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Imagine two people. One is completely blind. The other suffers from constant and intense back pain.
Who is healthier overall?
A landmark global health survey being launched today will explore the impact of different diseases and injuries. A person’s health state may limit how well parts of the body or mind work. Some people are not able to do everything that others can, with some people more severely limited than others. This survey intends to measure peoples’ priorities and values around these various states of health.
We are writing to ask you and your organization to participate in this online survey, which can be found at this link: http://gbdsurvey.org
The survey is part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, in collaboration with four other leading institutions: Harvard University, Johns Hopkins University, the University of Queensland, and the World Health Organization.
The goal is to collect responses from at least 50,000 people worldwide. Please consider sharing this page and encouraging participation within your organization. In addition, we would ask you to consider forwarding information about this survey to colleagues and contacts outside your organization who might be interested in participating.The survey takes about 15 minutes to complete. Participation is completely voluntary and anonymous. In the near future, we hope to translate the survey into additional languages.
By participating in the survey, you will contribute to the scientific understanding of global health problems and ultimately enable policymakers and health care leaders to make better decisions based on a stronger evidence base. Summary survey results will be posted online at www.healthmetricsandevaluation.org upon completion of the study in spring 2011
Pratibha Shah
INTRODUCTION
No single system of health care has the capacity to solve all of society’s health needs. This is especially true for a large, densely populated, developing nation like India whose health needs are acute. The AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy) systems of medicine have been used in India for centuries. Their wide acceptability, affordability, accessibility and availability make them ideal candidates for integration into the mainstream preventive and curative healthcare services in the country today.
This paper is an attempt to answer the questions – what is AYUSH* and why it was formed? The paper will talk briefly about the inception and history of AYUSH and also summarize the role and contributions of AYUSH in the healthcare system of India. Finally, the paper will outline the successes and challenges faced by this initiative of integration, and recommendations for future.
Source of the photo
BACKGROUND
Up until the early 19th century, Ayurveda – the traditional holistic Indian system of medicine, which primarily uses herbal formulations, was the main system of medicine used by the Indians. But with British colonization in 1857, modern Western medicine – the system of medicine used by the British, was introduced to Indians. It gained rapid popularity and inspired awe, not only because its usage provided instant relief, but also because the elite British Lords used it. This resulted in dislodging and sidetracking of the traditional systems of medicine. Modern medicine gained firm holding in the country in the century that followed.
But since independence in 1947, growing concerns about the adverse effects of chemical-based drugs and escalating costs of conventional health care, have led to a resurgence of public interest in holistic systems of health care. For the Government, a major area of concern has been the flailing healthcare infrastructure in the country. Although healthcare is one of the largest and rapidly growing sectors in India, in terms of revenue and employment, healthcare infrastructure in the majority of the country’s regions has not kept pace with the economy’s growth1.
Addressing these issues, the National Health Policy, formulated in 19832, pointed out that the vast infrastructure available in the form of thousands of hospitals and dispensaries, registered practitioners and hundreds of colleges, belonging to AYUSH systems, was being underutilized. This was because regulations and standards for this sector had never been developed or formalized, in the post independence era. The Policy suggested formation of Councils and Administrative bodies to help regulate and standardize the practice as well as education of AYUSH systems. This would not only help fill the large infrastructural gaps in the healthcare system, but would also strengthen the deep rooted traditional systems of medicine, thus preserving ancient heritage and knowledge base. The Policy stressed on planned efforts to integrate the AYUSH systems with modern medicine services, at appropriate levels, especially in regard to the preventive, promotive and public health objectives2.
As an outcome of this policy, the Ministry of Health and Family Welfare (MOHFW) created the department of Indian Systems of Medicine and Homoeopathy (ISM&H) in 1995, which was re-named AYUSH in November, 20033. Moving a step forward, a separate National Policy on Indian Systems of Medicine & Homeopathy was formulated in the year 20024, in order to augment the development of traditional systems of medicine in a systematic manner. This was in accordance with the WHO strategy for Traditional Medicine5. A few of the major objectives of the national policy for AYUSH are4:
1) To promote holistic health and expand the outreach of healthcare to people through preventive, promotive, mitigative and curative intervention of AYUSH;
2) To integrate AYUSH in healthcare delivery system and national health programs and ensure optimal use of the vast infrastructure of hospitals, dispensaries and physicians;
3) To provide full opportunity for the growth, development and utilization of AYUSH systems.
A separate Policy on AYUSH has helped establish a more specific framework of guidelines and goals for this move of integration.
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Naomi Rennard
The international health field values volunteerism and international service is often a global health professional’s first field experience. At BU’s orientation, Department Chair Jon Simon charged the International Health concentrators to think about serving with Peace Corps (PC). Peace Corps Volunteers (PCVs) have the opportunity to immerse themselves in a new culture and work in the development field for two years. PCVs have the potential to impact the communities in which they serve as well as gain an important new worldview.
The opportunity to work in the developing world attracts many young adults to PC. At the start of this paper, I hoped to learn the impacts of PCV’s work on their host communities. After some initial research, however, this goal became secondary to understanding the positive attributes of PC and what changes could be made to the program to generate measurable and potentially lasting impacts within host communities. Currently PC does not have a set regimen for evaluating volunteers, but I believe assessments could not only help PC fulfill its mission more effectively, but also provide volunteers with enhanced field experiences.
According to PCVs, PC is a unique and valuable opportunity to challenge oneself and understand development work (1). Over 200,000 volunteers have served abroad since PC first began in 1960, and its reputation attracts a variety of people seeking to enhance their understanding of the developing world (2). While PCVs often indicate their experience was valuable for them and their careers, many volunteers do not know their impact on host communities.
Methods: What do we know now?
Though most returned PCVs (RPCVs) willingly give first hand accounts of their experiences abroad, published literature regarding PCVs’ successes, struggles, and failures is limited. Despite the fact that evaluations have been shown to enhance public health programs and their impacts, standardized frameworks for evaluation of international volunteer programs have not been established (3). Literature has begun to create such frameworks, and these documents are useful for evaluating PCV’s experiences, but no framework has been universally accepted as an evaluation tool (4), (5), (6). For this paper, I conducted a literature review of databases such as Google Scholar and PubMed to find available literature on international volunteerism. To add perspective to available literature, I conducted a series of personal interviews with RPCVs.
Literature Review
The available literature is one of two types. The first addresses the impact international volunteerism has on the careers of volunteers. Some articles assess health and medical professionals and their past volunteer experiences (7), (8), (9). Other assessments discuss instilling a desire for volunteerism among youth in order to sustain volunteering and development-focused work throughout adult life (4). These assessments are important for understanding volunteers and their potential, but not as valuable in assessing the successes of volunteers’ fieldwork. The second type of literature, which may be more useful in evaluating international volunteer programming, focuses on program attributes and individual characteristics that can affect civil service experiences (4), (5), (6). In one article, “length of stay” is implicated as being one of the major determinants of volunteers’ fieldwork successes. The paper indicated the longer volunteers serve, the more likely they are to generate sustainable development in a host community. One study of volunteers from New Zealand discussed impetus to serve, impacts their service experience had on their personality and career, and what volunteers thought were their fieldwork successes (6). Similar to early reports of PCVs, participants in the study indicated they had to be “open [minded] and flexible” and willing to try new things (6,10).
Much of the available literature, whether about volunteers themselves or the programs in which they participated, disclosed that the dearth of evaluative research in the field led the authors to create new models for assessment. This indicates a need for standardized evaluations for volunteers, especially in established programs like PC.
Personal Interviews
I initially hoped personal interviews with RPCVs would illustrate the impacts their PC experience had not only on their careers but also on their host communities. Instead, however, I gained several views of PC and different perspectives regarding some of the limitations of volunteers’ fieldwork (Table 1).
Micah Pepper
In 2010, the HIV epidemic is expected to shift in intensity from Sub-Saharan Africa to Asia, with Injection Drug Users (IDUs) playing a central role in the rapid growth of HIV prevalence (Hammett). Drug use in Vietnam started growing during the USA-Vietnam War, but intensified after the economic liberalization of the late 1980s and 1990s (Thanh). In 2007, UNAIDS estimated 290,000 people living with HIV in Vietnam, with a 45.2 prevalence of HIV among IDUs in major urban areas and a 23.7 prevalence outside of urban areas[1] (UNAIDS Epi). HIV IDUs make up the largest proportion of HIV cases reported in Vietnam (Thanh), and this population is a central risk factor in the spread of the epidemic. Efforts in HIV prevention among IDUs have been slow and continue to face many cultural, social and political barriers. However, HIV transmission among IDU populations has reduced since adapting harm reduction policies such as Needle Syringe Programs (NSP), Peer Educators, and Opioid Substitution Treatments (OST) (Hammett).
RISK BEHAVIORS
IDUs are at high risk of HIV transmission in Vietnam due to unsafe injection practices. While studies indicate that sharing injection equipment has decreased over the past few years (Thanh), over 30% of IDUs reported sharing syringes in Hanoi (Pankonin). In addition to equipment sharing, the reuse of equipment and leftover drugs are pivotal in HIV transmission. Shooting galleries––discrete locations where drugs are sold and injected––are associated with high risk behavior as they support an increased likelihood of equipment sharing, less access to safe injecting equipment, and limited access to clean rinse-water or a clean injecting environment (Hien). Other risk factors for HIV transmission include receiving injections from drug dealers, injecting on the streets and sharing drug pots (Hien).
SOCIAL, CULTURAL AND POLITICAL RESISTANCE
Drug use carries huge social and cultural stigmas in Vietnam, and drug users are widely considered a “social evil” (Hammett). IDUs and people living with HIV often face discrimination, isolation, and fear of rejection. One qualitative study highlighted four common HIV-related fears and stigmas shared by people living with HIV: personal feelings of shame, behavior changes directed towards people living with HIV, a stigmas regarding HIV transmission, and general stigma attached to being associated with a person living with HIV. These stigmas and fears are harmful to individuals, families, and communities, and discourage people from seeking testing and treatment (Gaudine).
The possession, sale and use of drugs are illegal in Vietnam; those who are found in violation of these laws face strict punishments including forced detoxification, mass arrest, and incarcerations (Hammett). Recognized injection locations are often raided by law enforcement, and IDUs have developed quick and unsafe routines for drug use in order to avoid arrest, including discarding injection equipment in public areas (Pankonin). Fear of being arrested is a barrier to IDUs seeking safer injection practices. Despite the availability of safe injecting equipment through needle-syringe programs, IDUs remain reluctant to carry needles because of fear of being arrested, putting pressure on IDUs to get drugs and equipment from dealers or to participate in high risk needle sharing or reuse (Thanh). Harm reduction as a priority response for HIV prevention among IDUs was slow to start in Vietnam due to law enforcement and police resistance, a lack of political support, and unsafe practices. However, the implementation of harm reduction into Vietnam’s cultural, social, and political responses to IDUs plays a pivotal role in HIV prevention.
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Melissa Nondorf
Tobacco use is one of the most preventable causes of morbidity and mortality worldwide2. Implementing a successful anti-tobacco campaign is often extremely problematic, though. Aside from the obvious difficulty of persuading people to give up an addictive habit that they frequently enjoy, tobacco companies and their lobbyists always staunchly oppose such measures and do everything in their power to prevent governments from getting involved and passing tobacco use reduction legislation.
Poland has been an unusual success story in the fight against tobacco use. While in the late 1980′s it held the dubious title of most cigarette-addicted nation7, now the country’s legislation for tobacco control is considered one of the world’s most progressive1. Poland is in many ways a good case study for any nation looking to formulate its own tobacco control program. The country’s history, struggles and achievements are all worth investigating to discover common threads that might work elsewhere.
Poland could be considered something of a Phoenix that has risen from the ashes of Communism. Behind the Iron Curtain, the government “effectively brib[ed] and sedat[ed] its citizens with cheap tobacco, vodka, and red meat. Keeping proportionately low prices… was a means of keeping people happy7.” Such policies also caused Poles’ health to deteriorate. Smoking though, seems to have had the largest impact, especially on men. By the end of the 1980s, over half of the non-communicable disease burden among Polish men was due to smoking. Additionally, lung cancer – a direct effect of smoking – in Polish men was among the world’s highest10. Communism was overthrown in 1989 and Poles immediately went to work transforming their society into a freer and healthier one.
Under Communism, tobacco-related health information was heavily censored10. Many people smoked without any idea of the damage they were causing themselves and others. As democracy took hold in Poland and a market economy flourished, foreign tobacco companies descended upon the country. They mounted aggressive advertising campaigns, banking on the fact that Western-brand cigarettes had been a precious and revered commodity under the old regime7. Surprisingly, national smoking levels began to decline instead of increase. The percentage of adult males who smoked dropped from an all-time high of 64% in the mid 1970s to around 60% in 1985 and then 40% by 1998. The percentages for women fluctuated from 21% in the 1970s to 34% in 1985 and 20% in 19981.
There were several reasons for this unusual result. First, Polish scientists had taken notice of the plummeting health of middle-aged men back in the 1970s and began studying its relationship to smoking. Papers were published, but the information was withheld from the public. As soon as the country began to liberalize in the 1980s though, the scientific community acted. In 1990, the year after Communism fell in Poland, the country hosted a conference at Kazimierz titled “A Tobacco-free New Europe.” This was the first time health advocates from both sides of the Iron Curtain were able to come together and formulate plans of action to lessen disparities in health and address the damage being caused by cigarettes in Eastern Europe10. Then, in 1991, Poland’s Center of Oncology initiated what has become an annual event; the ‘Great Polish Smoke-Out.’ Every year prizes are offered to people who have quit smoking6.
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Karen McManemin
Gender inequality in Kenya is rampant and contributes to underdevelopment and high rates of HIV transmission. Almost 7% of the total population of 39 million is HIV-positive (CIA, 2009). Women account for the majority of new HIV-infections in Kenya. Women age 15-49 years have an HIV prevalence of 8.7% compared to only 4.5% among their male counterparts (UNAIDS, 2006). With a Human Development Index of 0.541, Kenya is the 35th poorest nation (UNDP, 2009). As a result of colonialism and structural adjustment programs, Kenya has an external debt of US$7.7 billion (CIA, 2009). Kenya’s public debt accounts for 54.1% of its GDP (CIA, 2009). Recently, Kenya’s debt has increased from borrowing money to fight HIV/AIDS. In 2008, the World Bank lent Kenya US$40 million for HIV prevention (Booth, 2004). GDP per capita in 2008 was US$1,580 (UNDP, 2009). Over 40% of Kenyans are unemployed and most of those that do work are in the informal sector (CIA, 2009). It has been estimated that the informal sector accounts for 35-50% of Kenya’s GDP (Mayabi, 2008). Women that are employed currently only make about 55% of men’s earnings and spend fewer of their working hours in paid employment (Booth, 2004).
Although Kenya does receive international aid, the government only spends about 5% of its GDP on health care (Allianz Worldwide Care, 2010). This is far less than the average spending for high-income OECD countries, which use about 9% of their GDP for health care (OECD, 2009). Total health spending in Kenya is about US$6.2 per capita (Allianz World Care, 2010). The WHO estimates that even a very basic set of services for prevention and treatment would cost more than US$34 per capita (Carrin et al, 2008). Thus, access to health care and quality services in Kenya is very poor. The Kenyan government should consider alternative HIV prevention strategies that empower women and generate revenue for health care such as legalizing, controlling, and taxing sex work.
Gender inequality throughout Africa puts women at increased risk of HIV infection because they are denied economic opportunities, autonomy and control over their personal lives (Booth, 2004). Lack of access to education and jobs forces many women to use sex as the primary or supplementary means of income. Sex work is illegal in Kenya, but research has shown that women in economically and socially constrained situations engage in a variety of behaviors that involve transactional sex (Harcourt & Donovan, 2004). The sad reality is that sex is often the currency that poor African women are forced to use in order to survive. A global typography in 2004 highlighted at least 25 behaviors that could fall under the category of “transactional sex” (Harcourt & Donovan, 2004). There is no way for a government to realistically establish which women are “prostitutes” or control the sexual behavior of a population through criminal laws. Criminalization of sex work is especially detrimental in light of the fact that many women have very few options for other means of economic or social mobility. When the state refuses to recognize a type of profession (e.g. selling sex), they don’t have to worry about working conditions, safety, health, or the subpopulation’s ability to make a decent living (Oakley, 2007).
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Molly McCoy
Introduction
When health care systems deteriorate in times of war, innovative heath care delivery strategies must be initiated in order to maintain medical care access for civilians. Stabilizing medical care facilities becomes more challenging when population displacement is inevitable.(1-3) The civil unrest in Burma exemplifies the need for critical attention to internally displaced populations (IDP), who likely have nowhere to safely go for adequate medical care.(1-4) Of particular concern is maternal and child health and delivering obstetric care to the internally displaced populations.
The focus of my analysis will be on the method of care delivery provided by the Mobile Obstetric Maternal Health Workers (MOM) Project. This initiative claimed to reduce infant mortality and increase access to medical care for women who had been displaced from their homes or who could not safely seek medical care.(1,5) This model could be successful as an alternative route of care delivery to reach other internally displaced populations in conflict zones.
Background
The military Junta officially took power in 1988. Democratic elections took place in 1990, but after their loss to Aung San Suu Kyi of the National League for Democracy, the military rulers still refused to relinquish power. By 2004, there were an estimated 526,000 IDPs in eastern Burma; and more than 240 villages had been destroyed, forcibly displaced, or abandoned in the previous two years.(6) Humanitarian access to IDPs continues to be problematic due to non-acknowledgment of an IDP problem from the government and ongoing conflict, making it difficult to obtain accurate statistics, as well as to deliver adequate medical care.(4,7-9)
High rates of maternal and infant mortality have been reported as compared to other nearby developing nations such as Thailand and Malaysia.(10,11) In 2006, the World Health Organization reported a maternal mortality rate of 360/100,000 live births and UNICEF reported an infant mortality rate of 74/1,000 live births.(11,12) It has been documented that 51% of infant mortality in Burma is due to Asphyxia and Sepsis, two avoidable complications with appropriate obstetric care.(13)
Health Care Delivery: Challenges
Today, there is essentially no access to governmental and international nongovernmental sources of healthcare within the conflict regions of Burma; where it does exist, healthcare spending by the State Peace and Development Council is extremely low.(7,9) Displacement and living in zones of conflict make traditional modes of healthcare delivery, such hospitals and clinics, ineffective due to lack of safety, transportation, and education about when and where to seek care.(1,2,5) Innovative health care delivery systems should be implemented to increase the level of medical care accessibility.
International aid groups throughout the world have traditionally focused on a facilities-based health systems approach.(10,14) This approach is practical in creating a comprehensive system in which multiple levels of care, necessary supplies, and many treatment protocols can be offered to patients in one place. However, because of the frequent uprooting of families in Burma, offering access to healthcare from a centralized, stationary facility is not feasible. Permanent-structure health facilities would be vulnerable to military attack—since 1998, 11/33 clinics were forced to relocate, five of which between October 2006-April 2007 according to the Karen Department of Health and Welfare.(1) Health-workers have noted that one major obstacle to delivering medical care in Burma is locating people who need medical attention.(5) With these challenges in mind, the alternative strategy of a floating health services network was considered.
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Sayaka Koseki
INTRODUCTION
Many studies have shown that increased socioeconomic status correlates with better population health (1) (2) (3). Japan has been a poster child of this theory; Japan’s life expectancy grew significantly during the post-World War II economic boom. Four socioeconomic factors are linked to health status in Japan: educational attainment, occupational gradient/class, income level, and employment (1). These variables strongly influence lifestyle behavior, diet, and stress, which in turn impact health status.
Improving these secondary factors may lead to improved health in populations with low socioeconomic status. For example, Okinawa prefecture of Japan, which ranks poorly on all factors, has one of the highest life expectancies in Japan. Their unique lifestyle, especially diet and social support, has counterbalanced these secondary factors, overcoming the socioeconomic barriers to longevity. Okinawa provides a new framework in which the government may tackle the health of marginalized populations. This paper shows how four key socioeconomic factors affect the population’s health status, and illuminates how non-socioeconomic factors could improve health by counteracting the negative secondary effects of low socioeconomic status.
 Japanese Sign
JAPAN: ECONOMIC GROWTH AND LONGEVITY TRENDS
Japan’s life expectancy at birth has increased at a staggering pace since the end of World War II. Japan’s life expectancy at birth increased from 70.3 years old in 1965 to 82.4 by 2006, a growth of 12.1 years (4). Comparatively, OECD countries’ average life expectancy increased only 9.2 years (Exhibit 1) (4). Life expectancy grew hand in hand with GDP growth in post-war Japan, with a correlation coefficient of 0.9437 (Exhibit 2).
FOUR KEY SOCIOECONOMIC FACTORS OF HEALTH
Kagamimori, et al. reviewed 45 journal articles regarding socioeconomic factors and health of Japanese populations and found that four factors have the most impact on individuals’ health (1).
Educational attainment
Relationship: Individuals with higher education can live in environments that allow for healthier lifestyle choices leading to better health conditions (2).
Studies: Fujino, et al.’s prospective cohort study showed that individuals with low levels of education had an increased overall risk of death, especially due to cancer and external causes (5). Researchers concluded that lower education levels increase the risk of unstable income, hazardous work conditions, and poor housing, all of which could contribute to worse health conditions. Additionally, research by Nishi, et al. showed an association between increased education level and lowered prevalence of smoking habits (3).
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Jadie Kim
Introduction
The suicide rate of the Inuit in the Canadian Arctic is among the highest in the world (1). Health Canada census showed the Inuit population had 135 suicides per 100,000 in 2003 (1,2,3). This rate is approximately 12 times higher than the overall Canadian suicide rate in 2003 (4). The suicide rate for the Inuit was highest among males, the majority of whom were between the ages of 15 and 24. Some of the reasons offered for this high rate of suicide among the Inuit is social and cultural change, geographic isolation, social and economic marginalization, and poverty (5). Suicide rates across the Inuit world were low as recently as the 1950s and 1960s. The ‘suicide transition’ occurred first in Alaska, then in Greenland, and later in the Canadian Arctic. This sequence follows in which the different national government had implemented policies which had huge impacts on Inuit lifestyles. Since, suicides began to occur more frequently. This paper will examine some of the factors that have contributed to the high suicide rate among the Inuit and analyze the challenges of current prevention.
 Photo taken by Ansgar Walk Canadian Health Care System for the Inuit
Health care in the northern region of Canada is different from its southern region due to its remote location and small population size. Most Inuit communities are served by nursing stations and often require patients to travel great distances to see doctors or receive specialized services (8). The most northern community in the arctic is approximately 2700 km from Ottawa (14). The unfortunate result is a delay or a lack of access to emergency services, early intervention, follow-up and services that reflect Inuit culture and language (8). Presently, most health care staff are hired from the southern region of Canada. This often presents the challenge of high turnover, and a lack of trust and understanding between providers and patients due to differences in language and culture (8).
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The National Institutes of Health’s Center for Scientific Review (CSR) has released a new video to show new applicants and others how NIH assesses over 80,000 grant applications each year to help find those with the most merit. With the majority of NIH’s $31 billion budget supporting grants to researchers, these assessments help ensure investments lead to significant
advances in science and health.
“The video provides an inside look at the dynamic way reviewers evaluate NIH grant applications,” said CSR Director Dr. Toni Scarpa. “You’ll see the rigor and integrity of their efforts, which have enabled NIH to identify ground-breaking research year after year.”
CSR also has released a companion video: NIH Tips for Applicants. In this video, the reviewers and NIH staff members featured in the NIH Peer Review Revealed video provide advice to new applicants.
Both videos incorporate many of the recent enhancements to the NIH peer review and grants systems. They replace a similar CSR video that has been viewed by thousands online and used by hundreds of research institutions across the country and abroad to train and educate new and established researchers.
You may watch these videos at the Public Health Lesson TV (PHLTV) by clicking here (NIH Peer Review Revealed) and here (NIH Tips for Applicants).
Sources: http://www.nih.gov/news/health/jun2010/csr-16.htm
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