Global Pulse Blog

Today’s guest blog post by Anand Reddi was originally published yesterday in The Huffington Post. Anand Reddi was a Fulbright Scholar in 2005, assisting the Sinikithemba HIV/AIDS clinic at McCord Hospital in Durban, South Africa. Currently, Mr. Reddi is a medical student at the University of Colorado, School of Medicine. Here, he reflects on Secretary Clinton’s speech earlier this week and the importance and potential of a Global Health Service Corp.

Stay tuned to Global Pulse Blog for more views on this monumental speech and its implications.

Yesterday, Secretary of State Hillary Rodham Clinton declared the U.S. government’s intent to create an “AIDS-free generation.” Secretary Clinton outlined a bold plan to reduce new HIV-infections, globally, including the eradication of pediatric HIV by 2015. This new strategy builds upon the success of the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. program that addresses HIV/AIDS in resource-limited settings.

A notable feature of Secretary Clinton’s “AIDS-free generation” initiative is to strengthen healthcare systems in sub-Saharan Africa. Clinton stated:

“We know we can’t create an AIDS-free generation by dictating solutions from Washington. Our in-country partners — including governments, NGOs, and faith-based organizations — need to own and lead their nation’s response. So we are working with ministries of health and local organizations to strengthen their health systems so they can take on an even broader range of health problems.”

Strengthening African healthcare systems is a view echoed by many eminent voices in the global health community. Last year, the Institute of Medicine (IOM) of the National Academy of Sciences authored a report entitled: “Preparing for the Future of HIV/AIDS in Africa: A Shared Responsibility.” The IOM report recommended the urgent need to increase African healthcare workforce capacity to address the HIV epidemic.

I offer Secretary Clinton a solution to assist African healthcare workforces and ensure the success of the “AIDS-free generation” initiative. Last year, in an editorial in The New England Journal of Medicine, Vanessa Kerry, Sara Auld, and Paul Farmer reintroduced the idea of enacting a Global Health Service Corp (GHSC). The GHSC, compromised of U.S. healthcare professionals, would provide medical education and technical assistance to enhance the healthcare workforces in low-income countries. The GHSC’s goal would “go beyond that of filling a human resource void to focus on infrastructure development, knowledge transfer, and capacity building.” The GHSC could also offer partial student loan forgiveness for U.S. corps members who engage in service abroad for a specified time period similar to the loan forgiveness offered by the National Health Service Corp.

To address the African healthcare workforce shortage, I encourage Secretary Clinton to adopt the principles of the GHSC. The success of the “AIDS-free generation” initiative depends on the availability of skilled healthcare workers in African resource limited settings. Additionally, the eventual transition from a U.S. to African led HIV/AIDS response requires the U.S. to teach and train healthcare personnel in recipient countries through collaborative partnerships that eventually lead to African ownership of their domestic healthcare needs.

Some may argue that enacting the GHSC, especially in the era of U.S. government austerity measures, is not prudent. However, the funding for the GHSC already exists. In addition to HIV/AIDS prevention and treatment, PEPFAR’s congressional mandate requires the program to “strengthen partner government [healthcare] capacity to lead the response to this epidemic and other health demands.” Last year alone, PEPFAR committed over $734 million in healthcare capacity building initiatives.

Global health is the moral litmus test of our time. As Secretary Clinton asserted: “An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future.” The U.S. should enact the GHSC to ensure the success and sustainability of the “AIDS-free generation” initiative.

-Anand Reddi, The Huffington Post

If you are interested in supporting the Global Health Service Corp please sign the petition to show your support. http://www.globalhealthservicecorps.org/index.php/petition/

Additionally, the Medical Student Section of the American Medical Association is considering a resolution endorsing the GHSC at its 2011 Interim Meeting in New Orleans, Louisiana.

Kaiser Family Foundation recently held a webcast on “The Future of US Multilateral Engagement on Global Health“ as part of the Foundation’s US Global Health Policy: In Focus live webcast series. This question and answer format webcast featured an expert panel including Mark Abdoo the director for Global Health and Food Security, Natasha Bilimoria the president of Friends of the Global Fight Against AIDS, Tuberculosis, and Malaria, and Jennifer Kates the vice president and director of Global Health Policy & HIV for the Kaiser Family Foundation, moderated by senior analyst Josh Michaud.

This discussion explores the approach taken by the United States to address Global Health funding historically and looking into the future. Discussions on global health funding often involve a division between bilateral approaches to funding versus multilateral funding engagement. Bilateral funding involves the provision of direct assistance from one government to, or for the benefit of, one or more other countries, with the donor having significant control over the target, approach and content of assistance. On the other hand, multilateral organizations such as the World Health Organization, the United Nations and the Global Fund, bring together global stakeholders to develop and collaborate on global health targets.

Historically, the US has commonly supported global health priorities via bilateral funding and programs but the focus on promoting multilateral organizations is growing. For example, the US was the first and is currently the largest donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and a key component of the Obama Administration’s Global Health Initiative includes a renewed and increased commitment to multilateral engagement. The shifting approach has led to questions regarding the appropriate focus for US global health engagement, the proper balance between multilateral and bilateral funding efforts and the appropriate role of the US government and other organizations in international treaties and other collaborative agreements.

Check out this and more global health-related webcasts and other valuable resources on global health policy at the http://www.kff.org/ website. A more detailed discussion on the US Government’s Global Health Policy Architecture is also available.

The UN Summit on the Millennium Development Goals was held this past week in New York City. Occurring at a crucial time, with five years remaining until the 2015 deadline, world leaders met to discuss needed actions to reach the eight global development targets agreed to by the world’s countries and leading development institutions in September 2000 at the Millennium Summit when the United Nations Millennium Declaration was adopted, committing the UN nations to a new global partnership to reduce extreme poverty and setting out a series of time-bound targets – with a deadline of 2015 – known as the Millennium Development Goals. The Millennium Development Goals include:

• End Poverty and Hunger
• Universal Education
• Gender Equality
• Child Health
• Maternal Health
• Combat HIV/AIDS
• Environmental Sustainability
• Global Partnership

The Millennium Development Goals Report 2010 summarizes the progress which has been made thus far while striving to meet these goals as well as potential actions, strategies and policies which could be implemented to continue positive progress.

This event is organized by the New York Medical Student Coalition Against Torture (NYMSCAT@gmail.com). Email to learn more, request materials, and get involved!

As I have written previously, medical professionals, students, and human rights groups in New York State are teaming up for action to pass the nation’s first law holding medical professionals accountable for assisting torture and abuse of prisoners.  AMSA is proud to join the list of organizations putting their support behind the proposed legislation:

• National Physicians Alliance
• Committee for Interns and Residents
• American College of Physicians-NY
• NY State Nurses Association
• NY Civil Liberties Union
• Center for Constitutional Rights
• Human Rights Watch
• Amnesty International
• Physicians for Human Rights
• I Have A Dream Foundation
• Metro NY Religious Campaign Against Torture
• (full list and statements at whenhealersharm.org/)

ANTI-TORTURE LOBBY DAY in Albany: Join AMSA and PHR with medical students from across the state in our first Anti-Torture Lobby Day in Albany on May 18th!  This is our chance to meet with our local lawmakers and tell them that ending torture is important to us as ethical medical professionals and Americans.  We will meet at 9AM for a white-coat press conference and advocacy training with experts from the Bellevue/NYU Program for Survivors of Torture, and follow up with advocacy meetings.  If you are a NY State resident and a medical or pre-medical student, don’t miss this chance for real-time local action for human rights!

Don’t forget to sign the petition: Stop Torture NY.org

Read AMSA’s statement of support after the cut:

Read the rest of this entry →

Farheen Qurashi, AMSA’s Jack Rutledge Legislative Director 2009-2010, and Mary Carol Jennings, AIDS Advocacy Network Chair 2009-2010, contributed to this post.  To join this event in NYC on May 13th, please contact Farheen at jrld@amsa.org.

On the campaign trail, President Obama pledged “to provide at least $50 billion by 2013 for the global fight against HIV/AIDS, including our fair share of the Global Fund, in order to at least double the number of HIV-positive people on treatment and continue to provide treatments to one-third of all those who desperately need them.”  HIV/AIDS patients and their advocates, including AMSA members, were important in getting then-candidates Obama, Clinton, and Biden to commit to these figures.

However, since taking office, the Obama Administration’s budgets have flatlined funding for AIDS programs.  Our commitments to fighting AIDS have not even kept pace with inflation: PEPFAR funding increased by only 2%  in 2010, while annual  inflation in most African countries is 7%.  Now, clinics around the world are reporting turning away patients with clinical AIDS who would previously have been treated, due to funding cuts (ITPC, 2010).

On May 13th, AMSA will be gathering for a white-coat protest at a Democratic Party fundraiser at St. Regis Hotel in NYC, to remind President Obama of his promises.  We will be joining activists from ACT UP, Africa Action, African Services Committee, NYC AIDS Housing Network, VOCAL-NY Users Union, Housing Works, Health GAP, Philadelphia Global AIDS Watchdogs, and other allies.  Join us, and let the President know that extending AIDS funding to meet the global need is important to you!  Please contact Mary Carol Jennings (marycaroljennings@gmail.com) for more details.

UPDATED: [05.11.2010] More information and disclaimer after cut. Read the rest of this entry →

The following is a guest post by Farheen Qurashi, AMSA’s Jack Rutledge Legislative Director 2009-2010.

U.S. student activists

Just a few days ago, we celebrated World Health Day – the progress we’ve made in providing aid to patients around the world, the diseases prevented and the treatments admitted. But, we still have a long way to go, and as we celebrated, we also remembered that there is much to accomplish and continue in global health aid.

Two weeks ago, Rep. Barbara Lee (CA-9^th) introduced HR 4933, the Global HEALTH Act of 2010. This is a key piece of legislation that makes bounds towards creating a comprehensive and integrated global health aid strategy, focusing on strengthening health systems of developing countries to provide comprehensive primary to tertiary care as well as expanding the vital health care workforce – including doctors, nurses, midwives and community health workers—in needy areas. There is a dire international shortage of all kinds of health workers, and this is a bottleneck to providing sustainable and adequate care to patient populations – strengthening the health workforce is a key part of strengthening an overall health system.

Importantly, the Global HEALTH Act:

• Creates the Global Health Workforce Initiative, which emphasizes training, retention, and support for needed health workers
• Mandates the creation of a multi-year, in-depth strategy for health systems strengthening, and authorizes necessary support for this strategy
• Ensures country-ownership and accountability to health strategies
• Authorizes support for health strategies to ensure the swift achievement of US global health goals
• Prioritizes the needs of marginalized and vulnerable populations like women and girls, sex workers, etc.

On the cusp of the US’s own health system reform movement, we must also remember our patients in need around the world. The Global HEALTH Act makes a much-needed and bold step forward for global health aid, and AMSA is proudly one of its original supporters, along with Physicians for Human Rights, Health Alliance International, Health GAP (Global AIDS Project), and other organizations.

The Global HEALTH Act, HR 4933, is currently awaiting discussion in the Foreign Affairs and Financial Services Committees of the House of Representatives. For the ideas within the bill to receive recognition, support, and success, we must ask our Congressmen to show their support by co-sponsoring the legislation.

To send your Congressman a message, click here.

To find out more about the Global HEALTH Act, click here.

To read the full text of the bill, click here.

This is the second in a series of posts for the American Public Health Association’s National Public Health Week.

Today, Wednesday April 7th marks World Health Day 2010. This year, the UN Secretary-General’s Message for World Health Day centers on the theme of urbanization and health with the campaign “1000 cities – 1000 lives.” The theme of Urban Health was chosen in the setting of a world in which the majority of the population is living in urban versus rural areas for the first time in history. At the same time, poverty is also shifting from sparsely-populated rural areas to urban areas especially in developing countries.

Disparities in people’s income, opportunities, living conditions and access to services along with numerous threats to public health including inadequate sanitation and refuse collection; industrial and traffic pollution; infectious diseases that thrive on squalor and crowded conditions; high rates of tobacco use; physical inactivity; unhealthy diets; crime, violence and the use of harmful substances are complex issues depending not only on public health measures but also social policy and governmental structures.

Source: Wikipedia

This is the first in a series of posts for the American Public Health Association’s National Public Health Week.

Most of us associate biodiversity with images of tropical rain forests and coral reefs. While these ecological hot-spots are an important source of medications and global ecosystem services, biodiversity also plays a key role in neighborhoods across the US through regulating the spread of diseases such as Lyme disease. But how is that possible, you might ask, and what can you do about it?

Lyme disease  affects hundreds of thousands of people across the US, with a greater concentration in the northeast. Recent decades have seen an explosion of urban sprawl across the northeast leading to decreased species diversity along with people living in close proximity to fragmented habitats.  But how are these related?

The connection is explained succinctly in Sustaining Life: How Human Health Depends on Biodiversity:

“The Blacklegged Tick (Ixodes scapularis) is the vector of Lyme disease, as well as of several other pathogens in the eastern U.S., and the primary reservoir for Lyme disease in this region is a common rodent, the White-Footed Mouse (Peromyscus leucopus)…Mice live in many different habitats, from pristine old-growth forest to degraded woodlots, garden sheds, and even kitchens. Several studies have demonstrated that populations of White-Footed Mice become very concentrated in small forest fragments, probably due to the absence of other vertebrate species that prey upon, or compete with them (forest fragmentation…affects predators over prey disproportionately). As a consequence, tick populations in small forest fragments have many White-Footed Mice, but few other mammalian hosts on which to feed, resulting in a high proportion of the ticks being infected and able to infect people. In contrast, in more extensively forested areas, the combination of fewer White-Footed Mice and more abundant, alternative, reservoir-incompetent hosts (an incompetent reservoir for Lyme does not pass on the Lyme bacteria to ticks that bite them, or does so poorly) results in a lower proportion of the tick population being infected.”

This phenomenon is known as the Dilution Effect: As species richness declines there is a subsequent decrease in the “dilution” of host-species making Lyme disease easier to spread. As the authors note, the dilution effect is not unique to Lyme, the same mechanism also operates in Hantavirus and West Nile Virus and possibly many others. As sprawl-based development patterns spread to more areas of the planet, we can only expect to see an increase in the number of dilution effect diseases unleashed upon populations worldwide.

So how can you increase biodiversity in your community and thereby help protect the health of your family and neighbors?

Get involved with your local conservation commission and bring these dangers to their attention. Find ways to support local parks and nature preserves. Also, if you have a yard or garden, try to plant local species that help support wildlife.  Most importantly: Education! If you are in college or school, talk to your professors about integrating awareness of biodiversity into curriculum.  Thanks to the UN and various donors, Sustaining Life is available at a very affordable price and can serve as a great textbook without placing a great financial burden on students. In addition, local schools can serve as great sources of biodiversity through gardens and planting of local species on grounds. Often these locals are less expensive to maintain, requiring less water and fertilizer.

These are just some ideas…we’d love to hear from GP readers with their experiences and success stories.

Home to over 400 million people, the Ganges river winds through India’s history, culture and countryside. Unfortunately, rapid industrialization and urbanization has left an unholy mark on the Ganges as dangerous amounts of untreated industrial pollution and human excrement enter the river every day.  These conditions are all too common in rivers worldwide  and create an environment ripe for diseases ranging from schistosomiasis to Cryptosporidium.

But long time advocacy is finally paying off as the WSJ reports that World Bank and the Indian government are set to spend $4 billion to “to ensure that by 2020 no untreated municipal sewage or industrial runoff enters the 1,560-mile river.”.  The methods proposed also have the benefit of being less carbon and electricity intensive than traditional wastewater treatment plants – key aspects for a country with chronic brownouts in a warming world.  In order to reach their goal, the government and partners will need to engage the most neglected slums which, if done right,  has the potential to create environmental justice at the same time as cleaning the river.

Of course, governments have a tendency of announcing lofty environmental goals which are then forgotten in the next election cycle. The Ganges also had a previous cleanup effort that failed to reach its goals, partly because of lacking public participation. Hopefully things will be different this time, but GP would love to hear from anyone with on the ground insight.

Note:  The GP editorial staff’s thoughts and hearts go out in solidarity to the residents of Port-au-Prince and their families, as well as our colleagues in Haiti.  We will be updating this post as more information becomes available.

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Earthquake Crisis in Haiti

Original post by Wilnise Jasmin [01.14.2010 @ 6:53 AM EST]

As you may have already heard, a 7.0 magnitude earthquake struck about 10 miles southwest of Port-au- Prince, Haiti at about 5 pm Tuesday night. The quake ravaged the infrastructure of Haiti’s fragile government and destroyed some of its most important cultural symbols.

“Parliament has collapsed,” Mr. Préval told The Miami Herald. “The tax office has collapsed. Schools have collapsed. Hospitals have collapsed. There are a lot of schools that have a lot of dead people in them.” He added: “All of the hospitals are packed with people. It is a catastrophe.”

President Obama promised that Haiti would have the “unwavering support” of the United States.

Haitian authorities and humanitarian aid organizations are struggling to respond amid devastation. Read the rest of this entry →