Finally in the (Global Health) Spotlight, Nurses Now!

With nurses being at the vanguard of health service delivery in many countries, it is obvious that their voices must be heard loudly, if good, effective policies and interventions are to be implemented. They must be empowered to participate in a meaningful way, in the planning, implementation and evaluation stages

By Clara Affun-Adegbulu*

Intern and Researcher, Health Policy Unit, Institute of Tropical Medicine in Antwerp, Belgium; Masters (MPH) student, University of Vienna, Austria

Finally in the (Global Health) Spotlight, Nurses Now!

 

Last week, on the 27th of February, Burdett Trust for Nursing, in collaboration with the World Health Organization (WHO) and International Council of Nurses, launched Nursing Now with a series of events worldwide. Nursing Now is a global campaign that aims “to improve health globally by raising the profile and status of nurses worldwide – influencing policymakers and supporting nurses themselves to lead, learn and build a global movement.”

As a nurse, and someone who is passionate about improving health, healthcare and access to healthcare, I am happy about this development. This is because even though globally, nurses account for almost 50% of the health workforce, they have, for far too long, been left out of global health discussions. In fact a quick scan through the CVs of many of the actors within the global health community, would show that doctors, economists, anthropologists, and other social scientists dominate the arena of health systems research and policy, with  nurses being highly underrepresented. Yet they play an important role in health systems all over the world, and will be critical to the achievement of the Universal Health Coverage (UHC) goal that was set during the 58th World Health Assembly in 2005.

According to the WHO, universal health coverage “means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.” Clearly, a key factor to the achievement of this goal, is the quality of health services which should be “good enough to improve the health of those receiving services.”

With nurses being at the vanguard of health service delivery in many countries, it is obvious that their voices must be heard loudly, if good, effective policies and interventions are to be implemented. They must be empowered to participate in a meaningful way, in the planning, implementation and evaluation stages.

How can this be done?

Firstly, the nursing cadre must be recognised as a fundamental part of the health system. This recognition should go beyond just empty words, and should be accompanied by fair pay for the people at the frontlines who are often the face of the health system. This will have the double effect of promoting gender equality, and sustainable development particularly in developing countries. Most crucially, fair pay for their work will show nurses all over the world, that they are as valued as any other member of the health profession, and their contributions are just useful and important. This is vital, because many nurses, as a result of constant belittling, do not think they have anything to contribute the health systems and policy discussions and debates.

Secondly, nurses should be trained properly and supported in their desire for professional development. They should also be encouraged to seek out further education opportunities particularly in research and academia. This would automatically give more of them, access to leadership positions, as well as the “rarefied” arenas where global health discussions take place.

There are many different solutions to this complex issue, but in my opinion, these are the two most urgent ones. They will of course not solve the problem of the lack of nurses’ participation in policy-making for health, but it is a good start.

 

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* Nurse and Public Health Masters student at the Medical University and University of Vienna. She is currently interning as a research assistant at the International Health Policy unit of the Institute of Tropical Medicine, Antwerp, working on a literature review project on health systems strengthening. Clara is particularly interested in global health and development policy

 

 

 

 

EPWG Statement on US Industry Request to Put EU on USTR’s Watch List

European Parliament Working Group (EPWG) on Access to Medicines 

EPWG Statement on US Pharma Industry Request to put EU on IPR Enforcement Watch List

 

6 March 2018 

We, the Members of the European Parliament Working Group on innovation, access to medicines and poverty- related diseases, hereby express our strong condemnation of the request from the US pharmaceutical industry trade body, PhRMA, to add the European Union to the United States Trade Representative’s (USTR) “Special 301” watch list.

We condemn this bullying tactic, aimed at influencing the work the EU has undertaken to review intellectual property (IP) incentives that create spiraling drug prices without raising the bar on innovation, and failing to serve EU citizens and governments. Prominent among them is a proposed revision of Supplementary Protection Certificates (SPCs) mechanism, which unnecessarily extends drug monopolies beyond the 20-year term of a patent.

The EU should not be penalized or discouraged from reviewing the negative impact of the current IP related incentives on biomedical innovation, as requested by the EU Council Conclusions on “Strengthening the Balance in the Pharmaceutical Systems in the EU and its Member States” from June 2016. We recommend that the European Commission continue its enquiry into how different IP incentives, and SPCs in particular, contribute to high medicines prices and therefore undermine universal access to treatment.

This PhRMA request is the latest in a familiar pattern of efforts by pharmaceutical corporations to coerce and pressurize governments through their various lobby groups, preventing them from using legal means to safeguard access to medicines, and pursue reforms which would better balance public health, access to medicines and competition with intellectual property regimes.

Pharmaceutical corporations, backed by the US government, have exerted continued pressure on India to offer more monopolies, stringent IP enforcement mechanisms and a moratorium on compulsory licensing at the expense of access to affordable medicines and public health safeguards.

At this very moment, PhRMA and the US government are currently pressuring the Colombian government to step back from efforts to introduce generic competition in response to the unaffordable price of Novartis’ cancer drug imatinib mesylate (Gleevec). If both the Indian and Colombian governments cave to this pressure, it could severely restrict access to affordable medicines in the future, with disastrous consequences for millions of people around the world.

It is of critical importance to respect countries’ sovereign rights to uphold health safeguards available under the World Trade Organization (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) and to implement these legal flexibilities in national law, policies and practices to balance private commercial interests with the right to life, treatment and health.

In particular, we note that a number of the companies that make up the membership of PhRMA are European. We urge them to clearly distance themselves from both this crude attempt to quash legitimate debate and investigation into the impact of business model on the health of their fellow European citizens, and PhRMA’s demands to sanction developing world countries for using legal means to secure affordable medicines.

We call on the EU to stay firm in face of US corporate pressure and to renew its commitment to review its IP incentives system, prioritising the health of patients and equitable access to medicines.

Reprinted from the original:

https://www.msfaccess.org/sites/default/files/MSF_assets/IP/Docs/6%20March_Draft%20statement%20EPWG%20Special%20301%20report%20rev.pdf

 

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Additional links

MSF welcomes Members of the European Parliament response to the US pharmaceutical pressure to stop EU action on high drug prices 

PhRMA Special 301 submission 2018

EU to get rid of big pharma-friendly SPCs

 

 

 

Global Health and Occupied Palestine

The occupied Palestine may be viewed as the intersection of public health, human rights and international humanitarian law. She is therefore well suited to illustrate the new concept of Global Health intended as a "reflecting critical space" which recognises transnational health and disease processes as "strongly socially oriented and characterized by the paradigm of complexity (and therefore necessarily interdisciplinary)". A global model of socio-political determination of health, the occupied Palestine serves as a lens through which to verify the seriousness of our commitment to the norms and principles that seventy years ago the whole humanity, as United Nations (UN), has consensually founded to protect her survival

By Angelo Stefanini

Centre for International Health, University of Bologna (Italy)

 Global Health and Occupied Palestine 

 

“The metaphor for Palestine is stronger than the Palestine of reality.”
Mahmoud Darwish, Palestinian poet, 1941-2008

 

Discussing Global Health in the occupied Palestine[1] entails exploring crucial issues of great importance for a region that for over fifty years has being militarily occupied, progressively colonized and violated in its fundamental rights[2].

Global Health can be defined as a “reflecting critical space” which recognises transnational health and disease processes as “strongly socially oriented and characterized by the paradigm of complexity (and therefore necessarily interdisciplinary)”[3]. It is thus not surprising that the current, pervasive bio-medical culture, which claims to be a-political, finds considerable difficulty in conceptualizing this vision of social and political determination of health.

To understand why what happens in the occupied Palestine and to the health of Palestinians does matter to the health of the entire world, it is necessary to situate the local liberation struggle in relation to a number of global processes that, directly or indirectly, affect the daily life of all of us.

Neo-liberalism as National Liberation (or “Free Market in an Occupied Country”)

A global process differently perceived by a large part of the world population and with a profound relevance to the Palestinian case is the widespread, increasing loss of fundamental human rights (such as health, education, work, etc.) which neo-liberal globalization has being brought about over the last decades.

Despite being born as an integral part of a broader political project of anti-colonial struggle and creation of a just world order, the Palestinian national liberation movement, once in power as Palestinian National Authority (PNA), did not keep its promises and ended up protecting the privileges of the national bourgeoisie and of international investors[4].

As happened to the African National Congress (ANC) in South Africa and to the countries of the former Soviet bloc, PNA has been the victim of the neoliberal globalization’s irresistible “logic” that has seen it suddenly becoming, through a boldly crafted shock therapy[5], an emblematic case of authoritarian neoliberalism.

The 2009 programme document for the creation of the Palestinian state, unsurprisingly highly commended by the World Bank and the International Monetary Fund (IMF), asserts “The economic system in Palestine shall be based on the principles of a free market economy”[6]. In the context of a historic crisis of legitimacy of the Palestinian national movement, torn apart by unprecedented internal political divisions, the programme, drafted by an unelected government and headed by a prime minister, Salam Fayad, direct expression of the IMF, outlines an apparently autonomous strategy to achieve the form of a state based on neoliberal orthodoxy, where cuts in public expenditures, trade liberalization and privatization of state enterprises are top of the agenda. Warmly received by a predictably favourable international recognition, this national emancipation through neoliberalism actually redefines a type of Palestinian liberation struggle so far unknown: “Neo-liberalism as national liberation”[7].

In reality, the occupied Palestine ironically illustrates how a neoliberal economic regime under colonial yoke may turn out as a case of captive economy[8]. In fact, in the West Bank and Gaza Strip a complex system of military and civil laws and regulations dictated by the occupying power ensures that a “free” market, where the Palestinian pharmaceutical industry might indeed have a significant role to play, is instead “prisoner”, dominated by Israeli and international competition with detrimental effects on the price of drugs and consequent restricted access to health care for the Palestinian population.

A model of a “state of exception”

A second global process with both direct and indirect effects on global health is the relentless weakening of the international legal framework established at the end of the Second World War, i.e. the international humanitarian and human rights law with the United Nations (UN) as its guarantor. This disastrous trend goes along with the international community’s acquiescent acknowledgment of being in a constant “state of exception”[9], characterized by the legal suspension of the rule of law and consequent enactment of liberticidal laws as an ordinary condition for waging the “war on terrorism”. In such a context the construction of walls, real and symbolic, emerges as the coherent answer to the unstoppable migratory phenomenon and to the flight of desperate masses from violent conflicts, natural disasters and despair.

If this is the condition that now seems to be looming over the Western world in the near future, the same has been for years the daily life of occupied Palestine. The wall that Israel has built, not just to lock the Palestinians in their own land but as a new border that transfers vast areas of that region to the Israeli side, embodies the violent and overpowering nature of those everywhere building barriers with the false pretext of security.  Every year a Special Rapporteur, an independent expert appointed by the United Nations Human Rights Council, reports on the situation of human rights in the Palestinian territories occupied since 1967. His/her findings, describing in detail the violations of Palestinian human rights carried out by the state of Israel, are publicly available[10]. Dozens of resolutions and UN requests to end Israel’s prolonged occupation and allow the Palestinian people to exercise its right to self-determination have been falling unheard.

The failure of the international community to respond to this arbitrary behaviour has produced a culture of impunity that allows Israel to feel entitled to any wrongdoing. At the peak of the recent so-called “stabbing intifada”, only brave journalists like the Israeli Amira Hass[11] dare to ask whether the army world leader in self-defence techniques has no choice but to execute in cold blood young assailants holding bare knives. Israeli “exceptionalism” has not only become normal, indeed is providing a precedent that other countries do not hesitate to follow in their own “war on terrorism”.

Similarly, the same oppressor, the Israeli settler who is illegally[12] grabbing Palestinian land in the West Bank and East Jerusalem, is shamelessly making a surreal inversion of the principle of human rights and of the categories of victimhood, guilt and abuse. This has given rise to the human right of settlers to expropriate indigenous populations, the human right to war legalized with drones, the human right to targeted killings and summary executions[13].

Global War Lab

The occupied Palestine illustrates the disturbing example of how Western powers understand “global war”. It is a subliminal surveillance war that the Israeli anthropologist Jeff Halper defines “securocratic war”, disguised as a “war on terrorism”, which fuels fear among the population, thus justifying the militarization of everyday life and of the whole society. What is needed to conduct this war is not only sophisticated conventional weapons; new military equipment, hi-tech surveillance systems, crowd control and biometric data collection are the novel tools of the trade[14].

This system of repression and control has been, and continues to be designed and tested in Israel and in the occupied territories over decades of “counter-insurgency” against the Palestinian population. In fact, the occupied Palestine represents the human laboratory in which Israel has been able to develop the skills and the technologies to promote herself to the outside world as “securityland”.

According to Jeff Halper, the importance of this mode of control lies in the fact that it responds to the ever more pressing preoccupation of global capitalism to maintain a favourable social order against the intolerable situations that it has created, such as increasing inequalities, civil wars and forced migration of hopeless populations.

From the “Israelification” of the US police to the “Palestinization” of the African-American uprising in Ferguson, Iraq and the refugee problem in the Middle East, the global ramifications of the Palestinian case are numerous.[15] [16]

The occupied Palestine as a global laboratory of the advancing hegemony of the state of security is also functional to the normalization and institutionalization of the so-called “chronic emergencies”, an oxymoron that is now part of the humanitarian language. Accepting this condition of chronicity as inevitable and necessary, in fact, is tantamount to legitimize a nation-state which on the altar of “security” has founded its existence, which may justify everything, even the unjustifiable, as a “right of self-defence” and on this right it builds its own case for impunity.

As stated by the Israeli historian Avi Shlaim in the wake of the Israeli attack on Gaza in 2009: “The unreported goal [of the war] is that the Palestinians of Gaza are seen by the world simply as a humanitarian problem thus deflating their struggle for the independence and for the birth of a state”.[17]

As long as a situation is defined as ‘emergency’, thus urging short-term interventions, the structural causes that are at the roots of the problem will inevitably remain in the background and distant in time.

The case of the occupied Palestine and of Gaza in particular as a humanitarian problem is evidently an expression of a global crisis of humanitarianism applicable to a number of other geo-political areas which for obvious, if unspeakable, interests the entire world prefers to see as “simple” humanitarian crises and where it is precisely these noble humanitarian efforts that prevent, perhaps unconsciously, a political solution.

Conclusion

The occupied Palestine portrays the image of a geo-political and symbolic space where global dynamics such as public health, human rights and international humanitarian law intersect. Far from being simply influenced by these processes, Palestine serves as a lens through which to verify the seriousness of our commitment to the norms and principles that the whole humanity has consensually founded to protect her survival. This was certainly what Nelson Mandela meant when he described Palestine as “the greatest moral question of our time”.

Note:

A slightly different Italian version of this post appeared on the blog saluteinternazionale.info at this link http://www.saluteinternazionale.info/2017/09/palestina-neo-liberismo-in-paese-occupato/

 

References

[1]These personal reflections are the result of the discussion that invigorated an otherwise perhaps boring training course (entitled “An Introduction to Global Health and Its Relevance to Palestine”) held from July 10 to 13, 2017 at the University of Birzeit (occupied West Bank). I thank the participants of the course for their unaware contribution to this paper.

[2] Israel: 50 Years of Occupation Abuses. Human Rights Watch, 04.06.2017. https://www.hrw.org/news/2017/06/04/israel-50-years-occupation-abuses Accessed on 02/03/2018.

[3] Stefanini A, Bodini C. (2016) Salute Globale: Uno Scenario Conflittuale, in (a cura di) A.A. Ferla, A. Stefanini, A. Martino, Salute Globale in una Prospettiva Comparata tra Brasile e Italia, Porto Alegre, Brasile/Bologna, Italia – Rede UNIDA/CSI-Unibo. Pp. 13-34.

[4] Khalidi R, Samour S. Neoliberalism as liberation: The statehood program and the remaking of the Palestinian national movement. Journal of Palestine Studies 2011; 40(2), 6-25.

[5] Klein N., The Shock Doctrine: The Rise of Disaster Capitalism. Penguin, 2007.

[6] Ending the Occupation, Establishing the State (Ramallah: Palestinian National Authority, 2009). P.7. https://unispal.un.org/pdfs/PA_EndingOccupation-Statehood.pdf Accessed on 02/03/2018.

[7] Khalidi R, Samour S. (2011) Op.cit.

[8] Captive Economy. The Pharmaceutical Industry and the Israeli Occupation. The Coalition of Women for Peace / Who Profits, March 2012. https://whoprofits.org/sites/default/files/captive_economy_0.pdf Accessed on 02/03/2018.

[9] Agamben G., Stato di eccezione. Torino: Bollati Boringhieri, 2003. English translation: Agamben G., State of exception, University of Chicago, 2005.

[10] Situation of human rights in the Palestinian territories occupied since 1967. https://documents-dds-ny.un.org/doc/UNDOC/GEN/N17/340/02/PDF/N1734002.pdf?OpenElement  Accessed on 02/03/2018.

[11] Hass A., Israel’s Cloned Security Guards. Haaretz.com, 26.07.2017. https://www.haaretz.com/opinion/.premium-israel-s-cloned-security-guards-1.5434828 Accessed on 02/03/2018.

[12] Resolution 2334 (2016) Adopted by the Security Council at its 7853rd meeting. 23.12.2016 http://www.un.org/webcast/pdfs/SRES2334-2016.pdf  Accessed on 02/03/2018.

[13] Perugini N. and Gordon N., The Human Right to Dominate, Oxford University Press, 2015.

[14] Halper J., War Against the People: Israel, the Palestinians and Global Pacification, Chicago University Press, 2014.

[15] Giraldi P., America’s Militarized Police – Made in Israel? The Unz Review, July 25, 2017. http://www.unz.com/pgiraldi/americas-militarized-police/ Accessed on 02/03/2018.

[16] Tamari S. and Thompson T., From Ferguson to Palestine, We See Us. Huffingtonpost.com, 10.16.2015. https://www.huffingtonpost.com/sandra-tamari/from-ferguson-to-palestine_b_8307832.html Accessed on 02/03/2018

[17] Feldman I. Gaza’s Humanitarianism Problem. Journal of Palestine Studies 2009; 38(3), 22-37.

 

Health Breaking News: Link 276

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 276

 

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Overcoming Public Health’s Perception Challenges

As the field concerned with society’s organized efforts to improve health at a population level, public health relies on myriad partnerships to achieve their goals – with healthcare providers, with the public, and with many other sectors such as schools, non-profits, and legislators.  

One of the biggest challenges in forging these partnerships? Helping people understand exactly what public health is and isn’t.

By Lawrence C. Loh*

Adjunct Professor, Dalla Lana School of Public Health, University of Toronto, and Director of Programs at The 53rd Week Ltd

Overcoming Public Health’s Perception Challenges

 

As an early-career public health practitioner, I’ve had the great fortune of learning very early on that partnerships are critical to the success of public health initiatives.

I’ve also learned that while many members of our workforce come through training for the acute healthcare system (one thinks not only of physicians, but public health nurses, research methodologists, analysts, epidemiologists and statisticians among others), our business is very different from that of healthcare and the extent of our partnerships carefully circumscribed to a large extent.

Beyond our connections to healthcare, I have also witnessed the importance of partnerships with other sectors beyond hospitals and clinics that truly drive health at a macro level – such as working with planning and transport departments on building healthy, complete communities, or with legislators in enacting laws that change context, such as successes with smoking bans, or targeting childhood obesity through healthy eating in schools. In all cases, the overarching health of the public is our primary focus and the context of our community our ultimate tapestry.

This need to partner means that encountering someone outside our field makes it refreshing and easy to start a conversation. Too often, though, public health experiences various challenges in sharing our goals and why we do what we do – mostly due to perceptions that sometimes seem pervasive. This commentary explores, from anecdotal but frequent experiences, some of the key perceptions encountered when working with healthcare partners and non-healthcare partners or the general public.

Healthcare misperceptions

Besides being occasionally forgotten altogether (such as the time when Canada’s Society of Obstetricians and Gynaecologists released a new website to help people find places to get tested for sexually transmitted infections—without including links to any of public health’s sexual health clinics) healthcare provider views of public health commonly encompass several broad themes:

  • Public health as catch-all / safety net: Perhaps reflecting the subspecialized nature of healthcare fields, some providers often think of public health as a potential venue for issues they have identified that don’t seem to have an immediate “owner”. At planning tables, I’m often asked if it’s public health’s responsibility to raise awareness around medical assistance in dying, or to assist with smoother transitions of care between community settings and the hospital, issues that are more appropriately and already adeptly handled by palliative care and healthcare administration colleagues respectively.
  • Public health as “anything that isn’t clinical”: Another common heuristic among clinicians is that anything that isn’t clinical is public health practice. I often hear stories, excitedly recounted, about how folks are “getting more into public health” as a result of crunching data from their clinical trials, teaching medical students, or sitting on a hospital committee. The most common example is the confusion between healthcare administration and public health, the former of which involves the organization of the healthcare system to improve system outcomes; the latter which involves working with partners to organize society to improve health.
  • Public health as “advocacy, and it’s easy… anyone can do it”: The other tack is that public health’s vast mandate to address issues that impact on community health means that its name is famously co-opted by advocates to describe their work on a specific issue of importance to public health. While certainly making important contributions, too often clinician advocates ascribe a certain ease to balancing “public health” and their clinical career owing to their various pet projects. This viewpoint occasionally presents a difficult starting point for a partnership, especially if contexts limit just how far the public health practitioners can push towards the ideal vision put forward by the single-issue clinician advocate.
  • Public health as “just another provider”: Still other clinicians assume that because public health provides some services (healthy sexuality clinics, breastfeeding supports, immunization clinics) that public health is simply another service provider. This challenges public health to work to broaden their perspective, helping them understand that the services they are familiar with are one part of the overall strategies being deployed to tackle community health issues.
  • Public health as “this is an important issue”: Finally, one of the most commonly used misperceptions around “public health” is using the name as an adjective to draw attention to an issue. One good example is human trafficking, which is being touted by some as a public health issue. An alternative take: human trafficking certainly leads to individual myriad health issues for those involved, which presents burdens on the healthcare system, and is largely driven by illegal activities and societal inequities. This means that the considerations to address the phenomenon actually lie outside of public health’s scope and expertise. It’s a serious issue to be sure, but calling it a “public health” issue links it to a field that lacks the levers, expertise, and resources to effectively address the factors driving this phenomenon.
Public misperceptions

Public health also manages parallel misperceptions among their non-healthcare partners and the general public. This tends to fall more along a spectrum:

  • Blissfully unaware: For the most part, if public health is doing its job right, most people don’t even recognize or know that it’s public health. This has led to various campaigns such as This is Public Health, which aim to highlight how every day, common sense interventions in our communities have actually made a difference in the health of populations.
  • Public health is healthcare: The average person who has some inkling around the field often links public health to its larger, better resourced healthcare partner. The presumption is that since there are doctors and nurses involved, there must be some sort of clinical care that is happening – and that must form the bulk of public health’s work.
  • Meddlers / health “nannies”: In some cases, familiarity breeds contempt. While many partners have positive views on learning about public health’s goals and modus operandi in promoting, protect, and optimize the health of the population—typically apart from the healthcare system—still others see the work of public health as treading outside of its scope. This is seen in resistance where public health advocates for better transit or cycle trails despite not being urban planners, or where calls to address poverty or improve social services are just another example of big government types meddling with free society.
Managing misperceptions and moving forward

In an era of healthcare cost containment, climate change and environmental health threats, greater polarization in society, rising chronic disease, emerging infectious diseases, among others, the role of public health in preventing disease and keeping people healthy and protected is even more important.

Effective public health practice holds some promise towards relieving the burden on our healthcare system partners and to improving overall societal, economic, and community outcomes. This is what makes managing various perceptions of public health so crucially important to our work as practitioners.

While there are few other fields that can compare for the number of ways its members are misunderstood—perhaps insurance and financial planners come to mind—public health practitioners must learn what they can that is relevant from their parallel challenges while figuring out how best to navigate our own unique challenges in perception.

A growing interest in public health and prevention among students, young professionals, and partner agencies also represents a first step to having those conversations to really share who we are and what we hope to accomplish together.

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*Dr. Lawrence C. Loh is Adjunct Professor, Dalla Lana School of Public Health, University of Toronto. The views expressed in this piece are his alone and do not necessarily represent the views of the University of Toronto or any other organizations that Dr. Loh might be affiliated with.

 

Health Breaking News: Link 275

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 275

 

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Health Breaking News: Link 274

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News: Link 274

 

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Nutrients’ Strategic Functions in Preventing Tropical Diseases

...it sounds as a prerequisite to create an organized code of micro - and macronutrients with a proper diet that should be applied to children in developing countries to decrease the risk of infections and tropical diseases...

By Adrian Boruch

Project Manager, ALVO Medical, Poland

The Strategic Functions of Nutrients in Preventing Tropical Diseases

 

The aim of this article is to discuss the relationship between decreased macro- and micronutrient intake and tropical diseases with a special focus on malaria illness. As the authors of the books and publications that I refer to in my arcticle claim, an essential prerequisite to the prevention of malnutrition in a community is the availability of food for the nutritional needs of people. As the human body has the ability to resist almost all types of organisms or toxins that tend to damage the tissues and organs, it is worth researching how the immunity can be enhanced be intaking right nutrients. It is an obvious function of our immune system to form antibodies and sensitized lymphocytes that can attack and destroy the dangerous forms of organisms or toxins. At the same time a further question may arise what can be done in nutritional human science to stimulate antibody production. Unfortunately, we do not have all the equal access to nutritional food and dietary deficiency diseases may reduce the body’s resistance to infections and affect our immune system. It certainly should start with proper global education at the earliest school level how to harvest, store, transport and process food and afterwards which nutrients should be chosen by men and women.

The authors of ”Malaria and nutritional status among pre-school children: results from cross-sectional surveys in Western Kenya” were trying to discover in their study whether undernutrition could be associated with increased or decreased malaria attributable morbidity. They point out that relatively few studies have examined the association of malaria with protein-energy malnutrition in areas with intense perennial malaria infection. Nevertheless, they write about studies conducted among severely malnourished children in refugee camps that proved that undernourished children experienced more malaria and malaria-associated morbidity. Protein-energy malnutrition affects millions of children in the developing world. The relationship between malaria and protein-energy malnutrition, that is most common in sub-Saharan Africa, is still controversial. Recent updates indicate that almost 1 million children die each year of malaria and according to ”Report of the Disease Control Priorities in Developing Countries Project” more than a half of these deaths are preventable.

According to Michael C. Latham in his ”Human nutrition in the developing world”, protein-energy, vitamin A deficiency, iodine deficiency disorders and iron deficiency are most common serious nutritional problems in almost all countries of Asia, Africa, Latin America and the Near East. He applies the survey prepared by FAO and WHO that reveals that one of every five persons in the developing world is chronically undernourished, 192 million children suffer from protein-energy malnutrition and over 2 000 million experience micronutrient deficiencies. He studies another defence mechanism that should be taken into consideration in relation to malnutrition and that is of increased production of white blood cells and the destruction of bacteria by white corpuscles. Children with kwashiorkor show a lower than normal leucocyte response in the presence of an infection. When malnutrition is present , these cells, unfortunately, appear to have a defect in their capacity to destroy bacteria.

The authors of ”Malaria and nutritional status among pre-school children: results from cross-sectional surveys in Western Kenya” claim that protein-energy malnutrition has been related to poor cognitive and school performance in young children. They reveal evidence that protein-energy malnutrition places children under five years of age at increased risk for mortality. The shocking fact that they use in their publication is the rate of 56 percent of child deaths that can be attributable to malnutrition’s  effects. Malaria is holoendemic and transmission occurs throughout the year, though the are two rainy seasons in Kenya and the estimated number of infective bites ranges between 60 and 300 per person per year. It is often observed that malaria infection causes an acute weight loss and the authors of this publication struggle to relate symptoms such as diarrhea and abdominal pain to that infection as a consequence of malabsorption of nutrients and decreased intake of them.

How would it be possible to obtain more nutritional food in developing countries and decrease the cases of vitamin, minerals and protein-energy deficiency? Michael C. Latham estimates that about 25 percent of the grains produced are lost because of bad post-harvest handling, spoilage and pest infestation. Regarding losses of fruits, vegetables and roots, these have been estimated to be about 50 percent of what is grown. Furthermore, about 10 percent of food is lost in the kitchen. Special means should be taken to prevent food losses during harvesting, transportation, storage, processing and preservation. However, much malnutrition in the world is not only caused by shortage of food, but also by disease.  Thus, Michael C. Latham suggests that a modest increase in cereal, legume, oil and vegetable consumption by children will greatly reduce the cases of protein-energy malnutrition. In his book we learn that most food in the world comes from cereals and the second largest amount of food comes from root crops, followed by legumes and pulses. World produces about 2 000 million tonnes of cereals, 600 million tonnes of root crops, 60 million of pulses, 85 million tonnes of fats and oils and 180 million tonnes of sugar per year. Industrialized countries produce more foods of animal origin like meat, milk and eggs. Lots of this food is lost before it reaches the consumer.

More dramatic effect of malnutrition is illustrated in the book as the fatality rates of measles, which is a severe disease with a fatality rate of about 15 percent in many poor countries because the young children who develop it have poor nutritional status. Michael C. Lathan states that in Mexico the fatality rate for measles has been reportted to be 180 times higher than in the United Stated, in Guatemala, 268 times higher, and in Ecuador, 480 times higher. It has been revealed that during a measles epidemic in the United Republic of Tanzania that measles is related to vitamin A deficiency and thus it has been shown that giving vitamin A supplements to children with measles who have poor vitamin A status greatly reduces fatality rates.

According to Healthline.com :

...getting adequate amounts of vitamin A from your diet should also prevent the symptoms of deficiency, which include hair loss, skin problems, dry eyes, night blindness and increased susceptibility to infections. Deficiency is a leading cause of blindness in developing countries. In contrast, most people in developed countries get enough vitamin A from their diet. The recommended dietary allowance (RDA) is 900mcg for men, 700mcg for women and 300-600mcg for children and adolescents. Food high in Vitamin A is Beef Liver (713% DV per serving 100 grams) , Lamb Liver (236% DV per serving 100 grams), Liver Sausage (166% DV per serving 100 grams), Cod Liver Oil (150% DV per serving 100 grams), King Mackarel (43% DV per serving 100 grams), Salmon – 25% DV per serving 100grams, Bluefin Tuna, Goose Liver Pate, Goat Cheese (13% DV per serving) , Butter (11% DV per serving 100g), Limburger Cheese 11% DV per serving , Cheddar 10% , Camembert 10%,Roquefort Cheese – 9% DV per serving, Hard-Boiled Egg – 8% DV per serving 100g, Trout – 8%, Blue Cheese 6%, Cream Cheese – 5%, Caviar – 5%, Feta Cheese – 4%DV per serving, Feta Cheese – 4% DV per serving.

The worth noticing and terrifying fact observed by Michael C.Lathan in his book is the result of an inter-American investigation of mortality in childhood showing that of 35 000 deaths of children under five years of age in ten countries, in 57 percent of the cases malnutrition was either underlying or an associated cause of death.

He points out that few children suffer from vitamin C deficiency as it can be easily obtained from fruits such as guavas, mangoes, citrus and from a range of vegetables. The most important minerals in our nutrition are calcium, iron, iodine, fluorine and zinc. Vitamin D is essential for the proper absorption of calcium, the result of iron deficiency is anaemia and iodine should be mostly absorbed with sea fish, seaweed and most vegetables grown near the sea. A proper diet full with nutrients could probably optimize the human immune system. Nevertheless, the main source of energy for most Africans are carbohydrates and they may constitute up to 80 percent of their diet in some cases. In industrialized countries, carbohydrates constitute only up to 50 percent.

Undoubtedly, more thorough studies should be performed to illustrate the strategic functions of fully nutritional diet in optimizing the human immune system and simultaneously in preventing serious tropical diseases. Still little is known about enhancing our immune system in severe conditions and it sounds as a prerequisite to create an organized code of micro- and macronutrients with a proper diet that should be applied to children in developing countries to decrease the risk of infections and tropical diseases. Taking into consideration the losses connected to harvesting, transport, storage and processing food, a possibility of delivering optional nutritional food products and nutritional food supplements to children in developing countries could be analyzed. Some brave attempts to reduce such losses might decrease the prices of grains, fruits, vegetables and roots, which would enable larger consumption of right nutritional products in developing countries. At the same time,  more emphasis ought to be placed on adequate school education about nutritional benefits for our health.

Looking for these outcomes, the commitment and accountability of national governments are essential. This comes as no surprise now that, as reported  …the current international directions and neo-liberal policies have critically impaired access to food in the resource-limited countries. Over the last 20-30 years, the World Bank and the IMF, and more recently the WTO, have forced countries to decrease investment in food production and to reduce support for peasant and small farmers. Under neo-liberal policies, state-managed food reserves have been considered too expensive and governments have failed to protect farmers and consumers against sudden price fluctuations. As such, the critics argue that the neo-liberal policies have destroyed the capacities of countries to feed themselves. And this occurs at a time when land grabbing and evictions as part of neo-colonialism policies, including for biofuel agribusiness, are on the rise in Africa and elsewhere under national governments complacency and a widespread corruption.

 

REFERENCES

  1. Human nutrition in the developing world, Authors: Michael C. Latham, Food and Agriculture Organization of the United Nations https://books.google.pl/books?hl=sv&lr=&id=diGLEXZEGh8C&oi=fnd&pg=PR3&ots=znsrjUB_ud&sig=GDT6ULJRtTrnxKq-qL-D9lTrR5Q&redir_esc=y#v=onepage&q&f=false
  2. Malaria and nutritional status among pre-school children: results from cross-sectional surveys in Western Kenya, Authors: Jennifer F. Friedman, Arthur M. Kwena, Lisa B.Mirel, Simon K. Kariuki, Dianne J. Terlouw, Penelop A. Phillips-Howard, William A. Hawley, Bernard L. Nahlen, Ya Ping Shi, Feiko O. Ter Kuile. Publisher: The American Society of Tropical Medicine and Hygiene, Source: The American Journal of Tropical Medicine and Hygiene, Volume 73, Issue 4, Oct. 2005, p. 698-704      http://www.ajtmh.org/docserver/fulltext/14761645/73/4/0730698.pdf?expires=1518449165&id=id&accname=guest&checksum=8E88E266A805D64B3395BEE53E95E11E
  3. Nutrition, child growth, and chronic disease prevention, Ricardo Uauy, MD PhD, Juliana Kain, Veronica Mericq, Juanita Rojas & Camila Corvalan, published online: 08 Jul 2009 https://doi.org/10.1080/07853890701704683
  4. Healthline.com, https://www.healthline.com/nutrition/foods-high-in-vitamin-a
  5. Nutrition-related diseases in Southern Africa: With special reference to urban African populations in transition, Alexander R.P. Walker Ph.D., D.Sc. https://www.sciencedirect.com/science/article/pii/027153179500067S

 

 

 

Health Breaking News: Link 273

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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