The Global Pulse Journal Blog

Recently members of several major corporations including Nike, EBay and the Modernizing Foreign Assistance Network (MFAN) presented an open letter calling on the US government and President Obama to take an innovative approach to carrying out the goals and visions committed to at the recent G8 summit and to develop a US global development strategy. They call on US leaders and Congress to develop a rewritten US development Act to replace the outdated 1961 Foreign Assistance Act. They discuss an approach to modernize foreign assistance in the global arena.

A  new survey from the Centers for Disease Control and Prevention (CDC) suggests that  heterosexuals living in impoverished communities are as much as five times more likely to be HIV-positive than the general U.S. population, regardless of race or ethnicity. In the US, the overall HIV prevalence rate for African Americans is eight times the rate for whites, and the rate for Latinos is three times the rate for whites. Yet in very-low income areas this CDC study found that these disparities do not exist. The study examined 9,000 people in 23 cities, finding that 2.1% of heterosexuals living in high-poverty urban areas were infected with the HIV virus, including 2.4% of those living below the poverty line and 1.2% of those living above it. This is in comparison to the 0.45% rate of HIV infection in the general US population. The authors hypothesize that the findings could account for many of the ethnic and racial disparities in HIV infections in this country, since African Americans are 4.5 times as likely and Latinos four times as likely as whites to live in poverty.

For a look at the US government’s role in improving global maternal, newborn, and child health check out the Kaiser Family Foundation’s recently released report entitled “The U.S. Government’s Efforts to Address Global Maternal, Newborn, and Child Health: The Global Health Initiative and Beyond.” The report discusses US efforts towards improving child and maternal health including the recently heightened focus placed on these issues by the Administration’s Global Health Initiative. It provides a detailed overview of the U.S. government’s response thus far, looks at U.S. funding trends for maternal and child health, examines international and domestic agencies’ activities related to maternal and child health, explores U.S. participation in international multilateral efforts and identifies key policy issues surrounding the future of the U.S. involvement in such health issues.

A related webcast and fact sheets on maternal and child health and family planning are also available.

In this week’s issue of NEJM, Dr. Lucas Restrepo from the Barrow Neurological Institute in Phoenix, AZ, articulates concerns over the impact of Arizona’s controversial immigration law, SB 1070, on access to medical care in the state:

It can be argued that health care providers who neglect to report illegal immigrants under their care will violate the law and be considered criminals. The bill provides physicians with no guidance as to what constitutes “reasonable grounds” to suspect that somebody is in the country illegally, leaving the particulars of such scrutiny to anyone’s imagination (although the fact that Arizona shares a border with Mexico rather than a European country suggests that whites will not be “reasonable” suspects).

Dr. Restrepo and colleagues also published a letter in the Arizona Republic earlier:

As physicians, we are concerned about the immigration bill signed by Gov. Jan Brewer. We care for many patients who may appear foreign based on superficial impressions. It is unclear whether health-care professionals like ourselves will infringe on the law if we don’t report patients or their families to the police or immigration authorities based on a vague suspicion of illegality. . . . Senate Bill 1070 tacitly prescribes a break with one of the oldest traditions of medicine: Physicians shall protect patients regardless of nationality or race [emph. added].

In a statement released on May 18, the National Physicians Alliance and CIR/SEIU-Healthcare condemn the law as “an affront to human rights and a devastating step backwards for the health and well being of the entire nation,” and warn that it will “create new obstacles to obtaining needed health care.”

More on Arizona SB 1070:

• Some 50,000 protesters gather in Phoenix on May 29 to demonstrate against the law
• Immigrant groups and workers’ organizations (Hispanic and not) urge a boycott of Arizona
• The Sound Strike, a group of musicians and performers headed by Zach de la Rocha, boycotts AZ

Does Arizona’s law go too far? Do you think it is likely to affect the practice of medicine in the state? Do doctors have a role to play in this debate? Join the discussion by leaving a comment!

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.

For the past seven years, the United States has supported and expanded its program to fight HIV/AIDS in developing nations, underwriting almost half of the world’s AIDS relief. But some are concerned by recent setbacks in the global campaign to fight disease in the developing world. At a time when the numbers of people infected with HIV is beginning to increase after stabilizing in countries like Uganda and the number of people in need of treatment is rapidly expanding, the US funding has not kept pace. With updated World Health Organization guidelines, the number of HIV-infected people eligible for treatment has expanded to 14 million, a large increase from the only 4 million people current in treatment.

In the face of this expanding pool of people in need, US government funding seems to be staying stable. For example, at the same time that the Obama administration has announced plans to expand HIV treatment to at least 4 million by 2013, they have also signaled no increases in funding budgets through fiscal 2011. Defending the administrations commitment to fight the global pandemic, Eric Goosby, the President’s AIDS czar, stated that “our commitment to universal coverage hasn’t wavered.”

For more on the global fight on AIDS and particularly the fight in Uganda, check out the Wall Street Journal’s January 30th article and slideshow.

This is the start of another GP Blog series, inspired by a recent workshop in New York City addressing the implications of human trafficking and commercial sex exploitation in the clinical setting. It is my hope that this series can help increase awareness of the issue, and keep the conversation going. Read the rest of this entry →

In somewhat belated honor of Mother’s Day in the US, I would like to share the following post by Vanessa Coleman at AMPLIFY:

According to the World Health Organization (WHO) , 99% of deaths during childbirth occur in low-income countries. For example, the chance of maternal death in high income countries is 1 in 7300, where as in low income countries it is 1 in 73. As young people, this is especially important and relevant because most of the young women who are dying could very well be our friends, schoolmates and classmates had they lived in a different country (particularly if they had been fortunate enough to live in a high income country as we do). The leading cause of death in young women aged 15-19 in low-income countries is from childbirth complications.

Leading causes of maternal mortality worldwide:

Within the US, maternal mortality rates are hardly cause for complacency.  The world’s foremost economic power (pending post-recession change in paradigm), we rank 28th in infant mortality, and 41st in maternal mortality:

Based on 2005 estimates, the U.N. analysis suggests that one in 4,800 women in the United States carry a lifetime risk of death from pregnancy. By contrast, among the 10 top-ranked industrialised countries, fewer than one in 16,400 are facing a similar situation.  The reason? According to experts, in many European countries and Japan in the industrialised world, women are guaranteed good-quality health and family planning services that minimise their lifetime risk.  Many independent experts and sympathetic legislators hold the current U.S. public health policy responsible for its dismal record because some 47 million U.S. citizens have no access to health insurance, most of them African Americans and other minorities. [IPS News]

Steep disparities in maternal health are linked to ethnicity and socioeconomic status, with African-American women being 4 times more likely to die in childbirth than white women, a point that is alternately called our “national shame”, and goes ignored.

More reading: How do socioeconomic factors affect disparities in mortality? by Deborah Maine, in the Journal of the American Medical Women’s Association, provides some nice historical context on maternal mortality in the US.

As we all come down from last week’s frenzy surrounding the (now renamed for lesser offensiveness to pork-marketing sensibilities) Swine-Origin Influenza Virus (S-OIV) H1N1 , is it possible that there is a hint of disappointment in the air?  Perhaps a whiff of anti-climactic letdown after the threat of feverish, lung-rending apocalypse?  Are we seeing a lucky escape from a close brush with global pandemic, at mercy of mutation and chance?  The product of a genuine, coordinated worldwide epidemic response?  Or merely the end of one news cycle and the beginning of the next?

While you ponder those questions, I bring you what could be one of the last updates before S-OIV H1N1 becomes terminally uncool.  As of Monday, April 4, the World Health Organization registered 1,085 laboratory-confirmed cases in 21 countries.¹ Mexico has begun to step down its safety measures, with restaurants and other venues for public activity set to re-open on Wednesday, and U.S. public health officials will be allowing schools to remain open in spite of the continuing spread of the virus, as most new cases appear to be mild.  In the business of assuaging fears, it has been confirmed by the WHO that eating pork is safe (so long as you cook it to 70°C/160°F first), and in the business of fanning fears of a different kind, U.S. conservatives are wasting no time in casting President Obama’s “overreaction” to the crisis as big-government encroachment.

For the fun flu facts reading selection this time,  I introduce another global health resource: the University of Pittsburgh’s Supercourse online series on epidemiology and global health.  Click on the Swine Influenza A link (or on the image below), pick your language of choice (including Spanish, Russian, Farsi, Vietnamese, and Hebrew), and click “Start” for a refresher on hemagglutinins, neuraminidases, and case definitions.

For a cool overview of influenza virus genetics, check out this article by Carl Zimmer in the New York Times:

Scientists first isolated flu viruses from pigs in 1930, and their genetic sequence suggests that they descend from the Spanish flu of 1918. Once pigs picked up the flu from humans, that so-called classic strain was the only one found in pigs for decades. But in the 1970s a swine flu strain emerged in Europe that had some genes from a bird flu strain. A different pig-bird mix arose in the United States.

In the late 1990s, American scientists discovered a triple reassortant that mixed genes from classic swine flu with genes from bird viruses and human viruses. All three viruses — the triple reassortant, and the American and European pig-bird blends — contributed genes to the latest strain.

And for possibly the best selection of flu-tracking maps you’re likely to find, this one is brought to you by Google and Rhiza Labs:

¹ For the epidemiologically-minded, with a lab-confirmed death toll of 26, this makes for a Case Fatality Ratio of 2.4% and falling with every new case of lab-confirmed disease in the absence of further deaths.  For comparison, your annual, garden-variety flu has a CFR of less than 0.1% in the general population, with a bimodal distribution of mortality (mostly limited to the very young and the very old).  Past flu pandemics have had CFRs in the 0.1%-2.5% range, while the dreaded H5N1 avian flu virus tracked in Asia in recent years showed a CFR of 14%-60% by various estimates (Li et al., J Epidemiol Community Health. 2008 Jun;62(6):555-9 ).  One previously reported CFR for zoonotically-acquired swine influenza was 14% (Myers et al., Clin Infect Dis. 2007 Apr 15;44(8):1084-8 ).  As you may suspect, flu CFRs are notoriously difficult to calculate, due to the wide incidence and under-reporting of mild cases.