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Question 2: In the context of India, what are potentially the most powerful interventions to broadly improve maternal health?
The article found that economic status, caste, ethnicity, education, gender, religion and culture (particularly a culture that discriminates against women, lower castes, and Muslims) were the most important structural factors that affected maternal and newborn mortality and morbidity. Factors on a more individual level included where women lived (rural, slums), young maternal age at childbirth, women’s exposure to mass media and maternal health messages.
Underlying many of these factors are questions of culture, specifically the Hindu caste system, discrimination against women, violence against women, discrimination against minority religions especially Muslims, prejudice by healthcare workers, etc. Cultural change takes a long time and is difficult, but there are interventions that politicians (government) in particular can institute that will make a real difference. Some of the strategies I think would be most influential include:
Improve access to institutional delivery, i.e. delivery in the hospital, by strengthening the local community health centers and district hospitals, making sure every woman has access to a hospital that is in a reachable location, educate women and families that it’s best for women to deliver in a hospital setting that can provide immediate care for childbirth complications. This is an intervention that is amenable to government control. The federal, state, and local governments can invest money into well-staffed and well-equipped community health centers hospitals.
Lifting everyone out of poverty, improving economic conditions, providing education to everyone, and especially to girls and women are other important factors, but since they go against deeply ingrained cultural beliefs, they may be more difficult to change.
One way to change culture is by explicitly investing in schools and education for girls, making sure all girls can go to school, by providing incentives, penalties for parents who keep their daughters out of school, and by making school free (and school uniforms free). That is within the control of the government. Social stratification and the class system in India will be difficult to change, but investing money and resources into education of girls and the social underclasses (or castes) could be successful.
Another area of intervention for lawmakers include passing and enforcing laws that punish violence against women and discrimination against women.
Hospitals and healthcare professionals can address some of the concerns that women have about delivering in a hospital (isolation/being left alone at birth; unnecessary C-sections which do occur etc). Hospitals can establish policies that allow family members to be present around and during birth, and hospitals need to engage in quality improvement to avoid unnecessary hospital-associated complications and C-sections that are not indicated and done because of convenience for the healthcare providers.
Invest in an emergency medical transport system that allows women with obstetrical complications who present to community health centers to be transported to district hospitals in a timely manner, free of charge, and with a qualified healthcare professional in attendance, if needed. In particular, it seems that change needs to happen in the negative attitudes that healthcare professionals in India harbor against women. Physical abuse perpetrated by healthcare professionals against women should be punish, and disrespect or discrimination should lead to discipline. Leaders of the government and individual communities need to address and penalize corruption by healthcare and government workers.
Since lack of accountability of healthcare professionals, community health centers, hospitals, and other components of the healthcare system were identified as a major factor in poor maternal outcomes, addressing this by providing incentives, punishments by government and ensuring proper supervision would likely make a difference in maternal and newborn outcomes.
I thought it very promising that mass media messaging about the importance of antenatal care and in-hospital deliveries seem effective. Since most people in resource limited settings seem to own or have access to some kind of mobile device, using existing networks (Facebook, WhatsApp) to educate women about maternal health via videos that don’t require literacy could be promising. Those women who have access to radios or TV can be reached that way. NGOs and the government could invest money into maternal and newborn education campaigns via these media.Global Tuberculosis Report 2020 – Reflections on the Global TB Burden, Treatment and Prevention Efforts. International Journal of Infectious Diseases, 2021
Question #1: From your perspective, why are people living in poverty most likely to suffer from TB, and how should this fact influence efforts to control the disease?Several others in the class have already mentioned potential factors why poverty leads to an increased incidence and prevalence of TB, such as crowed housing conditions (many people living in close contact infect others with TB which is transmitted through airborne particles), lack of access to medical care, lack of health insurance in the US, malnutrition, lack of education etc. This certainly makes sense.
The article mentions 5 major drivers of TB; one of them is poverty itself, another one is related to and mostly caused by poverty, namely undernutrition; and a third factor also related to poverty – household air pollution, meaning exposure to smoke from indoor woodburning stoves that women use for cooking, and which in turn leads to COPD. Interestingly, the other two major drivers of TB worldwide are not typically linked with poverty – diabetes which is often thought of as a disease of the wealthy; and tobacco smoking, which used to be highly prevalent in affluent societies and still is more prevalent in Europe than Northern America, despite concerted efforts by public health authorities to reduce tobacco use. Cigarettes cost money, so you would think poor people have less access to cigarettes, or they make poor choices if they spend their money on cigarettes.
It is interesting to consider the names of the 8 countries that account for two thirds of global TB cases, since many of these countries are NOT among the poorest in the world and some have a strong economy, in particular China (population 1.4 billion) and India (1.43 billion in 2023). While these two countries have a very large population that would explain their large absolute number of TB infected persons, less populous countries like South Africa (population 62 million in 2022) would not belong into the group of the poorest countries, nor would Indonesia (population 270 million in 2020).
I tried to find data or a list on the ranking of poor countries. The 8 poorest countries in the world are all in Africa, and only one other country besides South Africa (which is not a developing country) on the list of countries making up 2/3 of global TB cases is in Africa, namely Nigeria (population 218 million). Nigeria is the 42nd poorest country in the world, according to this ranking. (https://worldpopulationreview.com/country-rankings/poorest-countries-in-the-world)
There are various rankings of poverty that I found in my search; interestingly, in one ranking I noticed that no one in China lives below the national poverty line – redefining the poverty line is one way of getting rid of poverty, I guess. (https://en.wikipedia.org/wiki/List_of_countries_by_percentage_of_population_living_in_poverty)
In Africa, South Africa is the second wealthiest country, after the Seychelles, and Nigeria is the 12th wealthiest country, according to a multidimensional assessment scale that the World Bank uses. (https://hdr.undp.org/system/files/documents/hdp-document/2023mpireporten.pdf)
Overall, these data seem to cast some doubt on the exact nature of the relationship of poverty with TB prevalence and incidence. Things seem to be more complex than “poverty leads to TB.” It would be helpful to find data that report the prevalence and incidence of TB per 100,000 population, and then correlate it to poverty rankings.When I worked in a rural mission hospital in Kenya last fall, I learned from the local Kenyan doctors that TB was much more common in certain regions of Kenya than others, even in a radius of maybe 2 hours driving distance, and not considering the whole country. To me it seemed that the community with lower TB rates had just as much poverty as those where many TB patients were coming from. I also noted that Kenya ran out of TB meds provided by the WHO, or perhaps there were distribution problems caused by corruption, so that some districts did not get the meds provided for free by the WHO or some other organization.
Thinking back in history to a time before TB treatment was available, such as the 19th century, there were certainly many wealthy people who suffered from and died from TB.
The second part of the question is about how important addressing poverty is in treating TB. Lifting people out of poverty is good practice for all kinds of reasons. Improving access to education especially for girls, empowering women, providing clean water and improving sanitation, improving nutrition, are all aspects of decreasing poverty and improving health.
But how do we help people escape poverty, and why has so many billions of dollars been spent on development programs with limited effects? This is an important question to ask if we want to know how to actually help people get out of poverty and improve their health. And we need to know why programs have failed to make a difference in the past. Why has so much development aid (non-military) been spent on Africa in the last half century or more, and most people there still live in poverty?
Here are links to some thought-provoking articles:
https://fee.org/articles/the-sorry-record-of-foreign-aid-in-africa/ (article from 2001)
https://africanarguments.org/2022/08/how-useful-is-aid-to-africa/ (article from 2002) – this article reports that in the last thirty years alone, 1.2 trillion US dollars in development aid have been spent on Africa.
Here is an article by Dr. Paul Farmer about the problems with programs addressing poverty, and suggestions how to make them more effective. https://www.lessonsfromhaiti.org/press-and-media/op-eds/rethinking-foreign-aid/My observation from serving in short term medical missions work in resource limited settings, and also from traveling to many countries as a tourist and reading about these issues is that vast income inequalities exist in these countries, that corruption is a major factor contributing to poverty that needs to be uprooted for any country to escape poverty, and that in many poor countries dictators and ruling elites have hoarded the wealth and resources of these countries, thereby actively worsening the health and economic wellbeing of their population. Good governance and fighting corruption are the major factors that will bring people out of poverty.
Global Tuberculosis Report 2020 – Reflections on the Global TB Burden, Treatment and Prevention Efforts. International Journal of Infectious Diseases, 2021
Question #1: From your perspective, why are people living in poverty most likely to suffer from TB, and how should this fact influence efforts to control the disease?Several others in the class have already mentioned potential factors why poverty leads to an increased incidence and prevalence of TB, such as crowed housing conditions (many people living in close contact infect others with TB which is transmitted through airborne particles), lack of access to medical care, lack of health insurance in the US, malnutrition, lack of education etc. This certainly makes sense.
The article mentions 5 major drivers of TB; one of them is poverty itself, another one is related to and mostly caused by poverty, namely undernutrition; and a third factor also related to poverty – household air pollution, meaning exposure to smoke from indoor woodburning stoves that women use for cooking, and which in turn leads to COPD. Interestingly, the other two major drivers of TB worldwide are not typically linked with poverty – diabetes which is often thought of as a disease of the wealthy; and tobacco smoking, which used to be highly prevalent in affluent societies and still is more prevalent in Europe than Northern America, despite concerted efforts by public health authorities to reduce tobacco use. Cigarettes cost money, so you would think poor people have less access to cigarettes, or they make poor choices if they spend their money on cigarettes.
It is interesting to consider the names of the 8 countries that account for two thirds of global TB cases, since many of these countries are NOT among the poorest in the world and some have a strong economy, in particular China (population 1.4 billion) and India (1.43 billion in 2023). While these two countries have a very large population that would explain their large absolute number of TB infected persons, less populous countries like South Africa (population 62 million in 2022) would not belong into the group of the poorest countries, nor would Indonesia (population 270 million in 2020).
I tried to find data or a list on the ranking of poor countries. The 8 poorest countries in the world are all in Africa, and only one other country besides South Africa (which is not a developing country) on the list of countries making up 2/3 of global TB cases is in Africa, namely Nigeria (population 218 million). Nigeria is the 42nd poorest country in the world, according to this ranking. (https://worldpopulationreview.com/country-rankings/poorest-countries-in-the-world)
There are various rankings of poverty that I found in my search; interestingly, in one ranking I noticed that no one in China lives below the national poverty line – redefining the poverty line is one way of getting rid of poverty, I guess. (https://en.wikipedia.org/wiki/List_of_countries_by_percentage_of_population_living_in_poverty)
In Africa, South Africa is the second wealthiest country, after the Seychelles, and Nigeria is the 12th wealthiest country, according to a multidimensional assessment scale that the World Bank uses. (https://hdr.undp.org/system/files/documents/hdp-document/2023mpireporten.pdf)
Overall, these data seem to cast some doubt on the exact nature of the relationship of poverty with TB prevalence and incidence. Things seem to be more complex than “poverty leads to TB.” It would be helpful to find data that report the prevalence and incidence of TB per 100,000 population, and then correlate it to poverty rankings.When I worked in a rural mission hospital in Kenya last fall, I learned from the local Kenyan doctors that TB was much more common in certain regions of Kenya than others, even in a radius of maybe 2 hours driving distance, and not considering the whole country. To me it seemed that the community with lower TB rates had just as much poverty as those where many TB patients were coming from. I also noted that Kenya ran out of TB meds provided by the WHO, or perhaps there were distribution problems caused by corruption, so that some districts did not get the meds provided for free by the WHO or some other organization.
Thinking back in history to a time before TB treatment was available, such as the 19th century, there were certainly many wealthy people who suffered from and died from TB.
The second part of the question is about how important addressing poverty is in treating TB. Lifting people out of poverty is good practice for all kinds of reasons. Improving access to education especially for girls, empowering women, providing clean water and improving sanitation, improving nutrition, are all aspects of decreasing poverty and improving health.
But how do we help people escape poverty, and why has so many billions of dollars been spent on development programs with limited effects? This is an important question to ask if we want to know how to actually help people get out of poverty and improve their health. And we need to know why programs have failed to make a difference in the past. Why has so much development aid (non-military) been spent on Africa in the last half century or more, and most people there still live in poverty?
Here are links to some thought-provoking articles:
https://fee.org/articles/the-sorry-record-of-foreign-aid-in-africa/ (article from 2001)
https://africanarguments.org/2022/08/how-useful-is-aid-to-africa/ (article from 2002) – this article reports that in the last thirty years alone, 1.2 trillion US dollars in development aid have been spent on Africa.
Here is an article by Dr. Paul Farmer about the problems with programs addressing poverty, and suggestions how to make them more effective. https://www.lessonsfromhaiti.org/press-and-media/op-eds/rethinking-foreign-aid/My observation from serving in short term medical missions work in resource limited settings, and also from traveling to many countries as a tourist and reading about these issues is that vast income inequalities exist in these countries, that corruption is a major factor contributing to poverty that needs to be uprooted for any country to escape poverty, and that in many poor countries dictators and ruling elites have hoarded the wealth and resources of these countries, thereby actively worsening the health and economic wellbeing of their population. Good governance and fighting corruption are the major factors that will bring people out of poverty.
Neglected Tropical Diseases- an Effective Global Response to Local Poverty-Related Disease Priorities. Infectious Diseases and Poverty, 2020
Question #2: What, in your opinion, are two interventions that would be most effective against neglected tropical diseases?The article mentions 5 interventions to fight neglected tropical diseases: Large-scale preventive treatment; innovative and intensified disease-management; veterinary public health; integrated vector management; safe drinking-water, sanitation and hygiene (WASH). All 5 are important and effective. If I have to pick two that might be more effective than the others, my choice falls on the following: Ensuring WASH will reduce the burden of diseases transmitted via the fecal-oral route. Vector control through spraying insecticides indoors, using insecticide-impregnated bed nets / mosquito nets, eliminating sources of standing water, etc, will help reduce the exposure to mosquitoes and other vectors that transmit disease.
Why do I think the other three solutions might be less effective? Large-scale preventive treatment is not available for many neglected tropical diseases. Treating already infected people with effective medications is possible and important to those already infected, but preventing infections from happening in the first place by eliminating vectors and modes of transmission (through WASH) will likely impact many more people. Veterinary public health, i.e. treating infected animals, or killing them if treatment is not possible, is important, but not all neglected tropical diseases have animal hosts, and this solution might therefore be less impactful than the first two.Global Tuberculosis Report 2020 – Reflections on the Global TB Burden, Treatment and Prevention Efforts. International Journal of Infectious Diseases, 2021
Question #1: From your perspective, why are people living in poverty most likely to suffer from TB, and how should this fact influence efforts to control the disease?Several others in the class have already mentioned potential factors why poverty leads to an increased incidence and prevalence of TB, such as crowed housing conditions (many people living in close contact infect others with TB which is transmitted through airborne particles), lack of access to medical care, lack of health insurance in the US, malnutrition, lack of education etc. This certainly makes sense.
The article mentions 5 major drivers of TB; one of them is poverty itself, another one is related to and mostly caused by poverty, namely undernutrition; and a third factor also related to poverty – household air pollution, meaning exposure to smoke from indoor woodburning stoves that women use for cooking, and which in turn leads to COPD. Interestingly, the other two major drivers of TB worldwide are not typically linked with poverty – diabetes which is often thought of as a disease of the wealthy; and tobacco smoking, which used to be highly prevalent in affluent societies and still is more prevalent in Europe than Northern America, despite concerted efforts by public health authorities to reduce tobacco use. Cigarettes cost money, so you would think poor people have less access to cigarettes, or they make poor choices if they spend their money on cigarettes.
It is interesting to consider the names of the 8 countries that account for two thirds of global TB cases, since many of these countries are NOT among the poorest in the world and some have a strong economy, in particular China (population 1.4 billion) and India (1.43 billion in 2023). While these two countries have a very large population that would explain their large absolute number of TB infected persons, less populous countries like South Africa (population 62 million in 2022) would not belong into the group of the poorest countries, nor would Indonesia (population 270 million in 2020).
I tried to find data or a list on the ranking of poor countries. The 8 poorest countries in the world are all in Africa, and only one other country besides South Africa (which is not a developing country) on the list of countries making up 2/3 of global TB cases is in Africa, namely Nigeria (population 218 million). Nigeria is the 42nd poorest country in the world, according to this ranking. (https://worldpopulationreview.com/country-rankings/poorest-countries-in-the-world)
There are various rankings of poverty that I found in my search; interestingly, in one ranking I noticed that no one in China lives below the national poverty line – redefining the poverty line is one way of getting rid of poverty, I guess. (https://en.wikipedia.org/wiki/List_of_countries_by_percentage_of_population_living_in_poverty)
In Africa, South Africa is the second wealthiest country, after the Seychelles, and Nigeria is the 12th wealthiest country, according to a multidimensional assessment scale that the World Bank uses. (https://hdr.undp.org/system/files/documents/hdp-document/2023mpireporten.pdf)
Overall, these data seem to cast some doubt on the exact nature of the relationship of poverty with TB prevalence and incidence. Things seem to be more complex than “poverty leads to TB.” It would be helpful to find data that report the prevalence and incidence of TB per 100,000 population, and then correlate it to poverty rankings.When I worked in a rural mission hospital in Kenya last fall, I learned from the local Kenyan doctors that TB was much more common in certain regions of Kenya than others, even in a radius of maybe 2 hours driving distance, and not considering the whole country. To me it seemed that the community with lower TB rates had just as much poverty as those where many TB patients were coming from. I also noted that Kenya ran out of TB meds provided by the WHO, or perhaps there were distribution problems caused by corruption, so that some districts did not get the meds provided for free by the WHO or some other organization.
Thinking back in history to a time before TB treatment was available, such as the 19th century, there were certainly many wealthy people who suffered from and died from TB.
The second part of the question is about how important addressing poverty is in treating TB. Lifting people out of poverty is good practice for all kinds of reasons. Improving access to education especially for girls, empowering women, providing clean water and improving sanitation, improving nutrition, are all aspects of decreasing poverty and improving health.
But how do we help people escape poverty, and why has so many billions of dollars been spent on development programs with limited effects? This is an important question to ask if we want to know how to actually help people get out of poverty and improve their health. And we need to know why programs have failed to make a difference in the past. Why has so much development aid (non-military) been spent on Africa in the last half century or more, and most people there still live in poverty?
Here are links to some thought-provoking articles:
https://fee.org/articles/the-sorry-record-of-foreign-aid-in-africa/ (article from 2001)
https://africanarguments.org/2022/08/how-useful-is-aid-to-africa/ (article from 2002) – this article reports that in the last thirty years alone, 1.2 trillion US dollars in development aid have been spent on Africa.
Here is an article by Dr. Paul Farmer about the problems with programs addressing poverty, and suggestions how to make them more effective. https://www.lessonsfromhaiti.org/press-and-media/op-eds/rethinking-foreign-aid/My observation from serving in short term medical missions work in resource limited settings, and also from traveling to many countries as a tourist and reading about these issues is that vast income inequalities exist in these countries, that corruption is a major factor contributing to poverty that needs to be uprooted for any country to escape poverty, and that in many poor countries dictators and ruling elites have hoarded the wealth and resources of these countries, thereby actively worsening the health and economic wellbeing of their population. Good governance and fighting corruption are the major factors that will bring people out of poverty.
Dear Garnett!
Thank you for your thought-provoking response.
Here are my thoughts regarding question 1: You are correct, that we cannot control nature. However, the earth is warming – that is not debatable, but the debate is how much of the warming is caused by human actions. While I am not sure about the exact percentage, some, or a lot, of the global warming does seem to be caused by human action, and changing our actions to limit further global warming seems reasonable and attainable, though the exact measures and the costs and consequences associated with that should be debated.
I had never heard of the notion of “single global entity owned vertical farms.” If I understand your comments correctly, this would entail having all agricultural endeavors worldwide under one umbrella organization. This seems very unwise to me, especially since some of the organizations you mention, especially the UN, is very corrupt and gets played by certain nation states to their own advantage. I think if we charged the UN or WHO with running global agriculture we would see a lot of starvation I also believe that the consensus is that we actually have enough food production globally that no one in the world needs to suffer from hunger any more. Conflicts and wars cause most famines these days, not a lack of total worldwide food available.Regarding your thoughts about question 2:
The first smallpox vaccine was used in 1796. The WHO conducted a global eradication campaign between 1958 to 1977, the last naturally occurring case was in October 1977, and in 1980 the WHO declared smallpox eradicated. The relevant question is not how many vaccine skeptics there were early on, but how many there were during the WHO smallpox eradication campaign. I don’t know the answer, but it can’t have been many, otherwise the disease would not have been successfully eradicated.
You mention the cost of the MMR vaccine as a reason why some children in the US don’t get vaccinated. I learned tonight that there is a program that pays for the vaccines of children who don’t have insurance; it is called “Vaccines for Children.”
https://www.cdc.gov/vaccines/programs/vfc/index.html
The VFC program claims that they provide “all routine vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) at no cost to the participating healthcare provider.”
https://www.cdc.gov/vaccines/programs/vfc/providers/questions/qa-flyer-hcp.pdf
The cost of one dose of the MMR vaccine through the state health departments or anyone contracting with the CDC is actually $ 25, not $ 100 which is the private sector price.
https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html
From reading through the CDC and VFC material that I posted the links for, it is clear that any uninsured or underinsured child under 19 in the US can get any recommended vaccines for free. So cost is not a barrier to vaccination of children in the US.Globally, the WHO and other humanitarian organizations offer free vaccines and vaccination programs as well.
https://www.who.int/teams/immunization-vaccines-and-biologicals/essential-programme-on-immunization/implementation/immunization-campaigns
I imagine that depending on the country and the leadership of that country, individuals may or may not have actual access to vaccines. In those countries where the government is interested in getting their population vaccinated (which seems true for the vast majority of resource-limited countries), at least humanitarian organizations are trying to give everyone access. There is a lot more work to do in that realm for sure. Additionally, there are no doubt major limitations in reaching populations in war and conflict zones, as you mention. This echoes what I mentioned above about famine being man-made and related to war and conflict.Here is a link to an interesting research article about how to persuade vaccine skeptics: https://www.pnas.org/doi/full/10.1073/pnas.1504019112
You don’t persuade people by telling them vaccines are safe, but by showing them the negative consequences of what happens if their child gets the disease.I’ve tried to post this multiple times, maybe it will finally go through?
Neglected Tropical Diseases- an Effective Global Response to Local Poverty-Related Disease Priorities. Infectious Diseases and Poverty, 2020
Question #2: What, in your opinion, are two interventions that would be most effective against neglected tropical diseases?The article mentions 5 interventions to fight neglected tropical diseases: Large-scale preventive treatment; innovative and intensified disease-management; veterinary public health; integrated vector management; safe drinking-water, sanitation and hygiene (WASH). All 5 are important and effective. If I have to pick two that might be more effective than the others, my choice falls on the following: Ensuring WASH will reduce the burden of diseases transmitted via the fecal-oral route. Vector control through spraying insecticides indoors, using insecticide-impregnated bed nets / mosquito nets, eliminating sources of standing water, etc, will help reduce the exposure to mosquitoes and other vectors that transmit disease.
Why do I think the other three solutions might be less effective? Large-scale preventive treatment is not available for many neglected tropical diseases. Treating already infected people with effective medications is possible and important to those already infected, but preventing infections from happening in the first place by eliminating vectors and modes of transmission (through WASH) will likely impact many more people. Veterinary public health, i.e. treating infected animals, or killing them if treatment is not possible, is important, but not all neglected tropical diseases have animal hosts, and this solution might therefore be less impactful than the first two.Comment on Marion’s post:
Marion, great thoughts, and I agree with what you say. Why do you think some, or many, governments are not as involved in WASH and health programs as you would expect them to be? Is it because they don’t have to do anything since NGOs will pay for what in other countries the government, and the population’s taxes, have to pay for, such as basic sanitation? Is it because of dysfunctional or corrupt governments? How are NGOs contributing to or facilitating dysfunctional governments?Totally agree with what you say. Just one comment about good scientific evidence being able to convince vaccine skeptics – that does not seem to be the case – see the paper I found and quoted in my response to Garnett.
I saw this happening in Egypt when I visited there as a tourist recently – our Egyptian guide was lamenting the loss of arable land, especially in the greater Cairo area. The arable land is limited to a small strip along the Nile river there. The government is trying to get people to build new construction in the desert rather than the farmland. But then these cities need water, and we’ve seen the problems that brings in the high desert of the Colorado Plateau and in California (LA etc) or Arizona (Phoenix) or Nevada (Las Vegas) and the conflict about water distribution – the Colorado River does not even flow into the Gulf of California any more, like it used to do in the past, because all the water has been siphoned off along the way.
Dear Garnett!
Thank you for your thought-provoking response.
Here are my thoughts regarding question 1: You are correct, that we cannot control nature. However, the earth is warming – that is not debatable, but the debate is how much of the warming is caused by human actions. While I am not sure about the exact percentage, some, or a lot, of the global warming does seem to be caused by human action, and changing our actions to limit further global warming seems reasonable and attainable, though the exact measures and the costs and consequences associated with that should be debated.
I had never heard of the notion of “single global entity owned vertical farms.” If I understand your comments correctly, this would entail having all agricultural endeavors worldwide under one umbrella organization. This seems very unwise to me, especially since some of the organizations you mention, especially the UN, is very corrupt and gets played by certain nation states to their own advantage. I think if we charged the UN or WHO with running global agriculture we would see a lot of starvation I also believe that the consensus is that we actually have enough food production globally that no one in the world needs to suffer from hunger any more. Conflicts and wars cause most famines these days, not a lack of total worldwide food available.Regarding your thoughts about question 2:
The first smallpox vaccine was used in 1796. The WHO conducted a global eradication campaign between 1958 to 1977, the last naturally occurring case was in October 1977, and in 1980 the WHO declared smallpox eradicated. The relevant question is not how many vaccine skeptics there were early on, but how many there were during the WHO smallpox eradication campaign. I don’t know the answer, but it can’t have been many, otherwise the disease would not have been successfully eradicated.
You mention the cost of the MMR vaccine as a reason why some children in the US don’t get vaccinated. I learned tonight that there is a program that pays for the vaccines of children who don’t have insurance; it is called “Vaccines for Children.”
https://www.cdc.gov/vaccines/programs/vfc/index.html
The VFC program claims that they provide “all routine vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) at no cost to the participating healthcare provider.”
https://www.cdc.gov/vaccines/programs/vfc/providers/questions/qa-flyer-hcp.pdf
The cost of one dose of the MMR vaccine through the state health departments or anyone contracting with the CDC is actually $ 25, not $ 100 which is the private sector price.
https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html
From reading through the CDC and VFC material that I posted the links for, it is clear that any uninsured or underinsured child under 19 in the US can get any recommended vaccines for free. So cost is not a barrier to vaccination of children in the US.Globally, the WHO and other humanitarian organizations offer free vaccines and vaccination programs as well.
https://www.who.int/teams/immunization-vaccines-and-biologicals/essential-programme-on-immunization/implementation/immunization-campaigns
I imagine that depending on the country and the leadership of that country, individuals may or may not have actual access to vaccines. In those countries where the government is interested in getting their population vaccinated (which seems true for the vast majority of resource-limited countries), at least humanitarian organizations are trying to give everyone access. There is a lot more work to do in that realm for sure. Additionally, there are no doubt major limitations in reaching populations in war and conflict zones, as you mention. This echoes what I mentioned above about famine being man-made and related to war and conflict.Here is a link to an interesting research article about how to persuade vaccine skeptics: https://www.pnas.org/doi/full/10.1073/pnas.1504019112
You don’t persuade people by telling them vaccines are safe, but by showing them the negative consequences of what happens if their child gets the disease.Question 2: What do you believe are the most substantial barriers to global measles elimination, and how can these be overcome?
Click this text link to post your response: Graduate Certificate Week 1 Discussion ForumI believe the most substantial barriers to global measles elimination in resource-rich settings are lower immunization rates due to vaccine sceptics on both sides of the political spectrum who believe scientifically unsubstantiated claims (medical misinformation) about alleged risks of the measles vaccine, specifically a link to autism, as well as an increased mistrust of authorities, including the medical and scientific community at large, which in the US has been exacerbated by the COVID-19 pandemic, restrictive government policies and claims from and regulations developed by public health authorities that lacked sufficient humility about the limitations of scientific knowledge especially early during said pandemic. From my observation, this is much less a problem in Western Europe, Canada and Australia.
Overcoming the widespread public lack of trust in public health authorities in the U.S. will require acknowledgment of mistakes committed during the pandemic by said authorities, as well as efforts at educating communities with low vaccine uptakes about the scientifically documented risks of the vaccine (increased incidence of febrile seizures especially when given simultaneously with the varicella vaccine; small risk of anaphylaxis and ITP which is overwhelmingly benign and resolves on its own), as well as the potential seriousness of getting measles. This could best be accomplished if trusted authority figures from these communities spoke up about the importance and safety of the measles vaccine. Some measles cases occur in migrants who were never vaccinated in their home countries, so dedicated efforts to reach these groups are needed.
Unfortunately, what may finally convince vaccine skeptics to vaccinate their children is when measles infection rates are high enough so that enough parents know children with complications from measles, such as encephalitis leading to intellectual disability or death, or pneumonia, that they get more scared of measles than the vaccine.In resource-limited settings, mistrust of public health authorities and vaccine skepticism is also a problem in some communities, but lack of access to the vaccine due to poverty, political conflict and war is the much larger issue. Increased public health efforts at improving access to vaccination as well as education of the skeptical public are important, but conflict resolution and ensuring political stability, food security, access to education, and lifting people out of poverty are essential though difficult to accomplish.
Question #1: What system-wide changes, in your opinion, would most successfully increase world-wide food security?
This article reports the result of a survey of 69 academic experts about what they think the major challenges to food security are and what future research priorities should be. Three themes of causes of food insecurity are identified: Natural disasters, many related to global climate change, that often affect the same regions (“compounding events and cascading risks”); increased vulnerability of communities due to increased water demand not related to agriculture as well as economic instability and unpredictability of prices; loss of farm land due to industrialization or population growth leading to housing construction on fertile land, loss of biodiversity; and international and intranational conflicts leading to population displacement, migration, destruction of arable land, and inability of farmers due farm the fertile land due to political instability and lack of security.
Some of these problems are clearly more difficult to address than others, especially climate change and war and conflicts. I believe that the highest impact system-wide change to improve food security would be to establish peace and security in those regions of the world that suffer from war, instability, or failed states, especially since the article states that more than 50% of the world’s hungry live in conflict zones. I also believe that this is the most difficult to achieve and not likely to happen, but it would make the biggest difference.
Some interventions that have less impact, but are likely much easier to implement include aligning incentives for farmers with sustainable farming practices and crop diversification, establishing and enforcing policies that prevent the loss of arable land to housing and construction or industrial uses, and improved water management.
I am uncertain to which degree climate change is reversible, how much of it can be attributed solely to human activity as opposed to long-term climate cycles (the earth has been warming since the last ice age, with some shorter interspersed cooler periods such as the Little Ice Age), and I am uncertain what effect national and global efforts to address climate change will actually have. Nevertheless, climate change leading to increased natural disasters leading to food insecurity and death is clearly another area that needs to be addressed, if food security is to be improved.Hello everyone!
My name is Andrea Braun, I am board certified in critical care medicine, nephrology and internal medicine. I’ve worked exclusively in critical care medicine for the last 10 years. I’ve done lots of short term medical mission trips (to Indonesia, Nicaragua and Honduras, including many trips focused on human trafficking victims), and last fall, I finally had the time to work in a mission hospital in Kenya for a month (Tenwek, which has a 13-bed ICU and 6-bed stepdown unit). I taught critical care, especially critical care ultrasound, to critical care (and other) doctors in Mongolia for 3 weeks with Medical Education International. Currently, I’m between permanent jobs and working as a locum tenens, but hopefully will have a permanent job again by this summer.
I am passionate about medical education, including point-of-care ultrasound and of course critical care education, and I’m trying to figure out how I can use my skills and teach on the mission field, since this is where I feel I can make the biggest difference as a critical care doctor.
I’m taking this course to get better equipped in providing medical care in resource-low settings.