Week 11: Heathcare Financing and Health Outcomes in the Global Context

After considering the case study analysis, I really do think that cost effectiveness analysis is the way forward for deciding where resources should be allocated. There are only so many resources available and it makes most sense to use them in the most effective way possible. Though the discussion of this type of analysis brought up many criticisms, I do not think that there is a better way thus far for stakeholders and those providing the resources to analyze where their money would be best spent. It was interesting in class, that the point was brought up by Dr. Shahi that we don't have to worry about this type of thing in the US on the scale that developing nations do. We basically can have everything in regards to healthcare, if we wanted. But these other nations cannot, and until they are economically viable enough to reach a level where they can provide for all their healthcare needs, their needs to be some system that is effective at prioritizing what issues merit funding. I was curious about one of the articles 10 "best buys," the provision of insecticide treated bednets, because for some reason I was under the impression that there were more effective ways of addressing malaria in these regions, such as building up land on the swampy areas. I am not sure, maybe I just made this up. However, the discussion question that asked if the World Bank should require cost effectiveness analysis before they allocated funds seems to be an interesting one. I do not think that this can be the only measure they use when determing allocation of resources, however, I do think it should be incorporated and taken seriously.

An NPR article titled: Study: 634 Million People at Risk from Rising Seas

I found this article on the NPR website and thought it was an interesting addition to what we discussed in this lecture, "Monitoring, Surveillance and Rapid Response Capabilities." The article was about how it is known that sea levels are expected to rise in the next century perhaps by as much as a foot, and with the rise of the ocean will come more flooding of low-level cities and it has even been hypothesized that with global warming hurricanes might become more intense. However there has not been much data about who exactly this will affect. Using satellite data and census information, the researchers discovered that that low-elevation areas are home to 634 million people, which is about 1 in 10 people in the world. Those countries with the most people in these low-elevation coastal areas are China, India, Bangladesh, Vietnam, Indonesia, Japan, Egypt, United States, Thailand, and the Philippines, and the countries with the largest share of their population living in these areas are the Bahamas, Suriname, the Netherlands, Vietnam, Guyana, Bangladesh, Djibouti, Belize, Egypt, and Gambia. In addition, two thirds of the world's largest cities are in these low-elevation levels, which is a huge deal considering populations will continue to shift to urban areas throughout this next century. This article highlights the need to look to what is going to happen in the future and how well prepared we are and should be to handle the future effects of global warming on weather patterns. The people in these areas will be greatly affected by these weather changes and hopefully governments will work to achieve good monitoring and effective strategies to deal with the inevitable weather disasters that will strike in their homes in the future.

The idea brought up in class of telemedicine was so neat in my opinion. I think that the possibilities for how helpful that could be for patients are endless. Imagine not having to go through all the hastle when you have something like the flu or a cold, and need an antiobiotic, to just be able to e-mail or speak with your physician on the phone to obtain the appropriate antibiotic or whatever treatment is necessary. It seems that the cost of primary care could greatly be decreased through the use of this strategy. I have a story somewhat related to this. When I first got to Greece I was taking an antibiotic for an infection I had, and had used this antibiotic many times and had gotten to the point where I could recognize exactly when I had an infection and what I needed to take to get rid of it. A few weeks later, the infection came back and I knew that I needed to get the antibiotic again, only this time take it for a longer period of time to ensure the infection went away completely this time. Well, being the American I am, I went immediately to the local doctor and explained my symptoms and what medication I needed, and he wrote my prescription and I paid him 50 Euros. Well, then I went to the pharmacy and got this prescription (with much hastle because he didn't speak English and the doctor hadn't written down what I needed in Greek). When I came back and talked to the directors of the program (who were themselves Greek) they laughed that I had went to the doctor at all. Apparently in Europe, you do not need a prescription to go to the pharmacy to get drugs. If you know what you need, you just go there and get it. Thus, all those times we Americans know exactly what we have and know exactly what they are going to prescribe to us, we have to sit there anyway, wasting all that time and money, where in Greece they just skip that unnecessary step. This telemedicine idea just seemed like a move towards the system in Greece, and it just makes sense to me. Of course this system in reliant on the fact that trust has been established between you and your primary physician.

Week 8: Technology Innovation and Global Health 1: Biomedical Sciences

Though I have very little background in what this lecture discussed, I found it interesting and quite insightful. I think the thing that stuck with me most was when Dr. Shahi discussed the current situation of the US being at the "top of the hill." He described, in a very illustrative way, how once a country feels that they are secure in their developments, and do not have anymore mountains to climb and conquer, that they are already beginning to slide down the hill, allowing other countries who continue to strive to be always be better to begin to overtake it. Though the US does an enormous amount of research in every field and has come out with more then its share of innovative and progressive technologies, it seems as if the US has grown almost lazy and expectant that its reign over technology development will not be surpassed. Other countries, specifically in Asia, seem so much hungrier to make the big leaps that will eventually lead them to be leaders in technology development. It is my hope that researchers and developers in the US will realize that in order to stay on top we must continue to strive to be the first and the best at coming up with innovative and effective ideas.
Furthermore, I enjoyed the discussion about the biobusiness innovation landscape. I know the professor said that developers should focus on the summit opportunities, but I didn't understand why they should not focus on the cloud opportunities. I guess that part was over my head or something. I also thought the slide about the technology adoption challanges was neat, because it highlighted for me that I am so on the wrong end of the spectrum of where I should be in terms of accepting and incorporating new technologies into my life. I have always shied away from technology, and it has become quite apparent from this class that that is not a smart or viable strategy at all if I want to succeed in the 21st century.

I watched the video about Ethiopia for today, and it reminded me a lot of what we discussed in week 5 concerning global hunger. There is such a desperate need for people in developing countries to be trained in how to properly farm their lands so that they do not overuse it and destroy its fertility. If organizations and governments could recognize and take aggressive actions to address these land issues and realize that addressing these issues could help to alleviate many of the other problems that develop as a result of them, then I think that a huge step forward could be made. I also thought the video called UNDP HDR Water and Environment was interesting. The main recommendations of getting the government to make sincere policy change, however, didn't really seem realistic. The policy changes concerning sanitation and water in Western Europe and the US that were so effective in lowering the child mortality rates in recent history were instituted by governments that cared about the social welfare of its people because it was the people who were running the governments. In a lot of these African countries, there is so much corruption and so little power for the people to have any say in policy that these reforms are just not going to happen unless the international community puts more pressure on the governments to do something about it.

Interesting ariticle in Newsweek about men and depression in the US

I just read an interesting article in Newsweek titled "Men & Depression: Facing Darkness." I was really surprised to learn about some of the new therapies the NIMH is developing to treat depression. The article explained that the focus for treating depression was shifting in their research from boosting neurotransmitters (which is what antidepressants such as the SSRI's like Zoloft and Prozac do) to focusing instead on the endocrine system. They believe that perhaps if they can block overproduction of stress chemicals they can reduce damage to healthy nerve cells. I think that this is really interesting, because for so long researchers have been focusing on the brain and its neurotransmitters, and now they seem to be looking at depression more holistically and realizing that hormones (particularly stress hormones) most likely play an important role in the development of this disorder. Furthermore, they are trying to find fast-acting antidepressants that would relieve depression symptoms in a matter of hours, instead of weeks like the older antidepressants. They have tested one of these drugs named ketamine, which is apparently an animal tranquilizer, and so far in tests it has been shown to have both short and long-term effectiveness. It will be interesting to see if they can actually develop these extremely fast acting antidepressants. I think that though psychopharmacology is an extremely important part of treatment for depression, it is important no to lose sight that cognitive therapy is just as important. The article made an important point when it pointed out that antidepressant treatment is still more of an art then a science, and people can't expect drugs to always work exactly how they want them too, which is why cognitive therapy is such an integral part in treating depression.

Week 5: Nutrition, Food Security and Global Health

I remember in college I became extremely frustrated when I asked people why there had not yet been a solution to people starving in the world (individuals who I thought might have intelligent insight into the problem), and many of the responses I would get would be that it was not our problem. Complete apathy, which just baffled me. Many of them felt that the problem was too big and that it was too far displaced from America for it to really be something that we as a country should be focused on solving. I feel that one quote given in this lecture really articulated my frustration with the fact that in a world that is as technologically rich as it is, there are still people dying of hunger. It stated: "When I give food to the poor, they call me a saint. When I ask why the poor have no food, they call me a communist (Dom Helder Camara, Archbishop of Recife, Brazil)." I think that Dr. Shahi made a good point when he asked "if undernutrition is an underlying cause of 53% of deaths among children under five years of age, why are we not focusing on this issue." We know which parts of the world are affected most by hunger, so we need to focus our resources on eliminating this problem. The fact that women's education and status can play such a huge role in reducing child malnutrition is something that the WHO and other organizations need to focus more on. I think that perhaps these public health organizations should try to gain support from internationally famous people, such as Oprah, to help champion this cause (as someone in class pointed out, didn't Oprah just open schools for women in Africa recently?). One can look to the awareness of the global problem of AIDS that has been generated in the past decade and the fact that it has a lot to do with famous people taking an interest to convince the public of its importance. Hunger, like so many of the other issues we have discussed in class, is completely preventable. It is just an issue of coming up with an innovative solution and convincing the people who have the resources to do something about it that this issue is worth their time. I think one interesting solution Dr. Shahi proposed in class was to make it possible for farmers in developing countries to have web-based access to directly sell their produce to buyers, rather then losing most or all of the profit to the dealers in between. I also found the presentation about Ready-to-Use Therapeutic Food a really interesting, and in my opinion good, solution. I think that any step towards preventing hunger is a good one, regardless of whether it is only temporary or not.

"In parts of India, diabetes in a girl makes her virtually unmarriageable."

I just read Childhood Diabetes: A Global Perspective by Martin Silink and I think that it made some really good, tangible points. I remember when my step-father was diagnosed with diabetes, and not thinking it was a big deal because I didn't really understand how much the disease affects every aspect of someone's life. However, now that he faces the decision each month of where he should cut costs in his budget so that he can afford his necessary medications and insulin shots, I am constantly aware of how terrible it is to have diabetes. It's not just the fact that you have a disease with no cure, but that even if you try to make all the necessary lifestyle changes that you possibly can, you may simply not be able to afford the necessary treatment needed to keep the disease from getting worse. The above quote caught my eye, because I think the mere implications of that statement being true are profound. Imagine the quality of life someone in one of these developing countries faces just because they have diabetes. I can't fathom not being able to be married simply because I had a chronic disease like this. I completely agree with the WHO Report from 2006 that suggested that an emphasis on educating individuals about the benifits of exercise and diet are clearly not enough. There needs to be more awareness of governments and health organizations about how detrimental these non-communicable diseases are for societies and economies, and in order to achieve this I think there needs to be more funding of organizations dedicated to curbing this pandemic. I think that if governments get involved and work with these organizations to help spread the message of how to better prevent diabetes there can be vast improvement in the incidence rate of diabetes. Furthermore, I also think that individuals can make a huge difference. For example, look at the succes of the film "Super Size Me." Though it may not have revolutionized American's eating habits, I think that it did make people think about the health consequences of unhealthy lifestyle choices such as eating fast food.

Watch this:

AIDS orphans, World Vision

New WHO director

I just read a short article the professor posted called "New WHO Director Optimistic About Taming Global Health Threats" by Lisa Schlein. The director was quoted as saying: "When women are given a hand up in terms of household income, we see improvements in their own health and that of families and communities," she said. "When we think about the health in Africa, we must never forget the links between poverty and health. Poor health anchors large populations in poverty. Better health allows people to work their way out of poverty and spend household incomes on something other than illness." I think this sums up last weeks topic really well. The new director's great attitude and excitement at tackling many tough global health problems was refreshing to read about, and I hope she follows through on the initiatives she has promised to address.

Inequality and human development

I just got done reading the article from last week titled "Inequality and human development." I thought it was interesting, however some of the suggestions the article made had no logistical solutions as to how these ideas could actually be put into practice. It emphasized that one way to decrease inequalities is to close the gaps in educational opportunities, but how is this to be achieved until social change has been made to alleviate reasons the gaps exist in the first place? Furthermore, it also suggested that the poor need to be empowered in order to reduce poverty, but the article did not elaborate on any suggestions for how this might be achieved. Also, the discussion of the three "As" for reducing inequality left me a little puzzled. All three (access, affordability, and accountability) make sense, but who is going to pay for these to be acheived? Where is all this money going to come from? It just seemed to emphasize to me that so many of the reasons of why extreme poverty exists is because of all these reasons that feed into each other, and there doesn't seem to be a clear place to start in order to begin the process of breaking down this problem. The ideas it gave were great, and fairly intuitive if one thought about the reasons why one would be impoverished, but I didn't really get any sense of how any of these objectives might be achieved or where the money would come from to make these necessary changes.
I found the section of inequality and health in the United States quite startling. One quote that really caught my eye and helped put things in perspective was that 18,000 Americans die prematurely each year solely because they lack health insurance. I guess that is what happens when you live in the only wealthy country in the world that does not have a universal health insurance system, as the article points out.

My first entry--I'm a little overwhelmed...

After two classes of PM 565, I feel as though a whole new world of information and knowledge has been opened up and literally dumped on me. I never realized how many organizations for public health existed, how many acronyms are necessary to know in order to follow lectures, or how much more knowledgeable my fellow classmates are then I about the issues that have always been vague and undefined for me. I am extremely excited and honored to be a student among such accomplished and passionate people, and feel like for the first time in my college studies I can actually learn as much from my peers as I can from my professors. I have found myself wading through other's blogs, trying to catch up on the background of issues they are addressing, and am really enjoying the process of emerging myself in this program.
The reason I entered this field is fairly simple. For the latter part of my life, my family and I have lived without health insurance. This has greatly affected my family in more ways then one would imagine, and that is what initially sparked my interest. However, through friends who volunteered and worked abroad, I became increasingly aware of how little my problem was compared to those healthcare disparities people face in other countries. The second reason was that I want to make a difference (don't we all :)), and for some reason I have always been drawn to the field of health. I think it is because it integrates the two things I am good at: science and interacting with people.
Anyhow the lecture this week was great. I think the part that stuck with me most was the comment made by Dr. Shahi, when he said something like "the true test of development is when you can imagine a child from the poorest family you know and a child from the richest family you know, and if they would both be able to pay for their child to sit in the classroom that we are in right now, then that country has passed the test." And like he said, I don't think any country has truly achieved development. One can examine our own nation, the world's leader (for now) of development, and the gap that exists between the rich and the poor is unacceptable. There is absolutely no reason that people should not have access to basic health care needs. I am excited to see what the newly elected delegates in Congress will do in efforts to address these issues. And although I am new to California, I have already heard a lot of hype about certain initiatives the governor wants to implement in this state in terms of health care and it will be interesting to see what happens.