Last week, the World Health Organization (WHO) released a report entitled Women and Health: Today’s Evidence, Tomorrow’s Agenda. The report reviews evidence on health issues that affect women in all stages of life, from childhood, through adolescence and adulthood, and into advanced age. The report found that across the globe, women are societal and cultural inequalities that make them more vulnerable to health disparities. They die younger, and face challenges in mental health, malnutrition and lack of education. And while women are the primary caretakers of the sick and elderly all over the world, health systems are ill-equipped to support them and often fail them when they themselves need care.
This report, while sobering, comes in an era where the perception of women’s health is changing. U.S. Secretary of State Hillary Clinton and WHO Director-General Margaret Chan, two of the most prominent women in the international spotlight, have both made women’s health a priority, and both have made it clear that it is an issue that they feel passionate about. In an interview with Lisa Ling on the Oprah Winfrey show, Secretary Clinton stated that she believes that women’s rights are a national security issue. “[I]f you look at terrorism and extremism and abject poverty and a lot of the effects and the causes of instability, you more likely than not will find places that try to limit women’s roles and rights. And so often, those who stand against us stand against the rights of women. So we do have to integrate this into our national security.” When Dr. Chan took the office of WHO Director-General in 2007, she asked that her performance be judged in part on progress in women’s health. In her forward to the WHO report, Dr. Chan states that promoting women’s health is crucial to the health and development of the current and future generations.
In her address at the International Health luncheon at the 2009 APHA annual meeting, Dr. Susan Brems, the deputy assistant administrator of the Bureau for Global Health at USAID, emphasized the need to focus on women’s health – not simply as a means to access certain groups or target specific health indicators, but for the sake of the women themselves. While progress is being made in improving women’s health around the world, the WHO report underscores the fact that much work remains to be done.
The theme of APHA’s annual meeting is Water and Public Health. During the opening general session Dr. Mirta Roses Periago, Director of the Pan American Health Organization (PAHO) underlined the effects of climate change on human health, the new challenges faced by global health and the importance of access to safe water. Dr. Periago reinforced that combining water, sanitation and hygiene interventions can reduce up to 80% of the preventable water borne and related disease. The Millennium Development Goal target for 7c isto reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation. Dr. Periago stated that a one dollar investment in water and sanitation provides a $46 savings in social and development cost. The ideal would be to have water, climate change and equity addressed in a combined sustainable approach.
Celine Cousteau reinforced the importance of the connection between people and the environment. Ms. Cousteau is a story teller whose passion preserving our natural resources is equaled by her passion to bring health care to the indigenous people of the Vale do Javari reserve in Brazil. The film Amazon Promise is a celebration of one organization’s goal to bring health care to those in need…. the same passion found in so many of our public health workers around the globe.
The 2009 Annual APHA meeting has officially begun! The International Health Section has assembled a list of sessions and meetings related to international health for your use. Our blogs from the conference will provide a glimpse into the vast knowledge shared by our colleagues. The conference will continue through November 7, we hope you enjoy it.
“ The administration inherited a basket of bad apples from its predecessor: the budget deficit, the recession, a week economy and unemployment to mention a few. Among the problems, the health care crisis is the worst by far”
This quote is not recent since I published it on February 7, 1993 in the St Pete Times, an article titled “Health Care: Painful Remedies are needed”
I was referring to the Clinton administration and the President’s promise to produce his Health Security act within the first administration 100 days. As a reminder, at that time Republicans raised the issues of big government, increasing the deficit, government taking over health care, eliminating choices, more taxation, hurting the private sector and the rest of the same old story. Moreover, they introduced 6 more health plan proposals to the Congress until the whole reform issue faded away and was dropped. This was paralleled with an aggressive heavily funded campaign lead by the Republican Party, insurance companies, the pharmaceutical industry and others. Since then, and until 2008, every Democratic presidential candidate, learning the lesson the hard way, dropped the health insurance and universal coverage from his agenda.
In 1994, I published an article in the Florida Journal of Public Health (vol VI, no1) on “Reforming Health Care in the US and Europe: Why we Fail and They Succeed? “ It said: “Why health reforms succeed in all western countries? They established concrete health policies of universal access and user-friendly systems in the 30s and the 40s, guided by a solid commitment to national welfare and social solidarity. Second, the voice of interest groups is not so loud, and if it becomes so, its impact on policy-making is minimal since policy makers’ behaviors are put under stringent scrutiny of their well-informed voters. Third, the government and the elected representatives, who are elected by the watchful voters, are more trusted, and the government is allowed to govern, and elected representatives make decisions in the public interest”
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- * Samir Banoob, M.D, D.M, DPH, Ph.D. is a professor of international health policy and management and consultant to WHO, World Bank and international agencies who consulted with 76 countries.
Within the public health community, Community-Based Primary Health Care (CBPHC) is a common point of discussion. But rarely has the story been told by a Pulitzer Prize-winning author or captured in pictures for the National Geographic Magazine. The December 2008 edition shared with the world the story of The Comprehensive Rural Health Project (CRHP) in Jamkhed, India. “Necessary Angels” was the fitting title to a story of history and hope for village health workers who have healed communities, saved lives and transformed the place of the untouchable caste in the process. Read the rest of this entry »
I was surprised when I first heard about Dr. Sanjay Gupta’s possible appointment to US Surgeon General by president elect Barack Obama. What type of message did it send to young people in the field of public health that the pathway to leadership was through the lens of a TV camera rather than toiling in the trenches of public health programs? Read the rest of this entry »
As a lifelong international MCH professional, as a faculty member, and as citizen of the world, I am so excited about chairing IH Section this year. To me, what is so special about international health is that it is a transdisciplinary field. The term “transdisciplinary” may be new to some of you, so here’s the definition, developed by Piaget (yes, the same Piaget), translated by yours truly: “concerning interdisciplinary discourse, we hope to see a higher level emerge, “transdisciplinarity,” which would not settle for interactions or reciprocities between specializations, but which would internalize such interaction within an overall construct, and break down the walls between disciplines.” Read the rest of this entry »
There was much to appreciate about the APHA 2008 meeting in San Diego, but two sessions that started off the meeting will stand out in my mind for a long time.
On Saturday we were supposed to have a Trade and Health tour of Tijuana, but because of increased violence there the trip was called off. Instead, Tijuana came to us. Over the course of three hours we heard from some inspiring environmental health efforts (a successful community effort to clean up a disgusting toxic waste dump) and occupational health work (a maquila worker-turned-activist). The last hour was a fantastic film that I highly recommend to anyone interested in either or these topics:
Are we really making a difference? Should we account for our work and present transparent results, good and bad to our peers, host country partners and funding agencies?
This year the IH section hosted the second panel on “Aid Effectiveness and Accountability.” This panel is a follow on to the one we had last year. I am happy that the topic of Aid Effectiveness is raising more attention. I want to thank two guest presenters: Michael Hammer, Executive Director of the One World Trust, who came from the UK for this panel and Elisabeth Sandor of the OECD, who came from Paris for this panel.
One World Trus (www.oneworldtrust.org) is a fifty-year old non-profit organization in the UK evaluating and holding accountable organizations such as DfID, Aga Khan Foundation, etc. Their accountability report is a must for those working in IH. Last year the OECD decided to include health as its tracer sector and is monitoring progress towards the MDGs and the commitments made in Paris Declaration. Read the rest of this entry »
Attending the Community-Based Primary Health Care (CBPHC) workshop on Saturday, October 25 at the 136th annual APHA conference, I was reminded of how there truly can be “power in numbers”.
Having worked in domestically in tertiary care at a well-funded institution (basically the opposite of CBPHC) for almost a year now, I searched for common ground with the international community-based primary care group, relying on my relatively brief but highly educative experiences in international public health. I of course am still interested in community health and primary care, but as others noted in an earlier blog entry from this conference, the funding for positions in that field is minimal.
At the workshop on Saturday, I realized just how many dedicated people there are focused on this area, and that our strength is in combining efforts to accomplish our goals. I often witnessed how a group’s synergy can greatly improve its effectiveness and creativity. At the workshop, we split into 3 groups, each one discussing the major actions needed to further the field of CBPHC, including, documentation and dissemination, raising awareness, and finding funding. My group was charged with discussing how to create or find more resources to implement programs in CBPHC. Read the rest of this entry »
Where have international nutrition and health sector leaders been during this serious 2008 crisis of spiraling food crises that are worsening food and nutrition insecurity among the most vulnerable in the world?
At a lively, standing room only session (#3302) on the 2008 Global Food Crisis Monday at the APHA meetings, the 4 panelists and moderator agreed that it was much more than a crisis. It reflected a longer term structural and systems issue related to food poverty, international trade, climate change, energy and environment. Case studies on India and Ethiopia helped to contextualize the intra-country discrepancies in undernourishment, stunting and wasting.
On my Ethiopian case, I contrasted the apocalyptic press statements in September 2008 of the UN ( FAO, WFP,Humanitarian Affairs) with my Oct. 20th interview with the well-informed Minister of Health of Ethiopia who felt that overall high inflation and energy costs, as well as drought, were more serious shocks to health and nutrition of his people. In presenting the long and short-term trends in food access and malnutrition in Ethiopia, I found that this discrepancy in information reflects the lack of representative and reliable data on the evolution of the situation, causes and immediate effects. Read the rest of this entry »
Participants Trying to keep up with the flow of ideas
By Janine Schooley
Sometimes I get the question, “So what’s new and innovative in CBPHC?” The answer is that there isn’t anything new, and that’s the point! We already know what we need to do. We have the bullets, as someone said, but the gun seems to be elsewhere or malfunctioning. I think it isn’t that we don’t have the gun. I just think we have misplaced it, or it needs some tinkering to get to work, or we need to remind ourselves how to pull the trigger. I really dislike this analogy for it’s militaristic and violent connotations, but I couldn’t come up with anything better….So, to continue this horrible analogy, we have several bullets and they are inexpensive, tried and true. We know the power of exclusive breastfeeding, good antenatal care, immunizations, long lasting insecticidal nets, good nutrition, and other low cost, low tech interventions in terms of saving lives and improving quality of life. We’ve been talking about this for decades, not just amongst ourselves, the practitioners in the field, but at the highest policy levels. As the September 13-19, 2008 Lancet reminds us, a major milestone, the Alma-Ata Declaration, was issued 30 years ago. So what’s new isn’t the need for what the Alma-Ata Declaration so eloquently calls for, but perhaps it’s the realization that we still haven’t gotten there. In other words, we don’t need innovation. What we need is inspiration and, as Nike so aptly puts it “Just do it!”. Read the rest of this entry »
Attending the Community-Based Primary Health Care workshop yesterday was one of the most invigorating experiences I have had in quite a long time. It was so fantastic to meet people carrying out work that I have been constantly thinking and talking about the need for. As my colleagues and I struggle to establish a comprehensive community health center in Gatineau, Haiti we are constantly trying to figure out whether or not we are actually implementing best practices. While we all value the importance of making decisions based on evidence and learning from others’ mistakes, it is incredibly challenging to find detailed information. Through this process and past research, I have been made especially aware of the need for more accessible and thorough documentation of both effective and ineffective practices and implementation experiences in global health.
This is not to be unexpected as organizations carrying out this work are usually so over-extended and resource constrained that documenting their processes and practices often becomes low-priority unless it is to meet the requirements of funders. However, when this is the purpose of such documentation the tone changes from factual reporting of successes and failures to trying to demonstrate efficacy so that a donors will keep sending money, so financial survival is not the best motivating factor for the objective documentation needed. In my own experience so far, although we have said that documenting and sharing the entire process of establishing a community health center would be a very useful activity that we would like to do, we have thus far been unable to follow through while dealing with all of the day-to-day logistics of running a clinic, seeking/maintaining funding and the planning of future programs and community organizing. If we had a volunteer historian or could work with students to take the documentation process on as a project for course credit, it might be much more feasible. However, with limited time to coordinate such efforts and so many critical activities competing for our resources, this honestly falls relatively low on our hierarchy of needs.
I was encouraged when I recently heard about the Global Health Delivery Online www.ghdonline.org but somewhat disappointed that it thus far only includes HIV, TB and Technology discussion communities. Understandably, these are in the scope of the founding collaborators’ chief interests but I hope they will continue to expand this venue into other important realms in need of increased attention. Read the rest of this entry »
TB can be fatal. It is a worldwide epidemic that knows no borders.
I am a resident in Family and Preventive Medicine, concurrently working towards getting my MPH. I attended the Community Based Primary Health Care (CBPHC) workshop at the American Public Health Association National Conference, which was organized by APHA’s International Health Section on October 25, 2008. Project Concern International (PCI) facilitated the workshop.
We opened by discussing the principles of the 1978 Alma-Ata Conference, which include health as a fundamental human right, equity, and the emphasis on community participation.
We engaged in several spirited group discussions about the role of CBPHC in our own work and ideas for effective behavior change. A highlight was a presentation on the use of TB-Photovoice (http://tbphotovoice.org/tbpv2/index.php?option=com_frontpage&Itemid=1), a powerful means for creating effective messages of change from those who are most affected by the disease. At the end of the workshop we broke into groups to discuss either the documentation and dissemination of work, how to increase funding, and how to advance knowledge of CBPHC. My group was comprised of documenters and disseminatorsand we discussed starting a new journal that is a forum for talking about projects that are in the works or have been completed — this would allow newcomers to avoid reinventing the wheel, would serve as a forum for old hats to bounce ideas off each other around what did and didn’t work in their projects, and would also provide powerful individual stories, photos, videos, etc. that would assist with funding. The forum would be online, open access and free. Start up funding for such a new journal is actively pursued and hopefully we can capitalize on that. Wikipedia sounded like an option as well. Also, we want to try to connect students and young professionals with project managers so that we can recruit writers! Community-Campus listserv may be the way to go for that connection.
Overall, the workshop was stimulating and exciting – an opportunity to gather a collection of dedicated and passionate professionals to share ideas and projects that serve a common goal.
It is a New Year and a new beginning for communicating among members of the International Health Section of the American Public Health Association. What is new?
This “IH Blog”. It is a new tool (for us) to hear members about their concerns and issues related to global health.
I would like to invite you to write for the IH Blog. If you have any suggestions concerning topics that you would like to discuss, feel free to comment. Read the rest of this entry »
Within the public health community, Community-Based Primary Health Care (CBPHC) is a common point of discussion. But rarely has the story been told by a Pulitzer Prize-winning author or captured in pictures for the National Geographic Magazine. The December 2008 edition shared with the world the story of 
