Getting the Word Out About Africa

December 23, 2006 at 1:52 am (Michael's Posts)

A good NY Times article forwarded to me that I forward on to the community here.  The article discusses the recent efforts to mount a wide, deep campaign against the simple diseases that afflict the poor.  Seems like some of these folks are after our own hearts.  Give a look.  Definitely food for thought.

I was struck by the multilateral efforts and the strong sense of network between the major players.  They also notably call for more interconnectivity.  As a big believer in the ability of a strong, extensive network to get big things done, I took this as reinforcement of my beliefs.  And also as encouragement that what we are doing here to encourage discussion and collegiality is a good thing.

Cheers, Global Health folks, and happy holidays wherever you are.


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Making money appear

December 22, 2006 at 1:26 pm (Sarah's Posts)

Quick thought about a program that reminded me about our discussion about how the pot of money for public health programs isn’t fixed.  About a month ago, I heard Clinton and Sonia Gandhi speak at an event to launch a pediatric ARV program in Delhi.  They both spoke quite a bit about UNITAID, an organization started by the gov’ts of France, Brazil, Chile, Norway and the United Kingdom. My understanding is that there is now an “air-ticket solidarity levy” on airplane tickets (somewhere between 1-40 euro depending on the country, the ticket price, and a few other factors).  That money is going into the UNITAID pot, which is used to buy drugs for malaria, TB, and HIV/AIDS.  By consolidating drug purchasing, they have been able to pressure drug companies into giving lower prices for these drugs. It is also a continuous funding source, which assures more stable care.  I don’t know much about their distribution process, but I believe that is where organizations like the Clinton Foundation come in.  My friend who is working for the Delhi branch was personally delivering pediatric ARVs to a clinic as Clinton was doing his lecture circuit.  Nothing too amazingly novel, but I thought it was a good example of how thinking outside the box can pull in money where it “didn’t exist” before.

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Electricity and Gasoline Taxes and Asthma (yes, they’re connected)

December 21, 2006 at 5:10 pm (Michael's Posts)

So I’ve been a little absent lately for a number of reasons, but this will hopefully mark my re-entry into the Blog-O-Sphere. I have been thinking about health very Globally lately (strange, no?) and I am arriving at some interesting conclusions.
I think that we as health people have the obligation to hook up with economy people and environmental people and political people and do some changing around here.
I don’t know how much attention the alarming rise in the prevalence of asthma in inner cities (well, in cities in general) has gotten, but I think it should get re-examined. Asthma is something easily treated with inhalers, etc and so we don’t really think about it. When was the last time someone you know was killed by asthma? I know of one young man who went to my brother’s school out of all the people I have ever met. That’s not an enormous number and its smallness says something. Asthma is not grabbing headlines as a killer.
But it is infringing greatly on millions of lives (20 million, according to this site). This should also include those suffering from chronic bronchitis (9.05 million) and emphysema (3.57 million). Some of these people may be feeling the effects of smoking, but some are suffering for other reasons.
People who suffer from chronic lung dysfunction are greatly limited in the things they can do. Even with an inhaler, sufferers are unable to choose to do many of the things that those who are asthma-free can.
Get ready, I’m going to take a bit of a leap in the form of a series of very rhetorical questions.
Is this not a fundamental infringement on the basic freedoms guaranteed us by the constitution? Does our government not have the obligation to protect these fundamental freedoms? Is this not why we pay taxes? To protect Freedom?
Well, White House, I have a request. Read our little article and discussion on the scaling-down of regulations on coal power plants (More Polychlorinated Biphenyls, Please) and then think about your obligation to the residents of coal-powered states who are breathing air clouded with particulate pollution and eating food poisoned with mercury. Or fly into any urban center on a sunny day and note the brown rim that hovers in the air just above the tallest buildings, invisible from the ground but so obvious and sickening from the air. Do you think that cloud of pollution is benign as it is breathed in every moment by city-dwellers?
The United States is responsible for 25% of the world’s CO2. This is unacceptable. It’s because we drive too much and because we drive inefficient cars. It’s also because we consume too much fossil fuel in power generation. Why? Because we want to destroy the environment!
No. Actually, our prices are artificially low. They do not take into account all of the costs associated with them. Power costs do not reflect the impact of fossil fuel power on the environment or our health. It’s electricity, though! It’s not dirty! It’s just electrons! But how do we make those electrons flow through the power cords? Coal! Oil! Gasoline costs do not take into account that all of the junk that comes out of tailpipes and apparently just goes “up into the air” (that we’re BREATHING) is costing us years of productive life and wellness. These years are worth something. “That’s fine,” we say, “because when I get my bill, I’ll just pay it.”
But what about the freedom to pursue life and liberty and happiness? What if that’s limited by the rashness of unregulated pollution? Is there not a moral quandary here? I think that this freedom is priceless and we ought to treat it as such. By placing an appropriate tax on gasoline, use would decrease as prices rose. Air pollution would fall. By placing a similar tax on power production, energy prices would rise and we’d be more careful about how much power we use and again, air pollution would fall.
What’s that Big Oil? Detroit? You have some qualms?
DEAL WITH IT. We have the technology and the brains to build more efficient cars. We must find some way to do it. If this research and development was driven by prices that included the true costs of our lifestyles, it would get done. But unfortunately, government bodies are the only bodies that can enforce a tax that would make our prices truly appropriate. And they are suckers for the Oil Lobby and the Car Lobby. But those powers can be fought.
So. Here’s my proposal.
Environmental people: Figure out what can be cut. What are the current impacts and by how much SHOULD we lessen them?
Economy people: come up with a tax that could bring about this change. Current costs and use patterns versus ideal use patterns.
Politics people: lobby, lobby, lobby! Use the good information from the Environmentalists and Economists to convince our friends in Washington that there’s good reason to do this. We got people to quit smoking through a simple tax and tobacco is a HUGE industry. Why not this?
Health people: keep putting pressure on things like this and using your experience on the ground level of things to inform the others. As the people with their fingers on the pulse, we carry weight in society and it’s time to put that weight to good use.

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Perspectives on NGOs Abroad: Critical care or colonial enterprise?

December 20, 2006 at 1:23 pm (AE Beacon's Posts)

    Non Governmental Organizations (NGOs) including foundations, non profits, individual donors and multi national organizations (to a lesser extent in this essay) have all seen unprecedented increases in healthcare sector influence abroad particularly in the last twenty to thirty years. As these groups extend their international influence, it is important that we consider the pluses and minuses of their work.

            From a practical perspective, NGOs are often the most nimble health providers available. Able to rally resources quickly around an initiative they can represent the sole provider of services in emergency situations where a government system is either non existent or debilitated. With their increasing budgets and on the ground staff, NGOs are rapidly becoming semi-permanent facets of the health infrastructure in many developing countries.

            However, the growth of NGOs abroad presents a new and hereto underappreciated threat to the autonomy of developing countries. Are international health workers the 21st century missionary? Particularly in Africa the conditions are certainly ripe for the subjugation of locale governance. Decimated by disease, inter ethnic war, famine and poor infrastructure, the western world has once again arrived with a self righteous hubris reminiscent of the 17th, 18th and 19th centuries. Touting medicine and food we’ve resurfaced in virtually every area of health (not to mention other aspects of education, agriculture, defense and countless others) to “save” the day.  Ironically, the most capable of these aid workers are often members of the colonial powers many African countries fought so bloodily to overthrow (see most of Sub Saharan Africa).  

The international health NGO has seen staggering growth in power in influence abroad throughout the past decades. Unbridled by bureaucracy, these players have shown their potential to enact change quickly and unilaterally even in the face of chaotic situations. However, NGOs simultaneously represent a growing threat to local governments. Their inherently undemocratic infrastructure, fervid staff, blossoming budgets and medical capabilities combined with low resourced and under structured health systems set the stage for the unfettered subjugation of local powers.  As we continue to insist on stepping in, do we even know when to step out? Perhaps that time is going to come sooner than we think.

A final note. A few months ago many around the world were outraged when Madonna adopted a small Malawian child. For many the concept of a western woman (undoubtedly exacerbated by Madonna being Madonna) removing a child from a developing country and, what later appeared to be an unwilling father, conveyed a disgusting sense of culturally imperialism. And yet this same image adorns the cover of countless international health books, webpages and brochures. Would we find her actions more acceptable if she was wearing a stethoscope? Conceptually we do. As we move forward whether on the ground, in our writing or even in checkbooks with international aid, it is important that we are as self critical as we are compassionate. Don’t get me wrong, people are suffering and need care, but let’s just make sure we’re creating history reminiscent of Achebe and not Conrad.

 Æ Beacon

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Circumcision cuts the risk of HIV infection

December 13, 2006 at 3:54 pm (Alex's Posts)

Huge AIDS news today, picked up all over the world – male circumcision reduces the risk of contracting HIV by about 50%, as shown by two large-scale clinical trials in Africa.  The outcomes were so decisive that the studies were stopped midway through. Read the Reuters story here.  Stay tuned for reactions from the NGO community and governments, especially the American administration.

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Melinda Gates speaks

December 11, 2006 at 4:29 pm (Alex's Posts)

This interview with Melinda Gates in today’s Wall Street Journal is interesting for those who are curious about priority-setting at the Gates Foundation.  I thought it was especially interesting, in her answer to the sixth question down, the way she mentioned the copper mining industry in Zambia as a partner in malaria control.  No doubt they are an essential partner, but it makes me wonder what the mining industry is like there, and if certain “compromises” are being made for the sake of the success of their Zambia program…

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Funding two global killers

December 6, 2006 at 11:25 am (Alex's Posts)

All the recent discussion of vaccines is very timely, given GAVI’s recent announcement that it will begin funding pneumococcal and rotavirus vaccines.  This announcement has been heralded throughout the international public health community as long overdue, and will hopefully mean a significant scale-up in efforts to vaccinate children against these diseases, responsible for over a million and a half deaths annually, almost entirely in the developing world.

Though I know less about rotavirus, it continues to amaze me that pneumococcal disease (which manifests itself in a variety of ways, from simple ear infections to deadly pneumonia and meningitis) doesn’t get more play in the international media.  It kills more kids than malaria, long considered the greatest scourge affecting children in the global South, and many, many more than HIV.  And the vaccine that’s currently available is very expensive and not entirely appropriate for the developing world – it was developed for a Western, industrialized-country market, and doesn’t cover many of the strains that cause the most death and disease.

And yet, it’s something.  Hopefully, we’re seeing the public health community and the world wake up to this disease, and to the fact that there’s something to be done about it.  A new, more appropriate vaccine will hopefully be ready soon (there are a couple in the works), and let’s hope it’s big news when it is. 

(In the meantime, those seeking to learn more should read this rather fun and entertaining NY Times article on Orin Levine, the director of the PneumoADIP, who’s a big voice on pneumo vaccines and just a generally nice guy.  You have to register, but it’s free.)

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More polychlorinated biphenyls, please

December 5, 2006 at 2:41 pm (Sam's Posts)

I just read this article about mercury consumption in my foster home state, Pennsylvania. Now, I should be wary of the fact that this came from an insert in UPenn’s daily newspaper, entitled ‘The Green Times’. Nonetheless, it was somewhat illuminating.

Pennsylvania is the 2nd highest mercury emitter in the nation, and 80% of mercury is produced from 36 coal plants within its borders.

Allegedly, once you ingest mercury, you’re done. It’s not leaving your body, ever. Also, it’s a neurotoxin, especially dangerous to pregnancies due to its ease of traversing the placenta and entering the fetal brain.

There are several things being done to protect the people. One is, state advisories against more than a half a pound of Pennsylvania-caught sport fish per week. Another is, national advisories against certain’danger’ fish like swordfish and king mackerel. These messages might help a little, if they were brought to the public’s attention. Up to now, though, I’ve never heard anything about these advisories. I’ll bet nobody has.

Then, of course, there is the whole emissions trading deal. Mercury is no longer classified as a toxic pollutant (a federal decision), which means companies that produce a lot of it can buy emissions credits from cleaner companies instead of forking over the capital to restructure and reduce their own emissions. So the hazard of mercury exposure is totally out of equilibrium. Areas with more coal plants, or more generally, older technology, get hosed, while new money reaps all the benefits of the emissions credit trade. I’ve read plenty of times about claims that emissions trading is only marginally effective, but this is the first time I’ve been told that its effect isn’t just marginal, but highly uneven.

Good for the governor, Ed Rendell, that he is pushing for more rigid restrictions and a quicker plan for emissions reduction. Among other things, he’s trying to block Pennsylvania plants from trading in other states. Apparently states have a good measure of power to build on (or move or away from) existing federal policy. And this is where the change is going to have to come.

So to sum this rambling up, two things: Food health advisories could use a better accessing strategy; and the state legislature has a significant role to play in environmental health.

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A great little thing to read and sign

December 4, 2006 at 1:30 pm (Michael's Posts)

This is a great link that pertains to the conversation entitled “The cart and the horse” (at least it is loosely related). It’s a statement that calls on institutions of higher education to devote resources and support to research that affects the “developing” world. I agree with what it gets at (even though it remains grounded in a paradigm that I am not necessarily giddy about) and urge everyone to support them and be in touch with the issuers of the statement.

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Spam blocker!?!? What spam blocker??

December 4, 2006 at 12:54 pm (Administrative)

Hey all-

I just discovered that there is some kind of highly imperfect spam blocker in this blog format that marks some of your comments as spam and doesn’t even tell me it’s doing so. Then, it discards them after 15 days without posting them.

I am INCREDIBLY sorry if any of you have been trying to comment and have seen your good efforts gone to waste. It’s NOT OUR DOING!

From now on, I am going to diligently check the spam queue every day and be sure that it’s not preventing wonderful additions to our conversations here. As for past ills committed unconsciously, I apologize many times over. Please continue to comment and I will continue to try to figure this blog-o-sphere (or whatever you call it) out.

Thanks so much and again, sorry!

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