[Shajin]

I do agree with Sarah about the contemporary morality upholding moral relativism. I am happy that you took an example of virtues – the honesty / truth telling to explain about moral relativism.

[Shajin]

I agree with Rubel’s stand on the question “morality itself is deflated in a morally pluralistic world and that morality and bioethics degenerate into biopolitics”. I am glad Rubel brought out about the example of healthcare in India, in which poor patients are exploited during the time of medical crisis and about the commercialization of healthcare, with many of the healthcare and ethical issues entangled with religious and political agenda.

[Shajin]

I do agree with Kainey’s comment about the importance of cultural relevance in shaping common morality, highlighting the values from African American community. I do share your concern that bioethics should become more inclusive and serve the needs of all communities.

[Shajin]

Hi, my name is Dr.Shajin. I am a Pediatrician currently working as a consultant in Neonatology at a hospital in New Delhi. After my Pediatric residency, I worked for five years in a secondary level charitable hospital in North East India. I got to understand the challenges especially in the field of healthcare during my stint there. I came across INMED then and completed my certificate course in International Medicine and Public Health. My interest in Global health, especially in the Perinatal care space has made me pursue this Masters in International Health course. I hope this course will equip me to contribute to the care of vulnerable children living in resource limited regions. I am thankful to the Lord for this provision and grateful to INMED for giving this wonderful opportunity.

[Shajin]

I agree with Rubel that Demographics & Urbanization, Global environmental change and Technology are the three important environment influences on our health. Each of the factors affect us in several ways, especially the demographics and technology.

[Shajin]

What Alexis has mentioned here is very true. The drive towards moving into personalized medicine is one very important reason for a gulf between fields of Medicine and Public health.

[Shajin]

I am glad you touched upon years of disability in your response. One of the most important advantage of public health epidemiology is to work on prevention, thereby reducing the years of disability.

[Shajin]

Question #3: What advantages could be realized through renewed emphasis upon public health epidemiology?

The following are some of the advantages realized through renewed emphasis upon public health epidemiology:
i) It helps to address the equity in health
ii) It reduces the suffering by promoting health and reducing the incidence of illness
iii) If enabled to work effectively, public health can help medicine too by reducing preventable illness

[Shajin]

Question #2: A gulf has long existed between the fields of medicine and public health. What are the reasons for this gulf?

These are some possible reasons for the gulf between fields of medicine and public health:
a) In contrast to the highly visible gains in medicine (epidemiology), the benefits are difficult to communicate in Public health
b) Principle of Prevention Paradox, that population intervention provides little benefit to individual causes low motivation for Public health interventions
c) Attention towards personalized medicine
d) Standard epidemiologic methods can be easily applied to questions relevant in medicine than to public health

[Shajin]

Question #1: Which three forces in the coming decade will most alter the way our environment influences our health?

These are the three forces in the coming decade which can alter our environment influences on our health:
1. Demographics: Increased life expectancy, Large scale migration, Urbanization and increase in chronic illness
2. Global environmental change: Climate change, Increase in mean surface temperature(global warming),chemical exposures
3. Technology: Personal / remote sensor technology, application of OMICs, e-health

How must environmental epidemiology restructure its priorities to be relevant and effective?
1. Prioritize healthy aging: Better understanding of the effects of environmental exposures over life course on health
2. Increase equity of Information: Systematic data registration, low cost scalable data collection methods, decision analysis approaches
3. Reduce participant burden: Minimize participant burden using blood / urine sample collected as part of clinical care
4. Expand approaches to handle complexity: Improve Integrated risk assessments; move towards system-based approaches
5. Formalize data analysis: Appropriate methods for causal inference, favor semi-parametric, non-parametric methods
6. Adapt training of future environmental epidemiologists: Training in new techniques to scale existing methods & to be familiar with large scale computing

[Shajin]

Each and every reason mentioned above, by Rubel can be seen in any conflict situations and in places of war, favoring the spike in infectious diseases. These are exactly some of the reasons by which Iraq got a surge in their infectious diseases burden.

[Shajin]

I agree with Alexis in the importance of strengthening of Primary health care, which can go a long way in decreasing the infectious diseases burden. When Primary health care is streamlined, disease surveillance programs and screening programs also can be strengthened thereby reducing the incidence of infectious diseases.

[Shajin]

I agree with you on the factors that you have mentioned about the use of evidence-based clinical practice guidelines. I would like to stress upon the third point that you have mentioned about cutting costs, variation in health delivery systems and transition of medicine towards multidisciplinarity. Unless we have an evidence based clinical practice guidelines, with the transitioning of medicine happening in the current era, the patient will be at loss, because of the diverse treatment protocols. Hence evidence based guidelines, prepared from good quality evidence like systematic review are very important.

[Shajin]

Question #3: What are the factors that most compel the use of evidence-based clinical practice guidelines? What are some effective steps that could improve their use in low-resource communities?

Following factors compels us to the use of evidence-based clinical practice guidelines:

1. If the clinical practice guidelines are not evidence based, then it could be based on expert opinions. Now, expert opinions varied grossly between different specialties of expert clinicians and from within clinicians of the same specialty and also between those clinicians who made guidelines and clinicians who actually implemented them.

2. The composition of the guideline development group can influence the recommendations, if it’s not based on evidence

3. The recommendations made by clinical experts can be often in conflict of interest provided it’s not based on the research evidence

Steps to improve the use of evidence-based clinical practice guidelines in low-resource communities:
1. Evidence based guidelines should be developed keeping in line with the local factors
2. When an evidence based guideline is used from a different country or from other organization like WHO, make sure the guidelines can be applicable to low resource settings
3. Try to setup central agency to monitor the development of guidelines process.

[Shajin]

Question #2: What factors today most contribute to the decline in Iraq’s infectious diseases?

Following are some of the factors for the decline in Iraq’s infectious diseases:

a) Iraqi healthcare system is one of the best in Arab region and they were able to maintain the same momentum to an extent, even during the time of war and conflicts
b) Better vaccination coverage as compared to most of the Eastern Mediterranean conflict affected countries
c) Restoration of veterinary services post war
d) Reorienting the public sector towards primary care
e) Restoration of disease surveillance systems and screening programs
f) Proportionate increase in the number of primary health centers in relation to the increase in population

[Author]

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