baby_carriage_line_art

Framing the Health Disparities Problem

This past week, I had the opportunity to attend the National Institute on Minority Health and Health Disparities Grantees Conference. Over 1,000 people attended, all representing different parts of academia and the non-profit world, all coming together to collaborate and present research regarding health disparities. The National Institute on Minority Health and Health Disparities is a branch of the National Institutes of Health. It’s mission is “to lead scientific research to improve minority health and eliminate health disparities.”

What are health disparities, exactly? The Healthy People 2020 initiative defines it in the following terms: “If a health outcome is seen in a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health.” Health disparities can be seen, for example if we look at something like infant mortality.

Infant mortality rates in the US by race

Infant mortality rates in the US by race

Since 1980, the US infant mortality rate has dropped from 12.6 deaths/1,000 live births to 6.17. This is okay (though it should be noted that we rank as having the 55th lowest rate for the wealthiest country on the planet). This rate takes on a new life when we break it down by race. For Non-Hispanic Whites, the infant mortality rate is 5.5 deaths/1,000 live births. For Non-Hispanic Blacks, the rate is 12.8 deaths/1,000 live births. We can see disparities again when we look at childhood obesity rates. At the conference I learned that for the first time, the national child obesity rate seems to be plateauing; yet for white, upper class children, this rate is actually declining, and for Hispanic and Black children, this rate continues to climb rapidly.

It is probably not surprising that health disparities are closely linked to what is termed, “the social determinants of health,” which can include everything from one’s education level to how close one lives to a landfill. It is important to remember that long histories of power inequality have led to many of these social determinants, and therefore, the increased health status of some groups over others.

In the United States, health disparities are certainly a reality. What struck me most at the conference, though, was a question posed at one of the panel discussions. The facilitator asked, “How can we combat health disparities, when the work requires that we give more to those at the bottom, while giving less to those at the top?” Though it caught me a bit off guard, this idea makes sense. Have-nots need more resources and support so that they can “catch up” so to speak, to the Haves. Though similar, this is not exactly Robin Hood logic. The rich wont necessarily be loosing out so that the poor can gain. The way the question was framed insinuated this, and it made me realize that this is exactly how some people think of health equity work. Potential supporters can be turned off to a cause when it seems like they will be deprived of something. We have seen this argument come up again and again with the Affordable Care Act. Saying things like “they’re going to make us ration health care if everyone is covered” or “we will have to wait longer to get appointments” fosters this exact type of thinking. The problem is that we’re framing it all wrong.

We need to highlight that it is important to give those at the bottom more support than we give those at the top, not even because they deserve it, but because they need it and the people at the top do not. A salient example is one from Chile, where everybody is covered for health insurance. Their public insurance option is tailored towards equity as opposed to equality—those who need more support get more support and those who need less support, well, they wont be missing out on any free services, because simply put, they don’t need them. New mothers in the lowest income bracket receive, among other things, free baby carriages. If the health sector were to view patients as equal, they’d give these to the wealthiest mothers, too. The majority of mothers in higher income brackets would probably not take the low-cost baby carriage, if they can and want to buy one of their choosing. Equity, on the other hand, still means that all mothers can and will have baby carriages, but that we should be intentional with how resources are delivered, targeting those most in need.

So, how can we in GlobeMed at Tufts use this idea of framing to combat health disparities with our partner organization, PHASE Nepal? Right now, we are fundraising through our individual giving campaign. So far we have raised almost $4500 for, our project right now, which is hitting an important determinant of health: that of childhood education. PHASE Nepal will take the funds we raise this year and hire a teacher trainer, who will work with currently employed teachers in elementary schools in the communities that PHASE serves. This trainer will help teachers utilize methods to foster creative thinking and problem solving among students of Nepal. He/she will also support child clubs, which operate as extracurricular forums for the children to play, learn, do local development projects such as planting gardens, and talk about child rights. Additionally, we envision the formation of a health curriculum to be taught as supplementary material in the Child Clubs, so that these children can begin to learn about the importance of having a healthy body and mind.

When we think about how to bolster our fundraising efforts, we need to be able to discuss how the situation in Nepal came to exist, and about the power structures that perpetuate such inequalities. When we talk about this stuff, we have to know how to frame it in a way that will help us build support for our chapter, PHASE, and the global health movement at large.

To learn more about PHASE’s work, please visit http://phasenepal.org/

To donate to our project, please visit https://www.globalgiving.org/projects/child-health-education-program-in-nepal/

Right-To-Try

In 2013, a blockbuster movie came out, detailing the true story of how one man tested positive for HIV, was given thirty days to live, and proceeded to defy everyone’s expectations. The main character began exploring alternative options for treating HIV, which brought him to Mexico. There, he discovered medicine that was not approved in the United States, and was soon treating hundreds of people in his hometown. Dallas Buyers Club is pop culture’s interpretation of a very real debate in the world of health and healthcare today. When is too soon to try experimental drugs? If someone’s life could be saved, is it morally justifiable to withhold unapproved medications?

This year, five states– Colorado, Louisiana, Michigan, Missouri, and Arizona– have passed so-called “right-to-try” laws that expand access to experimental medications for patients in dire conditions. These laws have legally accomplished what Ron Woodroof attempted to establish in Dallas Buyers Club, and like in that story, lives could be improved or saved– but still, does that make it right?

Critics of these laws point out the very legitimate reasons why these drugs aren’t yet on the market: there could be undiscovered risks that would cause even more harm than any good the drug would do. The FDA exists for a reason, and allowing the right-to-try compromises the safety of the patient.

However, many terminally ill patients don’t have the time to wait for a request to the FDA to be processed, and the right-to-try is their opportunity to have a chance to live, or even just live a little better for a little longer. What do you think? Do we have a right-to-try?

For more information, check out this article.

Recap of the first Global Day of Action

Last week, the Tufts GlobeMed chapter and other Boston community organizations gathered at the Boston Commons to rally for the right to health, as declared by Article 25 in the United Nation’s Declaration of Human Rights. The UN is currently meeting to discuss post-2015 Millenium Development Goals and other aspects of development that should be prioritized in the coming years. The aim of the Global Day of Action was to make health a top priority on the agenda, and it was incredible to see the efforts of communities around the world fighting to make this happen.

Here is a video of how the first Global Day of Action for the Right to Health came together all around the world: https://www.facebook.com/video.php?v=309650355887192&set=vb.152728261579403&type=2&theater

Also check out a recap of what each community was rallying for on Storify: https://storify.com/Article25/global-day-of-action

To see more pictures and videos of different efforts from around the globe, like Article 25 on Facebook!

Samantha Nutt: Global Health Icon

In high school, I first heard about Dr. Samantha Nutt when she came to speak to my school about global health in war torn regions, the talk she gave was one of the most inspiring and eloquent speeches I have ever heard and since then I have been inspired by her career and her work around the world. I thought I would share a bit of what she has done to the GlobeMed community!

Dr. Nutt is the founder and president of War Child Canada, a charity that works in regions that have been torn apart by conflict. She focuses on helping women and children in these regions, providing health care, education and vocational training in order to get their lives back on track. She has worked in regions such as Afghanistan, Sierra Leone, Uganda, and The Democratic Republic of the Congo to name a few. In addition to her work with War Child she is a physician at the Women’s College Hospital in Toronto and is a Professor at the University of Toronto. In 2011, she was appointed the Order of Canada – the most prestigious honor bestowed by the Canadian Federal government for “for her contributions to improving the plight of young people in the world’s worst conflict zones, notably as a founder of War Child Canada.” How she ever has time to sleep, I am not sure!

Her recent book “Damned Nations: Greed, Guns, Armies and Aid”- a national bestseller – is a comprehensive look back on her career and her experience in the foreign aid industry. An excellent read that I highly recommend everyone check out as it mixes her personal narrative and experiences with facts about foreign aid, and its failures and successes.

She is someone who has inspired me and taught me a lot about foreign aid, and the challenges of effective distribution of health throughout war-torn regions. I find that her methods and philosophies about global health are very similar to GlobeMed’s! Everyone should check out her book, or even go on youtube and check out a couple speeches she has made to learn a bit more about her and War Child Canada!

Here are some I have found really interesting:

Future of Aid – Dr. Samantha Nutt Keynote

https://www.youtube.com/watch?v=ALCScV_CoA0 (starting at 5 minutes)

CBC News Our World: Africa’s Killing Field

https://www.youtube.com/watch?v=YCbdfMWZL54

 

By Adrienne Caldwell

Article 25 Speakers

On Sunday, Tufts GlobeMed chapter will be travelling down to the Boston Common to be a part of the Rally For the Right To health, a very exciting event that many of our members have been tirelessly working on for the past several months! At the rally there will be several exciting and prestigious speakers including Professor Brook Baker and Don Berwick. Some highlights of their decorated careers are as follows:

Brook Baker is a professor at Northeastern University teaching courses in Global HIV/AIDS Policy seminar, and disability discrimination law. The focus of his work is on movements that advocate for universal access to treatment, prevention and care for people living with HIV and AIDS. In addition, he is a senior analyst Health GAP (Global Access Project).

Don Berwick has had an extensive and meaningful career in public health including being the Administrator of the Centers for Medicare and Medicaid, President and Chief Executive officer for Institute for Healthcare improvement and worked directly on both the Massachusetts health care reform and the Affordable Care act. He has worked tirelessly to bring equality to the American health care system and improve access to health care for all.

So on Sunday, cancel whatever you may have planned, grab a friend, and head down to the Boston Common for a day of advocacy, action and incredible speakers! (Plus, I hear the weather is supposed to be beautiful!)

Why You Should Rally for the Right to Health with Us This Sunday

10517937_10204053232123345_7201460711138417780_o

Since the start of the semester there has been a lot of hubbub surrounding “Article 25” and a “Global Day of Action” and something about a rally? Just to clear up any confusion and get everyone on the same page here’s some basic background about what we’re trying to do.

“Article 25” refers to a specific statement in the United Nation’s Declaration of Human Rights which states that:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

Although it is not explicitly stated that medical care itself is a human right, having access to both health care and sick care regardless of geographic location or socioeconomic status is certainly an integral aspect of “security in the event of… sickness” and “a standard of living adequate for the health” of the individual.  The Millenium Development Goals (MDGs) have had a huge impact on the international move towards a healthier world, focusing on issues like poverty, hunger, HIV/AIDS, child mortality, and maternal health, and though a lot of progress has definitely been made, we still have a ways to go.  The UN is currently meeting to discuss post-2015 MDGs and other aspects of development that should be prioritized in the coming years and the aim of the Global Day of Action is to make sure health is on the top of their agenda.

The focus of the campaign in Boston is on erasing health inequities here in Boston as well as abroad, and in a timely manner. For this rally, we will be advocating for a Single-Payer Health System in Massachusetts and a $20 billion emergency fund for epidemics, so that catastrophes such as Ebola are never repeated. For us, Ebola is a case study for the need of health-systems strengthening around the world, and Article 25 demonstrates that we made that commitment long ago, but have a long way to act.

Please join us at the Boston event, a rally on the Common, on October 26th. It is one of the loudest ways we as students can make a splash in the fight for global health and equality and help choose the direction the international development effort is headed in for years to come.  It is absolutely essential that you all lend us your voices and make yourselves heard.

So, grab your friends, your peers, that random person you kind of recognize in the dining hall and say “hi” to in passing even though you don’t actually recall their name or where you know them from, and come together on October 26th on the Boston Common and make a stand for change and the right of human beings everywhere to live healthy lives.

Alex Boden is a junior majoring in Anthropology and Biology.  She is a member of the Policy team.

A reflection on Ebola fears in the U.S.

_76476153_76475767

If one were to flip through news channels or read the newspaper, it is very likely that an article or an opinion piece on the Ebola crisis will appear. A recent Time article written by Josh Sanbum points out that the probability of acquiring Ebola in the U.S. is almost zero. Despite this, parents are pulling children out of middle school in Mississippi, a Pulitzer Prize-winning photojournalist is banned from speaking at Syracuse University after working in Liberia, and an office building has closed in Ohio over fears of an exposed employee. Why is Ebola so acutely feared in a country where only three confirmed Ebola-related deaths have occurred, compared to the 4,400 in Africa? According to University of Oregon psychology professor Paul Slovic, it is all related to risk perception. As the media continues with its front-page headlines about a possible epidemic sweeping the nation, we forget about probability and statistics. There is no question that the Ebola outbreak in West Africa is dangerous and deadly, and requires a coordinated global approach and international efforts. But in the U.S., the flu will kill tens of thousands of people this year and heart disease remains the foremost cause of death. Technology and media allows stigmatization to occur at a rapid pace, and in the midst of counterproductive and unnecessary reactions it is important to educate oneself about the crisis and be grounded by facts.

Michelle Shah is a senior majoring in Cognitive and Brain Sciences.  She is a member of the Communications team.

Jump-start to the Year with PHASE

This week during our GhU information session we discussed what it means to have a successful partnership. GlobeMed defines a successful partnership in several ways: mutual respect among all actors, the community at the center of the system, open communication between all actors, and common vision for and measurement of success among other central goals. As a GlobeMed chapter we discussed what it means to us to have a successful partnership with PHASE Nepal, that benefits both ourselves as a chapter and benefit the communities in Nepal in a meaningful way. We aim to work together with PHASE in order to help them meet their goals all while achieving our fundraising aims and objectives of raising awareness within the Tufts community. This means a continual process of assessing what our needs are and how we can benefit PHASE Nepal in the most meaningful way. For this year, this means a fundraising goal of 10,000 dollars, which will go towards educational supplies for PHASE Nepal, and the communities they work in. For example, creating programs that work towards getting students to think creatively and critically instead of simply memorizing words and facts.

Adrienne Caldwell is a sophomore majoring in Biology and Psychology.  She is a member of the Communications Team.  

Article 25: Rally for the Right to Health

Article 25.1 of the Universal Declaration of Human Rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

On October 25th and 26th, people from all around the world will get together to rally for the right to health. Global Day of Action on October 25th is a day to remind ourselves that health inequity is a pervasive and pressing issue, and long-standing commitments are necessary to face these disparities. On October 26th, GlobeMed at Tufts is partnering with other Boston community organizations for a Rally for the Right to Health at Boston Commons in hopes of raising awareness of the global health crisis and making universal health coverage a goal in the 2015 UN agenda. This event and others like it will serve as the launching of local and national campaigns around the world, encouraging countries to make rights-based universal health coverage a main goal in the post-2015 agenda and promoting ways to allow individuals to launch their own campaigns. To get involved with the rally at Boston Commons, email tufts@globemed.org or check out the Facebook event: https://www.facebook.com/events/947549945259088/

For more information about Article 25 and Global Day of Action, visit http://join25.org/

Michelle Shah is a senior majoring in Cognitive and Brain Sciences.  She is a member of the Communications team.

A Bhalcandra School Update from Binod

It’s been just over 3 months since the GROW team returned from Nepal, and we’ve been anxious to check in on life in Rayale. When working with the child clubs at the Bhalchandra School and Shree Shanti Niketan, one of our main focuses was designing goals with the children that they could work towards and accomplish even after we had left. Sustainable solutions are a fundamental part of PHASE Nepal’s mission, and therefore the GROW team hoped to brainstorm self-sufficient yet attainable projects for the students to tackle this year. Because we were working with such incredibly driven and creative kids, we were never worried about the fate of the child clubs after our departure!

Thanks to Facebook, receiving updates on the latest happenings at Bhalchandra School is just a click away. Binod, an English teacher and the adult coordinator for the school’s child club, was more than happy to share both stories and photographs of some of the great work the Bhalchandra School Creative Child Club has completed in the short time since we’ve been gone. He told me how proud he was of their work, and it’s easy to see why! Here are some of the inspiring and innovative programs that the students have organized:

  • A quiz competition, in which the winner received a small prize paid for by the Bhalchandra School teachers and staff
  • A “week of sport” that included running activities for all students as well as a football (soccer) tournament for those interested
Bhalchandra School football tournament participants, (photo provided by Binod, in center).

Bhalchandra School football tournament participants, (photo provided by Binod, in center).

  • Activities for Children’s Day, a widely celebrated holiday in Nepal. While it was already customary for Bhalchandra School to host a special event, the child club volunteered to aid the adults. They managed crowds and materials, supervised the younger children, and provided water, tea, and biscuits to the rest of their classmates. Binod was also excited to share with us that they won 2nd and 3rd prizes in singing, dancing, and oratory competitions against 13 schools!
  • Maintenance of the vegetable garden started with the help of Nick and Morgan during the GROW trip. This was a special program that we were able to bring to fruition during our time in Rayale, so it was really cool to hear that the child club is still taking care of it, and that the vegetables are doing well!
Bitter gourd from the Bhalchandra School vegetable garden (photo provided by Binod).

Bitter gourd from the Bhalchandra School vegetable garden (photo provided by Binod).

We’re so lucky to be working with schools in Rayale that have such passionate children and adults, like Binod, supporting both GlobeMed and PHASE Nepal’s missions even when we aren’t able to be there with them. It’s great that we are able to keep in touch over Facebook and share in their success. Binod also described his hopes to implement a special management committee for the child club that would provide funding and adult assistance with programming, so we’re sure that we will only hear of bigger and better things from the Bhalchandra School Creative Child Club in the future!

 

Nick James Macaluso is a senior majoring in Biology and Environmental Studies.  He is a member of the Campaigns team.