Spotlight on Public Health
This VantagePoints issue is the first of a special quarterly series featuring a review of the year’s bi-monthly issues through a specific theme. This quarterly issue focuses on public health, and highlights the impactful work of public health thought leaders in our own community during 2017, and how they’re contributing to not only the health of our world, but its development.
July 1st, 2017 marked a new phase in global health as Dr. Tedros Adhanom Ghebreyesus began his 5-year term as the World Health Organization’s new Director-General. Dr Tedros will focus on several main areas during his tenure including achieving universal health coverage through the creation of healthcare systems; the management and prevention of healthcare emergencies by local communities; reproductive and women’s healthcare; children and adolescents; health problems resulting from environmental factors; and building a transparent and accountable WHO. Dr. Tedros has worked extensively in Ethiopia, serving as Minister of Health from 2012 to 2016. During his tenure, he created (among other achievements) 3500 hospitals and 38000 new health care worker positions, and increased the number of medical schools in Ethiopia from 3 to 33. In addition, the rate of new cases of HIV has dropped by 90%, deaths from malaria by 75%, and deaths from TB by 64%. It is also notable that he is the first Director-General from Africa in the seventy-year history of WHO.
The World Health Organization recently published the Global Health Statistics 2017: Monitoring Health for the SDGs. An important component of Director-General’s 5-year plan and beyond, is its alliance with these Sustainable Development Goals. WHO has reported success stories so far this year, such as strengthening health emergency preparedness in Ghana, reducing Malaria in Cambodia, improving maternal health in Kazakhstan, and a general improvement in both health and life expectancy in most geographic areas.
One important aspect of public health is the preparedness for emergency outbreaks of disease, which can happen anywhere at any time. Certainly, the recent outbreak of Ebola in West Africa is a devastating reminder. An often overlooked, but globally important set of communicable diseases are Neglected Tropical Diseases. By 2030, the SDG goal is to end the those epidemics, which saw one billion people or one-sixth of the world’s population, seeking treatment in 2015. Water-borne diseases, such as cholera, occur in many of the same environments, and they are also targeted for eradication by 2030. Currently, there is a serious outbreak of cholera in Yemen as a result of two years of heavy conflict in the area, which has caused one of the worst humanitarian crises in the world. People are dying right now and that is largely due to the inaccessibility of health care, and other contributing factors including violence, food shortages, unsanitary conditions, inadequate housing, closing of schools or the lack of available jobs. Health and sanitation systems have broken down, resulting in 5,000 new cases a day, with a total of 200,000 cases. Without any real involvement by Yemen authorities, the disease outbreak continues unabated, and cannot improve without the work and funding of the international community; it’s important for each nation to make sure that others reach sustainable levels of development. Two years ago, Yemen had conflict, widespread poverty, and poor governance, but the economy is now close to collapse. Communities around the world must be prepared for disaster, and our public health thought leaders are making sure that concerns are addressed at all levels, so local concerns don’t escalate to more widespread crises.
In regions like the Middle East, the political unrest allows for little input on the part of local governments for improvement in public health or poverty. The prioritization of public health policies, however, is what will actually lift people out of poor living conditions and into economic empowerment so that they can contribute to the development of their own countries.
Unfortunately, when it comes to the problem of forced displacement in the Middle East, the countries were not prioritizing the health and security of their people. Public health is a international security issue. Inadequate local health systems in developing nations or those nations facing significant inequality, contribute to the spread of diseases and worsening economic challenges across borders. Additionally, people will likely feel that they don’t have opportunities; when that happens, they can turn to violent behaviors. Part of the solution is health, and part is education. Noting that problem and its solution, organizations like Relief International have launched initiatives such as Project Turquoise, which addresses just that: “the situation is that these people [displaced by the Syrian conflict] are completely helpless. I think it’s the biggest humanitarian crisis in our lifetime. Their own governments have turned on them, but the world cannot turn on them. Honestly, it’s a safety issue. When we take people in such a desolate, hopeless situation and abandon them, it becomes a safety issue for the world. We need to empower these people in a positive way. When organizations like Relief International are providing education services, and when you empower the youth and the mothers—who we know are basically running the homes—you are going to create a group of responsible, contributing members of society.”
Even in regions unmarred by conflict, emerging nations often suffer from poverty, environmental concerns, and a lack of sanitation which impacts the health and vitality of their communities. VantagePoints recently featured Nature for Change, an NGO co-founded by Mohamad Tahar Jumaat, to help educate the local citizens living near the Gunung Leuser National Forest in Sumatra, Indonesia through community-based conservation. In addition to protecting their rainforest environment, the organization is making real change through poverty relief and improved public health; among other things, it provides food and the construction of sanitation infrastructure. As with the current cholera epidemic, maintaining sanitary conditions is key to not contract Neglected Tropical Diseases; Indonesia has one of the highest rates of NTDs in the world. At Nature for Change, the building of toilets promotes public health, and it allows citizens to be part of a home-stay program which promotes economic improvement and encourages eco-tourism.
For our global communities to continue to progress, public health must be addressed in each community. Without the physical well-being of a community, the people within it don’t have the ability to flourish or end the cycle of poverty. Good health simply makes a population more productive. Poor health kills, weakens, or impairs the functioning of children, making them perform poorly in school. For adults in those societies, higher education is less attainable, and they are less capable of gaining a job and have fewer job options available to them. When people are able to rise out of poverty, a local private sector can grow, and more jobs are created. This is something that concerns everyone, but developing countries and those most effected by the refugee crisis may have even more at stake.
In addition to providing proper sanitary conditions and community education, public health workers rely heavily on drug donations to treat, and ultimately prevent, the spread of disease through vaccines and other treatments. NTDs are diseases many people have never heard of, yet are often ancient in origin. They flourish in impoverished, and tropical environments. The large scale donation of pharmaceuticals, worth from two to three billions dollars a year, is vital to the reduction of these diseases around the world. Combined with effective healthcare systems aimed at educating communities to reach out for treatment, these diseases can be controlled. In 1986, for example, there were 3.5 million cases of guinea worm around the world – in 2016, there were only 25 cases, limited to three African countries.
Dr. Marcia de Souza Lima, a Public Health and NTD Specialist is currently an Executive Director with PASS. Her early practice of ophthalmology served as a springboard into an impactful tenure in pharmaceutical development. Dr. Marcia de Souza Lima discussed her work on Neglected Tropical Diseases in a recent interview with PASS and explained how they are “diseases of poverty” because they “disproportionately affect people who are in low-resource settings or otherwise neglected….most people in developed countries have never heard of them. NTDs are a direct reflection of people’s living conditions, and they are part of everyday life in a lot of developing countries. Children face some of the direst consequences because NTDs can keep them from attending school and impair their cognitive development. Some diseases like trachoma and onchocerciasis can have irreversible consequences like blindness.”
The promotion of health for children and adolescents is one of the focal areas in Dr. Tedros’ five year plan for WHO. The future of the world rests on the healthy development and education of today’s children, and there has been some progress in the last ten years. In Ethiopia, Dr. Tedros was able to lower the childhood mortality rate by two thirds during his tenure; in 2015, the world-wide childhood mortality rate dropped below 6 million for the first time ever. In 2016, PASS helped spearhead the Helping Hospitals Heal Children (H3C) project. This initiative was the brainchild of Ambassador Kadyr Toktogulov, the Kyrgyz Republic’s Ambassador the United States and Canada. H3C is an international health project aimed at improving the capacity and quality of care in two public pediatric hospitals in Kyrgyzstan.
It is easy to see why public health is such an important focal point for PASS. The topic includes diverse problems, which range from NTDs, to issues that more directly affect all of us, such as universal healthcare, clean air and water, and protecting our environment for future generations. In February, PASS’s Executive Director for Public Health, Dr. José Mosquera, sat down with Mr. Alejandro Tejeda in Arequipa, Peru to discuss Quechua Benefit, an organization dedicated to improving the lives of people in the Andes. PASS works with this organization, and provides strategy for resource generation and programming. Aside from offering education to children through their Casa Chapi school, Quechua Benefit also supports these communities with integrated health and development programs. Dr. Mosquera has led efforts to make their communities healthier and build the organization’s capacity to effectively support these communities, which benefit from deworming, illness prevention, and dental treatment.
VantagePoints shares the impactful work of international thought leaders from across professional fields, who are devoted to addressing the important issues facing our world today. These issues are intrinsically inter-related. We are reminded how public health, the environment, and the economy, for example, are linked. A positive impact in one area paves the way for a positive impact in all of them. In our global society, a positive impact in one country can also pave the way for a positive impact in another. On July 4th, let’s celebrate and share our hopes for not only our society, but our larger global society.