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Question 1: What additional elements would be necessary for universal health coverage to be effective?
Ultimately, the affordability of universal healthcare will need to be assured for it to be considered effective and worthy of continued funding. To do this, I believe it will be necessary for universal health coverage to incorporate a few different elements. Firstly, coverage must prioritize preventative medicine. When done well, prevention is a way to keep healthcare costs down and ensure a healthier population over time. Whether through vaccinations, screenings, or routine wellness visits, universal coverage needs to make access to preventative services an accessible reality. Secondly, universal health coverage will need to provide equitable health care for men and women. Unfortunately, in many places around the world this is not the case. However, I would argue that truly universal coverage and a truly healthy population means that healthcare is accessible to all and services rendered necessary are a reality for both men and women, rather than just half the population.
Question 2: What actions could improve community health workers career prospects?
In my opinion, making a career development program that is more structured would go a long way to helping improve community health worker career prospects and, in some ways, increasing the legitimacy of the role from both the domestic and international perspective. Sustainable evaluations of career training or education, while necessary, do not necessarily have to mimic traditional measures of educational competency like exams, but rather, may be focused on measuring proficiency in specific skills or responsibilities. Policy measures will need to be taken to incorporate the cost of career training and skill development.
Obviously, increases in financial compensation for community health workers will also help legitimize the role and increase peoples willingness to both enter the field and remain as a CHW for a long-term career.Question #1: What barriers exist to expansion of faculty development programming in LMIC (low and middle income) settings?
Low and middle income (LMIC) countries can face a number of barriers when trying to create or sustain faculty development programming. Limited financial resources remains one of the most fundamental barriers to the expansion of faculty development programming in LMICs, especially if there are other things that are considered more vital and thus are understandably prioritized over faculty development. Another key barrier is the lack of qualified local educators who are willing to lead such programming initiatives. We must address basic environmental factors like limited financial resources and lack of qualified talent, before we can implement any faculty development programming effectively.
Question #2: Which habit of exemplary clinical teaching is translatable to education in LMIC (low and middle income) settings? Can you provide an example of effective implementation from your own experience?
One habit of exemplary clinical teaching that was cited in the article that I believe is also translatable to education in low and middle income (LMIC) settings is “keeping it simple.” As the article stated, understanding general principles, and being able to effectively apply them, helps create clinicians able to provide clinical care and not just regurgitate complex scientific knowledge. Of course, as the article mentioned, teaching simply is paradoxically a very difficult thing to do. In LMICs, having a strong ability to simplify complex concepts and emphasize clinical care is important, especially given the wide spectrum of people who may be learning to provide patient care.
In my own life, I have found that it is the professors with the simplest presentation slides (as opposite to the professors with slide decks filled with lines and lines of text) that are the easiest to learn from. These skilled educators can distill their own extensive knowledge and bring it to, as the article states, “its heart essence.”Hi Safia! I appreciate how much of your own experience you have brought into your response this week! While many teaching techniques, such as role modeling, are powerful in many settings I agree that clinical training can often benefit from certain modifications in low and middle-income countries. This is especially true if training has typically not involved a certain “exemplary teaching technique or modality.” As people adapt more to learning and teaching with these modifications, more “traditional” or “perfect” examples of exemplary clinical teaching can be implemented.
Hi Charity. I appreciated your answer to the first question which mentioned that it is vital that compromise and cooperation occur across political and country divisions. Although different countries or political situations will create environments where specific negative health outcomes can flourish, ultimately, the necessities of good health are rather universal and if we are able to provide some sort of coverage that is able to work across divisions that will be the most helpful to people across the globe.
Question 1: What actions can healthcare educators take to help their learners to reduce cross-cultural barriers?
Like the article emphasized, cultural competency is an interdisciplinary phenomenon that should be integrated into the healthcare curriculum, so that learners are better able to interact with different communities and adapt to serving diverse populations. Obviously, each society will require individual training and cultural education, but I would argue that a foundational emphasis on developing cultural competency should still be incorporated into any quality healthcare curriculum. I think the best way to help learners reduce cross-cultural barriers would be to place learners into real-life mock scenarios that force them to face realistic cultural conflicts that they may come across in the real word. This teaching modality emphasizes cultural competency as a practical skill that uses flexibility, adaptability, and patience to reduce cross-cultural barriers, rather than simply a static, vague concept to memorize (learning from only textbooks or PowerPoint slides can sometimes cause this to occur). Given the diversity present in the US, learning alongside a diverse student and educator population may also help learners reduce cross-cultural barriers on a day-to-day basis.
Question 2: What prevention interventions could best help reduce consequences of complex humanitarian emergencies resulting from wars?
War is a devastating state of existence; the emergency consequences of war are immense. Population displacement, destruction of healthcare and sanitation infrastructure, and spread of infectious diseases are some of the more devastating consequences war can inflict on a population. Thus, effective prevention strategies are important to develop. One possible intervention that could help is to bolster the level of infectious disease prevention via vaccination programs and improved sanitation (the specific strategy should be dependent on the disease). Having a better protected population should help them withstand part of the devastation that war can wreck on healthcare resources and facilities (as well as the burden that violence places on an already weakened healthcare system). Another potential prevention strategy would be to focus on developing a solid economy, as a stable economy is a better buffer for humanitarian emergencies.
Hi Bethany! I really liked your point about using real life examples to teach cross-cultural issues. While I was working in an outpatient healthcare setting prior to medical school, I encountered a young female patient who had come in with her husband and three very young children. As I took a basic medical history, the patient’s husband kept interjecting with answers, effectively silencing the woman from explaining her own health history. Even as I was taking vitals, her husband kept insisting that I take his first. Based on the family’s clothing and language, they were most likely immigrants from a culture that was different from my own. While I consider myself relatively aware of the importance of practicing cultural competency and approaching such interactions in an unbiased way and with patience and understanding, the reality is, that it was much harder to do in with the stress of a busy waiting room, three screaming toddlers, and trying to maintain accurate electronic medical records. Practicing with real life scenarios, thus, offers a way to actually experience the complex situations in which cultural competency actually becomes a challenge in healthcare.
Question 1: What actions are most important to improve global nutrition?
As the article suggested, I would argue that the best way to approach global nutrition in the future will require a fundamental shift from a focus on addressing nutrient deficiencies (although these should continue to be measured and addressed as needed) to a focus on creating sustainable approaches to promoting overall health and wellbeing. Practically, this shift in thinking goes hand in hand with integrating topics that may be traditionally approached individually like food insecurity, malnutrition, and nutrition. Thus, nutrition research and interventions cannot only target the “nutrition space,” but rather, will need to work across multiple sectors to address nutrition needs.
One way to do this will be by targeting the food supply. I believe a focus on sustainable and local agriculture-led economic development can help shift food production towards less expensive and healthier foods. Over time, this kind of economic growth also develops a robust local economy of goods and services while providing low-cost food to communities. Prioritizing trade and policy that emphasizes access to nutritious foods is another strategy for change.
Question 2: In your opinion, what are today’s greatest obstacles to progress in global health?
Interestingly, the article found that while global health measured in age-standardized DALY rates has improved, the absolute number of DALYs has remained constant over the past three decades. Clearly, non-communicable diseases are becoming more of an obstacle to progress in global health and this will likely continue in the future. This fact, in conjunction with persistent infectious diseases that remain endemic to many nations, means that public health interventions will require a more complicated, multifaceted approach to save lives and reduce disability in many areas. Unfortunately, factors like insufficient healthcare infrastructure and poverty often complicate the ability of the global community to implement public health interventions easily.
Ultimately, however, I would argue that it is global instability, widespread conflict, and armed violence that create the largest obstacles to progress in global health. Huge amounts of the world’s population live in regions where conflict is an everyday affair. In such areas, regardless of how brilliant a global health strategy may be, it cannot be implemented to its full potential.
Hi Rabeea! I appreciate how you highlighted the article’s characterization of malnutrition as a “hidden” hunger, even in food secure countries, if necessary micronutrient needs are not being met. One interesting barrier (cited in the article) to improving this issue is the lack of sensitive and specific biomarkers for most micronutrients. Reliance on self-reporting is obviously an inherently flawed science and this is especially concerning for commonly deficient micronutrients like zinc. I would argue that global interventions to improve nutrition would benefit from more accurate estimates of micronutrient deficiencies given that the interventions would be able to offer a more targeted approach to the most significant malnutrition challenges in a community.
Question 1: Which, in your opinion, are the two most powerful pathways to improving infant growth in lower income communities?
As mentioned in the article, supporting the mother-infant dyad is important for ensuring infants thrive in lower income communities. In my opinion, keeping infants healthy begins by ensuring women are healthy and pregnant women get quality antenatal and postnatal healthcare; any intervention focused on infant health should include consideration of maternal health. Thus, I would argue that one of the more powerful pathways to improving infant growth in lower income communities is via maternal-focused interventions. There are a lot of ways of doing this but improving antenatal/postnatal nutrition and addressing community or family-specific socioeconomic and mental health factors will likely be potential avenues for change.
Addressing infant malnutrition, in my opinion, is another key path for improving infant growth in lower income communities. Providing healthy, safe, and adequate nutrition is key to improving infant mortality and morbidity. Broadly improving nutrition for infants is a lofty goal. However, supporting breastfeeding practices, whether through improved education, peer mentorship, or awareness campaigns, may offer a practical method of giving optimal nutrition to more infants in lower income communities.
Question 2: In the context of India, what are potentially the most powerful interventions to broadly improve maternal health?
Diversity in India is not only ethnic, but rather, is reflected in its economics, languages, religions, and geographies. It follows then that health and wellbeing in India will reflect this diversity. Thus, broadly improving maternal health in a country like India is especially challenging, requiring thoughtfully designed interventions that reflect the makeup and needs of the target population. In general, however, one intervention that I believe offers the potential to broadly improve maternal health is by improved availability and quality of primary health care for women. Without high level primary health care, a woman is already at a disadvantage before any pregnancy. Primary health care needs to include family planning information and help for conditions like diabetes or HIV/AIDS which have the potential to affect a future pregnancy. A woman who has benefited from primary health care may also be more likely to seek out maternal care when necessary.
Another important intervention is education. Per the article, a women’s education was consistently found to be associated with use of maternal health services in India. If a husband was educated, that fact also increased the likelihood that his wife would utilize maternal health services. Thus, education can be a powerful tool for increasing use of maternal health care. Education also opens new avenues for women to earn money independently and make reproductive decisions with better financial stability.
Hi Charity! Although the discussion board question asks for interventions that could broadly improve maternal health, I think your point regarding the level of diversity present in India (not just in relation to religion or culture, but also, in regard to language, socioeconomic status, education attainment, and family structures) speaks to the rather impractical nature of creating such interventions that can truly be applied broadly with the same level of success. Nevertheless, I would echo your answer that improved general education is one intervention that does have the potential to help improve maternal health outcomes in India. Apart from the many benefits you outlined, I would argue that education also empowers women in a more general sense, providing them a basis for applying to jobs and stabilizing their own financial futures (and potentially allowing them the freedom to delay or limit their children).
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?
There are many conditions associated with poverty that make it an important determinant of tuberculosis (TB). People living in poverty are more likely to face food insecurity or undernutrition which can predispose them to disease development and overall ill health. They are also more likely to live or work in congested conditions with poor ventilation which can increase TB transmission risk.
Addressing these risk factors will improve TB care and prevention but necessitates broader social and economic policy changes designed to reduce conditions of poverty. Importantly, this means that the stakeholders involved in TB control efforts will need to come from different disciplines and backgrounds.
Question #2: What, in your opinion, are two interventions that would be most effective against neglected tropical diseases?
Based on what I have read so far on the discussion board, much of the class has identified similar interventions from the combination of five selected by the WHO to combat neglected tropical diseases (NTDs). In particular, improved hygiene and water and integrated vector management were identified as interventions that would be especially effective against NTDs. I would agree with my classmates assessment; these two interventions would likely be effective at preventing many of the diseases included in NTDs. However, I think it is also important, at this stage, to find ways to integrate all NTD interventions into essential national health services or into broader public health programs funded in/by the countries, so that NTD interventions are more long-lasting and become part of the fabric of national healthcare efforts.
Hi Austin! I really liked your point about on-going issues detecting TB cases accurately. What is particularly concerning, in my opinion, is that these missing TB cases include patients with drug-susceptible or drug-resistant TB. Drug-resistant TB is a huge obstacle to the treatment and prevention of TB worldwide. Patients with drug-resistant TB often face poorer health outcomes, so being able to diagnose and treat these patients should be an important part of any global TB strategy. In terms of the broader public health space, and given the burden of TB worldwide, drug-resistant TB obviously is also an important contributor to antimicrobial disease resistance.
Question #1: What system-wide changes, in your opinion, would most successfully increase world-wide food security?
In my opinion, the most important, yet perhaps most ambitious, system-wide change necessary to increase food security is to find a “pathway to peace” throughout the world. This is clearly a lofty and seemingly impossible goal, especially given that the article states that half the world’s hungry currently live in conflict regions. The articles authors mention that even within the relatively short duration of their research project, several new conflicts emerged, including the Ethiopian civil war and the Ukraine-Russia war (notwithstanding the conflicts that began prior to the projects inception). In the two years since the publication of the article, major armed conflicts including the Israel–Hamas war, have also emerged.
There are a lot of incredible technological advancements and large-scale public health initiatives have been developed to increase global food security. Personally, I believe a focus on sustainable agriculture-led economic development is one of the most important of these strategies. Over time, this kind of economic growth develops a robust local economy of goods and services while providing low-cost food to communities. However, regardless of how effective such strategies are, they cannot be implemented to their full potential in an environment of widespread conflict, terrorism, armed violence, or political instability.
Question 2: What do you believe are the most substantial barriers to global measles elimination, and how can these be overcome?
Largely, global public health efforts to eliminate measles should be considered a success. However, persistent lack of complete disease elimination combined with significant outbreaks in countries once thought to be measles-free threaten the status of this success. I believe the most substantial barrier to global measles elimination are related to either historically low levels of immunization or recent decreases in vaccination rates. The data in the article demonstrates that in nations with higher vaccination rates, measles cases are lower or virtually nonexistent. Thus, vaccination is clearly a highly effective method of preventing disease; but this effectiveness is dependent on people getting the vaccine. Addressing this general barrier will require efforts tailored to be specific to target populations. Programs designed to increase access, address vaccine hesitancy, and lower vaccination cost are all potential ways of doing so.
Hi Bethany, I think your point about utilizing data effectively to improve food security, especially after extreme events, is interesting. Globally, as both you and the article’s authors mentioned, a plethora of data is being collected. Theoretically, this is a positive sign. However, I wonder how much of the data collected can be applied in an “on the ground” or practical way.
I also really like one of the phrases that you used in your response to the second question (“Measles is prevalent in some countries and not others.”). In my opinion, this is a key point to remember when thinking about barriers to the elimination of nearly any disease (measles included). Historically, how much aid and attention a disease receives is influenced by the particular country/region/people that the disease or condition is predominantly affecting. Acknowledging this factor is important for ensuring equitable resource distribution for many global health concerns.
