real life public health isn’t sexy

The field of public health does not lend itself to being glamorous or satisfying after a full day’s work.

I currently work as a Community Health Worker (CHW) in Detroit supporting a NIH funded grant using behavior change techniques to tackle childhood obesity among African-American adolescents.

Snapshot: Thursday, December 1st, 2011

After a meeting with my supervisor, I had three family appointments scheduled for the day. My first appointment was with a family that needed to be caught up after missing 2 weeks. We provide transportation for families that come into the office, so I had called them a cab. However, the cab company had not sent the cab after 45min. and the appointment had to be rescheduled for another day. My next appointment was with a Teen who obviously preferred not to be meeting with his Mom and me. We worked through topics on Hunger and Cravings, but had to finish early because I had another family appointment coming up. After waiting 10min., I called my last family to confirm and they had forgotten they were supposed to come in today.

I spent my 8 hours that day driving a lot and meeting with only my supervisor and one family. It was a long, trying day to only be able to check a few items on my weekly to-do list. The over-used quote that I have to keep reminding myself is:

“An ounce of public health is worth a pound of health care”

Hopefully somewhere down the line the families and Teens that I work with will someday use the skills and information that I share. All I can do is offer my knowledge and support for their efforts while reinforcing their positive changes.

Public health has become a buzzword along with the growth of the global health field. It’s great that health has become such a prominent topic of interest, but not everyone is going to save a life or change entire communities. Buzzwords don’t make the best career choices. It may be that you spend all day tracking people down and hoping some knowledge sticks, maybe you make posters for wellness events, or even get covered in dirt planting vegetables with kids who prefer to play video games. Public health isn’t sexy; work can be dirty, sometimes lonely, unappreciated and often unnoticed.

Public health is not a new field. It has been around for a long time, but in the media it has most often been portrayed by medical doctor drama series that always have to include twisted webs of personal relationships and hookups in broom closets from Boston to Kandahar.

Public health is intense and has its own great stories and dramas – can’t these stories tell themselves without the backdrop of casual sex and relationships gone wrong? When will the public be ready to watch a show that is about real public health?

The truth is that although public health may not be as glamorous as a television drama, but it is full of exciting adventures, dramatic endings, and stories of hope.

bicycles are for global health

In many cities across the US, cycling is growing in popularity and local governments are working to implement bike-friendly urban planning initiatives, but is it growing fast enough? The US ranks first in the world for percentage of population that is obese (34% for adults age 20 and older). Not surprisingly, the US also ranks near the low end for bicycle usage with 1% or less of its population using a bicycle.
Graph (above, Figure 2) from: Bassett, Jr., et al.,

Walking, cycling, and obesity rates in Europe, North America, and Australia, Journal of Physical Activity and Health, 5, 795-814

Bicycles have been around for a long time. There is a sketch for an early bicycle design in one of Leonardo da Vinci’s pupils’ notebooks from 1493. Over the years bicycles have been upgraded and modified, moving from being a luxury of the wealthy to the transportation of the masses. The advent of cars slowed bicycle usage in industrialized countries, but in less economically developed countries bicycles are still a primary mode of transporting people and goods. Likewise the production of bicycles has remained nearly double that of cars.

For many countries bicycles are at the front lines of public health, they just may not realize it. The US has been watching a steady rise in obesity rates as a result of inactivity and unhealthy diet choices. Many states and cities are working to implement programs to increase bike usage including: Rails to Trails projects, Bike sharing in Washington DC and Nashville, as well as increased bike lanes linking residential areas to commercial zones. These programs will all have a big impact of the health of the US population. The CDC states that the number on strategy for increasing physical activity is shifting from car trips to walking or biking. Bicycling Magazine notes that new bicycle commuters can expect to lose up to 13 pounds their first year of biking to work.

Graph (above, Figure 4) from: Pucher, J., et al., 2010

Walking and cycling to health: A comparative analysis of city, state, and international data, American Journal of Public Health, published online ahead of print

The benefits are huge, but that doesn’t always make it easy for people to jump right on a bike. A recent study led by Dr. John Pucher of Rutgers University found a direct correlation between percentages of adults with diabetes and percentages of commuters biking or walking to work in 47 of the 50 largest US cities (Walking and Cycling for Health, August 2010). To state the obvious, the increase in programs that promote bike usage and the increase in people biking will have a very positive effect on the health of populations

However, the US isn’t the only country working to get its citizens moving. Copenhagen (Denmark), known for being a biking city, launched “You won’t believe it… You’re safer on the bicycle than on the sofa!” A campaign run by the city’s Public Health office, their goal was to get more people biking to work instead of taking their car for a short trip. The campaign told Copenhagen residents, “Lack of movement in everyday life is harmful to health, while physical activity keeps the body healthy. Daily exercise for at least 30 minutes prolongs life by up to 5 years, and cycling can thus help to prolong life.” Even as a strong biking city even Copenhagen felt the need to better educate and mobilize its population. As can easily be guessed Denmark has a low rate of obesity at 9.5%.

In “developing” countries of the world obesity rates aren’t the greatest health risk, nor is low physical activity often a common unhealthy lifestyle. The health risks in “developing” countries are often related to access to health services and emergency transportation. Surely this isn’t an area where bicycles can have an impact!

In many low resource setting around the world, Community Health Workers (CHWs) travel from village to village, home to home to deliver health education and services. In many places CHWs rely on bicycles as their only means of getting from one place to another. Bikes Without Borders highlights the work of CHWs in Malawi utilizing bikes to increase their effectiveness and to help more people. Bicycles for Humanity collects almost 50,000 bikes a year and sends them to organizations that distribute them most often to healthcare workers and women. Since women do a majority of traveling in “developing” countries, a bike can help them to transport themselves, water containers, and goods to market.

Bicycles have even been modified to serve as ambulances in areas where there is no emergency transportation. The Bicycle Empowerment Network (BEN) in Namibia has implemented a very effective model for faster transportation where there is none. Drivers of the bicycle ambulances come from local organization and they receive training on use and maintenance.

Whether it is in the post-industrial cities of the US, modern cities of Europe, or in some of the world’s poorest regions, the simplest transportation technology can have huge impacts on the future health of our population.

Featured on the Americans for Informed Democracy Blog, where I’m blogging as a Global Health Analyst.

global health is everyone’s responsibility and human right

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(photo credit: WHO)

From the UN Declaration to Amnesty International, between Paul Farmer and William Easterly it seems that everyone has a different understanding of what constitutes a basic human right and the cause of its absence. Michael Keizner has been building the discussion on health and human rights on Change.org’s Global Health blog while NYU Professor, William Easterly has recently entered the debate as a response to Amnesty International’s position on poverty related to human rights. This fueled a response from Amnesty International, which stated that Easterly was “pretty off base.” Easterly followed his Amnesty International response with an end to his “human rights trilogy” by asking Paul Farmer who should be held responsible for satisfying the right to health care?

The World Health Organization (WHO) states health as a human right as:

“the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…”

It seems that Easterly’s human rights criteria is trapped in an old international law paradigm where there must be someone at fault or someone to blame. He also forgets that health is directly linked to food. You cannot have good health and not have food. Effective aid, not seen in today’s aid schemes, based in sustainable practices (not just buzzword reporting) that supports an individual’s right to develop themselves should look comprehensively towards the needs of a community of individuals. The ideas of human rights, foreign aid, and development should be less focused on international systems and more focused on building strong communities that meet their own human needs: health care, food, water, etc.

Within this debate of health and human rights, where does SCOUT BANANA fit. As an organization that makes and stands behind the statement that:

“global health is everyone’s responsibility and every individual’s human right”

Paul Farmer has the right idea, as Easterly quotes from his Tanner Lecture in 2005:

“only a social movement involving millions, most of us living far from these difficult settings, could allow us to change the course of history….troves of attention are required to reconfigure existing arrangements if we are to slow the steady movement of resources from poor to rich—transfers that have always been associated… with violence and epidemic disease… whether or not we can say “never again” with any conviction—will depend on our collective courage to examine and understand the roots of modern violence and the violation of a broad array of rights, including social and economic rights”

This is exactly similar to SCOUT BANANA’s understanding of health as a human right and a responsibility. It is a right where we do not attempt to place blame or hold the past accountable because those become frivolous exercises that produce no results. When we delve deeper into the root causes of issues, for example the driving forces of slavery, we must focus on a responsibility to not repeat the past and make ourselves accountable in the future.

There is no way that the entire European population and its descendants can be held accountable for the evils of the slave trade. While the same ideas of human rights did not exist in the time period of slavery, it is similarly difficult to place blame on systems (and populations) that drive the causes of poverty and lack of access to health care. Many people that I work with on development projects feel guilty that they are so privileged and wealthy compared to the communities that they work with that are so poor. SCOUT BANANA teaches its members to not feel guilty, but instead to feel responsible. Understanding personal privilege related to the oppression of certain populations within societal structures can assist in creating positive impacts. Human rights don’t necessarily have to be about placing blame, but rather developing an understanding of responsibility.

So Professor Easterly when you ask who is responsible for satisfying human rights: it is you, it is me, it is all those who dream of making a difference, and it is also those who lack the very human rights that we hold dear. Placing blame is not a concrete step forward, learning from history and recognizing where our privilege fits can be a first step towards effective actions. I too see Paul Farmer’s vision of a movement of millions, near and far, taking actions to shape a better future where human rights are everyone’s responsibility and every individual’s human right.

From the Article 25 of the Universal Declaration on Human Rights:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

 Written for the SCOUT BANANA blog.

the week in african health

Nyala, Kalma camp, South Darfur - March 2007 (MSF Photo Blog)

The impact of conflict on the environment and then the subsequent, direct effect on human health cannot be overlooked. This internally displaced peoples (IDP) camp in Sudan shows the seriousness of that impact.

Your Old Cell Phone Can Make a Difference in Global Health

Everyone in the global health sector is writing about the incredible reach of SMS technologies working for health in developing countries, and rightly so. Hope Phones has partnered with FrontlineSMS to provide old cell phones to communities in need through SMSmedic partner organizations.
More:
Your Old Phone Can Change the World

TeleMed
A service that I just recently came across is one that is not being as widely talked about. TeleMed is different from FrontlineSMS: Medic because it connects local health care workers directly to patients in need via SMS technology. SMS: Medic is focused on health infrastructure. TeleMed does not have a website up yet, but is definitely one to watch:

Paul Farmer and the US Government?

The other big talk within global health is whether Paul Farmer will take a job within the US government. Some have expressed great hope for potential reform others voice their plea with him to continue his incredible community based work outside the bureaucracies. My opinion is that Partners in Health has developed into a strong organization and does not depend on Paul Farmer to further their work. If he wants to take on the inefficiencies and inadequacies of the US government and global health, then all the more power to him.

Southern Africa: Global Financial Crisis Leads to HIV Budget Cuts

Broken promises abound as the economic crisis deepens and the right to health falters, but activists are coming together to ensure that funding for health and HIV are not cut. International donors are expected to slash budgets for health due to the economic crisis and health experts fear that this will lead to, “less food security and quality of nutrition, which will in turn put more stress on already weak health systems.” Paula Akugizibwe, regional treatment literacy and advocacy coordinator of Windhoek-based AIDS and Rights Alliance for Southern Africa (ARASA) in Namibia demanded, “We need to ensure that African lives do not become a silent casualty of the global financial downturn. Our lives are not cheap or expendable. We expect health to be prioritised over weapons, sports and lavish politics.” Tanzania was the first sub-Saharan country to announce a 25 percent cut of its annual HIV/AIDS budget.
Other budget cut impacts:
Guinea: Medicines Running Out

Zambian High Court to Hear Groundbreaking HIV Case

On Wednesday, the Livingstone High Court was supposed to hear a ground breaking case about whether mandatory testing for HIV and discrimination solely on the basis of HIV status is constitutional in Zambia. Unfortunately two days later news came that the trial was postponed until mid-July. Be sure to keep watching this story.
More:
Trial postponed until 15 July

HIV Prevention and Behavior Change

Mara Gordon writes on Change.org’s Global Health Blog about a direct campaign in Tanzania discussing behavior change. “This campaign is partially paid for by the President’s Emergency Plan for AIDS Relief, U.S. government money to fight HIV that’s notoriously had lots of conservative strings attached. Had I seen this ad a year ago, I probably would have dismissed it as unrealistic abstinence-only propaganda. But behavior change works. Behavior change – in combination with access to condoms, comprehensive sexual education, open discussion about HIV and sexually transmitted infections in general, all that good liberal stuff.”
More:
Changing Human Behaviors: Sexual and Social
During a course on Africa’s environmental history I wrote about the need for changing human behavior in both the sexual and social arena to make a real impact in HIV prevalence. The major social change is the response from Western institutions and organizations in how they talk about HIV/AIDS and Africa while seeking to change sexual behavior.
Lesotho: Cultural Beliefs Threaten Prevention of Mother-Child HIV Transmission
Health workers note an encouraging response to the PMTCT program. The number of facilities providing PMTCT has risen from nine in 2004 to 166 by the end of 2008. The number of women who received PMTCT and subsequent antiretroviral (ARV) treatment increased from 421 in 2004 to about 5,000 by end of last year, according to 2009 National AIDS Council statistics. “The primary health care coordinator at St. James Mantsonyane Mission Hospital, Khanyane Mabitso, says stigma and cultural beliefs make it difficult for medical personnel to follow up on HIV-positive mothers and their babies.”

Progress on health-related MDGs mixed

Many advances have been made in health. Some argue that these advances have been dwarfed by the HIV/AIDS epidemic, the economic crisis, or the failures of African governments. The WHO report shows that the only statistic with concrete results was the number of children dying before the age of five. Is this a solid example of the failure of big plans and blanket goals for development?

Sierra Leone: ACC Recommends Reform At Health Ministry

The Anti-Corruption Committee report provides a number of recommendations for reform all focused on improving the health care delivery services in Sierra Leone and eliminating the risk of corrupt practices in the health services across the country.
More on health service scale-up:
Chad: Paving the Way for Better Obstetric Care
Government meetings with UNICEF to help scale-up of health services for better obstetric care across the country.

Ten Things You Can Do to Fight World Hunger

The Nation provides an interesting set of things you can do in your everyday life to fight world hunger. They properly focus on how food, a basic human need, has been commodified in our global capitalist structure. “Our planet produces enough food to feed its more than 960 million undernourished people. The basic cause of global hunger is not underproduction; it is a production and distribution system that treats food as a commodity rather than a human right.” When in February I wrote that agricultural experts had said the food crisis of the last year was over evidence from this past week point to the contrary.
More:
Tanzania: Food Shortage Unnecessary
“Tanzania has since independence sang the song of ‘Agriculture is the backbone of the economy’, but little has gone into strategizing and implementing viable actions towards surplus food production.”
Kenya: UN Agency Makes First Local Food Purchase from Small Scale Farmers
The United Nations World Food Programme (WFP) has for the first time bought food from small-scale farmers in Kenya under a new initiative aimed at boosting agriculture by connecting farmers to markets.
Zimbabwe: Another Year Without Much Food
Rwanda: Nearly Half the Country’s Children Are Malnourished
Kenya: Over Three Million Face Food Shortages

Africa: High Level Engagement with Continent Has Started

Speaking at a gala reception in Washington marking the beginning of “Africa Week,” Carson said: “Most of the Obama administration’s Africa team is in place, and we are gearing up. We will continue to build on and strengthen the strong bipartisan consensus in Congress and among the people of America that has motivated U.S. policy towards Africa. Over the next four years, we will be focusing our efforts on strengthening democracy, promoting sustainable development, resolving or mitigating conflict, and dealing with transnational issues such as climate change and agriculture,” he pledged. While Obama has built a great team, the White House has yet to announce any Africa Policy, greater control and influence for the Bureau of African Affairs, or take any serious (or effective) action for the continent.
More:
Tanzania: Obama, Kikwete Meet in Oval Office on Africa’s Conflicts

World Bank Resumes Zimbabwe Aid

Zimbabwe owes the World Bank and the African Development Bank more than $1bn, how much potential does renewed aid really hold for the country. If the debt is not forgiven there will be no way the country will be able to rebuild necessary infrastructures for health, water, etc. There are countless case studies to show this historical fact. It must also be noted that Western sanctions were a huge detriment to a country in need, maybe this marks a turnaround?

Originally posted on the SCOUT BANANA blog.