Into the Humanosphere

Okay, word is starting to leak out so I wanted to tell the loyal readers of my personal blog (yes, those same 20 people) where I’ve moved.

I’m now at Humanosphere — an up-and-coming NPR blog on global health & development based in Seattle at KPLU.

We’re not quite ready for prime time, but I’d appreciate feedback from any of you while we’re in the “beta” phase.

Yes, I know it’s a weird name. What else would you expect? Read this description.

Humanosphere. Say it a few times out loud.

It’ll grow on you.

See you!

Tom

PS You can comment here, there or send me a private email at tpaulson@kplu.org

Transmogrification

Some folks have asked why I haven’t posted in a while. Well, as I said a week or two ago, I got a paying job as a journalist (imagine that!) and am having to undergo a sector change. I’m also having to learn a lot and haven’t had much time to feed my personal blog hole.

I will be posting again soon, but it will be for the local NPR affiliate KPLU as a global health & development blogger-curator (or whatever the hell I’m supposed to call myself now).

Please stay with me. I’ll let you know when the makeover is completed.

"Before" (thanks to Photofunia)

Hey, I got a job at NPR! Name that job!

me

There’s nothing official out yet, but I wanted my loyal (20 or so) readers of this brief and wondrous blog to know that I will soon be blogging about global health and development for NPR.

Suggest a name! For the blog, I mean. I already have a name.

We still have some time before settling on what this blog should be called. If we use your idea, I’ll get someone at KPLU to give you some jazz or something. Or maybe I could even blog you (… though I’m not sure what that means, or if it is correct usage … still learning the lingo… )

So here’s the deal. I’ll be working with the good folks at KPLU (88.5FM in Seattle, or kplu.org on the web), which as most of you locals know is one of the two NPR affiliates in the region. This is an experiment, an attempt to expand NPR’s web presence and move deeper into new media strategies.

What I want to accomplish is to help build a vibrant and informative dialogue about matters of global health and development. This blog will be about keeping up with the news, but it will also be a place where issues get raised, hashed out and debated. It will be a place where we get a sense of the people and the personalities behind this phenomenon known as “global health.” The success of this blog will depend upon you as much as on me.

Anyway, more on that later as we get closer to launch.

For now, what I’d like is a good name for the blog.

What do you think?

You can offer ideas here or send them to me at tpaulson@kplu.org

Thanks!

Tom

When Pig Flu Flew

When Will Swine Flu Fly?

Once again, critics are claiming public health experts last year hyped the potential threat of a uniquely piggish version of the influenza virus, the H1N1 virus – or so-called swine flu. This time, however, some of the critics add that the hype was done to benefit the drug industry.

The World Health Organization and other leading health authorities strongly reject the criticism saying they acted prudently given the risk of a deadly pandemic such as the world experienced in 1918.

The truth is likely somewhere in between.

The WHO did over-react to the threat, but hardly because it would help the drug industry sell vaccines and drugs. Part of the problem here is based on how we react to uncertainty and potentially deadly risks.

If the goal is simply to do whatever it takes to reduce risk, why aren’t we also setting up nuclear-tipped rockets to blast killer asteroids given that scientists say it is a near-certainty that the planet will again be struck by one of these things? Because, on balance, the cost and trouble of doing so seems unjustified given the level of uncertainty about when and where.

An especially dangerous flu pandemic like 1918 is more likely than a killer asteroid, but when and where it will strike is similarly uncertain. When the H1N1 virus was first discovered in a flu outbreak in Mexico, authorities sounded the alarm because young people had died and the virus contained a unique combination of pig, bird and human flu genes. The experts said a repeat of 1918 was a distinct possibility.

Pandemic. That was the word that got everyone excited. In the excitement, the pharmaceutical industry was exhorted by WHO and other leading health authorities to step up production of anti-viral drugs and vaccines to respond to the looming threat.

But, technically, flu is always pandemic since it spreads worldwide and kills a large number of people – every year.

As this “swine flu” spread worldwide, it became pretty clear early on that the mortality rate in Mexico was unique and due to some factor (perhaps poor health care) other than the virus. The death rates were not out of the norm for regular flu. But, because of the genetic nature of this virus, WHO and others continued to warn that this flu could still turn exceptionally nasty.

When the threat did not materialize, WHO changed its working definition of “pandemic” to remove its own requirement that to label an outbreak as pandemic must involve excessive mortality. People were still warned that this was something special. Individuals were urged to get vaccinated and agencies stockpiled drugs.

The recent criticism implies that the WHO was unduly influenced to keep fanning the flames by experts with ties to the drug industry. WHO director Dr. Margaret Chan says they were not.

Who knows? But one big lesson here is that you can’t un-ring a bell.

Tom

Putting the Gateses’ mission shift in context

I could really use a pie chart here, showing all the promised slices of international aid that remain missing or get removed as global priorities shift.

In the previous post, I noted Melinda Gates’ clarion call — and her accompanying $1.5 billion philanthropic pledge — for more to be done for women and children’s health worldwide. The Gates Foundation, Obama Administration and other governments or donor organizations appear to be turning more philanthropic and foreign aid attention to the terrible inequity of maternal and child deaths worldwide.

This a very worthy cause, but of course there are many worthy causes. And not all of them are receiving the funding or attention they deserve. AIDS was once the world’s top global health priority, but now it appears that funding for many existing projects aimed at battling the pandemic will remain flat or decline even as the number of those afflicted continues to increase.

The Gates Foundation claimed this is not so much a shift in focus as an expansion of an existing priority, but most observers did see it as a shift and a new focus. Some also noted that when you decide to emphasize one thing, it often means you de-emphasize something else.

The Gates Foundation has, for example, decided not to renew funding for a number of projects it helped launch years ago looking for an effective AIDS vaccine. The Global Fund for AIDS, Tuberculosis and Malaria is now struggling to merely respond to existing needs — trying to convince donors not to reduce funds and pointing out it needs something like $15 billion merely to keep on pace for the next few years. Meanwhile, people still die from AIDS and HIV still spreads as most still don’t receive the drugs they need to survive and prevent transmission.

This kind of “cause inequity” and mission shift is often shrugged off as inevitable given we do not exist in a world of unlimited resources.

But what is perhaps less excusable is when donors and governments make promises they don’t keep. In her Monday remarks, Melinda Gates noted that later this month leaders of the most powerful nations on the planet will convene in Canada at the G8 summit in Muskoka, Ontario. The Gateses and members of the Obama administration say they intend to especially push for new commitments to invest in improving maternal and child health.

Maybe someone should take a hard look at how many members of the G8 kept their previous global health commitments — and whether these new commitments represent true progress or sort of a shell game.

Side note: I couldn’t find any illustration showing all of the broken promises, but for those who like to think the U.S. does more than others when it comes to foreign aid, below is a bar chart that shows otherwise. We give much less, per capita and as a percentage of our GDP, than most developed countries:

U.S. Provides Comparatively Less Foreign Aid, Source: OECD

Tom

What We Mean When We Talk About Women & Children’s Health

The Gates Foundation on Monday announced that it planned to give $300 million every year over the next five years, a total of $1.5 billion, to programs that are devoted to improving the health of women and children worldwide. This now becomes one of the foundation’s largest initiatives.

“Women and children have finally moved up on the global agenda and I’m here to tell you that’s where they’re going to stay,” said Melinda Gates, speaking on the same day at a star-studded conference in Washington D.C. called Women Deliver. “Policymakers have treated women and children, quite frankly, as if they matter less than men.”

My friend Kristi Heim at the Seattle Times wrote a good story that tells you all about the grant announcement so I won’t repeat it. I had noted earlier that the philanthropy was shifting in this direction – which they claim is not a shift but merely an expansion of an existing priority.

Putting aside the question about whether the Gates Foundation can, in fact, guarantee what will be high on the global agenda (is there a global agenda?), it’s perhaps worth considering if women and children’s health issues really have been neglected as a matter of policy and agenda-setting. And if so, how?

Most global health initiatives that battle diseases like AIDS, tuberculosis and malaria benefit both genders and all ages since the bugs don’t discriminate.

I can’t think of any global initiatives devoted to men’s health but we have a number of organizations like CARE, Planned Parenthood and the Global Fund for Women focused on women’s health issues worldwide. We have even more organizations devoted solely or mostly to children’s health such as Save the Children, World Vision or the United Nation’s Children Fund (aka UNICEF). The Gates Foundation’s biggest project, GAVI, gets vaccines out to children worldwide.

And women, even women in poor countries, tend to live longer than men. So what are we talking about when we say women’s health is a neglected area?

We’re mostly talking about childbirth.

“When people talk about women’s health, they are often talking about maternal health,” said Emmanuela Gakidou, professor of global health at the UW’s Institute for Health Metrics and Evaluation. Women who survive childbirth may or may not live longer than men generally, Gakidou said, but the number of young mothers and children in poor countries who die from complications associated with childbirth is hugely disproportionate when compared to developed countries.

For example, she said, Italy sees an average of four mothers die in childbirth for every 100,000 live births while in places like Afghanistan or Malawi it is more like one maternal death out of every 100 births.

“These deaths are almost entirely preventable,” Gakidou said, adding that the new momentum on this front is because more people recognize “that women should not be dying while they are trying to have a child.”

Amy Hagopian, also a UW professor of global health, said she welcomed the Gates Foundation’s increased interest and investments in maternal health. But the most fundamental need of women in poor countries, she said, is a functioning health system with nurses, midwives and doctors.

“Women are dying because of the lack of these health services,” said Hagopian, adding that the Gates Foundation has so far shown little interest in funding efforts aimed at improving health services. “We already have lots of NGOs working on women and children’s health. Adding more people running around Africa claiming they have come to improve women’s health won’t solve the fundamental problem.”

Hagopian was among a number of people who recently advocated for and won passage of a resolution at the World Health Assembly in Geneva aimed at improving health worker retention in poor countries.

Tom

Partying for Prevention

Seattle has spawned all sorts of innovative approaches to selling things that most people would have thought couldn’t be sold – like a $5 cup of coffee or books without a bookstore. But even the boldest Northwest innovators likely wouldn’t have thought of this.

On Thursday night, young do-gooder entrepreneurs showed they could throw a killer party for 500-plus people in Seattle based on what most would have figured would just be a big buzz kill – diarrheal deaths in the developing world.

Partying on Purpose

“We could have sold 1,000 tickets,” said Kristen Eddings, one of the organizers of the sold-out “Party with a Purpose” held at the Pan Pacific Hotel in Seattle’s South Lake Union district.

If anyone had any doubts that global health has become a cause célèbre for young folks, this event should cast them aside. Sponsored by the Washington Global Health Alliance (where Eddings works), the Gates Foundation, Boeing and many leading health organizations in town, the purpose of the party was to raise awareness of critical issues in global health and especially of one big killer — diarrhea.

“I have a job that not only condones, but encourages me to talk about diarrhea at a cocktail party,” said Hope Randall, a young woman who works at PATH and helped run an informational booth at the event.

Randall and colleague Deborah Phillips showed party-goers how a simple 10-cent packet of salts, sugars and nutrients can prevent the death of a child. PATH is working to expand the use of this solution (called oral rehydration therapy, or ORT) in Kenya and throughout Africa.

Admission and raffle tickets sold at the event raised $13,000 to help the Kenyan government increase the use of ORT. Party-goers were also shown a brief video about rotavirus, a bug that causes deadly diarrhea and kills at least 500,000 children in poor countries every year. Diarrhea from all causes kills more than 1.5 million children every year.

Libuse Binder urges partygoers to change the world

“Any one of us can make a difference, beginning by becoming aware,” said Libuse Binder, author of “10 Ways to Change the World in Your 20s.” Binder, who formerly worked in LA for the film industry, said she moved to Seattle a few years ago because she sees it as the center of the humanitarian universe.

Eddings also told the crowd: “Bill Gates, Sr., sent us an email … He said he believes global health is the movement of our generation.”

Tom

India Rises, Leaving Poor Behind

Unlike in China, a leading physician activist says, India’s rising economic tide is not floating many boats to lift the poor up and out of poverty.

India’s rich and middle-class sectors are riding higher, getting richer, says Dr. Jonathan Fine, founder of the Nobel Peace Prize-winning group Physicians for Human Rights, while India’s hundreds of millions of poor people remain firmly anchored to the bottom.

Dr. Jonathan Fine, speaking to UW students

“Things are actually getting worse in many of India’s rural villages,” Fine said on a recent visit to Seattle. The Boston physician spoke Tuesday at the UW to a student-run global health group. Fine was in Seattle to meet with — and recruit volunteers for — a local branch of an organization devoted to assisting India’s poor, Association for India’s Development.

Malnutrition rates tell the story of inequity in India, Fine said. Hundreds of millions of Indians continue to live on semi-starvation diets, he said, despite there being enough food in India to feed everyone and despite India’s overall economic progress.

According to UNICEF, China has reduced its rate of child malnutrition to 7 percent while in India today more than 40 percent of young children are malnourished – a rate worse than in many sub-Saharan African countries.

“Initiatives aimed at improving health and welfare won’t have much effect if malnutrition is not dealt with first,” Fine contended. Hungry people are more prone to illness, he said, and malnourished children don’t learn or develop properly. “The Indian government continues to largely neglect this massive problem.”

Nearly half of India's children are malnourished, photo by Mike Urban

Tapoja Chaudhuri, who teaches at the UW’s South Asia Center, and her soon-to-be-doctor husband Sunil Aggarwal (he gets his MD in a week), agreed with Fine’s comments and are, for the same reasons, planning to become more active in efforts to assist India’s poor. Both said the gap between rich and poor in India is growing.

Chaudhuri, who grew up in Calcutta, said there are terrible conflicts raging across many parts of India today due to these entrenched inequities. Though the government portrays the fight as against communist terrorists, Chaudhuri said the conflicts are fueled not so much by ideology but by the disenfranchisement of many poor communities. Government economic policies, she said, tend to focus on large-scale development projects rather than on anything that directly benefits the rural poor.

“It is not at all paradoxical to me that India’s rapid economic growth is accompanied by high rates of malnutrition,” Chaudhuri said. The way India is achieving its overall growth, she said, is by often bulldozing over – figuratively and literally — already impoverished communities.

Chaudhuri plans to work on social justice issues in India next fall while Aggarwal, who plans to someday go there as a doctor, completes his residency at Virginia Mason Medical Center.

Tom

Study: AIDS Treatment IS Prevention

For the last few years, AIDS experts have been arguing about the claim made forcefully by some Swiss scientists that giving anti-viral drugs to people with HIV also prevents transmission of the virus to others. While there had been some anecdotal  and hypothetical evidence supporting this contention, there wasn’t much hard proof.

A Seattle team of scientists has now provided some pretty solid evidence, reported in the current issue of The Lancet.

Dr. Connie Celum

“We found a 92 percent reduction in transmission among those who went on (drug therapy),” said Dr. Connie Celum, a leading AIDS prevention researcher at the University of Washington and senior author of the study.

Working in seven African countries (Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia) with nearly 3,400 couples in which one partner is HIV-infected, Celum’s team followed 349 couples for two years after the infected partner qualified to begin taking anti-HIV drugs (ARVs, anti-retrovirals).

Standard procedure for starting ARVs is based on when the blood level of an immune cell targeted by HIV, known as the CD4 cell, drops below a certain threshold. In most African countries, that threshold is a CD4 count of 200 or lower (normal being from 500 to 1,000).

It’s worth noting, however, that there’s a fierce debate going on right now about whether it makes sense to use a higher threshold (of say 350, as is often done in the U.S.) or to just put people on ARVs as soon as they are infected. San Francisco’s Department of Health recently recommended that all HIV-infected people should get ARVs no matter what their CD4 count.

Of the couples in Celum’s study, only one of the HIV-infected partners on medication transmitted the virus to her partner as compared to 103 infections transmitted by HIV-positive partners not on ARVs.

Given that the AIDS pandemic is still on the increase and millions of those infected worldwide are still not receiving these life-saving drugs, the UW team’s findings give strong support to the urgent need for expanding access to drugs as an effective means to stop the spread of AIDS. Some experts say the spread of AIDS in Africa could be contained in as little as five years if everyone infected received treatment now.

AIDS activists used to chant “Treatment is Prevention” to make the case that people must be guaranteed access to treatment in order to encourage them to be tested and engage in prevention. Now, it appears that treatment is not simply a necessary partner to prevention. Science has shown that saving the life of an infected person is also a powerful method for preventing another infection.

Connie Celum's motto

Global Health Neglects Big Killers

The field of global health has focused largely on fighting “communicable” infectious diseases such as AIDS, tuberculosis and malaria. One of the leaders in the field, Dr. Jeffrey Koplan, thinks it’s time to broaden the focus to include the other killers communicated by advertising, entertainment and social encouragement of unhealthy behaviors.

“You don’t have to cough on people to spread disease,” said Koplan, who spoke Wednesday at the University of Washington as part of the Washington Global Health Alliance’s lecture series. Koplan, a former director of the U.S. Centers for Disease Control and Prevention, is vice-president for global health at Emory University in Atlanta.

The health effects of obesity, poor nutrition, tobacco use, the “epidemic” of fast food diets and the increasingly sedentary nature of modern living, he says, are all contributing to a worldwide increase in deaths and illness from chronic diseases like hypertension, diabetes, stroke and certain cancers (e.g., lung and liver).

Taken together, the death toll from these so-called “non-communicable diseases” far outpace the toll from infectious diseases worldwide, Koplan said, yet they receive much less funding, resources and attention in the global health field.

Spending by Disease Categories, The Lancet

Referred to in public health lingo as NCDs (non-communicable diseases), Koplan suggested rechristening NCDs as “neglected communicable diseases” because they are spread throughout the world today by communications — by advertising, media and the push to find new markets for tobacco, fast food, soft drinks and other unhealthy products.

More than half the men in China smoke, he said, and American fast food chains are a growing contagion. It has been estimated that China loses about $600 billion in annual productivity from heart disease, hypertension, diabetes and other diseases caused by unhealthy behavior, he said.

Despite the toll exacted worldwide by chronic disease, Koplan said many of the leading organizations committed to global health tend to shy away from devoting resources to combating chronic diseases. This may have to do with the complexity of battling these diseases of behavior, or of going up against industry. But he said the public health community’s success in combating tobacco in the U.S. shows it can be done globally.

The first step, Koplan said, is for governments, donors and leading public health organizations to recognize that the fight against chronic disease will be just as important to achieving success in global health as the fight against infectious disease.

Tom