YALE JOURNAL OF BIOLOGY AND MEDICINE 87 (2014), pp.227-229. Copyright © 2014.
FOCUS: GLOBAL HEALTH AND DEVELOPMENT
Introduction
J. Mark Erfe* and Jennie K. Choe
Issue Editors, Yale Journal of Biology and Medicine, Yale School of Medicine, New Haven, Connecticut
the Yale Journal of Biology and Medicine, our writers discuss diverse methods to achieve such advances in global health. Chen traces the significance of global health back to the establishment of WHO in 1948 and suggests reasons for its surge in popularity. He also explores some of the characteristics by which a health issue might be defined as local or global. He especially emphasizes the importance of a global perspective in medical and health education. Bolton addresses the often-overlooked burden of common mental disorders in the developing world, where they constitute a significant obstacle to promoting global health and development — especially in settings afflicted by war, deprivation, and disaster. He points out the significant impact that mental health problems have on global disability and suggests training nonprofessional community health workers to intervene quickly and cost-effectively on this widespread issue. Das and Patel both examine the specific global health problems that arise among vulnerable populations. Das investigates the negative effects of poverty and low literacy levels on maternal and child health outcomes. By interviewing women, their relatives, and their health care providers, Das identifies health information needs among low-income pregnant women in rural India.
The global health movement in medicine and health sciences has seen exponential growth in recent decades. A “global” perspective can be applied to virtually any undertaking in health care — from primary care to specialized research, from pathways that deliver vaccines to systems that deliver clean water, and from individual treatment to international health policy. The endeavors taken on in the name of global health tap into one of the fundamental values of those who work in the health professions; namely, that if death, illness, and suffering can be alleviated somewhere in the world, then perhaps they also can be alleviated everywhere in the world. At its best, the work of global health and development ensures that life-saving and life-changing medical care is never restricted by geography or by GDP. At its worst, it can allow inequality of care to be seen but remain unaddressed or even be exacerbated, such as when strict patent protection in developed countries prevented affordable antiretroviral drugs against HIV from being manufactured in the developing world. As global health providers, scientists, and stakeholders continue to face new challenges, it is hoped that the ultimate goal will always be real development, which goes beyond short-term donations of aid and works to create self-reliant, sustainable health infrastructure. In the current issue of
*To whom all correspondence should be addressed: J. Mark Erfe, Yale School of Medicine, 330 Cedar Street CB438, New Haven, CT 06520; Email: [email protected]. 227
228
Erfe and Choe: Introduction
She also identifies misconceptions and societal barriers that prevent them from meeting those needs and accessing timely prenatal care. Effective policymaking would address these gaps in health information and reduce the maternal and child health burden in India. Patel’s work as both a surgeon and the founder of a nonprofit organization involves another vulnerable population: the women and children in India who are victims of sex trafficking. Clinically, he is able to provide reconstructive surgery for burn wounds, exemplifying a way in which global health can apply to highly specialized fields as well as the well-known domains of infectious diseases and epidemiology. His non-governmental organization (NGO) has also been able to raise awareness of human trafficking as a major global health concern and implement health care education in the field. Spiegel and Al Hilfi provide unique perspectives on post-war global health. A major health concern that arises during conflict is the displacement of refugees and asylum seekers into neighboring countries, at great cost to asylum countries’ health systems. Spiegel finds that limited access to and utilization of antenatal care causes high incidences of delivery complications among pregnant Syrian refugee women, requiring high usage of emergency cesarean sections. Al Hilfi describes the landscape of health care in Iraq. The status of national security and levels of poverty, malnutrition, and social fragility all contribute to the deterioration of health infrastructure. Iraq and Syria provide stark confirmation that implementing a comprehensive national health policy and effective interventions across public and private sectors are of the utmost importance in any post-conflict or post-crisis environment. Lam and Rivera turn their attention to reviewing the safety and efficacy of the country’s protocol for screening blood from donors. Instituted in 1994, the national policy governing Philippine blood transfusions encouraged voluntary donation and banned commercial blood banks while attempting to prevent transmission of blood-borne pathogens such as syphilis, hepatitis B and C, and HIV. Comparing their statistical
measurements of residual risk for transfusion-transmitted infections to those of another study completed in 1992, Lam and Rivera provide evidence that the risk has decreased due to the national policy. They note, however, that adherence to the policy by blood donation centers should be improved. O’Connor examines the relationship between road traffic injuries and alcohol in low- and middle-income countries of the Western Pacific Region. Although 35 countries have recently passed legislation to improve road safety, few of these countries have passed comprehensive road safety laws and many do not adequately enforce their current policies. She uses medical records from a hospital in the Philippines to argue that current problems with collecting reliable and complete data prevent the passage and enforcement of laws that would save people from vehicular accidents. Her appraisal of the inadequacy of current public health initiatives and data collection methods for alcohol-related road injuries in the Western Pacific Region underscores the greater need for protective legislation and enforcement in those countries. Drislane’s two contributions illustrate in sequence both the current state of the medical system in Ghana and the development of a general medicine residency program at a 150-bed rural hospital. Drislane produces a detailed and insightful picture of the health care challenges that are faced by this West African nation due to its limited supply of resources and trained physicians. Even in a mature democracy with good rule of law, media pluralism, and a strong civil society, providing good medical care with the proper basic equipment and knowledgeable doctors requires economic capital and training that Ghana still struggles to obtain. The technical and financial assistance given by NGOs and international university partnerships continue to be vitally important in stabilizing rural health systems in developing countries and improving their quality of care. As physicians, public health workers, and advocates for equality among global health systems, it can at times be tempting
Erfe and Choe: Introduction
to focus on the immediate scientific obstacles preventing greater and more effective medical care for populations in developing countries. Our lack of an Ebola vaccine or anti-viral medication, for example, is exemplified by the intensity of the current outbreak in Africa. But we must also remember to focus on the less immediate, ancillary
229
health care infrastructure and the broader environmental and demographic factors that hinder medical care for many indigent populations. Only by focusing simultaneously on medical advancements and their support infrastructures and related systemic factors can truly equitable and sustainable health care systems be built across the world.
FOCUS: GLOBAL HEALTH AND DEVELOPMENT
Introduction
J. Mark Erfe* and Jennie K. Choe
Issue Editors, Yale Journal of Biology and Medicine, Yale School of Medicine, New Haven, Connecticut
the Yale Journal of Biology and Medicine, our writers discuss diverse methods to achieve such advances in global health. Chen traces the significance of global health back to the establishment of WHO in 1948 and suggests reasons for its surge in popularity. He also explores some of the characteristics by which a health issue might be defined as local or global. He especially emphasizes the importance of a global perspective in medical and health education. Bolton addresses the often-overlooked burden of common mental disorders in the developing world, where they constitute a significant obstacle to promoting global health and development — especially in settings afflicted by war, deprivation, and disaster. He points out the significant impact that mental health problems have on global disability and suggests training nonprofessional community health workers to intervene quickly and cost-effectively on this widespread issue. Das and Patel both examine the specific global health problems that arise among vulnerable populations. Das investigates the negative effects of poverty and low literacy levels on maternal and child health outcomes. By interviewing women, their relatives, and their health care providers, Das identifies health information needs among low-income pregnant women in rural India.
The global health movement in medicine and health sciences has seen exponential growth in recent decades. A “global” perspective can be applied to virtually any undertaking in health care — from primary care to specialized research, from pathways that deliver vaccines to systems that deliver clean water, and from individual treatment to international health policy. The endeavors taken on in the name of global health tap into one of the fundamental values of those who work in the health professions; namely, that if death, illness, and suffering can be alleviated somewhere in the world, then perhaps they also can be alleviated everywhere in the world. At its best, the work of global health and development ensures that life-saving and life-changing medical care is never restricted by geography or by GDP. At its worst, it can allow inequality of care to be seen but remain unaddressed or even be exacerbated, such as when strict patent protection in developed countries prevented affordable antiretroviral drugs against HIV from being manufactured in the developing world. As global health providers, scientists, and stakeholders continue to face new challenges, it is hoped that the ultimate goal will always be real development, which goes beyond short-term donations of aid and works to create self-reliant, sustainable health infrastructure. In the current issue of
*To whom all correspondence should be addressed: J. Mark Erfe, Yale School of Medicine, 330 Cedar Street CB438, New Haven, CT 06520; Email: [email protected]. 227
228
Erfe and Choe: Introduction
She also identifies misconceptions and societal barriers that prevent them from meeting those needs and accessing timely prenatal care. Effective policymaking would address these gaps in health information and reduce the maternal and child health burden in India. Patel’s work as both a surgeon and the founder of a nonprofit organization involves another vulnerable population: the women and children in India who are victims of sex trafficking. Clinically, he is able to provide reconstructive surgery for burn wounds, exemplifying a way in which global health can apply to highly specialized fields as well as the well-known domains of infectious diseases and epidemiology. His non-governmental organization (NGO) has also been able to raise awareness of human trafficking as a major global health concern and implement health care education in the field. Spiegel and Al Hilfi provide unique perspectives on post-war global health. A major health concern that arises during conflict is the displacement of refugees and asylum seekers into neighboring countries, at great cost to asylum countries’ health systems. Spiegel finds that limited access to and utilization of antenatal care causes high incidences of delivery complications among pregnant Syrian refugee women, requiring high usage of emergency cesarean sections. Al Hilfi describes the landscape of health care in Iraq. The status of national security and levels of poverty, malnutrition, and social fragility all contribute to the deterioration of health infrastructure. Iraq and Syria provide stark confirmation that implementing a comprehensive national health policy and effective interventions across public and private sectors are of the utmost importance in any post-conflict or post-crisis environment. Lam and Rivera turn their attention to reviewing the safety and efficacy of the country’s protocol for screening blood from donors. Instituted in 1994, the national policy governing Philippine blood transfusions encouraged voluntary donation and banned commercial blood banks while attempting to prevent transmission of blood-borne pathogens such as syphilis, hepatitis B and C, and HIV. Comparing their statistical
measurements of residual risk for transfusion-transmitted infections to those of another study completed in 1992, Lam and Rivera provide evidence that the risk has decreased due to the national policy. They note, however, that adherence to the policy by blood donation centers should be improved. O’Connor examines the relationship between road traffic injuries and alcohol in low- and middle-income countries of the Western Pacific Region. Although 35 countries have recently passed legislation to improve road safety, few of these countries have passed comprehensive road safety laws and many do not adequately enforce their current policies. She uses medical records from a hospital in the Philippines to argue that current problems with collecting reliable and complete data prevent the passage and enforcement of laws that would save people from vehicular accidents. Her appraisal of the inadequacy of current public health initiatives and data collection methods for alcohol-related road injuries in the Western Pacific Region underscores the greater need for protective legislation and enforcement in those countries. Drislane’s two contributions illustrate in sequence both the current state of the medical system in Ghana and the development of a general medicine residency program at a 150-bed rural hospital. Drislane produces a detailed and insightful picture of the health care challenges that are faced by this West African nation due to its limited supply of resources and trained physicians. Even in a mature democracy with good rule of law, media pluralism, and a strong civil society, providing good medical care with the proper basic equipment and knowledgeable doctors requires economic capital and training that Ghana still struggles to obtain. The technical and financial assistance given by NGOs and international university partnerships continue to be vitally important in stabilizing rural health systems in developing countries and improving their quality of care. As physicians, public health workers, and advocates for equality among global health systems, it can at times be tempting
Erfe and Choe: Introduction
to focus on the immediate scientific obstacles preventing greater and more effective medical care for populations in developing countries. Our lack of an Ebola vaccine or anti-viral medication, for example, is exemplified by the intensity of the current outbreak in Africa. But we must also remember to focus on the less immediate, ancillary
229
health care infrastructure and the broader environmental and demographic factors that hinder medical care for many indigent populations. Only by focusing simultaneously on medical advancements and their support infrastructures and related systemic factors can truly equitable and sustainable health care systems be built across the world.
