Earlier this fall, my oldest son invited me to watch him run his first half marathon in Durham, North Carolina. While standing at the starting line, facing hundreds of runners of different ages, I could not help but be amazed by the irony of the situation: In the midst of a region in the United States known as “tobacco road,” there was tangible evidence of a significant, healthier turn in people’s norms and behaviors.
I consider myself a pretty lucky person. I often work across the beautiful islands of the Caribbean, with their glistening turquoise seas, the lush greenery, fresh tropical fruit… I could go on, but I think you get the idea. Paradise is not always perfect, however: Beneath the postcard views is an often not-so-perfect public health system.
A recent “close encounter” in the Caribbean served as a stark reminder of this truth. Different from the movie “Close Encounters of the Third Kind”, it didn’t involve little green men nor giant floating spaceships, but something just as unknown, at least to me: chikungunya, a viral disease transmitted by the bite of infected mosquitoes.
Unfortunately, I was infected with chikungunya a little over a year ago during a work trip to the Eastern Caribbean in support a results-based financing project for the health sector. Our team was de-briefing near the ocean when it happened: I felt a quick sting from a mosquito bite, but didn’t think much of it. I felt unusually tired that evening, and by the next morning a number of other symptoms appeared – it was indeed chikungunya.
Measles cases in U.S. highlight need to eliminate vaccine-preventable diseases everywhere
The news media in the United States and abroad has been abuzz in recent days focusing on the measles outbreak at Disneyland. The irony of this situation is that measles, after being officially eliminated in the United States in 2000, reappeared in 2014 with 644 cases in 27 states as reported by the US Centers for Disease Control and Prevention (US CDC). The reason is simple: while in the 1980s, more than 97% of one-year olds in the United States were routinely vaccinated, the current share has fallen to 91%, facilitated by exemptions in some states that permit parents to “opt out” of vaccinating children on the basis of religious or personal beliefs. In other parts of the world, continued measles outbreaks in Europe, sub-Saharan Africa and Southern Asia have also occurred due to weak routine immunization systems and delayed implementation of accelerated disease control.
Food Safety is becoming a priority in Zambia. The government is revising its food safety strategy and preparing new legislation to improve and modernize food safety governance. In the private sector, a number of food enterprises are upgrading their food safety practices to stay on par with their peers abroad and cater to increasingly demanding consumers.
These improvements are timely and appropriate. While the extent of foodborne risks in Zambia isn’t fully known, recurrent cholera and typhoid outbreaks as well as the fact that 60 percent of the population suffers from diarrhea suggest that foodborne pathogens, poor hygiene and sanitation and other food safety risks are having a negative impact. Anecdotal information supports this point. In conversations with partners in Zambia, over a cup of coffee or dinner, I asked what they thought could cause diarrhea? Most of them responded that it was probably something they ate. They complained that while diarrhea was not a “big deal,” and that “their stomachs were used to bacteria,” it reduced productivity because they had to take sick days away from work. Aside from causing a high death rate among children and the elderly, these diseases place a significant burden on straining public health services, reduce the productivity of the working population and constrain development. Furthermore, the economic and human costs of these diseases are huge.
As we enter the second year of the “Stop TB in my lifetime” campaign, it is time to take stock of where we are and look at the key priorities for attaining this worthy goal. Beyond the banners urging the world to stop this curable disease are the faces of those afflicted by tuberculosis or whose lives were cut prematurely short. These faces remain etched in my memory and reinvigorate my drive to stop TB.
Another Sunday evening recently found me fuming through another science infotainment show as they abound these days on not-so commercial broadcasts. It made me think about how important science education is in development and how easy it is to do it wrong. Popular science education is essential, and not only in development. Climate change is one of the most obvious issues where people need to understand what’s going on and need to understand it fast. Health issues are another area where a better understanding of scientific principles can contribute to behavior change that could promote better public health. What I tend to see around, however, is not as useful as the producers may think.
On the eve of World Water Day (March 22), there is some good public health news that is unrelated to medical care for the “sick,” but to a critical investment that makes people healthier and more productive, and promises a higher quality of life, particularly among the poor.
The 2012 UNICEF/World Health Organization report, Progress on Drinking Water and Sanitation, says that at the end of 2010, 89% of the world’s population, or 6.1 billion people, had access to improved drinking water. This means that the related Millennium Development Goal (MDG) has been met well ahead of the 2015 deadline. The report also predicts that by 2015, 92% of people will have access to better drinking water.
But, the not-so-good news is that only 63% of the world has improved sanitation access, a figure projected to increase only to 67% by 2015, well below the 75% MDG aim. Currently 2.5 billion people lack improved sanitation. The report also highlights the fact that the global figures mask big disparities between regions and countries, and within countries (e.g., only 61% of the people in Sub-Saharan Africa have access to safe water).
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When healthcare professionals take the Hippocratic Oath, they promise to prescribe patients regimens based on their “ability and judgment” and to “never do harm to anyone”.
Although extraordinary progress in medical knowledge during the last 50 years, coupled with the development of new technologies, drugs and procedures, has improved health conditions and quality of life, it has also created an ever-growing quandary regarding which drugs, medical procedures, tests and treatments work best.
And for policy makers, administrators and health economists, the unrestrained acquisition and use of new medical technologies and procedures (e.g., open heart surgery to replace clogged arteries, ultrasound technology scanners to aid in the detection of heart disease, and life-saving antiretroviral drugs for HIV/AIDS) is increasing health expenditures in an era of fiscal deficits.
In many countries, I’ve see how ensuring value for money in a limited-resources environment is not only difficult but requires careful selection and funding of procedures and drugs. It also comes with serious political, economic and ethical implications—and with new drugs and technologies appearing every day, this challenge isn’t going away. What should countries do?