Public Health in Tel Aviv


By Jessica Hoffen

As a GlobeMed member, I had sat through presentation after presentation on the many study abroad opportunities available, anxiously awaiting my chance to board an airplane and, briefly, wave goodbye to America.  My turn finally came in the spring of 2015 when I landed in Tel Aviv as part of the Public Health and Society in Israel program run by Northwestern and Tel Aviv University.  As a student interested in the impact of culture and conflict on health equity, I hoped that through experiencing this region I would be able to better understand what has worked and failed in implementing health initiatives across ethnic lines. While public health was the focus of my studies in the region I found that what Palestinians and Israelis were most passionate about teaching me, was simultaneously the pervasiveness of those ethnic lines in everything they did and the joy and pride they found in their lives and their cultures despite these.

As an English-speaking American, the Israel-Palestine I had access to included Israelis and Palestinians, Sudanese and Eritreans, Thais and Filipinos; it was multi-ethnic, multi-religious and deeply, painfully divided. Through my program I visited a range of public and private health institutions that collectively provide for this diverse population.  All Israeli citizens, regardless of employment status, pre-existing conditions, ethnicity etc., have health insurance and access to the same basic care package. This covers a range of potential needs including; chronic disease treatment, transportation to the hospital, in vitro fertilization, and drug and alcohol rehab.  Notably missing from the list is mental health care, something that is simultaneously needed, due to the high rates of trauma experienced by people in the region, and taboo, because the prevalence of the trauma has led to the expectation that people should be able to “cope” on their own.

One of the aspects of the health system that I was most impressed by was the emphasis on adherence to care. Everyone has insurance so everyone’s health is monitored. As “big brother” as this may sound, it is very effective in containing disease outbreaks and in ensuring people attend their yearly check-ups and adhere to prescribed treatments. Early childhood nurses make home visits if patients miss an appointment, and tele-medicine, in which nurses regularly check in with patients over the phone, is used to keep track of the needs of chronic disease patients.

Despite these impressive initiatives, for the 25% of Israeli citizens who are not Jewish, the health system fails to provide consistent and equitable care.  In GlobeMed we frequently speak about the social determinants of health, specifically how issues such as trust between care providers and care recipients, distance of populations from hospitals, and responsiveness of the health system to certain populations, all influence health outcomes.  In my experience, Israel-Palestine is a case study in this reality. One example of this is the NephroLife clinic in Umm al-Fahm a primarily Muslim Palestinian town in the center of the country. The director of the clinic had tried to get the government to fund a dialysis center in the town so residents would not have to make the one-hour journey by bus to the nearest hospital. When the government failed to establish a dialysis center he founded NephroLife, a private clinic, that charges for its services. He is now working on bringing a hospital to the area, however, this too will be private, because he was unable to obtain government support.

Before visiting this region I had always held up universal health care as the gold standard of health systems.  However, the clinics I visited and the people I met while abroad made me realize how much this system of government oversight relies on trust between the people and government; trust that is easily broken through conflict and discrimination. Though I did not return to America with answers about how to improve cross-cultural care, I did come away with the firm belief that the first step to improving health outcomes anywhere in the world starts with building relationships that are rooted in respect, dignity, and recognition of history. 

Jessica 2


A History Of Failure: Why Global Health’s Past Is Important For Its Future

By Nida Bajwa

Anyone who has studied global health knows that the field is wrought by many many failures, and very few successes. It is easy to get discouraged from the field when analyzing the immense amount of failure and repetition of those failures in the field. However, in analyzing these failed histories perhaps we can arrive at a greater future. As students, what is our role? What do we want to achieve from our global health education? How can we take a history of failures and turn it into success?

The relationship between politics and global health is immense, and can be traced back to colonialism. The commonality that exists today is that healthcare to poor, developing countries is delivered by westerners who come in and impose their set of values upon the people, an idea borne from colonialism. In some hundreds of years, not much has changed. The white man’s burden rechanneled itself into delivery of global health around the world. Similarly, racism in America has found new channels but has not left us. To this day, America is a country with institutionalized, systematic racism. That racism is the same racism of the 1600s that began slavery, the same racism of the 1950s that spurred the civil rights movement, and the same racism that spurred the Ferguson protests just months back. Similarly, global health today is still a field that is battling with that stigma, a stigma that was embedded very deeply in our colonial history.

Sadly, global health has oft been used as a tool by those in power. Interestingly enough, the mortality rates of blacks vs. whites in hot climates served as justification for the trans-Atlantic slave trade. A measure of health, associated with progress and development, thus aided in justifying a brutal system of slavery. The same determinants global health advocates use to try to do good were used to do evil. The same determinants used to grant equity in healthcare were used to justify racism, colonialism, conquest, and the lingering consequences of these institutions we are still feeling today and quite possibly will reverberate for the rest of American history. You can’t escape your colonial past, you can only work with it.

Paul Farmer, an anthropologist in the field of global health, discusses the impact of colonialism and history in an essay titled “An Anthropology of Structural Violence.” In the essay, he explains the idea of structural violence as the oppressive systems in play which all those who are engaged in take part in, perhaps subconsciously. As American citizens, we are thus responsible for structural violence, whether or not we personally engage.

So how do we, as students move forward? How do we escape America’s colonial past? The answer is uncertain, but it is clear that some form of systematic change has to occur, most likely at a political and a social level. In order to truly impact change on a health level, you have to impact change on a social scale. Until systematic racism is no longer in play, how can health ever be equal? We will have to think critically as a nation, as students, and as global citizens in effecting change and hopefully, one day, we can undo the years and years of colonialism and the damage it has caused around the world.

Gates Foundation/Flickr

Guinea Worm Eradication in Nigeria, A Lesson To Learn From

By Gordon Younkin

You may have seen in the news a little over a year ago that the WHO declared Nigeria free of guinea-worm disease. While this may be considered old news, it is still worth examining the campaign that successfully stopped its transmission.

Guinea-worm disease, also known as dracunculiasis, infects people via contaminated waterways, especially in slow-moving streams or stagnant pools. After entering the human body, it stays matures in its host without causing any symptoms for about a year before painfully emerging from the skin of the infected individual. It then releases thousands of larvae, and its life-cycle repeats. There is no vaccine or treatment for the disease—it is most effectively stopped through preventative measures such as water purification and behavioral change.

In 1988, the Nigeria Guinea Worm Eradication Programme was launched in response to a World Health Assembly resolution calling for the global eradication of the disease. At the time, there were around 650,000 reported cases of guinea-worm disease in Nigeria alone. Over the course of the 25-year campaign, thousands of volunteers traveled door-to-door in communities across the county to search for and contain the disease.

What I think is most notable is the use of polio vaccinators to help in the surveillance efforts. The campaign was able to use existing health workers already familiar with the communities and culture to more quickly and efficiently eradicate guinea-worm disease. It is this kind of cooperation between different public health efforts that is crucial to the continuing improvement of health worldwide. Dr. Margaret Chan, Director-General of the World Health Organization (WHO), commended the collaborative guinea-worm disease eradication effort: “This is the kind of joined-up effort that makes the most effective use of our human and financial resources, and has a dramatic and measurable impact.”

The last case of guinea-worm disease in Nigeria was reported in 2008, and the country was declared Guinea Worm free in late 2013. While the polio vaccination campaign is still in progress due to a number of cultural and infrastructural barriers, Nigerian President Goodluck Jonathan is committed to stopping the transmission of wild poliovirus by the end of 2015.

If you are interested in more information about guinea-worm disease eradication efforts in Nigeria, some useful references are:

Putting Emotion Front and Center Once Again

By Nicholas Wang

We are inching closer to Article 25’s Day of Action on October 25. If all goes according to plan, it will be a monumental day for this brand new organization, which was founded within the past year by university students who had a simple idea for a grassroots global health advocacy organization. From that idea came the long, grueling process of formulating a tangible vision and plan for what this organization would look like and could accomplish. Long meetings both in person and over Google Hangout, hours upon hours of research and organization, aggressive network-building, and coordinated social media blitzes have all led up to a single day: October 25. There are events planned all over the world in more than 40 different countries with thousands of people attending and participating, from accomplished professionals to eager students to families and individuals that lack access to basic healthcare, all united in the belief that health is a human right. Quite the accomplishment for a young organization like Article 25.

But I think that oft-told narrative I outlined above ignores a key point: before there was the simple idea for a grassroots global health advocacy organization, there was a feeling, an emotion. It surfaced during classroom discussions, in assigned readings and documentaries, while traveling to and observing different neighborhoods and cities and countries, during conversations with classmates, friends, family, teachers and faculty, about politics, economics, policy, health, and society. It was the feeling that there was something wrong with the world, that it wasn’t quite fair that some people were born with access to health and others weren’t, that location, income, race, ethnicity, gender, sexual orientation, or religion could become a factor in determining whether you died young or old. And it was the emotion of frustration and anger at the world and the system for allowing this to happen, coupled with an overwhelming desire to do something about it. It inspired enthusiastic conversations between the young students who founded the organization, and permeates all of the events that will occur on October 25. We all feel this same passion, rooted in frustration and fueled by optimism and hope for the future: that there is something wrong and we should do something about it.

I know I felt that passion when I first heard about Article 25 and our Day of Action back in June. As Amee Amin and Jason Pace told me more about this organization and what they were hoping to accomplish, I sensed that this was not just a worthy cause and a worthy use of my time. It was something of a calling, an indescribable force that drew me in and made me want to shout from the mountaintops that health is a human right and we can do something about it. This organization empowered me to take my global health education to the next level, to step up my commitment, to join with these other like-minded individuals and create the change we want to see.

As the weeks went on, and the logistics got more and more complicated, and my mind started drifting towards the ever-approaching start of my senior year of college, I admit that the passion waxed and waned, often replaced with the dull regular reminder that I needed to get work done for Article 25. It was routine and often clerical and not as exciting, thrilling, or romantic as I had secretly envisioned it to be. To make matters worse, we are a team that is spread out all around the country, from Boston to Los Angeles, and bonding and building community via Google Hangout is difficult.

But now more than ever, with the Day of Action upon us, I think it is time for us to rekindle the spirit and passion and enthusiasm that we all once had. That is the core of what drives us to spend hours planning events and detailing logistics and sending dozens of emails. When you strip everything else away, what remains is that feeling that something is wrong, and that coinciding emotion that tells us to be both angry and hopeful. Our emotions are what will make the Day of Action meaningful and memorable, and are what will help this incredible organization continue long past October 25. If you are not yet part of our movement but feel the way we do, we encourage you to join us on our Day of Action, wherever you might be. You, like me, should feel excited, enthusiastic, and empowered about being able to make a tangible difference in our world.

Health Briefing: Uganda

By Michael Zingman

Key Statistics and Health Indicators:

Sources: WHO Uganda Statistics Summary, UNICEF Uganda Statistics, and MIT Global Health Uganda Country Briefing – Health

Total Population – ~36,346,000
Median Age – 15.7 years
Population Living in Urban Areas – 16% (Global average – 53%)
Healthy Life Expectancy at Birth – 49 years (Global average – 62 years)
Probability of Dying Between 15-60 Years (per 1000 people) – 389 male, 360 female
Population Over 60 – 3.7%
Per Capita Government Expenditure on Health (US $) – 10.4
Per Capita Total Expenditure on Health (US $) – 43.6
Total Expenditure on Health (% of GDP) – 8%
Prevalence of HIV (Adults 15-49) – 7.2%
Maternal Mortality (per 100,000 live births) – 435 (worst in Africa)
Degree of Infectious Diseases Risk: Very High
Top Food or Waterborne Diseases: Bacterial Diarrhea, Hepatitis A, Typhoid Fever
Top Vectorborne Diseases: Malaria, Plague, African Trypanosomiasis (Sleeping Sickness)
Top Water Contact Disease: Shistosomiasis

Ugandan Health Priorities

Recently, a survey report was published by the Pew Research Center’s Global Attitudes Project titled “Public Health a Major Priority in African Nations.” This survey used face-to-face interviews with people (at least 750 each) from Ghana, Kenya, Nigeria, Senegal, South Africa and Uganda. This widespread research was conducted over a one month period from March-April 2013 and has very interesting findings regarding public health priorities in each country.

Due to GlobeMed at Northwestern’s partnership with the Adonai Centre in Uganda, this article will focus on the surveys of Uganda. There, 800 adults were selected by varying regions and urbanity and interviews were conducted in seven different languages – English, Luganda, Rukiga, Luo, Lugbara, Ateso and Runyoro. The study showed that these adults thought that the most important priorities for the government include (in order of importance): building and improving hospitals and health care facilities, preventing and treating HIV/AIDS, improving access to prenatal care, improving access to clean drinking water, preventing infectious diseases, increasing child immunizations and fighting hunger. Across all countries surveyed, building and improving hospitals was the highest priority overall.

This article will focus on the two top priorities listed, hospital facilities and HIV/AIDS prevention and treatment.

First, the Uganda Ministry of Health has reported that there are 1.1 hospital beds per 1,000 people, 5.5 nurses per 10,000 people and 1.17 physicians per 10,000 people. Uganda’s healthcare performance is one of the worst in the world, ranked 186th out of 191 countries in the WHO ranking. That being said, health investment and hospital coverage have both increased dramatically over the past 5-10 years and the outlook is generally positive.  Utilization has also increased tremendously as the government eliminated user fees for health facilities in 2001, causing an 80% visit increase. Potentially the greatest issue regarding healthcare in Uganda is the poor distribution and inequity of health infrastructure. In some rural areas of Uganda, there is just 1 healthcare facility per 20,000 people, as compared to 1:5, 300 in Kampala, the capital city. Also, 16 out of 80 districts of Uganda have no hospitals at all. For the rural population, skilled health personnel is lacking too. While 80 percent of births in urban areas have skilled health personnel present, the rural areas only average 38 percent. On another positive note, however, the government is now focusing on poor areas to increase health spending. That being said, it does not seem to be enough yet – the poorest 20 percent gets 24 percent of health spending, while the wealthiest 20 percent gets 17 percent of health spending. It is important to note that the government is also not the only factor in healthcare of Uganda, the private sector is also crucial. In a survey from 2006, just 29 percent of Ugandans who sought healthcare went to public facilities, which make up 71 percent of all facilities. Therefore, private clinics, drugstores and NGO facilities are getting more usage.

Second, HIV/AIDS is a huge problem in Uganda due to 7 percent of the population having this infectious disease and due to the difficulties of prevention and treatment. Uganda, however, has been extremely successful in its HIV/AIDS responses, particularly due to early action when the epidemic struck in the 1980s. The percentage of HIV cases has decreased a large amount since the 1980s – at one point they were at 29 percent in urban areas. HIV/AIDS control programs, education campaigns, free antiretroviral (ARV) sources, and outside sources of HIV/AIDS funding such as from the World Bank, the Global Fund and President’s Emergency Plan for AIDS Relief (PEPFAR) have been tremendous in these efforts. NGOs have also played a significant role in the AIDS response. Uganda’s national strategic plan has an ambitious goal of reducing HIV infections by 40 percent over five years.

Both of these health priorities – building new hospitals and healthcare facilities and HIV/AIDS treatment and prevention – highlight the largest problems facing Uganda in terms of health. At the same time, they are ones with fairly positive outlooks and the government has generally done a very good job in improving healthcare. In line with government efforts, however, nongovernmental organizations can have a key role in countries like Uganda, working with communities to improve drinking water sources, sanitation facilities, immunization coverage, education on health issues, condom use promotion, etc. Organizations like GlobeMed can lead the way in working alongside the Ugandan government to focus on these health priorities, reduce health inequities and improve the quality of life for the 36 million people of Uganda.

Vaccines, Herd Immunity, and Disease Re-Emergence – What’s the Deal?

By Michael Zingman

We hear about immunizations in the news. We are encouraged to get vaccinated. We hear friends and family talking about how they just “never got vaccinated” for something.

We then hear about outbreaks and re-emergence of vaccine-preventable diseases. So what is causing this re-emergence exactly?

Vaccines are one of the most crucial global health resources and are significant tools that can be utilized to protect large populations in both developed and developing nations from disease. Many diseases are vaccine-preventable, meaning if hypothetically everyone were to be vaccinated, the disease would become eradicated.

One of such eradicable diseases is measles. Measles was once “eliminated” from the United States; however, recently, there has been extensive media coverage over a measles outbreak within the country. Measles was eliminated but not eradicated because of a slight minority of people who went unvaccinated, and this number has increased and allowed the disease to return. These cases were found to be from parents who chose not to vaccinate their children, which ultimately harmed others.

Other parts of the world have also seen a re-emergence of vaccine-preventable diseases. One interesting case is that of Syria and the re-emergence of polio this past October. Polio had come extremely close to eradication in that area of the world; unfortunately, it has re-appeared. This was due to two key factors: 1) because of the ongoing civil war, the normal childhood vaccination routines have been altered or disrupted, and 2) polio has spread from Pakistan (which is one of the three remaining countries in which polio is still active), particularly through children, including those in refugee camps and those displaced in Syria. Polio has even spread to Iraq from Syria, and there is growing fear over proliferation of the crippling disease.

So why can just a handful of unvaccinated people lead to a wide-spread re-emergence of these preventable diseases? The key is herd immunity.

Herd immunity is defined by the Centers for Disease Control as when “a sufficient proportion of a population is immune to an infectious disease to make its spread from person to person unlikely; even individuals not vaccinated are offered some protection because the disease has little opportunity to spread within the community.” This concept of herd immunity is why widespread vaccination is necessary for prevention of these diseases. In an ideal world, everyone would be vaccinated for all of the vaccine-preventable diseases. However, that is not a practical situation (at least not at the current time). Herd immunity can be very effective in protecting large populations from these diseases, but often can be difficult to achieve as some diseases require greater than 90% of the population to be vaccinated. This threshold is frequently not met and populations are left vulnerable.

With a growth of anti-vaccination movements in the United States and around the world, some parents have stopped vaccinating their children. This has led to a decrease in herd immunity for these vaccine-preventable diseases, permitting their re-emergence. These movements have surfaced due to a growing fear that vaccines can have adverse effects on children. This fear has been augmented by conflicting information regarding vaccinations, as well as personal accounts of negative vaccine effects, including those by physicians. Misinformation has even led a significant portion of the U.S. population to believe that autism can be caused by vaccines. This belief became prominent in the 1990s and was one of the reasons cited for the growth of this anti-vaccination movement.

Two key aspects of the debate over vaccinations include a lack of information (or misinformation) and a mistrust of governments, health institutions and research agencies. These are major problems in the United States, but also in many countries throughout the developing world, including those countries in which GlobeMed partner organizations are located. A lack of research to disprove these supposed negative vaccine effects has made it hard for the public health community to convince people that no link exists. Furthermore, much of this research comes from pharmaceutical companies, leading to mistrust of this research due to potential biases. An overabundance of information also has prevented people from receiving direct information from health institutions regarding vaccine effectiveness and has caused them to educate themselves from other sources that are less reliable. On a similar note, there is a lack of public understanding about vaccinations that stems from a mistrust of health institutions. It can often be more difficult to vaccinate people in developing countries in which people view vaccinations as a corrupt government program. Some people even believe that required vaccinations for schools are done for the economic benefit of the government.

All of these issues discussed have increased fear of vaccines in many locations around the world, including in those places with GlobeMed partner organizations. Vaccine education needs to be expanded and effective national vaccination action plans need to be both developed and carried out to increase herd immunity. GlobeMed and its partner organizations, as well as similar global health organizations, need to empower communities around the world in order to enhance vaccination efforts. Education through vaccine information is necessary to present to the public why population immunization is essential and why a decrease in herd immunity can have tremendous negative effects.

World AIDS Day

To celebrate World AIDS Day, take a listen to the following inspirational StoryCorps presentation:

For more coverage of the day’s events, news, stories, and to get involved, visit

In the spirit of giving, please consider donating to GlobeMed at Northwestern:

Global Warming and Global Health

It’s October now, but think back to this past summer; in most parts of the country it was blisteringly hot.  Over the whole United States, more than 80 people died because of the heat (  From January to June 2012 more record highs were achieved than all of 2011 combined (  While it is important to remember that a single year of high temperatures and hot summer weather alone does not prove the existence of global warming or climate change, it does make you wonder why Americans continue to think that global warming is not a real phenomenon.


But perhaps a way to get more people aware of the issues surrounding climate change is to introduce the problem not as an environmental issue but rather as a public health issue.  A recent NPR article illustrates this point:


Highlights from the article include the fact that public health is very rarely a partisan issue, that doctors and medical professionals are viewed as more trustworthy than environmentalists and journalists, and the overwhelming evidence that suggests a changing climate is indeed a drastic health issue that needs to be addressed sooner rather than later.  It may well be that environmentalists will turn to public and global health experts to help raise awareness of the issues surrounding climate change; otherwise, the death toll for summer heat waves may continue to rise.


Read the article and see what you think; share your thoughts by commenting on this blog post or on our facebook page and twitter feed.


Also remember to come to our open meeting for the chapter, tomorrow at 7pm at McTrib 3127!  And watch the presidential debates at 8pm right afterwards in Harris 107!

Public Health and Organic Food

Many of you may have heard that a recent study from Stanford researchers indicates that the health benefits of eating organic food are not as readily apparent as once thought, at least over a course of a few years (  Utilizing over 200 peer-reviewed studies that examined both the differences between organic and non-organic food and the health of people who eat organic and non-organic food, researchers concluded that: “The published literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods.” 


Reaction was widespread, but to make a gross generalization, many consumers were upset and felt duped or misled by companies advocating the benefits of organic food, which is often more expensive than comparable non-organic products.  After all, it only makes logical sense that putting more chemicals and artificial pesticides into your body would be worse for your health; this study seemed to refute that. 


There are a number of things to keep in mind, however, as people immediately pointed out after the study was published (,,, etc):

-First, the studies are short-term, looking into the health of individuals over a small period of time.  What the long-term effects of eating organic food are is perhaps even more important than understanding the short-term effects, and while such studies are currently under investigation the jury is still out and will be for a while longer.  Even though the health benefits alone were inconclusive for organic food, the study does say there is a much greater amount of pesticide residue on non-organic food.

-Second, having a specific organic label for certain types of foods adds to the transparency of the food industry, which has been anything but transparent in the past.  Having a clear understanding of where and how food is grown and processed is important to consumers.  The organic label, which is regulated by the FDA and the USDA, is just one relatively small way in which individuals can clearly recognize how a specific product came to be.

-Third, organic food is proven to be better for the environment.  Industrial, non-organic farms use chemicals and pesticides that are devastating for the local environment, polluting watersheds and negatively affecting animals and plants downstream.  Organic farms, on the other hand, contribute less to climate change, and do not put harmful chemicals in the soil, making them more sustainable.  Furthermore, organic meats are free of antibiotics and hormones that similar non-organic foods contain, thereby decreasing the presence of drug-resistant bacteria and hormone-related side effects such as early puberty in girls. 

-Fourth, and perhaps most importantly, organic food promotes a healthy lifestyle, where people celebrate the spirit of eating things that are maybe not necessarily better for you and your health but are grown sustainably and often locally, with the environment and the future in mind.  Organic food, as NY Times columnist Nicholas Kristof writes, can promote the health and happiness of farm animals:  Organic food, in this way, becomes a moral choice, not just a personal health choice. 


In the coming weeks it will be interesting to see how consumers react to the Stanford study; there may well be a decrease in the number of organic products sold. But it looks as if, at least in the interest of public health for cows and humans alike, organic may still the way to go.  The bioethics aspect, in a way, is the organic, locally grown cherry on top.

Malaria Vaccine Breakthrough: Implications for Global Health?

Malaria, transmitted by infected Anopheles mosquitoes, causes more than 780,000 deaths each year. The deaths occur disproportionately in Africa, particularly Sub-Saharan Africa. Conventional malaria prevention methods include insecticide-treated mosquito nets (ITNs) and indoor residual spraying (IRS).

Earlier this week, the results of a Phase III study in 7 African nations showed that RST,S/AS01 (vaccine against P. Falciparum – deadliest of the four malaria types) reduces the risk of severe malaria in children by 47 per cent. The drug is developed by GlaxoSmithKline in partnership with the PATH Malaria Vaccine Initiative, and funded by the Gates Foundation. It has taken 24 years since the drug development process started to get to this point.

What seems to be the world’s first malaria vaccine is well under way, with final results expected in 2014. However, amidst all the excitement and hope, one can’t help but wonder the implications of this vaccine on Global Health. Granted this is a significant health care and scientific progress, but most vaccines in use today have an efficacy of at least 90-95% (e.g. influenza vaccine). Can this malaria vaccine, and should it, be used by doctors in developing countries in the long term? How do you think public policy in developing countries, especially African nations, will change? Furthermore, how do you think the availability of this vaccine will affect the use of other and much cheaper malaria prevention methods such as ITNs and IRS?