individual levels should include increasing education and awareness about the risks for obesity. People must be made aware that there is a problem in the first place before they can decide whether or not they want to change their habits. Since people generally go for the quick fix than use the approaches may require personal sacrifices and lifestyle changes, prevention and intervention programs should be customized for each individual so that they would be able to continue the different strategies long after they have completed these programs (Choi et al., 2005). For those people that are aware of the problem yet have no control over the types of food or exercise facilities available to them, that is where the policymakers come in.
Efforts at the national level are incredibly important as governments and policymakers have the largest potential to make a difference and spearhead efforts towards addressing obesity. Even though individuals have the right to make their own choices as to what they feel is best for them, they do not have control over forces such as globalization, marketing, and corporate investment. However, instead of fighting against the food and beverage industries, we would be even more efficient if we partner with them and work together. Governments should reiterate to these industries that the goal is not to take over their businesses, but instead to work towards a common goal to benefit the greater good. Governments can use subsidies or other incentives to promote corporate investment in poorer areas to ensure that fresh fruits and vegetables are affordable and help to promote healthier food choices (Popkin and Mendez, 2007). Price manipulation, public education, and clear food labeling are also effective strategies that can be implemented (Chopra et al., 2002). Governments could also work with the private sectors to focus on creating social environments that encourage physical activity, walking, and more nutritious food choices (Choi et al., 2005). This is especially relevant in the workforce where employees may not have access to healthy cafeterias or facilities to exercise in.
Since globalization is contributing to the rising rates of obesity in developing countries, efforts at the international level are crucial to prevent this epidemic from getting worse. Governments and organizations need to work together on a global scale in order to achieve national objectives for the protection and promotion of public health (Chopra et al., 2002). One way to garner support for addressing obesity is through the creation of non-binding legal documents to promote global support for this issue (Chopra et al., 2002). Non-binding legal documents, which can be classified into intergovernmental resolutions and intergovernmental codes of conduct, have the advantage of flexibility while binding legal documents have the advantage of ensuring compliance (Chopra et al., 2002). The idea is to start with non-binding legal documents and then progress to the development of binding legal commitments (Chopra et al., 2002). Currently, the World Health Organization is promoting non-binding legal instruments through the resolutions of the World Health Assembly, but it is not planning on developing binding mechanisms yet (Chopra et al., 2002). Although introducing legal documents may seem a bit extreme to some, it may just be the driving force that is needed to unite international efforts and attention toward obesity.
Even though strategies at the community and national and international levels are necessary starting points, long-term goals require a multidisciplinary approach in order to coordinate efforts to increase the progress towards solving the obesity epidemic and subsequently to slow the spread of chronic non-communicable diseases. It is predicted that countries will lose billions of dollars and millions of lives over the next 10 years due to chronic diseases, so taking immediate action to address one of the biggest risk factors of these diseases will be worth it.
References
Butchko, H. and Petersen, B. 2004. The obesity epidemic: stakeholder initiatives and cooperation. Nutrition Today 39(6):235-244.
Choi, B.C.K., Hunter, D.J., Tsou, W., and Sainsbury, P. 2005. Disease of comfort: primary cause of death in the 22nd century. Journal of Epidemiology and Community Health 59:1030-1034.
Chopra, M., Galbraith, S., and Hill, I.D. 2002. A global response to a global problem: the epidemic of overnutrition. Bulletin of the World Health Organization 80(12):952-956.
Daar, A.S. et al. 2007. Grand challenges in chronic non-communicable diseases. Nature 450:494-496.
Popkin, B.M. 2006. Global nutrition dynamics: the world is shifting rapidly toward a diet l inked with noncommunicable diseases. The American Journal of Clinical Nutrition 84:289-298.
Popkin, B.M. and Mendez, M. The rapid shifts in states of the nutrition transition: the global obesity epidemic. In: Kawachi, I., Wamala, S., eds. Globalization and Health. New York: Oxford University Press. 2007:68-80.
Friday, April 17, 2009
Disaster Epi
Disaster epidemiology is a relatively new field that seeks to examine health outcomes in the midst of disasters. Disaster epidemiology was essentially defined in the late 50’s in a review by Harvard professors, Saylor and Gordon, as they sought to apply general epidemiologic procedures to the investigation of disasters both natural and manmade (Armenian, 4). It aims to assess what services are necessary to those immediately affected by disasters and also to study short and long-term factors that influence health during disasters as an aid to policy makers who prepare for future calamities. Two difficulties with disaster epidemiology cited in a review on the subject deal with “characterization of the population at risk and exposed to the disaster” and “estimation of the exposure to the disaster” (Dominici, 9). Two goals of disaster epidemiology cited in another review describe the necessity of “needs assessment” and “improvements in contingency planning for future disasters.” (Van der Berg, 56) In this blog, I will briefly evaluate these two limitations and two goals in relation to a pair of similar articles written on mental health outcomes following Hurricane Katrina.
The first article is titled “Mental Health Service Use among Hurricane Katrina survivors in the Eight Months after the Disaster” by Dr. Wang et al. The article examines mental health service use in Katrina survivors, finding that few of the study subjects received adequate care. Most respondents cited enabling factors (preventative barriers) as the main reason why their care was limited. Disaster epidemiology has difficulty characterizing the population exposed and at risk to the disaster along with estimating the population’s degree of exposure to the disaster. This problem was addressed in the article by using data from a sample of 1043 pre-hurricane residents that were part of a Hurricane Katrina Community Advisory Group (CAG) defined by FEMA as residents directly affected by Katrina living in certain areas in New Orleans and adjacent states. The residents sampled were surveyed through random digit dialing. An initial issue with the baseline surveys is calculating the proportion of respondents to the survey. In this study, an estimated 42% of those contacted responded to the survey, but verification of the true proportion of respondents is impossible given that there is no way to determine which phone numbers were working numbers. This highlights one issue with disaster epidemiology, in that locating and tracking members of the target population can be difficult given the damage to infrastructure and population dispersal that is a natural consequence of disasters. (Wang 1404) Another problem with defining the target population was that telephone calls were used to survey the population. By the author’s own admission, one important limitation of this technique is that “the most disadvantaged and possibly most severely ill people” (Wang, 1410) are underrepresented because they may not have access to telephones. This point underscores another common problem in disaster epidemiology, locating or characterizing those heavily exposed to the disaster. Mental health severity was examined using the validated K6 screening method and health service use was evaluated using reasonably standard methods. Outcome assessment will not be examined in depth as it does not relate specifically to challenges in disaster epidemiology.
The paper found that a significant portion of respondents had abandoned seeking mental health services following the hurricane. Most respondents claimed a lack of enabling factors prevented them from seeking care. Additionally, the authors write that “only 15% of respondents who were directly affected and 36% of respondents with probably posttraumatic stress disorder or depression sought mental health care by six months (Wang, 1408). This finding aids greatly with both needs assessment and contingency planning for future disasters. Policy makers can use this information to strengthen mental health services in the wake of a similar disaster in the future. The authors also found that the majority of Katrina survivors who did seek out mental health services did so through the general medical sector rather than engaging specialty services first. They go on to advise policy makers that specialty health personnel should be integrated into the general medical sector in the event of a disaster so that the disadvantaged can get the care they need. This recommendation demonstrates the importance of disaster epidemiology in contingency planning. The discussion portion of the paper spends a great deal of time giving recommendations to policy makers on how to approach mental health service during disasters in the future.
The second article, by Dr. Kessler et. Al, is titled “Trends in mental illness and suicidality after Hurricane Katrina.” The authors did a cohort study of hurricane residents, surveying their mental health and then tracking developments in their health over two years. A similar method, as in the previous study, was used to characterize the populations. Respondents were selected through random-digit dialing and selected from the 1.4 million families that applied for assistance from the American Red Cross, and also from those families that were housed in FEMA hotels. While the same issues that the earlier study encountered undoubtedly exist in study (calculating the true proportion of respondents and surveying those without access to telephones), I will focus specifically on characterization of exposure in this paper – another difficulty in disaster epidemiology. The authors spend a significant amount of time discussing stresses and mental health issues in the New Orleans Metro Area as compared to surrounding states. One difficulty in making this comparison, however, is that an equal amount of exposure (the amount residents were affected by the hurricane) is assumed in all groups. No true comparison could be made between residents in the metro area and residents in the surrounding states if their exposures were on different strata. Since there is no truly objective way of defining the exposure, all residents who were characterized by the government as affected by the hurricane and who applied for federal support are treated as equally exposed in the study. This issue is common to disaster epidemiology, in that quantifying exposure to a disaster can be problematic.
In terms of needs assessment and contingency planning, the article makes important points that can be valuable to policy makers. The authors found that there was a significant amount of mental health distress in areas outside New Orleans and that policy makers should plan to spread additional services in areas outside the most affected zone in a future disaster. The authors also found that mental health issues were very weakly related to socio-demographic variables, meaning that mental health is a pervasive issue affecting all age groups and demographics in the aftermath of a disaster (Kessler, 10). Finally, by performing a cohort study and evaluating mental health issues 2 years after the hurricane, the authors were able to determine that the prevalence of distress does not drop significantly immediately after a disaster and that assistance should be provided to those affected by a disaster in the long-term.
Works Cited
Armenian, Haroutune. "Epidemiology in War and Disasters."
Dominici, Francesca, Et Al. "Methodological Challenges and Contributions in Disaster Epidemiology." Epidemiologic Reviews (2005): 9-12.
Kessler, Ronald C., Et Al. "Trends in mental illness and suicidality after Hurricane Katrina." Molecular Psychiatry 4 (2008): 374-84.
Van der Berg, Bellis, Et Al. "The Public Health Dimension of Disasters - Health Outcome assessment of Disasters." Prehospital and Disaster Medicine (2008).
Wang, Philip, Et Al. "Mental Health Service Use Among Hurricane Katrina Survivors in the Eight Months after the Disaster." Psychiatric Services 58 (2007): 1403-410.
Wednesday, April 8, 2009
The Impact of War on Health by: Fabiola Enriquez
When it comes to the impact of wars on health, it is important to mention the great impact nuclear wars have on the environment and consequently, on the people’s health. Not only should we be concerned about the release of toxic chemicals from nuclear weapons, but we should also be aware of the damage the places of production and testing can cause to community living in those areas. Currently, there is a lot more information regarding of production sites in the United States than any other part of the world (1). It has been recorded that a majority of nuclear weapon production sites have to compensate retired workers since some suffer negative health effects from occupational exposure.
Not only are nuclear weapons to blame for increased health risks on humans, but we should also consider the destruction of buildings and homes by bombing. During World War II, 50 million people were displaced from their home and many cities including Warsaw, Berlin, Hamburg, Pisa, and Budapest were greatly damaged (1). The destruction of many homes included the demolition of irrigation networks making it impossible for inhabitants to get clean water. The population was at an increased danger of disease due to decreased availability of clean water and living in rundown homes with more individuals increased their risk to infectious diseases. In other countries like Japan, the damage was also intense, since bombs destroyed more than buildings. Bombarding caused the loss of rice harvest resulting in hunger, starvation and death.
Land mines are also a massive risk to the population that live among them. Countries around the world have thousands of land mines that do not follow international regulations, therefore there is no one controlling how close people live around those areas causing many deaths and injuries to civilians around the world. Land mines cause many deaths and they also prevent people from using this land for farming and agriculture. As a result, million of civilians starve to death because they are not able to utilize their country’s natural resources. Health concerns are not limited to humans, but they also include the pollution of soil, destruction of plant life, and disruption of water streams. Wars affect the health of people when pesticides and other air pollutants are used to threaten the safety of the population. The distribution of contaminants is utilized to destroyed crops and increase health risks in a desired population causing a great deal of stress for people’s health and their harvests.
When war takes over a country, it is important to consider that foreign troops are exposed to new virus, bacteria and parasites. Such was the case in 1990 when U.S. troops had been sent to the Persian Gulf, when Iraq went to war with Kuwait. According to records gathered by the University of Chicago, more than 50% of troops stated to have experienced an episode of acute diarrhea (2). Most of the soldiers that were affected by acute diarrhea were infected with Escherichia Coli and Shigella Sonnei. Medical staff found vegetables and fruits produced locally to be the culprit of these cases of gastroenteritis. After this produce was studied, they realized that these were the foods that caused acute diarrhea to most of the troops. Also, many soldiers were sent to field locations and cohabitated close to one another, shared substandard latrines and washing facilities, which gave place to the spread of these enteropathogens (2). Another major risk to the soldiers happened when a food handler got sick and was careless when it came to food preparation.
When troops are sent to foreign countries they run the risk of being to exposed to different kinds of pathogens that they would not have encountered in their native states. Such is the case of Leishmaniasis, which is a protozoan parasite that causes a visceral infection on the skin. Some of the symptoms experienced by the troops were fever, enlargement of the spleen, liver, and lymph nodes (2). Unfortunately, it was difficult of cases of visceral L. tropica to be diagnosed due to the lack of sensitivity or skin screening test. At the same times most people who were known to have this infection presented visible signs of Leishmaniasis. Those living in the urban areas were thought to be at lower risk of contracting the infection because they were less exposed to the vectors of and primary hosts which are the sandfly and desert rodent, respectively. Most troops were lucky to have been sent to these are when sandfly were at their lowest stage of activity (2).
War between any numbers of countries causes a great deal of devastation to their cities, buildings, crops, men, children and women. Women are greatly affected by war during this occurrence and after it. The United Nations made an effort to help women and sent them to a refugee camp in Oru Village, in Ogun State, Nigeria. Between January and March 2004, a study was performed to evaluate how forced migration affects the incidence of disease among women (3). Women provided accounts of their experiences during the war. Since most women were left to fend for themselves, a great number of them suffered the malevolence that comes with war and conflict. Women were raped by foreigners and those who realized no one could protect them. This put them at increased risk of contacting sexually transmitted diseases and HIV. Some women were even forced to engage in commercial sex work, some were physically abused and forced to marry.
War is known to negatively effect families, social, physical development, and to increase morbidity and mortality. We cannot forget about the impact it has on human’s mental health. Two studies performed in Afghanistan show the damage war caused a great number of inhabitants. A survey of 799 adults demonstrated that 67.7% of those who answered it had a diagnosis of depression, 72.2% experienced symptoms of anxiety, and 42% had post-traumatic stress disorder (4). Another crossectional study performed in Afghanistan used the responses of 1011 people and found that 38.5% of them experienced depression, 51.8% had symptoms of anxiety, and 20.4% had a diagnosis of PTSD (4). In the Balkans, children were also studied, and it was found that children between the ages of 9 to 14, showed high levels of post-traumatic stress symptoms which was related to the type and amount of exposure to traumatic events.
Similarly to the previously mentioned studies, others show an account in such places as Cambodia. Studies that included children, demonstrated that even after being followed for 3 years, these children showed 48% of Post-traumatic stress disorder, and 41% of depression symptoms (4). Even though traditional healers, monks, and elders had a great impact on the population’s mental health, after the war, this was not the case any longer. Many people during the war lost their respect and changed their beliefs making it difficult to find support during these traumatic times. Even if victims of war are taken to refugees, many times they do not show improvement because they have already experienced traumatic events and because they do not have the support system they had back at homes. Also, their personals beliefs could get in the way of the thorough understanding of Western ideas, when it comes to mental health.
Children are negatively impacted by war in many ways. Not only is their health jeopardized, most also develop mental disorders as well as developmental issues. Children are usually in need of an adults care, but when war happens this relationship in interrupted because of parents’ dead or separation from family members. Many times children are forced to fend for themselves and even take care of younger siblings once parents are gone. Children are not permitted to develop properly because now they have to assume the role of a parent and provider (5). Seeking proper health care is also a disadvantage of children during war. Most kids are not mature enough to know the importance of received health services and many times ignore this part of their lives. Also, children might have been physically injured and they might not be able to attend school or learn any physical work that would have allowed them to support their families in the future. Without an education or necessary work experience, these children are at a great disadvantage when they grow up.
During war, most children will not receive proper health care, which includes immunizations. This increases their vulnerability to a variety of diseases that could threaten their life. The lack of food also increased their risk of disease because of malnutrition. Sometimes children are recruited to fight in wars making them highly susceptible to injuries and death. Since children do not have the development of an adult they find themselves at a great disadvantage when they themselves engage in warfare (5). It is necessary for programs that focus on helping those that have been exposed to war to include physical rehabilitation and mental health services.
- Leaning, Jennifer. Environment and Health: 5. Impact of War. CJMA 2000; 163(9): 1157-1161
- Bennett T, Bartlett L, Olatunde OA, Amowitz L. Refugees, forced displacement, and war. Emerg Infect Dis . 2004 November
- Hyams, Kenneth C. Hanson, Kevin. Wignall, F. The impact of Infectious Diseases on the Health of U.S. Troops Deployed to the Persian Gulf. University of Chicago Press, 1995. Clin Infect Dis 1995; 20:1497-1504
- Farhood, L. The Impact of War on the Physical and Mental Health of the Family. Soc Sci Med. 1993 Jun;36(12): 1555-1567
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