Organizing and Mobilizing for Change

Where do we go from here?

My insights: There are so many potential directions that public health can develop into in the future including:

• Eliminating Health Disparities


• Devote resources not only to research and development, but also to policy, programs, advocacy, promotion, prevention and treatment.


• Establish limits on health care costs, and pharmaceutical costs.


• Enhancing global health leadership and partnerships through both the public and private sector.
  

What is important to keep in mind is that when we (as public health professionals) reach out in these different areas, we have to remember that the world is diverse and each public health initiative will have its unique challenges. One other important point is that the world is full of very educated people who may be interested in collaborating with you in your ideas and initiatives and you shouldn't be afraid to contact them for guidance or advice.

Unique quotes
“People don’t change when you tell them there is a better option. They change when they conclude they have no other option.” – Michael Mandelbaum quoted in The World is Flat, Thomas L. Friedman, pg 462

Moral Considerations in Global Health

My Insights:
With growing technology, why do health disparitites still exist?

• More resources are being put forth into research to increase knowledge as opposed to spending resources on existing knowledge, unless commercially profitable—illustrating how market forces are a more powerful influence on the practice of medicine than health needs (very sad).
• Second, concern for those who are most severely affected by ill health seems to be generally considered less valued. The most ill are typically living in the poorest countries in the worst circumstances, and are away from the daily interactions of most people in developed countries (developing technologies, and spending money on health issues).

Graphical references: Ethics are never black or white. It's not like someone can act or think objectively at all times. For example as Professor Shahi asked, “is murder ever justifiable?” Automatically, one might say, no. To kill another is wrong and unjust. But my answer is ... yes ( in cases of self defense, I believe so) and so even the lines behind murder can shift. Unique quotes: "The power of choosing good and evil is within the reach of all." - Origen

The Changing Role of the Private Sector

My Insights:
This week I was gave an presentation/oral review of an article I read on the topic of the changing role of the private sector in the global health arena. The article was called, "Yogi Wears Prada," from the WSJ in September 2006 and it discusses how the growth of high end yoga vacations is forcing traditional retreats to change some of their granola ways. The reason I talked about this article is because yoga (deeply intertwined with Hindu religion) as a private sector has now gone global (a $3 billion dollar industry in the U.S.). It is becoming prevenlent in the public health arena becuase it is used to help improve health by treating stress or even as a form of exercise. I thought it was important to discuss one case example of a private sector which has gone public and even become a watered-down version of what it was originally intended to to - as it does in this article. I wanted to explore the ramifications when one particular industry goes public and in all I thought it was great to consider ...

• Is Yoga in the Western world a positive acculturation (do you view Yoga as a celebration of multiculturalism, promoting more open and tolerant cultural dispositions)?
• Or, has this the processes of commercialization debased the sacred practice?

Graphical Reference: Privatization is thought to be evil, and public health is thought to be humanitarian - but when they work together are they like Jekyll and Hyde?

Unique Quote: "Blessed are the flexible, for they shall not be bent out of shape." - Unknown Author

Health Care Finance

My Insight:
Health care financing is a touchy issue - for two reasons - 1. it's expensive and 2. not everyone has access to health care services.

1. Should health costs be the responsibility of public or private programs? And are we spending too much on health care? In 2001, internationally, we spent about $3,059 about 10% of the GDP.
2. Even more prevalent - only 12% of this money is being spent on low and/or middle income recipients. Low and middle income people account for 84% of the international population and 92% of the burden of disease.

From these statistics one may observe that a lot of money is being spent, and somehow is being misdirected away from 84% of the global population who could benefit from it.

Graphical Reference:In the U.S., we spend 15.2% of our GDP on health care, which is more than any other country internationally.

Unique quote:"Fixing our health care system as a whole is our primary challenge, and to make it happen you need to get engaged – to pound the pavement, get your hands dirty, endure real sacrifice, take on antiquated thinking and help lead the public debate.” Senator John Kerry.

Responses to Natural Disaster

My Insights:
More resources need to be devoted to emergency preparedness. There is a ton of data which supports the idea that emergency health interventions like temporary shelters and field hospitals are indisputably more costly and less effective than preparedness-related health activities.

Several problems include: decision makers and relief workers lack of experience with disaster management because of frequent turnover in their jobs and lack of funding. Strategies include developing public support and political initiative in periods where there is no disaster. Efforts should commence in a long term, institutionalized format.

Graphical reference:
The hurricane Katrina in 2005, may not have only been the result of nature but potentially man made. Humans may be causing global warming and are thus the culprits of our own demise...

Inspiring Quote:
The human spirit needs places to go to, where nature has not been rearranged by the hand of man. ~Author Unknown

Technology Innovation and Global Health

My Insights are:
Times are changing. With innovations in information technology (IT), transforming health care through IT will result in significant cost savings to governments, insurers, and individuals over the long term as well as reduce stress on economies and workforces. It will provide opportunities for people to keep records of their own health.

Many inequalities exist in access to health care services with up-to-date IT developments (lack of available services to the public in developing nations and access limitations due to price inequalities in developed nations) and this is one of the biggest problems... how to effectively introduce IT innovations in a cost-efficient manner so that there is improved access to all. Another problem is that there needs to be global collaboration with the increase of more public-private parterships.

Graphical References:
Thermography as a way to diagnose breast cancer. It uses colorful imaging sensors to display areas where cancer could or is developing. Also the picture at right is a before (L) and after (R) of a hair restoration treatment at the Hair Restore Japan Contest in Tokyo.

Inspiration Quote:
Technology... is a queer thing. It brings you great gifts with one hand, and it stabs you in the back with the other. ~C.P. Snow, New York Times, 15 March 1971

Technology Innovations

My Insights: Here are four challenges and great themes in the 21st century.

• Integration of out international perspectives


• Translating research into technological innovation


• Create partnerships and alliances across industries


• Demonstrate value and wealth through entrepreneurial ideas.

My initial thoughts to these four challenges is that they are redundant and simplistic but unfortunately these themes are still not a reality. It's easier said than done to envision a world who already follows all four of these ideals. We, as the United States are not yet integrating our technological advances, knowledge, resources and wealth with those in the developing nations (as we are a capitalistic nation) but we must integrate with each other. We must continue to translate new emerging ideas into technological advances. Yesterday, I read about the realization of providing HIV tests to those in the ER, in Los Angeles County, and providing test results to patients in a one hour turn-around time. The problem stated was that many people do not know they are carrying the HIV virus and for up to 10 years on average, it goes undiagnosed (according to NPR). Those who do take the HIV tests, have a tendency to not return after the two-week wait period and show up for the in-person deliverance of results. In other words, the waiting period is lengthy and the results are only given when patients show up in person, which is rather daunting to most (according to wsj.com). Anyways, translating the idea of awareness of HIV into technology is such as amazing idea for two reasons:

1. Public health officials hope of improving health care delivered to those with HIV because an earlier diagnoses can help in delivering accurate treatment of HIV patients who are accessing basic and other services, and


2. Reducing the number of incidence cases appearing because the assumption is that when people know they are HIV positive, they will take precautions to reduce the spread through sexually protected scenarios.

Graphical References: With rapid increases in biomedical sciences, millions of people living in developing countries are in situations of dire poverty with limited access to clean water sources, food, safety, homes and even basic health care. Why cannot the developed countries devote more resources with the potential for science and technology to merge to improve living conditions, control disease and improve lives.

Inspirational Quotes: "Discovery is seeing what everyone else has seen and thinking what no one else has thought." - Albert Szent-Gyorgi

Environment, Sustainability and Health

My Insights: From the reading, I learned about the unique relationship between... environmental pitfalls and poverty. I never really considered povery a link to environmental problems, but after the reading I do see a connection.

"Many environmental problems stem from poverty—often contributing to a downward spiral in which poverty exacerbates environmental degradation and environmental degradation exacerbates poverty. In poor rural areas, for example, there are close links among high infant mortality, high fertility, high population growth and extensive deforestation, as peasants fell tropical forests for firewood and new farmland..." - United Nations Development Programme (2003). Chapter 6 - Public Policies to Ensure Environmental Sustainability. Human Development Report 2003. Oxford University Press.

Graphical Image: Global warming is causing deserts to become drier which causes drought and famine (called desertification - like the Sahara in Africa); and ocean temperatures to raise and become warmer which will cause violent weather patterns like flooding, hurricanes and tornadoes (as in the Atlantic Ocean) .

Two Contrasting Unique Quotes on global warming that unfortunately have divided the people of United States:
"Two thousand scientists, in a hundred countries, engaged in the most elaborate, well organized scientific collaboration in the history of humankind, have produced long-since a consensus that we will face a string of terrible catastrophes unless we act to prepare ourselves and deal with the underlying causes of global warming."
AL GORE, speech at National Sierra Club Convention, Sept. 9, 2005

“...we have an environmental movement that is run by people who want to fight, not to win.”
Dr Patrick Moore, founder member of Greenpeace,writing in the Mail on Sunday, May 2000

Mind, Behavior and Global Health

My Insights: In lecture 6, 2.16.07, we talked about mind and spirituality. I think the most memorable part of the lecture was when we talked about Maslow's Hierarchy of Needs pyramid. This is such a simplistic was to look at emotional and mental needs but I do agree that it is a great overview. It is cheifly suggesting that each individual has a set of needs, and with each step up the pyramid the individual is able to attain more superficial needs. For example the bottom-up approach is...

1. Physiological - eat, breathe, water and sex
2. Safety - security and health
3. Loving/Belonging - family, relationships, intimacy
4. Esteem - self esteem
5. Self-Actualization - morality, creativity, spontaneity

Great Quote: it made me think of how powerful the mind is in relation to one's own reality.
"Let the beauty of what you love be what you do." - Middle Eastern quote

Nutrition and Food Security

My Insights: In lecture 5, 2.8.07, our class talked about nutrition, food security and global health - like poverty and hunger, malnutrition, obesity, and agricultural food security.

First we went over some definitions related to food security such as:

• Chronic Hunger - the condition of constant malnourishment or recurrent undernourishment and results in stunted growth. Affecting about 798 million.
• Acute Hunger - severe undernourishment that causes wasting and starvation and is addressed with emergency food and aid. Affecting about 67 million.
• Hidden Hunger - micronutrient and vitamin deficiencies which are often seen in obese and overweight. Affecting about 2 billion.

We talked about how 40 thousand children die each day because of poverty and hunger and most of these deaths happen in India, Sub-Saharan Africa, and China. I thought it was interesting that China's numbers, while daunting, are rapidly improving and a large number of those are moving into a healthier status, which is indicative of political and economic improvements in China.

There's something I'd like to mention. Both developed and developing nations are experiencing problems related to food and health. The developed nations are dealing with over consumption issues like obesity and malnourishment. For the record, obesity doesn't equate to healthy individuals; in fact, many who are obese are not receiving a balance in their intake of recommended daily allowance of both micro and macro nutrients including: vitamins, minerals, fats, carbohydrates and protein for optimum health. The reasons for malnutrition include: over consuming some nutrients and neglecting others all together, or simply eating above the recommended daily allowance; this becomes unsafe. Eating at a level of upper intake limitations is dangerous and terminal and toxic; many people consume foods high in saturated and trans fatty foods, YES, eating too many of these can be toxic especially in terms of people developing diabetes, cancers and heart disease.

On the other hand, developing nations are dealing with issues of food insecurity where many are not even capable of accessing food on a routine basis and are undernourished.

My take, why don't we implement a weight watchers type of system in the public school system which centers around portion sizes and eating a balance of healthy foods that satiate appetite. Teach people from a young age about the importance of not overeating in our developed nation.

Great quote:
"There's enough on this planet for every one's need
but not for every one's GREED."
- Mahatma Gandhi

Graphic reference: Seeing images of poor undernourished children as well as the images of the sad and paralyzed obese.

Interesting Link to Radio Piece on Global Obesity: talking about the rate of obesity in France has doubled in recent years, to 12 percent — a figure approaching U.S. fat stats. http://www.npr.org/templates/story/story.php?storyId=6994649

Presentation Info: Jack and Emma discussed agriculture as a way to improve economic conditions. There was some debate over whether agriculture should be pushed in regions of corruption and war where this seems to be low on the agenda - but we felt that these are typically the regions who need the most help economically and would benefits most from these interventions.

Non-Infectious Diseases

My Insights: In lecture 4, 2.1.07, our class talked about non-infectious diseases globally - like Cancer, Heart Disease, Stroke, Diabetes, and Genetics. There was a lot to cover and I found myself really interested in the topics we discussed; it was very thought provoking and I only wish I was this interested in other classes throughout my schooling.

There's something I'd like to mention. There is a unique way to think about the approach of public health professions and that is as damage controllers, in the case where they are in the world treating preventable conditions such as AIDS victims, when the world already has a epidemic on their hands. The second approach to public health is to deliver prevention to those who need it, like the people who are becoming obese, which is a risk factor for developing heart disease, diabetes, and cancers. Most of the PH people I talk to imagine that they will spend their careers preventating the onset of diseases through awareness and education.

But education and awarness simply isn't enough. People don't typically proact - they react. People get haircuts when their hair is too long, they don't get their haircut 2 months before it needs cutting. Many people think of their health the same way... they don't need to exercise - they look attractive, healthy, why worry?

I think as PH professionals we need to change the way insurance programs work, and maybe implement an idea where when people come into the office and they show precursor signs of disease, they should be enrolled in modifiable lifestyle programs. Impossible I'm sure, but it's my two sense anyway.

Great quote:

"The Superior Physician prevents sickness;

The Mediocre Physician attends to impending sickness;

The Inferior Physician treats actual sickness."

- Traditional Chinese Proverb

Graphic reference: Smegma (foreskin) increases cancer in women.

Presentation Info: I even gave a presentation, with my lovely class mateWilson, on cardio vascular disease - and in the process of doing research I found some great information on the National Geographic website plus the video we used in our presentation. http://www7.nationalgeographic.com/ngm/0702/feature1/

Infectious Diseases

Lecture from 1.25 was all about communicable ( infectious diseases). It reminded me of the first day of class when Professor Shahi said, "It's a wonder that so many people cram themselves into airplanes with all sorts of germs and bacteria, share the same air for a period of hours, and walk away clean from disease."

I thought of exposure and forces of health three reasons. 1 - immunity from immunizations, 2 - how fortunate enough to live in a sanitary environment, I am to have a high level of health as to be able to fight off foreign diseases, 3 - a pandemic is imminent.

1. Immunizations - those countries and people who can afford immunizations at birth (that aren't weighed down with mercury) typically do benefit by being immune to contracting awful diseases like smallpox.
2. Rich vs. Poor - "...diseases hide among the poor." That's why Malaria is in S. Africa and not in the USA. The USA has paid for land reform eliminating swamp lands, and curing the people from the disease - so mosquito's can't pass it along.
3. most infectious diseases are first introduced to a community kills a handful of people... and a few years later the disease returns as a fiercely fatal pandemic (i.e. the Spanish plague). It kind of makes us think that after SARS in 2003/2004 we were introduced to this corona virus, and since then we as a global community should be humming the jeopardy tune and waiting around for the avian flu to return in a similarly horrid manner.

The final point I have to make is that, "neglected diseases" affect as many individuals worldwide in mortality and morbidity as AIDS, for which there is AIDS day, numerous AIDS foundations, walks and charitable ideas; but the neglected diseases such as elephantitis are typically not on the public health officials' agenda.

RevolutionHealth.com

In years past, people could search on www.webmd.com for free medical information, but there's an article about Steven Case, an entreprenur, who is waging that consumers will pay up to $100 annually for premium health services on the new website: www.RevolutionHealth.com. He is claiming to "remake" the health care system by including interactive chats, information, storing and maintaining personal health records (i.e. a one stop shop). Here is a link to the article.

http://online.wsj.com/article/SB116943004976583309-search.html?KEYWORDS=revolution+health&COLLECTION=wsjie/6month

Lecture 1.18.07 - Globalization, Development and Health

My opinion on 2 topics raised… Controversy between the expanding pie vs. the fixed pie – is there an end point to our resources? I believe not – is there an end to how much someone can smile, no way – if you wanna smile you’ll find a way, if we want everyone to be healthy - we will find a way. Also, I loved it when Professor Shahi said, "a true way to measure the test of human development is to look at the wealthiest children and the poorest children in a region – and if both have a chance to survive – then the society has a chance to thrive" (but I guess this only is possible in communist societies where everyone is given the same opportunities to flourish).

Globalization is a controversial topic because overall its implications are beneficial to those who follow suit with emerging trends, but it can also be detrimental to those who aren’t able to broaden their horizons and go global. The point to take away from this lesson was that we, as members in the public health profession cannot be negligent to addressing all side effects of globalization (inequalities in sanitation, life expectancy, access to healthcare, safety). We must acknowledge and create policies so that adopting globalization can go smoothly. It will be essential to continue to globally research and respect the benefits of globalization for as long as we can work together as a world to be healthy and safe together.

https://blackboard.usc.edu/courses/1/20071_pm_565_41128/content/_267071_1/Emerging%20Trends%20in%20Health%20slides%202.ppt?bsession=200346&bsession_str=session_id=200346,user_id_pk1=2023,user_id_sos_id_pk2=1,one_time_token=#263,8,The North/South; Rich/Poor Divides

Our class discussions this week were very interesting because we talked about how globalization can bring about two types of implications when introduced to a society. It can first bring about change in a positive manner and this happens … so long as the people “ride the wave,” welcoming and adjusting to new ideals such as innovations in technology like industrialization with factories. The other way globalization affects people is negatively. This happens when resisting change causes people to become marginalized in ways both socio-economically, politically and they then suffer. This is an issue is when a society has both innovators and laggards within the same boundaries. A gap evolves to separate the innovators from the laggards which creates a rich/ poor, urban/rural, north/south divide – which affects everything from human development to safety and security, or as Dr. Shahi said, “The haves, and the have-nots.”

Great Article 1.16.07

I read the most amazing article in the WSJ this morning it's about the public health care system in China. It's called, "In China, Preventative Medicine Pits Doctor Against System" by Andrew Browne.
http://online.wsj.com/article/SB116891144192977210.html?mod=hps_us_pageone

The article talks about how in Dr. Hsu, provides free medical advice on, "how to avoid high blood pressure," and he also dispenses cheaper medications (i.e. generic drugs vs. brand name options), which has made him an outcast among physicians and medical professionals in China. The bottom line as the article stated, Dr. Hsu is bad for business profits because encouraging prevention lowers the number of sick people needing medical attention and expensive drug prescriptions.

Health care in China is privatized, and the most startling statistic mentioned is that 2/3 of the 1.3 billion population have no health insurance and must pay up front for treatment, and if they cannot, the hospitals refuse treatment. The article mentions that those who have money have the opportunity to live, but those without money, "wait to die." Forty-three percent of hospital patients in 2003 discharged themselves early, against medical advice, and 2/3 of them because they had no more money, based on findings from the Chinese Health Ministry. In one instance a three or four year-old boy was rushed into a hospital suffering from the toxic effects of pesticide poisioning. Doctors told the man to get more cash before they would help the child, so he left to get the money and when he returned to the hospital it was too late, the child had already died. This incident angered some 2,000 people who mobbed the hospital.

In this country, the physician income is comparable to the average income, but phyisicans can make multiple times their salary as they order more numbers of expensive tests per patient: such as cat scans, pace makers and laser surgeries - the more ordered the more cash flow it added to their salaries.

Readings after Lecture 1.11

Week 1 - Global Health Issues
I've done the readings and watched the videos for weeks one and two, and I've began to reassess the way that I perceive the world as a westerner, similar to Professor Hans Rosling suggested, "Us as the western world, and them as the third world."

I have to agree that I have always believed that there are greater disparities between the two worlds. In all actuality there is such a spectrum of health disparities within each country that there is no telltale way to homogenize health descriptions of a country or region becuase the best health care of the third world may be better than the worst care of the western world.

In regards to the 8 Millenium Developed Goals by 2015 all I can say is wow, what an ideal. The MDGS 8 ideals, see pitcure above. I feel so synical to think that none of these will be acheived - but I have a hard time believing that our nation will contribute to these goals internationally when all our politians in DC seem to be focused on is winning a war that we are under staffed, ill-equipped to win - and yet determined to stay the course for however long stubborness guides the way. As some are calling it, the worst foreign-policy blunder since the Vietnam War.

Week 2 - Does Inequality Matter?
Plato once said, “There should exist among the citizens neither extreme poverty nor again excessive wealth”, he wrote, “for both are productive of great evil,” a very biased opinion at inequality... if I don't say so myself. However, there is a substantial amount of evidence to support this statement - in the areas of wealth, religion, gender, ethnicity. As case examples Pakistan and their unequal gener issues along with their coinciding decreased economic growth; as well as Bolivia and Ecuador's conflict about natural resources between wealthy and the poor indigenous people and overall decreased outputs.

I really agreed with the idea that there is a strong correlation between poverty and inequality. One really cool thing that I liked from one reading was about comparing the average income of the poorest 20% of the people, as a way to compare statistics as opposed to comparing average income of countries.

The video looking at Taiwan, Vietnam and Kenya was very eye opening. I didn't realize how important globalization is to benefitting the economy and living conditions. I am very impressed at how far Taiwan has come, and I found it very unique that the Kenyans said that when they needed food during drought - no food was aided, but when they were harvesting wheat - wheat was imported with an overabundance and market competition. Here's the video link: http://video.google.com/videoplay?docid=5633239795464137680&q=globalization&hl=en

The second video posed an issue, why do we only think about health or safety when it is challenged."
Most shocking, was the part about the Marshall Islands have endured with the 67 bombs... and their aftermath of harming the regional inhabitants. Here's the video link: http://video.google.com/videoplay?docid=-2366159791400068176&q=globalization&hl=en

Lecture 1.11.07

The first course lecture on Thursday 1.11.07 demostrated a refreshing and innovative approach to the master public health program as well as to public health.

A few things were exciting to listen to... one was that my final could potentially get published as long as the paper is good (i.e. a b+ or better). That's exciting news, although it was funny to hear that the last class who published a book brought in about $80 in profit.

I liked the philosophical quotes he included in lecture they were motivational and philosophical. "The Best Way to Predict the Future is to Prevent it," Alan Kay. They reminded me of the movie, "The Secret," which is about the laws of attraction and the present being a result of past efforts and thinking, and present efforts will show tomorrow.

Gurinder, presented a slide which predicted leading causes of death in the year 2020 internationally. As of 1990 the top three causes of death were: lower respiratory infections, diarrheal disease, and conditions arising from perinatal care. In 2020, the top three causes will be heart disease, major depression, and ironically road traffic accidents (lol - I can attest to poor drivers in LA).

The current global statistics he presented were alarming, but I can't say they were new about the trends in increasing heart attacks, obesity (30% of the population in 2000, up from 12% in 1960) and chronic diseases like cancer and diabetes, and away from influenzas and diarreal deaths.

My favorite slide what entitled "evolution of humankind, it this our future..." which showed the evolution of mankind starting as homosapiens and ending in overweight poorly postured fools.