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Public Health in the News – September 29, 2014

Global

  • Nature News has a fantastic profile of Sheik Humarr Khan and other public health workers as they fought against Ebola in Sierra Leone.
  • Science is not enough to stop Ebola – we need social change as well.
  • We may have made huge progress in the fight against HIV, but there is a problem with the often-repeated sentiment that as long as HIV+ individuals take their medication, they will be fine. Mosaic has a fantastic piece profiling four people living with HIV in the UK – their stories of daily life, dealing with physical and mental health issues, are eye-opening.

National

Chicago

Northwestern


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Public Health in the News – September 21, 2014

Global

National

  • Sugar has long been known to raise blood sugar levels, thereby contributing to glucose intolerance and obesity. So why hasn’t the introduction of artificial sweeteners done more to lower the upward trend in obesity prevalence? A new study suggests that artificial sweeteners may also raise blood sugar by altering the content of the gut bacteria.
  • NPR’s Science Friday interviews Dr. Paul Ruggieri, who has just written a book about how money influences healthcare.
  • A new device has been developed that can help patients fight infections. The so-called “artificial spleen” can remove bacteria, viruses, and bacterial toxins from blood.
  • Caitlin Doughty, a mortician, has just published a book talking about her profession and advocates for a more open, accepting attitude towards death.
  • Few treatment options are available for people with a progressive form of multiple sclerosis, but a new global initiative is offering research money for scientists who are focusing on this more serious form of the disease.
  • A new projection of population growth estimates that the world will have over 12 billion people by 2100 – more than has been predicted by previous studies. Wired explains where the estimate came from and analyzes what this may mean for the sustainability of our planet.
  • President Obama signed an executive order this week that aims to develop a new plan for fighting the increasing problem of antibiotic-resistant bacteria.

Northwestern


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Public Health in the News – September 14, 2014

Global

  • Scientists mapping the spread of Ebola gave grim news that it is likely to spread to hundreds of thousands of people and last up to 18 months more before it is under control.
  • A cool new device may help global health workers everywhere. Called K-1, it is the first syringe to automatically disable once it’s used. This new weapon in the fight against diseases spread by dirty needles was unveiled at the TEDMED conference in Washington, DC.

National

  • Though many people who bought their health care through the federal marketplace will be automatically renewed in June, officials are encouraging consumers to revisit the marketplace to compare plans and ensure that they get the right amount of financial assistance in 2015.
  • Some good news in the public health world! The US Geological survey announced that pesticide levels in our waterways have dropped, due to strictly enforced legislation, making it safer for humans to access these water sources.
  • Overriding the veto of the governor, the Missouri state legislature (majority Republican) has enacted one of the strictest waiting periods of abortions in the country – 72 hours.
  • An amazing gift of $350 million has been made to Harvard School of Public Health, now the Harvard T.H. Chan School of Public Health. This is the biggest gift in the schools history.

Illinois/Chicago

  • After finding 11 confirmed cases of EV-D68, a respiratory virus, in Chicago, public health officials are sending messages for staying healthy through Chicago Public Schools. The best advice: wash your hands.
  • The Chicago Tribune published a nice piece on Chicago’s public health nurses.  Read it here.

Northwestern

  • The U.S. Department of Energy is set to collectively give Northwestern University and the University of Illinois at Urbana-Champaign more than $8.4 million for clean energy and research and development.
  • In Chicago, most kids with asthma or food allergies don’t have a health management form on file at school, a new study by Feinnberg faculty member Dr. Ruchi Gupta, shows.


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Public Health in the News – September 7, 2014

Global

  • Three former directors of the CDC, Bill Foege, James Mason and David Satcher offer their insights into why the Ebola outbreak in West Africa is just one example of the serious need to boost global health security worldwide, and urge the global health community to began shifting priorities over the next months and years.
  • Sierra Leone has imposed a 3-day Ebola quarantine, requiring all citizens to stay in their homes while a team of 7,000 health workers go door to door to find people infected with Ebola who may be hiding. Doctors Without Borders and other international health organizations worry this will make matters worse.

National

  • A new study by researchers at the Johns Hopkins Bloomberg School of Public Health suggests that normal-weight nutrition and exercise counselors feel significantly more successful in getting their obese patients to lose weight than those who are overweight or obese.
  • Today’s New York Times uncovers a large population of young people, who, working on American farms are being exposed to nicotine and other dangerous chemicals. Though public health officials are calling for change – politics continues to get in the way.
  • Another Johns Hopkins Bloomberg School of Public Health study analyzing how the ways companies selling alcoholic beverages present “be responsible” messages really only serve to promote the product and not the safety message. Read the full study finds in Science Direct.

Illinois/Chicago

  • Small businesses in Illinois will get access to the federal health insurance marketplace earlier than other states. The Small Business Health Options Program, or SHOP, will open in late October, ahead of the November 15th open enrollment, for businesses with fewer than 50 full-time workers.
  • Dr. Raymond Patterson, a mental health expert in Illinois testified that the prison system “is substituting segregation for mental health treatment” for some inmates, he said. The state also has not provided documents that guards are referring isolated inmates to mental health care if needed, according to Patterson and the inmates’ lawyers.

Northwestern

  • A study by Northwestern Memorial Hospital in Chicago found that overweight owners who exercise with their dogs are more likely to lose weight and stay motivated than those who work out on their own.

 


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Book Review: “Global Health Law,” by Lawrence O. Gostin

by Juliet Sorensen, Clinical Associate Professor of Law, Northwestern University. Reprinted from Juliet Sorensen‘s review of Lawrence O. Gostin’s Global Health Law originally published in the Times Higher Education.global health law For those who would dismiss health law as a mind-numbing blend of insurance policy and the regulatory state, think again. Lawrence Gostin here presents a persuasive and inspiring call to action for lawyers and legal scholars to harness their talents to the fundamental goal of health for all by utilising human rights standards, international treaties and activist litigation. Tedious it is not.

To be sure, the jurisprudence of global health is still in a nascent state, in part because the concept of a right to health is difficult to articulate. This is, after all, the same right to health that a US Court of Appeals dismissed as being “boundless and indeterminate…‘devoid of articulable or discernible standards and regulations’…[a] nebulous notion that [is] infinitely malleable”. Gostin acknowledges this limitation and others, including the scant enforcement powers of international conventions, which depend on governments with the political will and capacity to effectively implement their provisions at the domestic level. But global health is not merely a recitation of aspirational standards and toothless laws, and the author exhorts individual nations and the international community to apply meaningful governance standards to global health even as the right to health continues to evolve and gain acceptance. By definition, global health is not limited to the developing world. This is acknowledged in the book’s early sections on global health narratives and global health justice, which note that profound health inequalities are found in rich countries – two of the narrators featured here are Native Americans living on reservations – just as in poor countries. Nonetheless, Gostin asserts that because “the determinants of health are not bound by national borders”, wealthy states have an obligation to pull their weight. He notes that although the World Health Organisation has called on rich countries to devote approximately 0.1 per cent of their gross national income to development assistance for health, in 2010 official development assistance for healthcare from Organisation for Economic Cooperation and Development member states was less than 0.05 per cent of their gross national income. Gostin notes astutely that although basic public health is considered a “baseline requirement for a functioning society”, wealthy countries today are uninterested in fundamental public health services overseas (a notable exception to this rule is the US Peace Corps, which has long focused on water and sanitation as essential to global health and economic development). The history of public health successes – including the establishment of the WHO, the eradication of smallpox and globalised information sharing about disease – demonstrates that challenges to public health are not overcome by science alone. Rather, social mobilisation through law and activism holds governments accountable to the public health. Global health law is here defined as setting out the international legal framework that is needed to empower advances in global health, consistent with the values of social justice. Just as global health itself involves many disciplines, diverse areas of the law affect global health. Gostin supports criminal enforcement to redress the public health impact of counterfeit medicines and corruption’s corrosive effect on health. Although free trade and intellectual property rights may prompt a knee-jerk reaction of distaste in some, Gostin acknowledges the balance of interests in commerce, science, public health and human rights that global health law reflects. Moreover, he sounds a warning note to public health advocates inclined to criticise the World Trade Organisation without doing their homework: the public health community, he says, “must understand trade regulations in order to safeguard health and promote justice”. Gostin devotes the book’s last section to current initiatives in global health law that form part of “the quest for global social justice”. These include an innovative, binding international “framework convention on global health” and a multilateral treaty that would provide incentives for research and development based on global health needs rather than pure profitability. The same treaty would provide opportunities to improve the innovative capacity of developing countries and expand the access of those countries to scientific knowledge. Neither convention exists today. But in the words of Lao-Tzu, “a journey of a thousand miles begins with a single step”. Global Health Law makes a compelling case that the law’s time in the march towards global health is nigh.

 


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Public Health in the News – August 31, 2014

Global

National

Illinois

Northwestern


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“Better But Not Well”

By Osefame Ewaleifoh, PhD/MPH Candidate

“The pattern of psychotherapeutic practice in America is seriously imbalanced in that too many of the ablest, most experienced psychiatrists spend most of their time with patients who need them the least.” – Jerome Frank (1961)

bbnw1

Recent news events, from the current non-stop gun violence to celebrity suicides, have made mental health more visible today than they have ever been in the past. Beyond race, gender or sexual orientation, the mentally ill remain the most widely marginalized group in society by almost every criterion. In Better But Not Well, authors Richard Frank (Harvard) and Sherry Glied (Columbia) provide an exceptionally engaging and comprehensive retrospective on the evolution of contemporary mental health care in the United States since the 1950’s. Better But Not Well is an intellectual treasure trove   for any reader – from the casual health consumer to the avid health care scholar – as it attempts to answer the question of both how and why the current mental health landscape in the United States evolved.

bbnw2Figure 1. Timeline of mental health financing

In its rich and very thoughtful first seven chapters, Better But Not Well contemplates both policy and practice changes that have influenced how mental health is perceived and treated in the U.S. The authors begin by establishing a very broad overview of the major trends and factors that have led to improvement in mental health care. Next they consider the composition, characteristics and proportion of the mentally ill in society from 1950 until today, asking if this population has changed or remained relatively constant through the years.

To attempt to better understand the specific factors that have driven improvement in care, the authors explore changes and innovations in our treatment capacity for the mentally ill, noting that while there have been incredible advancements in treatment capacity, these improvements are not widely accessible or disseminated. Moving beyond treatment capacity, Better But Not Well provides overwhelming data that the true driver of the current advancements in mental health has been the evolution of mental health care financing and government policies.

Untitled 4dFigure 2:  Trends  in Mental Health care spending

Changes in mental health financing have altered everything from the structure of care (a shift from institutionalized centralized care to decentralized mostly outpatient care) to the supply of care providers (more social workers, psychiatrist and mental health workers) and the funding and affordability of care (more federal dollars are spent on health care today than ever before). The authors carefully explore how each of these factors has affected the quality and delivery of mental health care, arguing that while the financial revolution has led to increased care accessibility by decentralizing care delivery it has created a system where no single agency is exclusively responsible for the care of patients – which could be very detrimental for severely ill mental health patients who must utilize multiple levels and agencies for their care.

bbnw3

Figure 3. Trends in the institutionalization of the mentally ill.

The authors conclude with specific examination of how the current evolution of mental health care has affected various populations, from veterans to the homeless. They argue that while substantial progress has been made since the early 1900s, where the mentally ill where corralled and locked up in insane asylums, much work remains to be done.
Unlike every other disease-related group (DRG), the mentally ill are the only group that that is often blamed for their condition. Thus while no one ever accused a cancer or dementia patient of “weak will” most mental health conditions are still erroneously perceived to result from “weak will” and “bad character”.

bbnw4Figure 4: Public Perception of mental illness

Clearly much work remains to be done. In Better But Not Well Frank and Sheryl excellently argue that we have to do better for people with mental health issues, and perhaps the way to do this is by expanding general social welfare programs and making insurance programs for the mentally ill more mainstream. To some degree this is precisely what the mental health provisions of the Affordable Care Act attempt to do – only time will tell the true impact of the ACA on mental health care.

References:

Figure 1 :Timeline on mental Health Financing. Better But Not Well. Richard Frank and Sherry Glied.

Figure 2: Trends in mental health care spending. Better but not well. Richard and Sherry Glied.

Figure 3:Trends in state and county mental hospitals in the U.S. from 1970 to 1992. Ronald W. Manderscheld, Ph.D. et al.

Figure 4: Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. B G Link, J C Phelan, M Bresnahan, A Stueve, and B A Pescosolido


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Public Health in the News – August 24, 2014

Global

  • As though West Africa didn’t have it hard enough, Ghana is now reporting nearly 70 deaths from a cholera outbreak that began in June.
  • In Liberia, unrest continues as citizens resist the quarantine in the Monrovia neighborhood of West Point, as well as a nationwide curfew – an effort to control the spread of Ebola.
  • A recent study in Science Magazine, looking at which is better, oral or injection polio-vaccine, found that while oral vaccine is easier to dispense, injection vaccine lasts much longer and could be more important to use in conflict or remote areas.
  • The New Yorker magazine recently published a great article about Vandana Shiva, a pioneer in the flight against G.M.O’s.

National

  • The ALS “ice bucket challenge” continues to dominate social media sites, with many celebrities and politicians taking the challenge. So far the ALS Association has received nearly 42 million dollars in donations.
  • A University of Maryland School of Public Health report found that air emissions trump water pollution and drilling-induced earthquakes as a top public health threat posed by future fracking projects in Maryland.
  • Interesting and unexpected news about the role botox may play in preventing cancer.

Illinois/Chicago

  • This past week, the Chicago Department of Public Health partnered with nearly two dozen local organizations for “Nobody Quits Like Chicago” week, highlighting the city’s efforts to encourage citizens to quit smoking.
  • e.a.t. (education, agriculture, technology) Chicago has been issued the first ever emerging business permit. e.a.t. Chicago creates healthy food spots in vacant news stands.

Northwestern

  • Depression is known to be a common symptom of Parkinson’s disease, but remains untreated for many patients, according to a new study by Northwestern Medicine investigators in collaboration with the National Parkinson’s Foundation (NPF).
  • With an average wait of five years for those on the kidney transplant list, Northwestern researchers suggest that changing policies and how we allocate available kidneys based on localities.

 


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Project Spotlight: “GOALI: Improving Medical Preparedness, Public Safety, and Security at Mass events”

by Michelle Diana Bradley, MPH

The Bank of America Chicago Marathon is one of the largest marathons in the country.  The limit of 45,000 registered runners is usually reached months in advance of race day.  Millions of spectators crowd the streets of Chicago with extreme excitement to watch and cheer on runners pacing through 26.2 miles.  Public safety and security for events of this magnitude are a high priority for race organizers and officials of the City of Chicago.  Engineering and medical faculty at Northwestern University have teamed up with marathon organizers and to implement the project GOALI: Improving Medical Preparedness, Public Safety, and Security at Mass events. This project studies approaches of developing ways to reduce or eliminate any risk of harm due to natural hazards along the race route by using optimization methods1.In the case of a marathon, course design decisions are related to the route to be followed and the locations of aid stations, medical tents, and volunteers on the course 1. The multi objective model format allows the data analyst to consider the best measures of performance for the race course design1.  By coupling this information with field observations, a safe and medically accessible race course can be identified. Northwestern University faculty members working on this project include: Jennifer Chan, MD, MPH; George Chiampas, DO; Sanjay Mehrotra, PhD; and Karen Smilowitz, PhD.

photo courtesy of the Chicago Sun Times

photo courtesy of the Chicago Sun Times

Dr. Chiampas, a Chicago native, is an associate professor in Emergency Medicine here at Northwestern University.  He also serves as the medical director of the Bank of America Chicago Marathon.  We had a chance to catch up with him after he returned back to Chicago from traveling with the US Men’s National team to the World Cup as their official doctor.  Dr. Chiampas discussed two major outcomes from this project. The first outcome being enhanced situational awareness which allows for real-time response to medical emergencies for participants at mass events.  Research investigators want to provide a way to investigate medical emergencies and security situations in a timely manner.  The second outcome will be to provide operational prospective through global leadership.  The research team will host seminars to disseminate best practices from this research to other mass events in the Chicago region and worldwide (1).  When asked what will be the most important factor in enhancing the Chicago Marathon route for runners, Dr. Chiampas replies, “resources and allocations of resources throughout the route.”

  1. Chan, J. Chiampas, G. Mehrotra, S., Nishi, M., and Smilowitz, K. (2014). GOALI: Improving Medical Preparedness, Public Safety and Security at Mass Events.  Retrieved on July 7, 2014 from https://www.collectiveip.com/grants/NSF:1405231

 


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Book Review: “Homicide, suicide and mental illness in Africa”

(Princeton University Press. 1960)

                                                                          By Osefame Ewaleifoh

It is remarkable that the most comprehensive review of mental health and suicide in Africa was written in the 1960′s. This fact underscores how little we know today about the reality of mental health need and suicide in Africa.“Homicide, suicide and mental illness in Africa” was compiled and edited by Paul Bohannan, a Rhodes Scholar and professor of Social Anthropology at Oxford in 1960 and provides a rich ethnographic assessment of mental health,  homicide  and suicide in west Africa at the end of European colonial rule of the region.

This timeless must read volume work was conceived after Dr. Bohannan and his colleagues stumbled into a cache of judicial and police documents belonging to the British Colonial Lords in East Africa. This discovery prompted Paul and his collaborators to compile and analyze similar data sets from other regions of the continent from Uganda, to Kenya and Nigeria. This regional ethnography on mental health and suicide provided the first descriptive empirical report on homicide, suicide and mental health in West Africa. Among other things the authors asks  questions such as how do suicide rates in Africa compare with other parts of the world, what factors drive homicide, suicide and mental health in the region and finally what is the response and impact of suicide on the local community.

Among other things the author makes the interesting observation that homicide rates among Africans in Africa were significantly less than Africans living in the United States and Europe, emphasizing the need for a contextual consideration for homicide. On the other hand the authors’ studies suggest that suicide in Africa was not as rare as previously assumed.

Data on suicide rates were particularly difficult to obtain in the region since it was considered such a taboo subject among local communities and thus rarely formally reported. Despite these limitations, the authors make the interesting observation that suicide in the region was driven by such factors as loss of status, childlessness, impotence, adultery and vengeance. Furthermore unlike in the west, African communities perceive suicide as having major negative spiritual ramifications in the communities. Thus tribal leaders go to great lengths to prevent suicide, making it an effective bargaining chip between dissatisfied citizens (who might threaten suicide) and tribal leaders. Unfortunately, this particular volume fails to explicitly capture or address the role of mental health in driving suicide in the region.

Beyond giving a global overview of the role of homicide suicide and mental health in West Africa, the authors focus on specific local communities to explore specific trends and patterns unique to those communities. In Ghana, the authors reported similar forms of mental illness as those observed in Europe. The authors make the argument that witchcraft in the region makes it difficult to fully study mental health, since a lot of classic mental health cases are typically ascribed to witch craft in the region. Thus, the authors spend considerable time contemplating the similarities among the symptoms observed in the mentally ill in the region and those thought to be possessed by evil spirits.

So much has changed in Africa since 1963 when this volume was originally published still the thematic relevance of the subject has only become more pressing. The Colonial governments are long gone, geographical boundaries have been redrawn and most of the countries in the region have all won their independence since 1963 completely altering the social and geopolitical landscape of the region. Still the mental health need remains largely the same. More significantly it is remarkable that there has been almost no follow up study to this volume. The lack of widespread interest in mental health in Africa is understandable- it neither seems like an urgent or important need. With limited resources to devote to all the health concerns in the region, funds naturally get allocated to health concerns perceived as more urgent and important. Unfortunately, mental health care in the region has not been thus prioritized.

While there are clearly limitations and weaknesses with the current volume- the most obvious being how dated the information in it is- this ethnographic study provides an important historic foundation for health workers and researchers interested in mental health in the region.

Mental health is a complicated and notoriously difficult public health challenge- even in the west with all the available resources. Still as a first step it is time we allocate some resources to simply understand the current status of mental health need in Africa at least as a prelude to future action.

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