Most Popular Global Health Posts
The Global Economic Downturn and Global Health
Published January 10, 2009 @ 09:05PM PT
The worsening global economic situation is scaring the spit out of all Americans. But, frightening as it is in the developed world, it may well hit the developing world harder. While some protection will be provided to the countries that are less connected to the world economy, everyone is going to take a hit. Here are a few of the most obvious consequences for global health:
(Before I start, I want to point out that UNICEF has written a really excellent paper on this. I'll be reviewing it in my next blog post. For now I'll just give you my own take. We'll find out tomorrow how closely that coincides with UNICEF.)
Hunger
This one is tragically obvious. A weak global economy means less income, and less income means less food. Malnutrition rates will rise across the board, throughout the world. I think people are going to be surprised by how bad malnutrition will get in some developed countries, and I think that it's going to be gruesome in places that are already food insecure, like Somalia and Afghanistan.
Girls
It is generally accepted that girls and women suffer most during uncertain economic times (although I have seen evidence to the contrary). Already lowest family priority in many countries, girls tend to lose a disproportionately large share of shrinking family resources. Families put their money into boys, expecting them to become breadwinners. The global downturn will lead to lower educational attainment by girls, earlier marriage, and a worsening of female health status. It may also see girls enter sex work in greater numbers, whether because they were sold by their parents, or as a deliberate, desperate, decision to earn money.
Childbearing patterns
Global economic problems will exacerbate existing patterns. In countries where children are a cost-center, we'll see even lower fertility rates. In countries where children are a profit-center, rates will go up. So we'll see fewer children per capita in countries like Sweden and Japan, where child rearing is expensive and children do not contribute money or labor to the family. In countries like Pakistan or Bolivia, where children contribute to the family income, birth rates will rise. Russia could go either way. Nobody understands Russian fertility.
A teeny-tiny glimpse of optimism
Within national budgets, foreign aid makes up a vanishingly small percentage of total spending. In 1975, donor nations got together and made a historic pledge. They would dedicate a fixed percentage of their GDP to foreign aid. A whole .7%. Less than one percent of their total budgets. And, of course, they haven't actually achieved that target.
That bit is depressing. But the silver lining is that it's really not worth cutting aid budgets, not even in an economic downturn. There is no reason that donor assistance should shrink. The World Bank and the International Monetary Fund have already explicitly stated that they will not cut aid as a result of the economic situation. We're also starting to see encouraging comments from donors.
If foreign aid levels are maintained, we'll be able to protect the poorest and most vulnerable from some consequences of the financial downturn. It's not much, but it is something.
More resources on commercial sex workers
Published January 09, 2009 @ 09:54PM PT
(cartoon drawn by sex worker comes from the EMPOWER foundation website)
To follow up on my last post about commercial sex work and HIV, I wanted to highlight some excellent information sources about sex work. It's a topic that is key to many global problems - human trafficking, global health, human rights. That has led to some really interesting research being done, from a lot of different disciplinary perspectives. I have also noticed that for some reason, we have the gift of a lot of first-person information about commercial sex work; we get to learn from them telling their own stories and teaching about their world.
Elizabeth Pisani wrote a really interesting book called The Wisdom of Whores, and she followed it up with a blog of the same name. Recently she has written about smoking ARVs (she's not convinced it is really going on) and Indonesian pornography laws, and argued that we can't actually treat our way out of the AIDS epidemic.
The Sex Workers Present channel on blip.tv is a great example of a first-person resource. It features videos made by sex workers around the world (okay, mostly Cambodia) expressing their views on policy and law that affects them. It's an impressive advocacy tool, and an enlightening view into a complicated and dangerous world. I am especially fond of this program because the sex workers aren't just telling their stories because someone thinks is valuable or therapeutic. They are using their voices to advocate on issues that affect their lives.
Making Sex Work Safe is an excellent resource guide on planning projects to address commercial sex work.
The Empower Foundation in Thailand is an NGO devoted to helping sex workers improve their own lives. It takes a neutral stance on the issue of sex work, focusing instead on helping individual sex workers live lives of their own choosing. The Empower Foundation website is a fascinating view into the lives of sex workers and the Foundation's activities.
Sex Work and HIV - like peanut butter and jelly?
Published January 09, 2009 @ 08:26PM PT
Amanda wrote about HIV and sex trafficking today in the end human trafficking blog, so I thought I'd toss out my two cents.
People really like to pin HIV transmission on sex work. I think it's comforting to think of AIDS as something that belongs to risk groups like sex workers and drug users, and not something that can happen to regular people.
The truth, as always, is more complicated. While AIDS has a devastating impact on commercial sex workers, prostitution is not synonymous with the spread of HIV. Sex workers are at a very high risk for getting AIDS, pretty much globally. But they are not necessarily a major driver of AIDS epidemics. In some places they are, especially Southeast Asia and Central Asia. In other places, like Western Europe, not so much. There is an awful lot of conflicting writing out there about HIV and commercial sex workers. Some of it is good, and some of it is based on very shoddy research.
The best paper I have seen on the topic argues that there are two important numbers that determine whether sex work is an important drive of an AIDS epidemic. The first is the percentage of the total country population made up by sex workers. The second number is the percentage of sex workers infected with HIV. Together, they represent the role of commercial sex workers in the epidemic.
This means that global organizations like PEPFAR and the Global Fund don't get far trying to set general policies on reducing HIV in commercial sex workers. Effective responses will be planned country by country, and adapted to local circumstances within a nation.
Sometimes it’s good to be wrong
Published January 08, 2009 @ 09:21PM PT
Astute commenter Evelyn Garland pointed out that I got it wrong about the President's Emergency Fund for AIDS Relief (PEPFAR). There is no longer a required 7% of funding for abstinence-only education.
The Abstain, Be faithful, use a Condom (ABC) approach remains, but in a less directive way. Instead of a mandatory 7% level of funding, implementers have to write an explanatory report if they spend less than 50% of their prevention budget on abstinence and fidelity. It's still a lame attempt to force a useless activity into places where it won't work, but now it has leeway. That's a huge improvement. (In my own defense, I was keeping track of the PEPFAR reauthorization process, but I somehow missed the shift from a hard budget earmark to this gentler language.)
The change in prevention requirements is not the only interesting thing about the new PEPFAR.It now allows funding for tuberculosis vaccine development, and formally authorizes assistance to develop microbicides against HIV. It also mentions medications for opportunistic infections like thrush and pneumonia. Since opportunistic infections often end up killing people with HIV, being able to use PEPFAR money to fight them is a big deal.
So, in conclusion - I was wrong about the PEPFAR legislation, and I am very glad to know that.
Five Global Health Problems that are much worse than they sound
Published January 08, 2009 @ 09:04PM PT
When I ask people about global health, they usually mention HIV or bird flu. Sometimes tuberculosis. But there are some really destructive problems that people hardly think about at all. Here are five:
1. Diarrhea
In the developed world, diarrhea is an inconvenience. It's embarrassing and you probably have to go buy some Imodium. To children in the developing world, diarrhea is often a death sentence. Diarrhea and dehydration resulting from it kills more children under five than malaria, AIDS and tuberculosis combined. The worst part is that there is good treatment for diarrhea, if we can make it available - oral rehydration salts, and IV hydration if necessary.
2. Respiratory infections
In a child who is already malnourished or sick, respiratory infections go from mild colds to pneumonia very quickly. Influenza is always dangerous for children. 20% of the children who die in the developing world die of respiratory infections; mostly from pneumonia.
Top ten global health video resources
Published January 07, 2009 @ 08:25PM PT
If you’re someone who prefers your information visual, there are a lot of global health video resources out there. There are, I admit, a lot of slidedeck-with-commentary videos, and a fair share of speaker-at-a-podium, but there are also some really innovative uses of the video medium.
1. Ernest Madu: Bringing World Class Health care to the developing world Dr. Madu’s talk at the TED conference is an inspiring account of providing excellent health care, despite resource constraints and challenging circumstances. His optimism is infectious, and makes you see how the world could be better.
2. Cambodian Sex Workers fight HIV/AIDS through video. In Caught Between the Tiger and the Crocodile, Cambodian sex workers advocate against a law which that holds sex workers exclusively responsible for condom use, that they believe to be abusive. This powerful video demonstrates why. The sex workers, by the way, have their own blip.tv channel.
3. Millions Saved – Ruth Levine presents past successes in Global Health, and what we can learn:
4. James Nachtway: Extremely Drug Resistant Tuberculosis James Nachtway is a documentary photographer who has been moved to tell the world about the ravages of extremely drug-resistant tuberculosis. This slideshow of his photographs is moving and excruciating.
5. Hans Rosling rocks the house with his slides on global health statistics. This is an absolutely amazing presentation.
6. The Charlie Rose Show did a global health panel, with some big name speakers: Ann Veneman, Jeffrey Sachs, Peter Hotez, Paul Nurse and Tonya Villafana. It’s a nice introduction to global health issues.
7. I didn’t pick this one for the soundtrack, but it helps. An overview of Global Health disparities, with a soundtrack from Blind Boys of Alabama.
8. Cheryl Scott, chief operating office of the Gates Foundation, talks about what can actually be done to improve global health.
9. Jim Yong Kim, a Harvard global health professor, talks about the challenges of improving access to HIV/AIDS medications, and about how the drugs alone are not enough. There’s no embed code for this one, so you’ll have to click on over to the Boston University website that hosts it.
10. “What are you going to do about it?” Harvard School of Public Health on HIV/AIDS. An inspirational story of a doctor who began doing volunteer HIV work. No embed code here either – I guess universities really like to contain their content.
Abstinence only education needs to be stopped
Published January 07, 2009 @ 07:41PM PT
So, we finally have conclusive proof that abstinence-only education doesn't work in the US. In fact, it's worse than just not working. Abstinence-only education is worse for teenagers than doing nothing at all. Young people who go through an abstinence-only education program are just as likely to have sex and they are more likely to do so without protection. And let me tell you, most public health types have known this for years. Abstinence-only education is a useless, damaging load of hooey.
For those unfamiliar with sex ed - abstinence-only education is exactly what it sounds like. It is an educational principle that young people should be taught to abstain from sex and why abstinence is important. It does not provide information about contraception or about sex and sexuality. The curricular focus is solely on why sex must be postponed.
Now, I am not one to ignore the role of culture in educational interventions. Every situation is unique. It seems to me though that if we can't get fundamentalist Christian teenagers in Southern Mississippi to abstain from sex, it's not a huge leap to argue that we also can't get people from historically polygamous cultures to abstain from sex. In other words -
It's time to abandon Abstain, Be faithful, use a Condom. This is the mantra of PEPFAR, the US-funded President's Emergency Fund for AIDS Relief. All PEPFAR-funded HIV education efforts must follow that formula, and include all three points. 33% of all HIV prevention funds - 20% of the PEPFAR budget - must be - according to the organization's congressional mandate- spent on abstinence only education.
Yes, that's right. We are requiring that 7% of our HIV budget be spent on programs that have been scientifically proven not to work. Oops! Sure, nine out of ten Americans have sex before marriage. But we expect the developing world to do better at that kind of thing, right?
PEPFAR is a good idea. More money for AIDS prevention and treatment is a good thing. Wasting limited PEPFAR funds is not. It's time to free the PEPFAR budget from loony congressional restrictions on what can be funded. PEPFAR should be funding the efforts that will do the most good for the least money. End of discussion.
