Summer 2010
Climate & Health
It is easy to imagine the effects of global warming – glaciers melting, changing weather patterns – as the thermometer passes the 100°F mark this summer.
After a year of incongruous weather, it is safe to say that few doubt the existence of climate change. Anthony Costello, director of the University College of London’s Institute of Global Health, references a Stanford University study that shows skeptics of global warming comprise at most 3 percent of the community. That said, we are only beginning to discover the lasting impact of our changing climate.
If we reach the high end of climate model predictions, the earth could warm by 7 degrees by 2100, way beyond the heat endurance of humans and mammalians. But even before that, and taking the middle of model predictions, the effects would be profoundly felt: food and water insecurity, heat stress, communicable diseases, population migration, and deaths from extreme climatic events.
But even with this dour look into the future, there is a dearth of hard, measurable evidence to show the health effects of this change. As Onome Akpogheneta notes in her piece, evidence to reflect climate change effects on mosquito-borne diseases has not kept pace. So, too, is the case with climate migration.
And Kathleen Mogelgaard of Population Action International talks about how women are disproportionately vulnerable to climate change, and how we need to address population growth.
Come with us through this summer issue, as we turn the prism on climate change and look at its effects on health. Also, remember, the discussion continues through blogs in the online edition of the magazine at
www.globalhealthmagazine.com.
The Editors
Features
Climate Change: Skeptics Step Aside
Why we should take climate change seriously
Connecting the Dots
Reproductive Health and Solutions to Climate Change
Will Bugs Creep North as Climate Heats?
Changes in climate will cause an increase in vector-borne diseases
People on the Move as the World Warms
Global warming creating climate refugees
From the Front Lines of the Global AIDS Fight
South Africa's leading HIV/AIDS experts weigh in on the country's status
A Photographer’s Encounter in Kroo Bay
Documenting the slums of Freetown
Online Exclusives
Going Viral
What's the buzz on Twitter, Facebook and other places online
Dim Sum
Books, films and other cultural forays
Field Notes
Community support key to combat TB in Malawi
Cool Escapes
Morgan Roth explores a sleepy seaside gem in Mexico
Screenshots
Cars per 1,000 people
Forest cover as % of land
Carbon Dioxide Emissions
Spring 2010
Tracking Goals
The word implies an achieved and desired outcome, more specifically, the end of a challenge. In global health, our goal is to improve the lives of people around the world primarily by reducing the burden of disease.
The Millennium Development Goals, ICPD, Alma Ata, and other targets have guided much of the work in our community in recent years. While we are nowhere close to reaching them, we carry lessons – the need for vaccines, better delivery systems, newer, less expensive, more portable technologies – that accelerate progress. In addressing the goals, we gain better tools and greater wisdom toward achieving them.
As Linda Fried and Lynn Freedman of the Mailman School of Public Health allude to in their article, goals keep us on track. They enable resources to be mobilized amid decreases in funding and emerging disease threats. But it begs the question, are we finding sustainable solutions?
Robin Gorna of the International AIDS Society reflects in her article, it’s not the goals that are the problem. Rather, it is a lack of commitment to following through with what needs to be done in order to achieve them. But we all know that lip service is not enough. Resources – money, people, knowledge – have to be invested for real gains to be made.
And then there is smallpox eradication – the gold standard in public health achievements. As Dr. D.A. Henderson shows, through ingenuity and plain stubbornness, it has been eradicated. To think that with a single mindset in the late 1960s, and with an international staff that never numbered more than 150 in the field, the World Health Organization provided the framework within which all countries could constructively work, even during the days of the Cold War.
Indeed, there are still many lessons to be learned, and many challenges to be conquered.
The Editors
Features
Is Universal Access for HIV a Realistic Goal?
From my perspective, the problem is not over-promising. It's under-achieving
Chasing goals rather than solving problems?
This is a critical time to be cognizant of the broad changes that are in process
The Death of a Disease
In 1967, 43 countries experienced more than 10 million cases and 2 million deaths
NGOs Seek Seat at Table
With Big $ Behind Them, NGOs Want Haitian Partnership
From the Ground Up
Rebuilding Haiti's Health Structure
A New Angle on Pediatric HIV/AIDS in Swaziland
This child's parents are HIV-positive, and she is HIV-negative
Achieving Maternal Health
MDG 5: Getting Further, Faster
Online Exclusives
Hot Escapes
Tina Flores Explores the Gentile Side of Santo Domingo
Dim Sum
A collection of book reviews, music picks and other cultural forays
Going Viral
What's the buzz on Twitter, YouTube, Facebook and other places online
Field Notes
Cuban-Trained Doctors in Haiti for the Long Haul
Dominican Republic
Tina Flores Explores the Gentile Side of Santo Domingo
Screenshots
Child Nutrition
884 million people not using improved water sources
% of total health spending
Winter 2010
Health Systems
To take up the challenge to address health systems is a little daunting, to say the least. The components are complex and numerous, and the breadth of work to be done enormous. WHO’s building blocks of health systems strengthening are service delivery, health workforce, information, medical products, vaccines and technologies, financing, and leadership and governance. Alone, each piece is a challenging, but necessary component of a greater whole.
On the surface, it would seem that the key to improving health systems might be structures logistics, meeting supply and demand. But as this issue of GLOBAL HEALTH shows, at the core of health systems strengthening is people.
There is a need to foster a cadre of leaders across the globe to catalyze change. Building capacity on the ground to improve the flow of goods, services and information is a crucial component for most developing countries. Newer buildings, fancier equipment and access to information technology are not a panacea for all that ail these crumbling systems. They merely facilitate the work that needs to be done.
Also, perhaps most notably, the global health community needs to address the issues of health care workers – from training to compensation to migration. It has often been a lightning rod for great debate, but the topic of health workers is, perhaps, the most complicated and arguably the most important of all if any system is to be sustainable.
Join the conversation by making a comment.
The Editors
Features
Health Worker Migration: Disease or Symptom?
Do health workers who leave developing countries, and the organizations that hire them, cause death?
Greater than the Sum
Information Technology and Health Systems Strengthening
In-Country Supply Chains
Why are they the weakest link in the health system?
Leadership and Management
The New Prescription for Health Systems Strengthening?
Health System’s Levers
Global health community shifts focus to health strengthening
The Road Not Taken
The role of transportation in global health systems
The Making of Anatomy of a Pandemic: A PBS Documentary
How was the H1N1 film created?
Online Exclusives
Hot Escapes
Jessica Mack explores Bocas del Toro, Panama
Going Viral
What's the buzz on YouTube, Facebook and other places online
Dim Sum
A collection of film picks, book reviews, and other items of note in the global health field
Field Notes
Laurel Lundstrom on a project providing grants to reduce maternal and infant mortality in Indonesia
Screenshots
Causes of Death in China and India
Natural Disasters
Sexual Violence Among Adolescent Girls
Fall 2009
Chronic Diseases
Heart disease, diabetes, depression – diseases of the rich, yes. But of the poor as well? It’s hard to fathom that in developing countries, which lack even the most basic health interventions, people struggle with the same chronic illnesses that plague their peers in wealthier nations.
While HIV/AIDS, malaria and tuberculosis have taken center stage, chronic diseases such as mental illness, cardiovascular disease and cancers have been sidelined. Yet according to the World Health Organization, developing countries shoulder more than 60 percent of the global burden of coronary heart disease.
As we see in this issue of GLOBAL HEALTH, chronic diseases, much like their communicable counterparts, are overarching conditions that have immense impact on the health of the population. Moreover, developing and transitional economies are less able to address these so-called “diseases of the rich.”
In countries taxed by HIV, infectious diseases, malnutrition and diarrhea, screening for depression, cancer and heart disease might not be priorities. But as the articles in this issue show, it is just as important to address non-communicable diseases if we are to improve the lives of people around the world.
The good news is that we know what to do – eat a healthier diet, increase physical activity, stop smoking. But there are even harder fixes: systems need to be put in place so that there is a greater emphasis on prevention, early screening, and treatment. This cannot happen, of course, without greater investment in strengthening health systems within countries. We need to build capacity in-country to ensure the long-term sustainability of all health interventions.
Features
Probing Health Ministries
John Donnelly on quandaries facing African health ministers
Rapid Changes in Asia Alter Health Landscape
Asia's growth is taxed heavily by urbanization, industrialization
Think Africa’s Disease Burden is HIV? Think Again
Africa acquiring diseases of the wealthy, without the wealth
North American Diseases Go South of the Border
Root causes of chronic disease are more complex than junk food and tobacco
Cancer, Silent but Intense, Threatens Systems
Pandemic tests health systems, social structures
The Killers We Ignore
Chronic illness overtakes infectious diseases
Kiev Diary: TB, AIDS and Junkies
Seeing IDUs through new eyes
Online Exclusives
Cool Escapes
How to take great photos from the field
Going Viral
Dim Sum
A collection of film picks, book reviews, and other items of note
Field Notes
Middle East wrestles with mental health challenges
Screenshots
How Safe Are Aid Workers?
Human Trafficking
# of Hospital Beds for Every 10,000 People
Summer 2009
Infectious Diseases
They are our daily norms - drinking water, a mosquito bite, breathing. All seemingly innocent and unavoidable, but it takes very little to become infected with an infectious disease.
The adage goes, disease respects no borders or socio-economic status. While that is true to some extent, your address and relative wealth (at least on the global scale) determines, in large part, whether or not you will succumb to one of these diseases. If it didn't, why do so many infectious diseases impact those in low-resource settings?
Let's face it. The neglected tropical diseases The Carter Center is fighting to eradicate would not continue to plague millions if they were rampant in Geneva or New York. Most New Yorkers probably can't define lymphatic filariasis, much less spell it. Indeed, many infectious diseases are mere by-products of impoverished circumstances - lack of clean water, living in refugee camps, etc. Rotavirus, discovered 35 years ago, still plagues many communities. And while recent years have seen a relative boom in funding for neglected diseases, as M Moran et al. show, these resources have, in large part, gone to the "big three" - AIDS, TB and malaria.
But relatively recent collaborative efforts, such as the partnerships fostered by sanofi pasteur, as well as the network for TB vaccine researchers in Africa, are expediting the progress being made in treating and preventing diseases. Innovative ideas are likewise being implemented in the disease surveillance side of infectious diseases. Rats indigenous to Africa are being used to detect TB. The Internet giant Google is tracking the spread of disease online.
We hope that this issue is a catalyst for discussion.
Features
Leveraging Partnerships
Collaborations are Potent Tool, says CEO of sanofi pasteur
The Allure of Eradication
Dr. Hopkins of the Carter Center on the Holy Grail of Afflictions
Tracking the Flu
Google 'Threat Detectives' Stalk Outbreaks Around World
Neglected Disease Funding Remains Off the Mark
Where is the money going?
Charting Malaria’s Demise
Modern cartology + disease surveillance = better understanding?
Pakistan’s New IDPs
Mental health and diarrhea plague SWAT Valley refugees
Poet Soldiers
Soldiers get personal about HIV/AIDS in the Caribbean
Online Exclusives
Going Viral
Dim Sum
A collection of film picks, book reviews, and other items of note
Cool Escapes
Havana, Cuba. Immerse yourself in the history and hedonism of this island nation
Field Notes
Researchers collaborate on developing first TB vaccine in 100 years
Screenshots
Polio Eradication Progress
Infants Not Immunized With DTP3
% of Women Who Believe It’s OK for Husbands to Hit Them
Spring 2009
Hi Tech Health
Technology is a tool that lets people help themselves, be it finding today’s prices for their fish or crops, reminding them to take their medicine, or surveying the epicenter of the latest outbreak of disease. Never before in history has so much information been available to so many people in the most remote corners of the globe.
To think that this revolution is merely in its infancy is astounding. But with it comes challenges to do it right, be flexible enough for change, and to harness the technology to do what we need it to do, and not what it dictates to us. These are the challenges, but the opportunities are boundless.
Features
Credit Card Know More About You Than Your M.D.?
Lack of information is a big challenge facing health systems
Are Cell Phones Leading the mHealth Revolution?
Mobile phones leapfrog over landlines and lagging Internet
Is Open Source Good for Global Health?
Legal and free, it can be shared, adapted and reused
Low-Tech Saves Lives
Intervention addresses postpartum hemorrhage in low-resource settings
AIDS Hotline for Ethiopian Health-Care Workers
A toll-free telephone service that provides accurate and up-to-date information
The Million Dollar Email
Raising $25 million online by keeping the message simple
Rwanda’s Living Legacy of Violence and Healing
Women of Rwanda, were impregnated by their captors, contracted HIV/AIDS, or both
Online Exclusives
Going Viral
What's hot online
Dim Sum
A collection of film picks, book reviews, and other items of note
Cool Escapes from the Hot Zone
Discovering the dungeons and dragons of Ljubljana, Slovenia
Field Notes
The death of his younger brother spurs a physician to action
Screenshots
World Population by 2050: Top 10 Gainers and Losers
Skilled Health Workers
Youth and Smoking
Winter 2009
Feeding the Hungry
The world food crisis is undermining the promising trends in global health over the past decade. Malnutrition, according to the World Health Organization, is a major threat to public health worldwide, responsible for one-third of child deaths and 10 percent of all diseases. It has negative effects on education, economic growth, productivity and income. As food prices rise due to energy costs and increased population, families will be forced to spend even more than the 75 percent of their disposable income they currently spend on food. In the end, the global community may find it a challenge just to stay even.
Features
Is the U.S. Using Money Wisely?
Critics advocate for a more efficient, development-oriented food program.
How Did We Get Here?
The causes of higher prices are the subject of much analytical and policy debate.
The African Green Revolution
Africa is looking to a new project - The African Green Revolution - as its hope to feed the hungry.
Sustained Fixes for Nutrition?
Nutrition-dense foods are lifesavers but they are not a long-term solution.
Secrets, Taboos and Private Lives in Jamaica
A poet's journey into world of HIV becomes deeply personal
The Financial Crisis and Global Health
Shortfalls in aid and donor revenue may be substantial
Big Pharma Bets on Emerging Economies
Nuanced approach reflects ability to pay in new tradeoff
Online Exclusives
Cool Escapes from the Hot Zone
Explore another part of Kenya, one with beaches, donkeys and history
Going Viral
What’s hot on YouTube, Facebook, LinkedIn and other places online…
Dim Sum
A collection of film picks, book reviews, and other items of note
Field Notes
Female Community Volunteers Save Children from Pneumonia Deaths in Nepal
Screenshots
How People Pay For Health Services
World Bank, World Health Organization survey trends
Where are the Refugees?
Countries most prevalent in hosting displaced people
2.6 Billion Without Toilets
Where improved sanitation is lacking around the globe
