Most Popular Global Health Posts
Female Condoms, a Mea Culpa
Published January 06, 2009 @ 09:22AM PT
(photo credit: wikipedia France)
It’s been accepted wisdom in global health for quite a while that nobody likes the female condom. It’s bulky. It makes a squeaky noise while in use, and you can still see it after it has been inserted. It’s expensive. It’s difficult to put in. It is, all in all, profoundly unsexy. (admit it - you even find that picture up there vaguely icky)
And despite all that, it looks like accepted wisdom has been wrong. Here’s the thing we forgot – for a huge slice of the female population, sex has nothing to do with “sexy.” Sex is paid work, coerced work, a form of slavery, or an unpleasant duty for one’s husband. In those circumstances, a little insertion effort in return for protection from HIV or Herpes is well worth it.
Which makes those of us who scoffed (And yes, I was one of them. I bought a female condom, found its looks and feel hideous, and never thought about it again except as a very bad idea.) look like insensitive jerks that can’t get past our own experience.
I was put in my place by a recent Oxfam paper that someone recommended to me on Twitter. Called “Failing Women, Withholding Protection,” it thoroughly debunks the idea that the female condom is hated by users. It says that the reasons for neglecting female condoms “mirror the common reasons for not using a male condom: responses formed by ignorance, culture, denial, ‘poverty’, and conservatism. Added to this are overarching errors of a lack of leadership, a huge funding bias against existing forms of primary HIV prevention, failure to scale up programming, and failure to invest in strategies to lower the cost of female condoms.” Ouch.
South Africa’s Mail & Guardian online was way ahead of me on this discovery. It was already making this point in 2005, when it said that “Sniggering at the (female condom), it seemed, was a privilege only for those lucky enough to have a choice about whether to sleep with a man who wouldn’t wear protection.”
It’s pretty clear at this point that neglecting the female condom is a public health embarrassment. A commenter on the From Poverty to Power blog pointed out that it really doesn’t matter if most people hate the female condom. Most contraceptive methods have trouble with acceptance. The question is – even if it is hated – why has no one supported efforts to improve the design? It could make a major difference in female empowerment, and yet it hasn’t been pursued.
If you want to do something about this neglect, you can join Prevention Now, a global anti-AIDS campaign that promotes the female condom.
About the female condom
The female condom was developed by a Danish physician named Lasse Hessel, who is really pretty eccentric. He also invented two kinds of diet pills, and used MRI technology to determine how women could better experience sex.
It consists of two rings, connected by a polyurethane or latex sheath. One ring is inserted into the vagina, while the other remains outside. It serves as a barrier method against HIV and sexually transmitted infections. It is less effective than the male condom, but far more effective than using no protection. You can find more information about female condom effectiveness here, and instructions for use here.
Global Health Ideas for Change – My Thoughts
Published January 05, 2009 @ 10:01PM PT
Let me start off by saying that I have nothing to do with the ideas for change selection of this site. It's based on how many votes each idea gets. The topic editors have no special say in which ideas move forward and which don't. So this is my opinion on each of the three ideas in the Global Health category, but I don't have any extra weight in the voting. Don't take my word for anything; go check each idea out for yourself before you do any voting.
Idea # 1 - Peace Care -- Bring Together Peace Corps and Resident Physicians to Impact Global Health
Summary: Peace Care would have Peace Corps volunteers partner with an American residency programs to do exchanges. The goal is to build long-term health system capacity in developing countries.
I strongly agree with the premise of this idea. Global health disparities are severe, and health systems in developing countries are in desperate need of support. Additional staff and training would be of real assistance.
However, I am not convinced that Peace Care would be the best way of achieving that outcome. Exchanges are always expensive. Airfare, housing, and insurance add up fast. It might be better to use the funds you would have spent flying a resident to support local master trainers in training physicians, or some other project to improve health system capacity. Secondly, it is very hard to maintain the impact of exchange programs. Once participants pass through the program, their efforts are often lost. Lastly, I really can't tell for sure what the residents are bringing to the table. How exactly will they build local capacity?
Idea #2 - Invest in health workers to improve the health of the poor
Summary: The US should increase investment in human capital for global health, by creating a corps of physicians, nurses, pharmacists, lab technicians and computer specialists and deploying them to hard-hit countries lacking health infrastructure. The US should also support the training and employment of community health workers in these countries.
Once again, I agree wholeheartedly with the premise here. Human capital for improving global health is an extremely important issue. Health care providers are an key part of improving human health, as are health systems.
I have concerns, though, about the ability of a few individual advisors to change entire health care systems for the better. Systemic change takes money and political will. The idea does not mention budgets for these advisors to spend, and I think that people who stay in a country for 1-3 years will not be able to develop the political traction to bring about change. This idea is similar to both the Liberia Fellows program, and the USAID global health fellows program. We could look to their experience to see if this one would work.
As for the second part of the idea - I love training community health workers. I am totally on board with that. And working through existing funding mechanisms is the fastest, most efficient way to do it.
Idea #3 - Save Children from Preventable Diseases
Summary: Fight preventable causes of child death by supporting low cost interventions, and do more research on ways to reduce child mortality.
Overall, I think this idea is great. There are so many things we can do to save children's lives - water filters, vaccinations, oral rehydration salts. These are proven to work, and don't cost much. Several of them have been included in the Copenhagen Consensus. We can protect vulnerable children using tools that actually work. We should do so, immediately.
My concern about this idea is that it is so broad. It includes vaccine research, water filters, vaccine research, and more. That is a lot to implement and to track and evaluate. Focusing on one aspect or child mortality might be a more effective way to go.
All in all, I think each of the three ideas represents some serious thought about global health and how to make it better. We've got something to learn from all three.
Global Health predictions for 2009, part two - reader contributions
Published January 05, 2009 @ 07:49PM PT
(photo credit: Julien Harneis)
There were some fascinating comments on the global health predictions post. Just in case people have been skipping the comments, I wanted to call out five of the most intriguing comments:
1. Disability issues will become an official part of public health, with less special interest lobbying or focus on specific divisions/types of disease/disability. - Darlene Matthews
2. A revival of the debate regarding patents and how much control pharmaceutical companies have over their intellectual property, when considering the human impact of drugs and vaccines not being affordable enough for people who need them the most. This may be particularly prominent in the area of HIV treatment. - Vanessa Mason
3. The availability of safe clean water supply in a time of global environmental change will be a major growing issue from both a health and a political stand point. - Ned Snyder
4. India and China will see major public health problems; their populations are large enough to make that certain. - Santeh Galobale
5. More pilot programs using mobile technology as a rapid information source in rural areas in the developing world. - Nathaniel Whittemore
Eight Ways to Make a Difference in Global Health
Published January 04, 2009 @ 09:06PM PT
(image credit: World Economic Forum)
Global health can seem like an overwhelming field. It covers so many different topics, and is affected by so many different things. It's hard, sometimes, for one person to see a way to make a difference. But you don't have to be Bill Gates to make a difference in global health. The key is to figure out what you care about, and then figure out what you can give. It could be money, it could be time, or it could be expertise.
1. Identify the health issues you think are most important, and educate yourself about their causes and solutions. You can’t be an effective advocate if you don’t know what you’re talking about. The about section of this blog will get you started if you need an easy place to begin.
2. Spread your new knowledge around. Talk to your friends. Comment on blogs (this one, perhaps), put an interesting link in your Facebook profile, or start a blog yourself. Write to your newspaper.
3. Join MERLIN's Hands up for Health Workers campaign. MERLIN is a humanitarian NGO devoted to creating a world where basic health care is available to all. Their Hands Up for Health Workers campaign is dedicated to training health workers around the world, to make health care available to everyone.
4. Volunteer online with UN volunteers. The UN volunteer program places mid-career professional with UN agencies around the world that need their expertise. The online volunteer program allows UN agencies to post specific tasks that they need help with which can be done virtually. You just browse the list and find something you want to do. It lets you give your time to a whole range of things, in the kind of small bites you can easily donate. It’s a great use of the internet. The health volunteer requests are here, and they currently include grant-writing, database development, and online teacher training.
5. Hold a fundraiser for a health cause you believe in. This could be as simple as a bake sale or as complicated as silent auction. Ehow has handy instructions on how to plan a fundraiser.
6. Use your internet presence to fundraise for the causes that matter to you. You can start a fundraising page here on Change.org.
7. Join the White Ribbon Alliance for Safe Motherhood. Giving birth shouldn’t lead to death, but every minute a woman dies in childbirth. Support the White Ribbon Alliance to help make motherhood safe for all women.
8. Advocate for increased government funding for global health priorities. Write your elected representatives, and call for your government to devote funding to global health. I suggest safe motherhood, child survival, and primary health care as funding priorities, but those are just recommendations.
Global Health Includes You
Published January 03, 2009 @ 07:01PM PT
(Image credit: Isabel Bloedwater)
It’s easy to fall into the habit of thinking of global health as other people’s problems. Particularly the problems of poor people living far away from you. But the fact is, we’re interconnected, and people in the more-developed world have health problems, too.
And health problems in any one place affect the rest of the world. Not just in an idealistic, John Donne sense, but in an immediate practical way. These impacts run from brain drain to affecting the world market for poppies.
That means that one important way to affect global health is take care of your own health, and that of your community.
On a personal level, don’t become part of the worldwide epidemics. Use a condom, eat carefully, don’t smoke. Get some exercise. Wash your hands a lot. Research any medical conditions you have, and be an active participant in your own care. Stay up to date on health issues that affect you and your family.
On a community level, take your role as a community member seriously. Look at your community, and identify what you personally can do to make people healthier. Can you pick up litter or rubbish to make your community more walkable? Can you provide some fruit to go with the office candy dish? Distribute condoms at your next kegger? Can you volunteer at a clinic or a shelter? Finally, join others in your community to bring about change. Locate community organizations that promote health and well-being, and join them. Give your time, your energy, your money, or all three.
Individual choices do add up. Make the choices that add up to positive change.
Five Global Health Predictions for 2009
Published January 02, 2009 @ 08:06PM PT
(Womens leprosy ward in India. photo credit: Erin Collins)
Antibacterial resistance will get worse
Antibacterial resistance will keep getting worse. Bacteria are evolving at a terrifying rate, because of overuse and abuse of antibiotics. As a result, more and more first-line antibiotics will become useless, in both the developing and developed world. A standard treatment for either malaria or tuberculosis will cease to be effective, and the WHO will remove it from the treatment guidelines.
Malnutrition
Rising world food prices are going to mean poor people go hungry more often. We’ll see substantial increases in rates of malnutrition. There will be more UN appeals to help the starving, and they will rarely be fully funded, as cash-strapped governments start to cut their donations.
Improvement in AIDS care
We’ll see longer average life spans for people living with AIDS. This will result from better access to HIV drugs because of new funding sources and cheaper generic drugs, better treatment of opportunistic infections, and more focus on nutritional support for people with HIV. The rates of new infections will continue to rise, but the infection itself will be better controlled throughout the world than ever before.
Scandal involving fake or contaminated drugs
A large amount of fake or contaminated pharmaceuticals will be discovered; something that has international reach and is on the scale of the melamine contamination this fall. Drugs and their ingredients travel long distances, with relatively little tracking. A problem with Chinese or Indian manufactured pharmaceuticals could affect most of the planet. While finding the source factory might not be difficult, removing all affected product from store shelves would be impossible. We’ll learn that the hard way in 2009.
Tropical diseases on new places
We will see traditionally tropical diseases like malaria, sleeping sickness, and dengue fever spread. The neglected tropical diseases will start to seem a lot scarier. At least one of them will be diagnosed repeatedly in a location that has never seen indigenous tropical disease before. (my money’s on Onchocerciasis)
Can we end Dengue Fever by altering mosquitoes?
Published January 01, 2009 @ 09:28PM PT
Dengue fever is a tropical virus, spread by infection-carrying mosquitoes. It’s a nasty debilitating sickness that goes after kids. It has so far been limited, as it needs a warm climate, but global warming has been expanding the dengue habitat. We've seen a steady expansion of dengue's territory since the 1980s, and a 30-fold increase in cases of dengue over the last 50 years. It has no vaccine, and no treatment beyond intravenous hydration. It kills 5% of the people it infects, and 40% of those who go untreated. Dengue is especially fatal to children under 15 years old.
So far, all attempts to develop drugs to fight Dengue have failed. Efforts have focused on developing drugs which target certain parts of the Dengue virus, killing it. They may well see success, but it will take a long time before we’ve got drugs that work.
Since Dengue is mosquito-borne, the other way to fight it is to go after the mosquitoes. Researchers in Australia are doing exactly that. They have cultured bacteria in order to inject them into mosquitoes. The bacteria then shorten the mosquitoes’ lives. A normal mosquito lives for a month; these bacteria-infected mosquitoes only live for two weeks.
And why does the mosquito’s life span matter? Because the Dengue virus takes its time maturing, and it is only infectious at the end of its cycle. Two weeks isn’t long enough for the Dengue virus to do its thing. So the mosquitoes can fly around biting everyone they want (unfortunately) and play their role in the eco-system (food for bats and frogs, mostly) but still refrain from spreading Dengue fever around. That’s pretty nifty.
If the thought of getting rid of Dengue wasn’t cool enough, here is an even better thought: malaria has a complicated life-cycle that lasts 10-18 days in the mosquito. Shorter-lived mosquitoes might well reduce the spread of malaria as well as Dengue.
If you want to do something personally to fight Dengue, you can sign up at the World Community Grid, and donate your computer’s excess computing time to developing drugs to kill the Dengue virus.
