Global health

Jump to: navigation, search

Global health is a field at the intersection of several disciplines epidemiology, economics, demography and sociology that concerns itself particularly with international health issues. Examples of global health issues include international law (and its effect on health systems), global warming (and the implications for population health), globalization and health, the Framework Convention on Tobacco Control (FCTC), and The Global Alliance for Vaccines and Immunization (GAVI), among many others.

History

The modern era of global health promotion began in World War II with the realization that malaria was taking a significant toll on military personnel. In 1942, the U.S. Public Health Service created the Office of Malaria Control in War Areas to control malaria around military bases in the South and other territories.[1] By 1946, the MCWA had expanded and been renamed the Communicable Disease Center or CDC, which is today called the Centers for Disease Control and Prevention.[2]

In 1948, the member states of the newly formed United Nations gathered together to create the World Health Organization. A cholera epidemic that took 20,000 lives in Egypt in 1947 and 1948 helped spur the international community to action.[3]

One of the greatest accomplishments of the international health community since then was the eradication of smallpox. The last naturally occurring case of the infection was recorded in 1977. But in a strange way, success with smallpox bred overconfidence and subsequent efforts to eradicate malaria and other diseases have not been as effective. Indeed, there is now debate within the global health community as to whether eradication campaigns should be abandoned in favor of less costly and perhaps more effective primary health and containment programs.

For a variety of reasons, fewer resources were made available for global health in the late 1970s and 1980s—just at the moment when the AIDS virus was beginning its worldwide spread.

The beginning of the 21st century, however, saw renewed interest, particularly after Microsoft Chairman Bill Gates started spending billions of dollars on international health initiatives and research.[4]

Viewing global health

In the past, public health authorities have taken a disease-specific approach to studying and making improvements in global health. The successful campaign to eradicate smallpox is an example of how such a focused approach can bring about real health benefits. See also HIV/AIDS, malaria, tuberculosis.

More recently, however, some health advocates have argued that a broader approach, across several disciplines, is needed to make lasting progress in public health. One such approach would emphasize the need to establish primary health care clinics--that treat as well as immunize against the routine diseases of childhood, provide maternal health care, family planning, emergency room services, and services for the most common infections diseases--all in one place.[5]

Other approaches emphasize the needs of children, women's rights, or advocate recognition of health as one of the basic human rights. See also bioethics, gender discrimination.

Brain drain – a major obstacle for public health in sub-Saharan Africa

Background

Healthcare workers – doctors, nurses, midwives, pharmacists, mental health workers, lab technicians, etc – are the very core of any functional health system. In its World Health Report of 2006, The World Health Organization (WHO) states that “the workforce is central to advancing health” because “workers are in the unique position of identifying opportunities for innovation … [and also] function as gatekeepers and navigators for the effective, or wasteful, application of all other resources such as drugs, vaccines and supplies.”[6] In fact, studies have shown a direct correlation between an increase in the number of healthcare workers with an increase in child and maternal survival.

Unfortunately, the current global situation reveals a significant shortage of healthcare in much of the world – the most severe cases occurring in sub-Saharan Africa. The World Health Organization estimates that sub-Saharan Africa is suffering a shortage of more than 800,000 doctors, nurses, and midwives, and an overall shortfall of nearly 1.5 million health workers. This translates into a mere 3% of the world’s health workers struggling to combat 24% of the global disease burden. Currently, about 38 of the 47 countries in sub-Saharan Africa do not meet the WHO recommendation of a minimum of 20 physicians per 100,000 people; in fact, approximately 13 of them have 5 or fewer physicians per 100,000 people, and Malawi in 2004 had only 266 physicians for a population of around 13 million (2.1 per 100,000)[6] This alarming shortage has a variety of root causes: a lack of sufficient training capacity to produce the number of health workers necessary, inadequate salaries, and most significantly, the migration of health workers from poor countries to richer countries, a phenomenon commonly called “brain drain”.[7]

The crux of the problem – why has “brain drain” occurred?

In their report An Action Plan to Prevent Brain Drain, the organization Physicians for Human Rights defines “brain drain” of health workers as “part of a series of internal and international migrations of health personnel to areas deemed more favorable, including rural to urban areas, and less developed to more developed countries within the developing world.” The phenomenon is best understood as a symptom and aggravating factor of weak infrastructure due to failed or unstable political and economic systems within sub-Saharan African nations, rather than as the actual cause of inefficient healthcare systems. The migration of healthcare workers from sub-Saharan countries to primarily Anglophone countries like Britain, the United States, Australia, and New Zealand is due to a variety of reasons:[7]

  • Inadequate salaries or benefits: A 2002 survey listed monthly salaries for physicians that range from US$50 in Sierra Leone to US$1,242 in South Africa, while wages in destination countries like Canada and Australia are approximately four times those in South Africa.
  • Poor work environments: characterized by heavy workloads, weak infrastructure, weak management and support systems, and a lack of institutional knowledge.
  • Dangerous environmental factors in the workplace: Workplaces are often dangerous due to a lack of sanitation and proper supplies to protect healthcare workers from prevalent and easily transmitted diseases like HIV and tuberculosis. These conditions combined with very high HIV prevalence rates in this region of the world have created an extremely precarious situation and only a handful of African countries have created programs to treat and counsel HIV-positive healthcare workers. The need for an effective solution is most pressing: for example, the WHO estimates that if HIV-positive healthcare workers in Botswana are left untreated, the proportion of those dying as a result of AIDS could reach 40% by 2010.
  • The shortage of healthcare workers in richer countries: The industrialization of countries around the world has raised the standard of living in those societies and thus shifted the industrialized world’s age distribution - there are now more elderly people than ever before. As a result, there has been a growing need for healthcare workers in most parts of the world – including both the US and Britain. This has led to the emergence of vigorous international recruitment efforts on behalf of the health systems of richer countries.

Efforts to combat the problem

The WHO’s World Report has outlined several key criteria that must be met in order to curb the migration of healthcare workers and to ensure a sustainable health care system in sub-Saharan nations:

•Building strong institutions for education is essential to secure the numbers and qualities of health workers required by the health system.

•Assuring the educational quality of those institutions

•Improving the performance of the health workforce by creating a system that includes supervision and adequate support systems.

•Ensuring fair and reliable compensation

•Allowing women equal access to health work as a career choice

•Ensuring safe work environments

•Retirement planning.

Additionally, many host countries have attempted to restrict their healthcare systems’ dependency on foreign healthcare workers through legal restrictions. For example, Britain implemented a "code of practice" in 2001 that prohibits its National Health Service organizations from recruiting health workers from certain African countries. Unfortunately the code is applicable only to the public sector, and thus the private sector has continued its recruitment practices. Other countries have opted to enter into bilateral agreements with other nations (such as the one between South Africa and Britain, or several others between South Africa and its poorer neighboring countries), allowing health care workers to train and work in both countries for a specified period of time.[7] Additionally, many African countries (such as Uganda) use scholarships to medical schools as a means to guarantee that physicians practice within their home countries for a significant amount of time.

Organizations addressing the problem

•World Health Organization (WHO) (http://www.who.int/en/) The World Health Organization, established in 1948, is the United Nations specialized agency for health. The organization’s objective, as set out in its Constitution, is the attainment of the highest level of health by all the world’s populations. The WHO is primarily occupied with achieving the health-related components of the Millennium Development Goals (MDG) agreed upon by the UN General Assembly in 2000. The MDG relate to the following: 1) poverty; 2) primary education; 3) gender equity; 4) child mortality; 5) maternal health; 6) HIV/AIDS, malaria and other diseases; 7) environmental sustainability; and 8) global partnerships for development.

•International Labour Organization (ILO) (http://www.ilo.org/public/english/index.htm) The International Labour Organization is a UN specialized agency which seeks the promotion of social justice and internationally recognized human and labor rights. The organization creates international labor standards by setting minimum standards of basic labor rights (ex: freedom of association, the right to organize, collective bargaining, abolition of forced labour, equality of opportunity and treatment, etc) It has played a major role in promoting governmental efforts to reduce workplace violence for health care workers.

•Health Volunteers Overseas (http://www.hvousa.org/) An organization founded in 1986 that works to increase health care access and sustainability in developing countries through clinical training and education programs in child health, primary care, trauma and rehabilitation, essential surgical care, oral health, infectious disease, nursing education and burn management.

•Physicians for Human Rights (http://www.phrusa.org/) An organization that operates on the central belief that “human rights are essential preconditions for the health and well-being of all people.” They investigate and expose violations of human rights worldwide and educate health professionals and medical, public health and nursing students in an effort to create a culture of human rights in the medical and scientific professions.

•International Center for Equal Healthcare Access (http://www.volunteersforprosperity.gov/busorg/profiles/iceha.htm) An international not-for-profit organization that allows healthcare professionals to teach transfer their expertise on HIV care and infectious diseases to colleagues in developing countries through clinical mentoring.

Opportunities for student involvement

•Offer financial support to any of the organizations listed above.

•Call your senators to support the African Health Capacity Investment Act currently co-sponsored by Senators Durbin (D-IL), Coleman (R-MN), DeWine (R-OH) and Feingold (D-WI). The bill would authorize the US government to use $200 million a year by 2009 in conjunction with African governments and organizations in efforts to build a self-sustaining health care workforce by reducing brain drain through providing adequate salary, increasing health worker safety, and expanding training and educational opportunities.[8]

•Volunteer – there are hundreds of organizations available for students (both within and outside of health professions) to volunteer to train healthcare workers in less developed countries – here are a few major resources:

-The International Healthcare Opportunities Clearinghouse (http://library.umassmed.edu/ihoc/) A database designed for health-care professionals and students who are interested in volunteer work with communities at home or abroad. It was created in 1996 by a small group of faculty members and students from the University of Massachusetts Medical School and the website serves as a database through which qualified candidates can attain grants for programs.

-Peace Corps (www.peacecorps.gov) A governmental organization established by President John F. Kennedy in 1961 as part of his effort to promote world peace and friendship. Volunteers are asked to complete a 27 month stint in a foreign country while working in one or more of the following areas: education, youth outreach, and community development; health and HIV/AIDS; agriculture and environment; business development; and information technology.

-International Center for Equal Healthcare Access (http://www.volunteersforprosperity.gov/busorg/profiles/iceha.htm) This is an international not-profit organization that allows healthcare professionals from developed countries the chance to transfer their expertise on HIV care and infectious diseases to colleagues in developing countries through clinical mentoring.

Sanitation education in rural communities in developing countries

Introduction

One critical component of Global Health in rural communities in developing countries is health, hygiene, a sanitation education. In the following discussion, the term “sanitation education” will be used indiscriminately to describe any activity that involves the distribution of knowledge as it relates to personal hygiene, sanitation, and the spread of disease, particularly the spread of disease as it relates to the fecal-oral track. This kind of education is of utmost important in rural communities in developing countries, where often the lack of basic sanitation education leads to series illness and death .

It could be argued that the lack of basic sanitation education is one of the leading “causes” of death in rural communities in developing countries. The spread of water borne disease such as typhoid and chronic dysentery could be drastically reduced through appropriate education programs. For example, it is often the case in rural communities in developing countries that it is not the access to safe water the posses the biggest issue, but the lack of utilization of methods and techniques to purify water. Techniques such as water boiling or chlorination are often not utilized in these communities because there is not a perceived need, or a real threat or danger, associated with the potential for water borne disease. Sanitation education as it relates to basic germ theory, as well as disease related to the fecal-oral track can also increase the health in a community. This includes such things as proper hand washing techniques, and caring for sick community members. When utilized effectively, education can empower individuals to successfully achieve their optimal levels of health

There is a particular need for Sanitation Education in rural communities in developing countries among the youth population . As stated in the World Health Organizations “Water Sanitation and Health”:

Hygiene promotion campaigns are most effective among younger populations, and students can be targeted both as beneficiaries and as agents of behavioral change within their families and their communities.

On sanitation education hinge all other aspect of development related to sanitation. Before the implementation for water purification technology to help prevent the spread of water borne disease, the basic concepts of sanitation must be understood and comprehended. Before sanitation systems can be implemented, there must be a perceived need for sanitation practices themselves. Education is the means by which these perceptions may be developed.

Basic steps in a Sanitation Education Program for Rural Communities in Developing Countries

The following steps in and sanitation education program are adapted from a model used by the Citizen Planning and Housing Associated in Baltimore for local sanitation education seminars and sessions in the city of Baltimore :

  1. Form a leadership group / committee within the community to plan and develop a sanitation education program for the community. With the leaders of the community, make a list of all sanitation problems in the area, problem areas, etc.
  2. Talk to the members of the communities extensively. See what cultural, social, habitual issues might be working against / for healthy sanitation practices
  3. Design the educational program, tailoring it specifically to meet the localized needs of the community in question, utilizing the cultural norms perceived in step two. Invite criticism or comment from the community members and committees Implement the community wide educational events, and distribute education materials to households
  4. Arrange for a special group meetings for high risk groups, such as school children, mothers, and expecting mothers
  5. After the educational seminars, provide ways for hands real life application of the information within the educational program. Use real life challenges in rural communities in developing countries. Options might include cleaning a certain area of the community to keep it from harboring disease, or in having community members transmit the information to surrounding local communities
  6. Include the leadership of the community and the community members themselves in all aspects of the design and implementation of the education program.

Current efforts

Currently there are many organizations working in sanitation education in rural communities in developing countries. The following outline a few of these organizations:

GSK, PHASE program http://www.gsk.com/community/phase.htm

“Every year over 2.2 million people globally die of diarrhoeal disease, mostly children in developing countries. It's one of the world's biggest killers, yet one of the most easily preventable.

PHASE - Personal Hygiene and Sanitation Education - is a simple hand washing programme for school children that saves lives.

By providing guidance on the importance of hand washing and other hygiene practices, PHASE aims to reduce diarrhoea-related disease linked to poor hygiene and to improve children's overall health and well-being.

PHASE currently operates in six countries, reaching more than 270,000 children and their extended families:

  • Kenya, Uganda and Zambia in Africa
  • Nicaragua and Peru in Latin America
  • Bangladesh in Asia” Focusing Resources on Effective School Health (FRESH) http://www.freshschools.org/ “The FRESH framework, an intersectoral partnership to Focus Resources on Effective School Health, provides the context for provision of safe water and sanitation facilities for children in schools. Creating a healthy school environment by provision of safe water and sanitation facilities within schools, to improve children’s health, well being and dignity, is likely to be most effective where it is supported by other reinforcing strategies. These strategies include policies to provide a non-discriminatory safe and secure environment, skills based health education, provision of health and other services, effective referral to external health service providers and links with the community. The FRESH framework provides this context by positioning provision of safe water and sanitation among its four core components, that should be made available together for all schools:
  • Health related school policies
  • Safe water and sanitation
  • Skills based health education
  • Access to health and nutrition services” International Water and Sanitation Centre (IRC) http://www.irc.nl/sshe “School Sanitation and Hygiene Looking for sustainable approaches to improve the health of school children through better hygiene behavior and a healthy school environment. These IRC thematic pages deal with Water, Sanitation and Hygiene (WASH) in schools, until recently called SSHE: school sanitation and hygiene education.”

    Future needs

    In education sanitation in rural communities in developing countries, education materials are often the key component which is lacking. The need for effective methodologies and practices in sanitation education cannot be overemphasized. Particularly, the development of educational materials which are general in their format, but modifiable to fit a cultural context, are needed to assist in sanitation education in rural communities in developing countries. Because there may be high illiteracy or language barriers, sanitation concept, pictorial representation of sanitation concepts are often most effective. The development of such pictorial educational tools for teaching about basic sanitation practices would provide a necessary resource to many development and governmental agencies, and would prove incredibly powerful in sanitation education.

    Childhood mortality

    According to UNICEF, 10.5 million children die before they reach 5 years of age. That translates to roughly 30,000 children dying every day.[9]

    Causes

    The main causes of childhood death are illustrated in the chart below and include malnutrition, poor neo-natal care, and conditions such as measles, malaria, HIV/AIDs, pneumonia, diarrhea, tetanus. This last group causes roughly half of childhood deaths, but the ailments are largely preventable and/or treatable.

    File:Causesofdeath.jpg[10]

    The greatest single cause of child mortality is poverty. Poor and disadvantaged families are unlikely to have access to safe water, proper sanitation, or an adequate diet. These factors greatly increase the risk of contracting disease. Once a child is sick, she is likely to die because impoverished families are unlikely receive prenatal care or lifesaving medical services.[9]

    Disparities

    File:U5byarea.jpg[11] File:Mdg.jpg[12]

    Unsurprisingly, children in undeveloped countries have a greater chance of dying than children in developed countries.

    Similarly, wealthier families experience fewer child health care issues than poor families.

    Another disparity is that mothers with at least a secondary school education tend to have children with fewer health issues than mothers who did not receive such a level of education. The exact reason for this is unclear, but most likely the mothers who received a secondary education are better off socio-economically that those who only finished primary school. Therefore, the families with more educated mothers may have less exposure to disease-causing agents and greater access to medical facilities.[13]

    The final common disparity is that male children are generally healthier than female children. Again, the reasons for this are not clear, but some societies favor male children over females, so perhaps males are more likely to receive better food and living conditions than young girls.

    Solutions

    The situation is not hopeless. There are many easy solutions to improve child health worldwide. In fact, millions of children can be saved with these simple activities:

    • Breastfeeding through 1st year. This simple solution provides infants with essential nutrients from their mother’s milk, and prevents them from ingesting infected water, which may carry diseases their immune system cannot yet fight.
    • Vaccinations to fight measles, tetanus, etc. Vaccinations are one of the most effective means of preventing disease. For about $17, children are protected against polio, measles, tetanus, diphtheria, Hib and other diseases. Vaccinating for these main childhood killers could save approximately 1.4 million children each year[14]
    • Use of insecticide-treated mosquito nets. This $3 solution can prevent malaria, a major cause of death in tropical areas. The Global Health Council estimates that less than 15% of children who are at risk of contracting malaria are protected by such a bed net.[15]
    • Proper intake of vitamin A and zinc to fight infection and nutritional deficiencies. Vitamin A both strengthens the immune system and prevents blindness. Zinc also helps the immune system fight disease and allows the body to grow normally. Both supplements are inexpensive and easy to administer.
    • Oral rehydration tablets to reduce diarrhea related deaths. Dehydration caused by diarrhea is a huge cause of death in children. A simple ORT solution of water, salt and sugar rehydrates children and can prevent death from diarrhea. This simple treatment could save 1.8 million kids each year.
    • Antibiotics to fight infections, anti-malarial drugs. Once infected, few families are able to gain access to or afford medications that could save their children. This is especially true as effective medications are quite expensive, while the cheaper alternatives no longer work because the vector has developed resistance to them.

    Current efforts

    Despite the existence of such simple solutions, less than 60% of the at-risk population has access to these treatments. There are many efforts underway, though, by governments and non-profit groups to increase this number and to educate families on child health care.

    On a governmental level, in 2000 141 countries signed the Millennium Development Goals, which outlined key measures to develop societies and meet the needs of the poor. Goal 4 is to “reduce child mortality”. By making this an obligation for governments, administrations are focusing increased resources at both preventative and therapeutic measures to increase and improve the lives of millions of children.[16]

    Non-government organizations (NGOs) and other private groups are also working to combat child mortality. Current campaigns include vaccination programs, such as bringing polio vaccines door-to-door in India. Mothers are instructed in basic neo-natal care. Family planning programs reduce STDs and ideally give women more control over the number and spacing of her children. This planning can prevent a family from having more children than it can adequately provide for, and thus has a role in maintaining the health of children. Finally, HIV/AIDs programs reduce the stigma of the disease, help those who have the virus obtain anti-retro viral drugs, and prevent the disease from being transmitted further. In some countries, drugs are available to prevent an HIV-positive mother from passing the disease to her children through childbirth or breastfeeding.

    Key organizations

    Several major organizations are working tirelessly to increase the quality of life for children by improving their health. The biggest groups today are:

    • UNICEF- The United Nations Children’s Fund works for children’s rights, survival, development and protection. www.unicef.org
    • CARE- humanitarian organization focused on fighting global poverty. www.care.org
    • Save the Children- an international organization dedicating to helping children in need. www.savethechildren.org
    • Bill & Melinda Gates Foundation- created in 2000 to reduce inequalities in the US and around the world. www.gatesfoundation.org

    Educational opportunities

    National Center for Education in Maternal and Child Health. The Center is part of Georgetown University’s Public Policy Institute and provides “leadership to the maternal and child health community in … program development, education, and state-of-the-art knowledge – to improve the health and wellbeing of the nation’s children and families.” http://www.ncemch.org/

    University of South Florida College of Public Health. USF’s program prepares students for entering the field of international public health by focusing on “assessment and intervention strategies useful in resolving health problems of primarily undeveloped countries”. USF students can also combine this program with the Peace Corps Master’s International Program to obtain long-term field placement. http://publichealth.usf.edu

    New York Medical College School of Public Health. The program prepares students for intermediate level work in federal and international agencies. “Courses focus on the role of primary health care in less developed countries with a concentration on prevention and control of communicable disease and nutritional problems.” The program may be particularly beneficial to individual working with health service delivery to multi-ethnic populations. http://www.nymc.edu/sph/internhlth.htm

    New York University's new Master's Program in Global Public Health. The NYU Global MPH is a collaborative effort of 5 of NYU's premier professional schools and the first degree at NYU not to be housed in a single school. Multidisciplinary in every aspect, the program seeks students who have completed an advanced degree (master's or above) in medicine, dentistry, public service, social work, education, management and other fields and prepares them to assume leadership positions in the rapidly emerging field of global public health. http://www.nyu.edu/mph

    Columbia University Mailman School of Public Health. The Global Health track incorporates both theory and practice into the curriculum, including a six-month overseas practicum. This program is primarily for students who wish to become practitioners in their areas of health interest. http://www.mailman.hs.columbia.edu/globalhealth/globalhealth-ms.html

    For a more complete list visit: http://www.asph.org/document.cfm?page=773#

    For more information of child health

    References

    1. History of Malaria, http://www.cdc.gov/malaria/history/index.htm#mcwa
    2. CDC's Origins and Malaria, http://www.cdc.gov/malaria/history/history_cdc.htm
    3. History of WHO, http://www.who.int/library/historical/access/who/index.en.shtml
    4. Official Gates bio, http://www.microsoft.com/billgates/bio.asp
    5. Essential Health Care for the Poor: Promoting Health Systems (2003: International Journal of Health Planning and Management), http://www3.interscience.wiley.com/cgi-bin/abstract/106561854/ABSTRACT?CRETRY=1&SRETRY=0
    6. 6.0 6.1 World Health Organization, 2006. The World Health Report 2006. <http://www.who.int/whr/2006/en/index.html>
    7. 7.0 7.1 7.2 Physicians for Human Rights, June 2004. "An Action Plan to Prevent Brain Drain: Building Equitable Health Systems in Africa. <http://www.phrusa.org/campaigns/aids/pdf/braindrain.pdf>
    8. Global AIDS Alliance - GAA Action Alert <http://www.globalaidsalliance.org/actions/cd_Action_August_7_2006.cfm>
    9. 9.0 9.1 “Child Mortality”, UNICEF Statistics, http://childinfo.org/areas/childmortality/.
    10. UNICEF Statistics “Child Mortality” http://childinfo.org/areas/childmortality/.
    11. UNICEF Statistics “Child Mortality” http://childinfo.org/areas/childmortality/.
    12. "Millennium Development Goals”, UN 2006 http://unstats.un.org/unsd/mdg/Resources/Static/Products/Progress2006/MDGReport2006.pdf.
    13. "Millennium Development Goals”, UN 2006 http://unstats.un.org/unsd/mdg/Resources/Static/Products/Progress2006/MDGReport2006.pdf.
    14. Global Health Council-Child Survival http://www.globalhealth.org/view_top.php3?id=226.
    15. Global Health Council-Child Survival http://www.globalhealth.org/view_top.php3?id=226.
    16. “Millennium Development Goals Report”, UN 2006 http://unstats.un.org/unsd/mdg/Resources/Static/Products/Progress2006/MDGReport2006.pdf

    External links

    Global health and HIV/AIDS

    HIV/AIDS Links to specific articles on Wikipedia for scientific entry:

    Human Immunodeficiency Virus is a retrovirus that first appeared in humans in the early 1980s. The term “HIV-positive” is used to describe someone infected with this disease. HIV progresses to a point where the infected person has AIDS or Acquired Immunodeficiency Syndrome. HIV becomes AIDS because the virus had killed off CD4+ T-cells that are necessary for a healthy immune system. Today, there are treatments that can prolong life and delay the onset of AIDS by minimizing the amount of HIV in the body.

    HIV/AIDS is transmitted through bodily fluids. Unprotected sex, intravenous drug use, blood transfusions, and unclean needles spread HIV through blood and other fluids. Once thought to be a disease that only affected of drug users and homosexuals, it affects everyone. It can also be passed from a pregnant woman to her unborn child during pregnancy, or after pregnancy through breast milk. While it is a global disease that can affect anyone, there are disproportionately high infection rates in certain regions of the world. Additionally, the primary method of spreading HIV is through heterogeneous intercourse. Because of the biological presence of more surface area in the receptive sex organs of females, women represent a higher rate of infection for the disease.

    Culture of HIV/AIDS HIV/AIDS has been linked to cultures since its discovery. The disease was originally referred to as GRID for Gay-Related Immune Deficiency and initially thought to be related solely to the gay community. Because of this view and the lack of information about the disease, blood banks were not adequately screened leading to the origin of a much larger infected population. Finally, although women are more susceptible to the disease, there are many cultures in which the women has no access to contraceptive or barrier devices, often leading to infection and impregnation. This serves to only spread the HIV further.

    This diagram depicts the route of transmission of HIV/AIDS, based on the development of the epidemic in Russia. It represents a common relationship between drug users, sex workers, and periphery persons (other sexual partners).


    ( russia_aids_web.gif)

    Region: HIV/AIDS is a global problem and infects people all over the world, but certain regions have much higher infection rates. HIV/AIDS is most prevalent in Sub-Saharan Africa, where it is considered pandemic. It is also prevalent in South and Southeast Asia, Latin America, Eastern Europe, Russia, and urban areas in more developed nations.

    Region HIV Infection (millions of people) Sub-Saharan Africa 25.8 Asia 8.3 Eastern Europe and Central Asia 1.6 Caribbean .3 Latin America 1.8 North America, Western and Central Europe 1.9 Middle East and North Africa .51 Oceania .074


    Examples

    South Africa

    Age group (years) 2000 prevalence % 2001 prevalence % 2002 prevalence % 2003 prevalence % 2004 prevalence % 2005 prevalence % <20 16.1 15.4 14.8 15.8 16.1 15.9 20-24 29.1 28.4 29.1 30.3 30.8 30.6 25-29 30.6 31.4 34.5 35.4 38.5 39.5 30-34 23.3 25.6 29.5 30.9 34.4 36.4 35-39 15.8 19.3 19.8 23.4 24.5 28.0 40+ 11.0 9.8 17.2 15.8 17.5 19.8 (http://www.avert.org/safricastats.htm)

    South Africa 2003 Adults with HIV/AIDS (15-49) 5,300,000 Women with HIV/AIDS (age 15-49) 3,100,000 AIDS Deaths 320,000 Adult HIV Prevalence % 18.8 Children with HIV/AIDS (age 0-14) 240,000 Orphans due to AIDS 1,200,000 (http://www.unaids.org/en/Regions_Countries/Countries/south_africa.asp)

    Vietnam 2003 Adults with HIV/AIDS (15-49) 250,000 Women with HIV/AIDS (age 15-49) 84,000 AIDS Deaths 13,000 Adult HIV Prevalence % .5 (http://www.unaids.org/en/Regions_Countries/Countries/viet_nam.asp)

    Argentina 2003 Adults with HIV/AIDS (age 15-49) 130,000 Women with HIV/AIDS (age 15-49) 36,000 AIDS Deaths 4,300 Adult HIV Prevalence % .6 (http://www.unaids.org/en/Regions_Countries/Countries/argentina.asp)

    Prevalence of HIV/AIDS in sub-Saharan Africa: The prevalence of HIV/AIDS in sub-Saharan Africa is due to several different factors. Many scientists believe that HIV originated in Africa. There are two different strains of HIV, HIV-1 and HIV-2, one of which is almost exclusively found in Africa. Additionally, poverty and HIV prevalence have been shown to correspond as poverty prevents adequate education about the disease as well the purchase of the expensive drugs necessary for its treatment. A disproportionately large percentage of sub-Saharan Africa lives in extreme poverty leading to the continued cycle of HIV infection.

    Success Story: Thailand Thailand is one of few nations to have reversed the spread of HIV/AIDS. Through mass media campaigns, increased condom use, and halving the population of sex workers, Thailand reduced the number of new infections to 21,000 in 2003 after a rate of 140,000 in 1991. Also, AIDS education programs were implemented into every school, “anti-AIDS” commercials were broadcast ever hour on radio and television stations, and condoms were distributed at commercial sex houses. The “100% Condom Program” (that distributed these condoms) was most effective, requiring use on both the worker and customer, closing establishments that did not follow this rule. There have since been two more phases in Thailand’s fight against HIV/AIDS, ‘The National Plan for Prevention and Alleviation of the AIDS Problem” from 1997 to 2001 and 2002 to 2006. (http://www.avert.org/aidsthai.htm) Despite these success stories, however, there is still much ground to cover in the treatment and prevention of HIV/ AIDS.

    Obstacles to recovery

    Global Disparity

    Ninety-six percent of people with HIV live in the developing world, most in sub-Saharan Africa. The epidemic continues to grow in this region, with nearly a million new infections between 2003 and 2005.

    In six African countries, (Botswana, Lesotho, Namibia, South Africa, Swaziland and Zimbabwe), more than one in five of all pregnant women have HIV/AIDS. In Swaziland, nearly 40% of pregnant women are HIV-positive.

    Without prevention efforts, 35% of children born to an HIV positive mother will become infected with HIV. At least a quarter of newborns infected with HIV die before age one, and up to 60% will die before reaching their second birthdays.

    (From http://globalhealth.org/view_top.php3?id=227)

    Ignorance of the Infected

    A recent CDC report found that of a population sampled that were found to be HIV positive, 48% did not know that were infected with HIV.

    Ignorance of the Disease

    “People are more ignorant of how HIV is transmitted than they were five years ago, a poll says. Despite rising infection levels in the UK, 12% fewer people know the virus can be passed on through unprotected sex, the survey of 2,048 people revealed.”

    (From http://news.bbc.co.uk/1/hi/health/4885120.stm) One of the aspects of HIV/AIDS that makes it particularly difficult to address is the fact that it straddles the line between social and infectious disease. It is a highly infectious disease given certain behaviors. Questions immediately facing global health advocates include, “should attempts be made to curtain HIV/AIDS behavioral origins, develop treatment for those infected, or advocate preventive measures for those engaging in high-risk behavior?”

    Negative behavioral connotations

    HIV/AIDS was originally termed GRID for Gay-Related Immune Deficiency due to its initial emergence among gay communities. Today most of the newly infected individuals are women that get the disease through heterosexual intercourse.

    Current initiatives, goals and involvement

    One current goal is to stop the spread of HIV/AIDS by the year 2015. This goal was agreed upon by the heads of state of 189 nations at the Special Session of the United Nations General Assembly on HIV/AIDS in 2001. Two key elements to achieving this goal, as outlined in the Millennium Development Goals are health care and education. Awareness, as brought about by education, is also important for ending negative stigmas, denial, and lack of access to healthcare and resources.

    1) EDUCATION - Improve distribution and dissemination of materials - Teach students in school starting at young ages

    2) HEALTH CARE

    -Provide through NGOs in low resource settings – CARE, WHO, UNAIDS and more
    

    - Educate and train doctors and nurses - Incentives to prevent brain drain - Achieve Millennium Development Goals - Increase access to drugs & medication - Improve distribution of medications

    3) AWARENESS & PREVENTION

    - Discredit myths
    - End negative stigma associated with HIV/AIDS
    

    In the United States, one current program is PEPFAR (The President’s Emergency Plan For AIDS Relief). President Bush initiated this program June 19, 2002 and plans to fund the fight against AIDS with $15 billion in the next five years in 15 countries, mainly in Africa but also including Vietnam, Haiti and Guyana. For a spreadsheet of partners with PEPFAR, visit http://www.avert.org/media/pdfs/pepfar-partners.pdf.

    Receiving Treatment The chart below presents the number of people needing and receiving medical treatment for HIV/AIDS. There is a stark contrast between different regions, in both numbers of infected and percentage treated, for example between Latin America and Sub-Saharan Africa. Drugs to treat HIV/AIDS are usually anti-retroviral pills, but this may also include drugs such as Nevirapine, which counters mother-to-child-transmission during pregnancy, childbirth and breastfeeding. (http://en.wikipedia.org/wiki/HAART) (http://en.wikipedia.org/wiki/Nevirapine)

    Currently, a single-pill treatment is being developed. This will help alleviate problems that arise when patients are unsure of which pill to take when and in what quantity. One of the first places it was available at a cheap price was Thailand, proof of the continuing success there in the fight against HIV/AIDS. (http://archives.cnn.com/2002/WORLD/asiapcf/southeast/03/23/thailand.aids/)

    UNAIDS/WHO Estimates People Receiving Treatment in June 2006 People Needing Treatment in 2005 Treatment Coverage in June 2006 Sub-Saharan Africa 1,040,000 4,600,000 23% Latin America & the Caribbean 345,000 460,000 75% East, South, & South-East Asia 235,000 1,440,000 16% Europe & Central Asia 24,000 190,000 13% North Africa & the Middle East 4,000 75,000 5% All Developing & Transitional Countries 1,650,000 6,800,000 24% (http://www.avert.org/aidsdrugs.htm)

    Research

    Research is taking place all over the world in an effort to invent an HIV vaccine. Several phase I trials have taken place, followed by phase II trials. In 2005, two vaccines made it through phase III trials but proved unsuccessful. Global efforts are coming closer to developing potential successful vaccine, awaiting the discovery of one that succeeds in phase III trials. Many of the complications that have accompanied the marginal success of the treatment is that to be effective most anti-HIV drugs must be taken in conjunction with other drugs in a “drug cocktail.” The body also develops and immunity to these drugs after consistent treatment, decreasing their effectiveness. (http://www.cdc.gov/hiv/vaccine/vudev.htm)

    Funding for research comes from governments, NGOs, international organizations, and private health care investors. For research information, tips and guidelines in the United States, visit:

    UNAIDS: The Joint United Nations Program on HIV/AIDS

    Center for Disease Control: HIV/AIDS Prevention

    President’s HIV/AIDS Initiatives

    Ford Foundation: Global Initiative on HIV/AIDS

    Office of the U.S. Global AIDS Coordinator

    The Global Business Coalition

    Getting involved

    Educational, Volunteer and Work Opportunities: UNAIDS http://www.unaids.org/ This site has many links to programs organized by region all over the world, including Burundi, Kazakhstan, Moldova, and Honduras:

    AVERT http://www.avert.org/ Information divided by region/country/continent, statistics, success stories, HIV/AIDS history and photos, affected groups, gay and lesbian issues, treatment and care, HIV/AIDS education, interactive quizzes, prevention methods, links for teens, and many other sections.

    CARE http://www.care.org/

    Global Health Alliance at New York University http://gha-nyu.org/ The GHA at NYU is a student-run organization focused on raising awareness of global health within New York University and beyond, through: education, advocacy, networking, and community service.

    CDC (DHHS Center for Disease Control and Prevention): For information from the United States government:

    (NIH OAR): National Institute of Health - Office of AIDS Research: this website has online broadcasts in both English and Spanish about HIV/AIDS

    National Institute for Mental Health Center for Mental Health Research on HIV/AIDS:

    Research Opportunities and Grants: Funding: This website has several links to funding applications sponsored by various government agencies:

    amfAR: The foundation for AIDS Research, is one of the world’s leading nonprofit organizations dedicated to the support of AIDS research, HIV prevention, treatment education, and the advocacy of sound AIDS-related public policy.

    DHHS –Health Resources and Services Administration http://hab.hrsa.gov/grant.htm

    Much good information exists about HIV/AIDS; however, it is often buried under layers of myths and misconceptions. Valuable HIV knowledge can be gained from activities ranging from community involvement to viewing the informational movie, “And the Band Played On.” Here are several websites.

    Know HIV/AIDS

    • [9]
    • [www.WorldVision.org]
    • [www.thewellproject.org]
    • [www.usdoctorsforafrica.org]

    Global Health and Stateless Border Populations: Transforming Health Systems for Invisible Women, Men, and Children

    • The Border is point of entry and departure for both legal and illegal migrant workers • The Border is a point of entry and departure for victims of human trafficking • The Border is a local place where indigenous populations live • The Border is a local place where internal and foreign migrants live • The Border is a local place where internally-displaced people and refugees live

    According to recommendations made by the 2005 Millennium Development Goals (MDGs), entire health systems should be viewed as social institutions and not merely the sum of its medical achievements. Sadly, current health disparities among Stateless Border Populations (SBPs) pose unique challenges and problems in a growing “borderless” world in one sense, and an increasingly “exclusive” and shut-off world system in another sense.

    Hence, poverty on the periphery and among populations that are not officially recognized as Thai is a specific case example of the shortfalls in achieving MDGs, as well as the shortcomings of development for once rural and isolated areas that have in recent years become exposed to a less-than regulated globalization. The progress made in health promotion and education has not kept up with the impressive speed of road and infrastructure development to better facilitate trade and industry development. Thus, documenting growing cases of “invisible” populations in Thailand’s border with Myanmar—those men, women, and children not officially registered in the civic bureau as Thai citizens due to a number of factors—becomes another way to monitor global awareness about how and why significant health disparities continue to exist and the political and economic context in which these situations occur.


    source: thailand.gif

    Specific Health Concerns: HIV/AIDS Prevalence

    Stateless ethnic minorities, along with irregular and undocumented foreign migrants living along the Thai-Burma border have difficulties accessing the country’s public and private health care system. Specifically, those who are not registered migrants or do not have Thai citizenship are not entitled to the country’s 30-Baht Social Security scheme. Keeping in mind that a broad range of factors affect an individual’s state of health, including education level, degree of cultural assimilation, food security, and occupational hazards, data by Jones (2004: 23-24) shows a higher and increasing prevalence of HIV/AIDS among border populations, especially among ethnic minority groups such as the Akha, Yao, and Shan tribes. Women from these tribes are especially vulnerable, not only those who participate in the sex trade but also those who are infected by their migrant worker husbands. These findings undermine Thailand’s impressive achievements in fighting the disease only a decade earlier, and the health problems seems to be getting worse among stateless and undocumented migrants and hill tribe ethnic minorities.

    International conventions on Stateless Populations are below:

    Convention Relating to the Status of Stateless Persons of 1954

    Convention on the Reduction of Statelessness of 1961

    In recognition of the multiple factors and complexities surrounding the problems border populations face, and the diverse legal status among a multi-ethnic and mobile mountain population, health system responses should extend beyond communicable infectious diseases and move into the political, economic, and social realm. Interdisciplinary dialogue, coordination, and cooperation remain essential on all levels.

    Regarding Health Disparities among Ethnic Minority Population

    The present situation of Thailand’s stateless population—primarily the indigenous hill tribe peoples (ITPs)—illustrates a prevalent need to assess global health cases within a migration-based context. As a result of complex political and historical circumstances that have yet to be resolved, an estimated 500,000 indigenous peoples are without citizenship and cannot legally work or travel within Thailand (UNESCO 2004). Of special concern is the growing underclass of stateless children who are not registered at birth. The largest study of 12,000 hill-tribe households by UNESCO-Bangkok, UNICEF, and the Thai Ministry of Interior and Social Welfare will further determine reasons behind lack of birth registration among individual families. This report should be released early next year (2007). Visit www.unescobkk.org for more information. Please also note that Thailand has ratified the Convention of the Rights of the Child of 1989 (CRC) with reservations on Article 7. For more information on what this means go to Plan International website and read the convention text at http://www.unhchr.ch/html/menu3/b/k2crc.htm.

    For more information about the rights of ethnic minorities around the world, please go read the text on Indigenous and Tribal Peoples Convention of 1989, C169

    How Stateless Populations Links to Human Trafficking:

    The problem of trafficking in persons is increasing world wide. Yet the number of policies and programs to combat trafficking has also increased. Today, Thailand is one of a handful of countries that is recognized by the international community as a leader in its response to labor exploitation and child prostitution. Without meaning to invalidate past and current prevention efforts, there are problems with understanding trafficking and its root causes that indicate a need to re-evaluate the progress that has already been made and to ask the question: who are the trafficking victims in Thailand today? Despite improvements made among particular populations or geographic regions, the economics of this phenomenon has largely been left unchanged. Trafficking is a business, but it also exists in the larger context of migration, globalization, and political history.

    The conflict between upholding universal access to health care and respecting national autonomy is especially dynamic within border communities in the Thai provinces of Chiang Mai and Chiang Rai. These provinces share borders with Myanmar, formerly known as Burma or the Shan State, and are located among Thailand’s most beautiful mountain ranges and pristine forests. The Highland Hill Tribes—made up of mainly 7 ethnic groups that have originally migrated from China, Myanmar, and Vietnam—face enormous difficulties in a rapidly developing nation that has systematically ignored ethnic minority existence since the first Thai census in 1956 failed to include highlanders in its records.

    The question of why populations have become “invisible” to their governments will involve a critical look at past political policies as well as present economic trends that have both increased the supply and demand for cheap labor and the increased risk of human trafficking among vulnerable “stateless” populations. Stateless populations become vulnerable not only because they lack citizenship, as language barriers and lack of resources and social connections make migration dangerous as well. But research by Ophidian Research Institute and UNESCO-Bangkok has singled out lack of citizenship the greatest single risk-factor for highland women and girls to become trafficked or otherwise exploited.

    Recommended documentary to watch:

    “A Right to Belong” “Trading Women” both written and directed by David Feingold, UNESCO-Bangkok

    ORGANIZATIONS AND FUNDING:

    The following organizations both work for and with the disadvantaged people living along the Thai-Burma border in Chiang Mai and Chiang Rai.

    UNESCO-Bangkok: has established the Clearing House on Preventative HIV/AIDS education for the Greater Mekong Subregion. Initially established to monitor human trafficking in highland villages of the north, it now also monitors trends in HIV infection on a district-wide level. www.unescobkk.org

    Pattanarak Foundation: local, not-for-profit organization focused on the needs and aspirations of disadvantaged groups living in Thailand’s border areas. With 4 project sites in Ubonratchatani and Kanchanaburi province, Pattanarak is especially interested in the health issues that stateless, ethnic, and migrant communities face. Visit www.pattanarak.or.th for more information.

    Plan International: With a country-office located in Bangkok, Plan International Thailand has conducted joint research projects with UNICEF to draw closer links between statelessness and lack of birth registration. www.plan-international.org

    IMPECT (Inter Mountain People’s Education and Culture in Thailand Association): Made up of a strong alliance between Thailand’s ethnic minority community living along the border, IMPECT funds, collects, and processes documents for citizenship applications by hill tribes people, as well as provide legal services for individual registrations.

    Rockefeller Foundation: The South-east Asia Regional Office puts a special emphasis on individual and institutional ability to understand and respond to cross-border and inter-cultural challenges. LAB (Learning Across Boundaries in the Greater Mekong Subregion) funds 2 grants designed to increase Cross-Border Health and support for Upland Communities in Transition. www.rockmekong.org, rf-bkk@rockfund.or.th

    Human trafficking websites

    Specific Links to Related Human Rights Conventions:

    Universal Declaration of Human Rights of 1948 (UDHR)

    Convention Relating to the Status of Refugees of 1951 (ratified by Cambodia and China)

    Supplementary Convention on the Abolition of Slavery, the Slave Trade, and Institutions and Practices Similar to Slavery, 1957

    International Convention on the Elimination of all Forms of Racial Discrimination of 1965 (CERD)

    International Covenant on civil and Political Rights of 1966 (CCPR)

    International Covenant on Economic, social and Cultural Rights of 1966 (CESCR)

    Convention on the Elimination of all Forms of Discrimination against Women of 1979 (CEDAW)

    International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families of 1990

    Convention concerning the Prohibition and Immediate Action for the Elimination of the Worst Forms of Child Labour, 1999

    Convention Against Transnational Organized Crime, 2000

    Nutrition

    Among pre-school children, 53% of deaths in the developing world are due indirectly to malnutrition. Greater than two billion people in the world suffer from micronutrient deficiencies (including lack of iron, zinc, vitamin A, iodine). Malnutrition impairs the immune system, increasing the frequency, severity, and duration of childhood illnesses (including measles, pneumonia and diarrhea) while making children more susceptible to infectious diseases.1

    An individual’s nutrition not only affects their health, but their ability to survive, their cognitive development and their work capacity.2 Appropriate and affordable interventions are necessary to improve nutrition throughout the world. These ought to be paired with other health promoting interventions such as clean water and sanitation. Goal #1 in the United Nation’s (UN) Millennium Development Goals is to eradicate extreme poverty and hunger. Between the years of 1990 and 2015 it hopes to halve the proportion of people who suffer from hunger. This will be done through mobilizing domestic resources, scaling up public investment, international aid, and various other regional efforts.3 Sub-Sahara Africa and Southern Asia are the regions worst affected by chronic hunger. As of 2006, the levels of chronic hunger in these regions (in which people lack the food needed to meet their daily needs), has made progress, though not at the desired rate. Globally, the amount of people going hungry increased in the years from 1995-1997 to 2001-2003.4

    Diarrhea Diseases

    Diarrhea often results from diseases spread due to poor sanitation and results in dehydration. Though intravenous treatments (IV) are affective for treating diarrhea in developed countries, such resources are not available in many improvised countries, leading to high diarrhea related mortality rates.5 In 1990, diarrhea disease was the 2nd highest contributor to the disease burden in the world and it’s anticipated that it will be the 9th highest contributor by the 2020. In developing regions diarrhea diseases are the 4th leading cause of death.7 A method of oral rehydration therapy has been developed to treat diarrhea in such places. By mixing water, sugar and salt and administering it to the affected child, dehydration can be prevented.6 In specified locations this technique was taught to one woman of each household, cutting child mortality in half.6

    Micronutrient deficiency

    More than 2 billion people are at risk of iron, vitamin A, iodine, and zinc deficiencies. The lack of such micronutrients affects the general functioning of the body, often resulting in a person being underweight, having their daily functions impaired, and increasing the severity of common infections (e.g. measles, diarrhea). Micronutrient deficiencies also compromise intellectual potential, growth, development and adult productivity.2

    Interventions include micronutrient supplementation/fortification. In the 1950s a major public health initiative in developing countries included the fortification of basic grocery store foods. Other interventions include the delivery of concentrated micronutrient drops or capsules.6 Education in proper nutrition and information detailing the nutrient capacity of local foods will further alleviate this problem.

    Fifty million children under the age of five are affected by vitamin A deficiency. Such deficiency has been linked with night blindness. Alfred Somer discovered that rod cells in the eye can’t make a protein called nodopsin without vitamin A. Nodopsin allows people to see in low light conditions. Without it people are unable to see at night and their cornea eventually erodes, leading to total blindness. Additionally, vitamin A gives necessary strength to the epithelial lining of organs. Without this individuals are more susceptible to disease.6 While in many places a vitamin A injection is not practical, clinically vitamin A drops have allowed patients to see perfectly the next day.6 Long term study showed that vitamin A also has the potential to reduce child mortality rates by 23-34% in areas where vitamin A deficiency is common.2 In Nepal vitamin A is distributed in capsules. Public health workers trained local women to become volunteers. Rallies and parades were hosted to encourage people to receive the medication. Now this serves as a model program for 70 other countries. It is estimated that thus far this cost effective program has saved some 250,000 children.6 Iron Deficiency affects approximately one-third of the worlds' women and children. It causes anemia and is associated with 20% of maternal mortality, 22% of prenatal mortality and 18% of mental retardation globally. In children, iron deficiency compromises mental development and learning capacity.2 Zinc Deficiency increases the risk of mortality from diarrhea, pneumonia and malaria. Supplements have been proven to reduce the duration of diarrhea episodes.2 Iodine deficiency is the leading cause of preventable mental retardation. As many as 50 million infants born annually are at risk of iodine deficiency. Global efforts for universal salt iodization are helping eliminate this problem.2 Dietary diversification is an intervention which (in addition to supplementation, fortification, and other methods described above) strives to increase the consumption of Vitamin A, iron and other micronutrients. By improving access to micronutrient rich and locally produced food, this type of intervention is potentially cost efficient and sustainable. Education and promotion of a diverse diet are crucial to the success of such interventions. Such programs are currently in use in countries including Indonesia, Bangladesh, Mali and the Philippines.2

    Obesity

    For the first time in history, there are more overweight people in the world than underweight people.6 This reflects industrialization, urbanization, economic development and increasing food market globalization.7 Such advancements have essentially engineered physical activity out of life in many developed countries. In such locations, there is also an abundance of food available to foster obesity. Obesity is preventable and very expensive to treat. It is associated with numerous chronic diseases including cardiovascular conditions, diabetes, stroke, cancers and respiratory diseases.6 About 46% of the global burden of disease is accounted for by obesity.9 Obesity does not only affect developed countries. The rates of type 2 diabetes, associated with obesity, have been on the rise in countries traditionally noted for hunger levels. In India for instance there are about 35 million people who currently have type 2 diabetes. It’s estimated that in 20 years 75 million of India’s 1.1 billion residents will have type 2 diabetes.10

    Key resources

    Bill and Melinda Gates Foundation Global Health Program “The foundation is guided by the belief that all lives, no matter where they are lived, have equal value. The mission of our Global Health program is to encourage the development of lifesaving medical advances and to help ensure they reach the people who are disproportionately affected.”

    BRAC “BRAC works with people whose lives are dominated by extreme poverty, illiteracy, disease and other handicaps. With multifaceted development interventions, BRAC strives to bring about positive changes in the quality of life of the poor people of Bangladesh.”

    Canadian International Development Agency “The Canadian International Development Agency (CIDA) is Canada’s lead agency for development assistance. It has a mandate to support sustainable development in developing countries in order to reduce poverty and to contribute to a more secure, equitable, and prosperous world.”

    Doctors without Borders “Doctors Without Borders/Médecins Sans Frontières (MSF) is an independent international medical humanitarian organization that delivers emergency aid to people affected by armed conflict, epidemics, natural or man-made disasters, or exclusion from health care in more than 70 countries.”

    Food and Nutritional Technical Assistance “The Food and Nutrition Technical Assistance Project (FANTA) supports integrated food security and nutrition programming to improve the health and well being of women and children.”

    Food and Agriculture Organization of the United Nation “The Food and Agriculture Organization of the United Nations leads international efforts to defeat hunger. Serving both developed and developing countries, FAO acts as a neutral forum where all nations meet as equals to negotiate agreements and debate policy.”

    Global Alliance for Improved Nutrition “GAIN is a leadership and service hub for an alliance of organizations committed to ending vitamin and mineral deficiencies.”

    Global Health Council “The Council works to ensure that all who strive for improvement and equity in global health have the information and resources they need to succeed.”

    Grand Challenges in Global Health “The Grand Challenges in Global Health initiative was created to help researchers achieve the scientific breakthroughs needed to prevent, treat, and cure the diseases of the developing world.”

    Harvest Plus “Harvest Plus seeks to reduce the effects of micronutrient malnutrition by harnessing the power of plant breeding to develop staple food crops that are rich in micronutrients, a process called Biofortification.”

    United Nations Educational, Scientific, Cultural Organization “UNESCO functions as a laboratory of ideas and a standard-setter to forge universal agreements on emerging ethical issues. The Organization also serves as a clearinghouse – for the dissemination and sharing of information and knowledge – while helping Member States to build their human and institutional capacities in diverse fields.”

    United Nations International Children's Emergency Fund “UNICEF is the driving force that helps build a world where the rights of every child are realized. We have the global authority to influence decision-makers, and the variety of partners at grassroots level to turn the most innovative ideas into reality.”

    United States Agency for International Development “USAID is an independent federal government agency that receives overall foreign policy guidance from the Secretary of State. Our Work supports long-term and equitable economic growth and advances U.S. foreign policy objectives by supporting: economic growth, agriculture and trade; global health; and, democracy, conflict prevention and humanitarian assistance.

    World Bank “The World Bank is a vital source of financial and technical assistance to developing countries around the world, with the mission of reducing global poverty and improving living standards.”

    World Health Organization “The World Health Organization is the United Nations specialized agency for health. WHO's objective is the attainment by all peoples of the highest possible level of health. Health is defined in WHO's Constitution as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

    References

    1. American J. Clinical Nutrition 2004;80:193-8 2. US Aid Health: Nutrition Overview, 5 September 2006 http://www.usaid.gov/our_work/global_health/nut/index.html#. 3. Investing in Development: A Practical Plan to Achieve the Millennium Development Goals. 4. Millennium Project. 2005 5. Millennium Development Goals Report. UN. 2006 6. Rx for Survival” WGBH Boston video. 2005 7. Murray and Lopez, eds. The Global Burden of Disease. Murray and Lopez eds. 1996 (http://www.hsph.harvard.edu/organizations/bdu/GBDseries.html) 8. WHO: Diet and Physical Activity: A Public health Priority, 6 September 2006 <http://www.who.int/dietphysicalactivity/en/>. 9. WHO: Global Strategy: Overall Goal and Guiding Principles, 6 September 2006 < http://www.who.int/dietphysicalactivity/goals/en/>. 10. Modern Ways Open India’s Doors to Diabetes, 19 September. 2006 <http://www.nytimes.com/2006/09/13/world/asia/13diabetes.html?pagewanted=5&_r=1>.

    HIV/AIDS in Relation to Global Health

    HIV/AIDS Links to specific articles on Wikipedia for scientific entry:

    Human Immunodeficiency Virus is a retrovirus that first appeared in humans in the early 1980s. The term “HIV-positive” is used to describe someone infected with this disease. HIV progresses to a point where the infected person has AIDS or Acquired Immunodeficiency Syndrome. HIV becomes AIDS because the virus had killed off CD4+ T-cells that are necessary for a healthy immune system. Today, there are treatments that can prolong life and delay the onset of AIDS by minimizing the amount of HIV in the body.

    HIV/AIDS is transmitted through bodily fluids. Unprotected sex, intravenous drug use, blood transfusions, and unclean needles spread HIV through blood and other fluids. Once thought to be a disease that only affected of drug users and homosexuals, it affects everyone. It can also be passed from a pregnant woman to her unborn child during pregnancy, or after pregnancy through breast milk. While it is a global disease that can affect anyone, there are disproportionately high infection rates in certain regions of the world.

    This diagram depicts the route of transmission of HIV/AIDS, based on the development of the epidemic in Russia. It represents a common relationship between drug users, sex workers, and periphery persons (other sexual partners).

    Region: HIV/AIDS is a global problem and infects people all over the world, but certain regions have much higher infection rates. HIV/AIDS is most prevalent in Sub-Saharan Africa, where it is considered pandemic. It is also prevalent in South and Southeast Asia, Latin America, Eastern Europe, Russia, and urban areas in more developed nations. Region HIV Infection (millions of people) Sub-Saharan Africa 25.8 Asia 8.3 Eastern Europe and Central Asia 1.6 Caribbean .3 Latin America 1.8 North America, Western and Central Europe 1.9 Middle East and North Africa .51 Oceania .074

    Examples: South Africa

    Age group (years) 2000 prevalence % 2001 prevalence % 2002 prevalence % 2003 prevalence % 2004 prevalence % 2005 prevalence % <20 16.1 15.4 14.8 15.8 16.1 15.9 20-24 29.1 28.4 29.1 30.3 30.8 30.6 25-29 30.6 31.4 34.5 35.4 38.5 39.5 30-34 23.3 25.6 29.5 30.9 34.4 36.4 35-39 15.8 19.3 19.8 23.4 24.5 28.0 40+ 11.0 9.8 17.2 15.8 17.5 19.8 (http://www.avert.org/safricastats.htm)

    South Africa 2003 Adults with HIV/AIDS (15-49) 5,300,000 Women with HIV/AIDS (age 15-49) 3,100,000 AIDS Deaths 320,000 Adult HIV Prevalence % 18.8 Children with HIV/AIDS (age 0-14) 240,000 Orphans due to AIDS 1,200,000 (http://www.unaids.org/en/Regions_Countries/Countries/south_africa.asp)

    Vietnam 2003 Adults with HIV/AIDS (15-49) 250,000 Women with HIV/AIDS (age 15-49) 84,000 AIDS Deaths 13,000 Adult HIV Prevalence % .5

    (http://www.unaids.org/en/Regions_Countries/Countries/viet_nam.asp)

    Argentina 2003 Adults with HIV/AIDS (age 15-49) 130,000 Women with HIV/AIDS (age 15-49) 36,000 AIDS Deaths 4,300 Adult HIV Prevalence % .6 (http://www.unaids.org/en/Regions_Countries/Countries/argentina.asp)

    Success Stories: Thailand Thailand is one of few nations to have reversed the spread of HIV/AIDS. Through mass media campaigns, increased condom use, and halving the population of sex workers, Thailand reduced the number of new infections to 21,000 in 2003 after a rate of 140,000 in 1991. Also, AIDS education programs were implemented into every school, “anti-AIDS” commercials were broadcast ever hour on radio and television stations, and condoms were distributed at commercial sex houses. The “100% Condom Program” (that distributed these condoms) was most effective, requiring use on both the worker and customer, closing establishments that did not follow this rule. There have since been two more phases in Thailand’s fight against HIV/AIDS, ‘The National Plan for Prevention and Alleviation of the AIDS Problem” from 1997 to 2001 and 2002 to 2006.

    Current Initiatives, Goals and Involvement: One current goal is to stop the spread of HIV/AIDS by the year 2015. This goal was agreed upon by the heads of state of 189 nations at the Special Session of the United Nations General Assembly on HIV/AIDS in 2001. Two key elements to achieving this goal, as outlined in the Millennium Development Goals are health care and education. Awareness, as brought about by education, is also important for ending negative stigmas, denial, and lack of access to healthcare and resources. 1) EDUCATION - Improve distribution and dissemination of materials - Teach students in school starting young

    2) HEALTH CARE

    - In low resource settings – WHO, UNAIDS, 
    

    - Educate and train doctors and nurses, prevent brain drain, - Link all this back to Millennium Development Goals - Increase access to drugs & medication

    3) AWARENESS & PREVENTION

    - Discredit myths
    - End stigmatization of disease
    

    In the United States, one current program is PEPFAR (The President’s Emergency Plan For AIDS Relief). President Bush initiated this program June 19, 2002 and plans to fund the fight against AIDS with $15 billion in the next five years in 15 countries, mainly in Africa but also including Vietnam, Haiti and Guyana. For a spreadsheet of partners with PEPFAR, visit http://www.avert.org/media/pdfs/pepfar-partners.pdf.

    Receiving Treatment

    UNAIDS/WHO Estimates People Receiving Treatment in June 2006 People Needing Treatment in 2005 Treatment Coverage in June 2006 Sub-Saharan Africa 1,040,000 4,600,000 23% Latin America & the Caribbean 345,000 460,000 75% East, South, & South-East Asia 235,000 1,440,000 16% Europe & Central Asia 24,000 190,000 13% North Africa & the Middle East 4,000 75,000 5% All Developing & Transitional Countries 1,650,000 6,800,000 24% (http://www.avert.org/aidsdrugs.htm)

    Research is taking place all over the world in an effort to invent an HIV vaccine. Several phase I trials have taken place, followed by phase II trials. In 2005, two vaccines made it through phase III trials but proved unsuccessful. Global efforts are coming closer to developing potential successful vaccine, awaiting the discovery of one that succeeds in phase III trials. (http://www.cdc.gov/hiv/vaccine/vudev.htm)

    Currently, a single-pill treatment is being developed. This will help alleviate problems that arise when patients are unsure of which pill to take when and in what quantity.

    Funding comes from governments, NGOs, international organizations, and private health care investors. For research information, tips and guidelines visit:

    Educational, Volunteer and Work Opportunities: UNAIDS http://www.unaids.org/ This site has many links to regional programs all over the world, including Burundi, Kazakhstan, Moldova, Honduras:

    AVERT http://www.avert.org/ Information divided by region/country/continent, statistics, success stories, HIV/AIDS history and photos, affected groups, gay and lesbian issues, treatment and care, HIV/AIDS education, interactive quizzes, prevention methods, links for teens, and many other sections,

    CARE http://www.care.org/

    CDC (DHHS Center for Disease Control and Prevention)

    (NIH OAR): National Institute of Health - Office of AIDS Research: this website has online broadcasts in both English and Spanish about HIV/AIDS

    National Institute for Mental Health Center for Mental Health Research on HIV/AIDS:

    Research Opportunities and Grants: Funding: This website has several links to funding applications sponsored by various government agencies: http://www.cdc.gov/hiv/topics/funding/index.htm

    amfAR: The foundation for AIDS Research, is one of the world’s leading nonprofit organizations dedicated to the support of AIDS research, HIV prevention, treatment education, and the advocacy of sound AIDS-related public policy.

    DHHS –Health Resources and Services Administration http://hab.hrsa.gov/grant.htm


  • Linked-in.jpg