Public Health in Tel Aviv


Jessica

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

 


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.


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:

http://www.npr.org/2012/11/30/166162027/a-lifes-ministry-springs-from-a-dilemma-over-aids

For more coverage of the day’s events, news, stories, and to get involved, visit http://www.worldaidsday.org/

In the spirit of giving, please consider donating to GlobeMed at Northwestern: http://www.globalgiving.org/projects/increase-public-health-and-sanitation-in-uganda/


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 (http://annals.org/article.aspx?articleid=1355685).  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 (http://www.npr.org/2012/09/07/160766896/organic-food-study-may-not-change-consumer-habits, http://www.nytimes.com/2012/09/07/opinion/why-organic-is-better-never-mind-the-study.html, http://articles.latimes.com/2012/sep/05/opinion/la-ed-organics-20120905, 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: http://www.nytimes.com/2012/09/09/opinion/sunday/kristof-where-cows-are-happy-and-food-is-healthy.html?src=me&ref=general.  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?

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Organization Spotlight: Tiyatien Health

A worthy organization recently brought to the chapter’s attention is Tiyatien Health, a not-for-profit that works to rebuild the failed health system of Liberia.  Liberia is still struggling to recover from a horrific civil war that ended in 2003. Tiyatien Health, headed by the liberian-born doctor Rajesh Panjabi, strives to provide what it terms “justice in health”, health equity for all Liberians.  It focuses on providing free medicine and health care to those who need it. Rajesh and all involved place great importance on teaching Liberians how to care for themselves and administer to others in order to create a health system that won’t only help those in need, but will sustain itself. Tiyatien also works with the Liberian Government to create a permanent, functioning health system and supports sustainable economic ventures in order to combat poverty. Check out Tiyatien’s website at http://www.tiyatienhealth.org/, or the GlobeMed website for the chapter at University of Michigan, who partners with Tiyatien Health, at http://www.globemed.org/[uofm] .


A perspective from Paris

In many ways, Paris is not so different from New York, Chicago, or any major city in the United States. There are all the modern amenities, locals are chic and cosmopolitan and pop culture in Europe has largely molded itself around American media. The one thing people tend to point out is that the French tend to take their time to enjoy the ordinary. The lifestyle is slower, whether it’s how long it takes a waiter to bring over a check or the way Parisians linger over three-hour dinners of bread, wine, cheese and espresso even on weekdays.

In time, I realized that this way of life reflects the lengthy scope of European history and, in turn, the principles around which many European societies are organized. Unlike the United States, many EU member states have over a thousand years of history, have waged countless wars with their neighbors, and have often redrawn messy national borders. With this sense of history comes a sage understanding of the life course, of personal success, and of mortality; not everyone is exceptional, and no one is exceptional when it comes to death at the end of one’s life.

There seems to be more of a collective sense of the past, a true focus on the present, and generally less anxiety about the immediate future. The socialist redistribution of wealth and development of the welfare state demonstrate the importance of enhancing the lives of all citizens in the present rather than focusing on future gains trickling down from a small elite. The French welfare state ensures that one has the tools to be a productive member of society, and, in the case of illness or unemployment, that he or she will be offered social assistance.

It would be essentializing to say that there is only to live, work and enjoy in France. But I think the U.S. as a state and as a culture has a lot to learn from France in terms of approaches to life, success, and an individual’s place in the society. It is a preoccupation with being the best and having it all that has characterized and shattered the American economy. So while we bemoan the demise of American exceptionalism, Americans need to understand the falsehood of individual exceptionalism and rethink the notion of what it means to live a happy life. The sooner we realize that the vast majority of us are ordinary, that it’s good to be ordinary, and that–even in a capitalist society–ordinary people deserve protection from market failure, the sooner we can start working towards reducing health and other inequalities in America. –TIFFANY WONG

Tiffany Wong is a former co-president of GlobeMed at Northwestern and is studying on the Northwestern International Program Development Public Health in Europe Program.


Wearing red on Dec. 1 World AIDS Day

GlobeMed at Northwestern encourages everyone to recognize World AIDS Day this coming Wednesday, December 1.

In America, someone is diagnosed with AIDS every 10 minutes. In South Africa, someone dies due to HIV or AIDS every 10 minutes. HIV/AIDS is often described as a disease of developing countries, but the Centers for Disease Control and Prevention estimates that at the end of 2006, there were 1.1 million HIV positive adults and adolescents in the US.

In neighboring Chicago,

  • In 2006, there were 21, 367 people living with HIV/AIDS in Chicago.
  • In 2006, there were 754 new diagnosed AIDS cases in Chicago and 1,557 HIV cases.
  • Among news diagnoses, 74% were male and 26% were female.
  • Overall infection rates have declined by 20% in the last six years, but the rate among adolescents age 15-24 has increased by 42%.

(All statistics are from the Chicago Department of Public Health, STD/HIV/AIDS Surveillance Report, Summer 2008.)

So here are 5 things you can do to commemorate World AIDS Day

  1. Find out the facts about HIV and talk to your friends, family, and colleagues about HIV — make sure they know the reality, not the myths.
  2. Know your HIV status: get tested if you have put yourself at risk.
  3. Talk to all new sexual partners about using condoms. Using a condom during sex (especially vaginal or anal sex) is the best way to protect yourself and your partner from HIV and other sexually transmitted infections.
  4. If someone tells you they are HIV positive, treat them with respect and don’t tell others without their agreement.
  5. Wear a red ribbon as a symbol of your support for everyone affected by HIV, and to raise awareness. The red ribbon has been an international symbol of AIDS awareness since 1991. It has been worn as a sign of support for people living with HIV. Wearing a red ribbon for World AIDS Day is a simple and powerful way to show support and challenge the stigma and prejudice surrounding HIV and AIDS that prevents us from tackling HIV. –KATIE SMILEY