The NPHR Is Looking for Staff Writers!

The Northwestern Public Health Review (www.nphr.org) is looking for staff writers to contribute to the growing blog section of the NPHR website. Writers will assist with the development of a Northwestern Faculty and Project Spotlight Series. This contribution opens opportunity to meet, learn about, and network with all the interesting research occurring here at Northwestern. Writers will be assigned stories as needed, but no more than one per week. Writers can also share pieces relative to their own work or any other article of interest to the field of public health.

Northwestern students, faculty, and staff are eligible to apply. If interested in joining the NPHR blogging team, email nphr@u.northwestern.edu

What does it look like to be a socially conscious business person? Read on!

by Annie Conderacci, Kellogg MBA student

Do business interests have to conflict with those of the public good? In light of recent corporate scandal, greed, and corruption, I frequently ask myself this question. As a Social Enterprise major at Kellogg, I believe it is a firm no, but we future business leaders can do more to be better citizens.

The desire to study socially responsible business lured me to Kellogg–while several MBA programs provide students with advanced management skills and functional knowledge, Kellogg’s Public-Private Initiative (KPPI) provides a socially-conscious MBA curriculum. Understanding the responsibility that comes with the power of leading major institutions, Northwestern’s faculty encourages its students to consider the social impact of the challenges and opportunities presented by an ever-changing, inter-connected world.

NEF
The group at Nayral/NEF Micro-finance agency

The intersection between business and policy fascinates me, particularly how both can work together to shape people’s lives. The Health and Human Rights course through KPPI was an opportunity for me to focus on public health, a crucible for public-private conflict and partnership. The course’s readings and lecture components focused on international health issues and the policies, programs, and business initiatives to combat them. In parallel, we worked in groups on research projects to address public health issues for the town of Douentza, Mali, taking our macro content knowledge of public health and implementing it at a micro level.

The course’s project in Mali was an opportunity to pool the wealth of resources from Northwestern and its partner organization, the Near East Foundation (NEF), to implement health initiatives in limited-resource environment.  I was eager to test and implement my management and professional skills in a setting that could have such a profound social impact.  In a corporate setting, change management and quality of life issues were rarely matters of life and death. With this project, I jumped at the opportunity to implement changes with such gravity, but I also hoped to bring those experiences back with me, allowing them to influence my decision-making as a more socially responsible and compassionate manager.

I was fortunate enough to travel with a group of students to Douentza, Mali, to conduct a project gap analysis with our NEF counterparts, seeing in person where our research fell short and where our public health interventions could have a lasting, powerful impact.

Finally, this trip and this project would not be possible without the resources and dedication of Northwestern University, its dedicated faculty advisors, Juliet Sorensen and Karin Ulstrup, the Near East Foundation, and the members of our project’s Community Advisory Board in Douentza. Thank you.

Public Health in the News – April 13

Global

  • West Africa’s Ebola outbreak is spreading to other countries. Some patients, however, have recovered enough to return to their homes. Meanwhile, NPR reports that one drug on the horizon may be able to target the Ebola virus.
  • A recent study has found that global health funding has increased over the past several years. Research done by the Institute for Health Metrics and Evaluation showed that development assistance for health reached $31.3 billion in 2013.
  • Money that funds malaria clinics in Southeast Asia may not always be used very effectively – although it may still be reducing cases of malaria in other ways, argues grad student Daniel Parker in a recent blog post.

National

Chicago

  • April is STD Awareness Month, and Chicago area clinics are increasing their efforts to raise awareness and get people screened for HIV and STDs.

Northwestern

  • Daniel Young, MPA, IPHAM Center Administrator and Director of Education for the Center for Global Health, is a finalist for NU’s employee of the year!
  • Northwestern Memorial Hospital has been performing organ transplants for 50 years, making it the longest continual provider of transplants! Read a previous NPHR blog post about organ transplantation here.

A day in Mali -The Northwestern Access to Health Project

By Osefame Ewaleifoh

 Image

Access to Health Mali group in Dogon Country

The Northwestern Access to Health Project (NAHP) was started three years ago by the pioneering efforts of Clinical Associate Professor of Law, Juliet Sorensen. The goal of the project was simple, to leverage and integrate legal, medical, and business skills of Northwestern students to research health issues in communities in dire need through her course, Health and Human Rights. Over the years the course has grown to become one of the most popular courses in the graduate school, attracting a cohort of students from the law school, medical school, business school and programs in public health. Beyond providing a comprehensive introductory legal framework for students interested in public health, the program has increasingly focused on providing practical opportunities to students to apply group-focused interdisciplinary research techniques in real time to help address access to health challenges around the world. Each year, the class focuses on a particular community in which they work with local partners to identify the causes and determine possible solutions to major health issues. This innovative learning strategy has not only been beneficial to the students; it has been invaluable to the communities from South America to Africa, who benefit from the personalized practical solutions that students develop during the course.

In 2012, several insurgent groups from northwestern Mali attacked the government, seeking independence. Douentza, a picturesque village North of the Mopti region of Mali, was among the villages occupied by the insurgents for nearly two years. On the 15th of March this year, a group of five students and I, drawn from the Northwestern law school, business school and the program in public health, traveled to Douentza with Professor Sorensen and Dr. Karin Ulstrup, her medical school counterpart, to look for new ways to improve access to health in the region.

Our journey through Mali began with a 12 hour drive -from Bamako to Douentza with a brief stopover in Seguo. The road out of Bamako was in remarkably good shape—and continued to be so at least up until we approached Doeuntza where things got a little dusty and bumpy. Our first stop in Douentza was the Near East foundation (NEF) Local broadcasting studio. Although unadorned and low-tech by any western standards, the broadcast studio provides the essential services of education, entertainment, health information and connection between the community and the external world. Unlike most other local institutions the broadcasting station was able to survive the 2012 occupation by agreeing to read the Koran 40% of the time but insisting that the remaining 60% of the time was free, independent programming. On how the radio station survived the conflict, the head broadcaster Boucary proudly beamed “we are an independent voice!”

 

Image
Radio Douentza

Our next step from the studio was the meeting with the community advisory board (CAB), a group of health experts and community leaders assembled by the Near East Foundation to tackle access to health in the community. This group consisted of the head of the central hospital, a community youth leader, a women’s union leader, school leaders, a leading midwife, the regional cultural leader, and our host and organizer the regional director of the Near East Foundation. During our conversation with the CAB it became quickly clear how truly multi-factorial the challenge of access to health in the region was. According to the Chief attending of the central clinic, the central problem to access to health in the region was poverty and illiteracy. The role of widespread poverty was particularly significant as it fueled other factors such as malnutrition which was a major driver of infant mortality in the region. The role of malnutrition and childhood mortality became more apparent during the tour of the facility as we ran into a starving child cradled by his father with severe malaria. Thus while malaria on its own might not necessarily be fatal, coupled with severe malnutrition, malaria in children could be fatal.

Image

At the main clinic in Douentza, the nurse draws blood to test for malaria

Next, we toured the main health center for Douentza and the outlying villages. We saw the social service room, the surgery center for appendectomy and C-sections, the maternity ward, and dentist. To address the lack of a resident specialist, once every year, a visiting ophthalmologist would be sent from Bamako to perform cataract surgery, which happens to be a major health issue in the region. During our visit we met two kind doctors who had already done 45 surgeries that morning – and it was only 11.30 am. Looking back, it was truly impressive how much the hospital is able to achieve with so little resources. This attitude was perhaps best captured in the words of the Chief attending: “we have the knowledge of the health issues, we just don’t have the capacity”.

Following our time in the hospital we also visited the local microfinance center called the “Nayral NEF” created by the NEF. Unlike the radio station, the credit union wasn’t functional during conflict. One of the business models for the Nayral NEF was simple; get women to form small units of accountability, about 10 women per unit. With 5000 Malian Francs, this unit joins the credit union and each woman in the group receives a small loan contingent on the other women paying back their loan. This system has been remarkably effective in that there are now about 200 women’s groups participating in the program. Unfortunately during the war a lot of women lost their initial capital and had to be refinanced by NEF to resume the process. According to the Nayral representative, currently about 75% of the women make their interest payments each month, a slight dip from the pre-conflict repayment rates.

Image

Outside the main clinic in Douentza

We spent the remainder of our time trying to understand the role of education in the region. To do this we visited both the local school superintendent, the local high schools, middle schools and nursing schools. A reoccurring theme was how much the recent conflict had destabilized an already fragile educational ecosystem. Even more dire was the low rate of female education in the community – driven by poverty and culture. Most families want their daughters married by age 14, which often involves pulling them out of school. While the government has begun putting effort into this problem, much remains to be done.

The goal of the trip to Mali was simple – with boots on the ground, try to understand the practical limitations to access to health in a community that has been severely disrupted by poverty and war. Our ultimate intent is to integrate theory and practice together with what our informants shared with us to look for creative new ways to solve health access problems in the region. Working with our partners as the project evolves, we hope the project will make a lasting and useful impact in Doutenza.

Want to hear more? read MBA student Annie Conderacci’s reflections on the NU Access to Health Project’s blog: http://northwesternaccesstohealth.blogspot.com/.

 

Public Health in the News – April 6, 2014

Global

  • World Health Day, on April 7th, will focus on vector borne diseases. The World Health Organisation has recently declared that vector-borne diseases such as malaria, dengue and Japanese encephalitis could be eradicated through preventive measures and more financial commitment for campaigns against the diseases.
  •  A United Nations report this week warned that a warming planet will exacerbate existing health problems in the coming decades.
  •  A special edition of the Lancet calls for increased attention to combating multi-drug resistant Tuberculosis, which causes 1.3 million deaths each year.

National

  • Get ready for activities around National Public Health Week (NPHW), April 7-13. The theme this year is “Public Health: Start Here.” Many schools of public health will be holding special events in line with this years theme. NPHW is an initiative of the American Public Health Association.

Illinois

  • This past weekend, health care policy makers, practitioners, and technologists gathered  to talk about how we could make the most of public health data here in Illinois.
  • On April 8, the Illinois Department of Public Health’s Disability and Health Program will sponsor a webinar entitled, ‘Partnering with People with Disabilities in Emergency Preparedness Activities.’ The webinar, which will take place from 1–2 p.m. is designed to help emergency preparedness professionals include people with disabilities in emergency planning and exercises.

Chicago

  • Petroleum Coke, aka petcoke or black dust, a residue of oil refineries (namely the BP plant in Whiting, Indiana) has been blowing into Chicago’s southeast side, causing potential health problems such as wheezing and shortness of breath. Mayor Emmanuel’s office has vowed to address the issue.
  • The popular Chicago fast food chain, Portillo’s, could face $150,000 in lawsuit damages for those who got sick from a salmonella outbreak in the restaurant.

Northwestern

  • A new study from Northwestern Medicine reports that the timing, intensity and duration of your light exposure during the day is linked to your weight.
  • Dr. Patrick Kiser, faculty member in the department of biomedical engineering at the McCormick School of Engineering and Applied Science and in the department of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, has invented the first-of-its-kind intravaginal ring that reliably delivers an antiretroviral drug and a contraceptive for months. This could have a huge impact for women, both to protect against HIV and unwanted pregnancy.

A Primer on HIV Treatment as Prevention

Kate Klein, MPH candidate

As I write, HIV experts are meeting at the The International HIV Treatment as Prevention Conference in Vancouver, Canada. Treatment as prevention has become the new and exciting avenue that advocacy, behavior change, and clinical HIV practitioners have embraced in recent years to combat transmission.  But what does the general public know about treatment as prevention? As a lead in to an in depth article on the cost effectiveness of HIV treatment as prevention, written by Adina Goldberger for the forthcoming edition of the Northwestern Public Health Review, I would like to provide here some history and background on the topic.

HIV treatment as prevention was first pioneered by Dr. Julio Montaner and his team in 2006 at the British Columbia Centre for Excellence in HIV/AIDS.  The idea is that if HIV positive individuals are placed on Highly Active Antiretroviral Therapy (HAART) early enough, it will decrease the amount of the HIV virus in their system (their viral load) to undetectable levels. This not only turns HIV into a manageable chronic condition, but it also highly decreases the chance that an HIV positive person would transmit the virus to a sexual partner. Thus, if transmission is decreased than eventually HIV will no longer spread at the incredibly fast rate it once had.

Dr. Montaner and team published a major paper in the Lancet [1] calling for the expansion of access to HAART based on a mathematical model which predicted dramatic declines in HIV prevalence if HAART access were made universal. Over the next few years, Dr. Montaner and his team continued to mount and present evidence for the importance of the model, gaining the attention of UNAIDS and other major health organizations. Picking up on the momentum, in 2009 the World Health Organization published its own model, based on Montaner’s, that calculated that HIV transmission could be virtually eliminated by 2020 in countries with high levels of HIV prevalence. The only catch is that everyone in the community must be tested for HIV infection once a year and then those who tested positive must be provided antiretroviral therapy [2].

UNAIDS2015DeathsAverted

In 2008, the Swiss National AIDS Commission issued what is now referred to as the “Swiss Statement.” The statement asserted that “an HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact”. The statement was originally intended as an authoritative guide for Swiss doctors, in response to numerous prosecutions and convictions of many HIV positive people who had exposed their partners to HIV. The statement was to provide a legal connection for the medical evidence that doctors were to provide in such cases. Thus the Swiss Statement codified that fact that if an HIV positive person had a undetectable viral load, than it would be impossible for them to transmit the virus and could not be convicted of exposing their partner [3].

The momentum continued in 2010, when China became the first country to embrace the model, implementing a country-wide treatment as prevention strategy. The in 2011, the New England Journal of Medicine published the results of a major study [4] conducted by the US National Institutes of Health. The study, conducted in 13 countries, reporting a 96% reduction in the transmission of HIV in those receiving immediate treatment versus those receiving delayed treatment. The study was stopped four years early because it was deemed unethical to deny treatment any longer for the group that was delayed treatment. Since then UNAIDS has signed on to support treatment as prevention, launching the Treatment 2015 framework, which calls for intensified action and innovation to expedite treatment scale-up [5].

Treatment 2015 has set the goal for its members of reaching 15 million people by 2015. The framework has set up three pillars; demand, invest, and deliver. It lays out a plan for national preparedness to “rapidly bring HIV treatment to scale and strategically focusing resources on key settings and populations with high HIV prevalence and unmet need for HIV treatment” [6]. Included in this plan the near universal move to prevent Mother to Child HIV Transmission using what is known as Option B+, a policy which gives HIV-positive pregnant women immediate and lifelong access to antiretroviral therapy, regardless of their CD4 count.

The field of HIV treatment as prevention is still evolving rapidly, but all signs point to a potential game changer in the progression of HIV transmission worldwide. With no vaccine in sight, treatment as prevention is continuing to gain traction as funding and research priorities favor this movement. To learn more about this issue, stay tuned for the upcoming edition of the Northwestern Public Health Review.

References:

[1] Montaner, JS et al. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet. 2006 Aug 5;368(9534):531-6.
http://www.ncbi.nlm.nih.gov/pubmed/16890841

[2] Granich RM et al. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 373 (9657), 48-57, 2009

[3] Swiss National Public Health Office – Clinical Experts and HIV/AIDS Therapy Commission (Translated from French to English)
http://www.edwinjbernard.com/pdfs/Swiss%20Commission%20statement_May%202008_translation%20EN.pdf

[4] Cohen, M et al. Prevention of HIV-1 Infection with Early Antiretroviral Therapy. New England Journal of Medicine. 2011 Aug 11;365:493-505. http://www.nejm.org/doi/full/10.1056/NEJMoa1105243

[5] Columbia Centre for Excellence in HIV/AIDS (BC-CfE). http://treatmentasprevention.ca

[6] Treatment 2015, page 7. http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2013/JC2484_treatment-2015_en.pdf

 

 

Public Health in the News – March 30

Global

National

Illinois

Chicago

Northwestern

  • NU football players were recently granted the right to unionize. The Motley Fool discusses what this means for things such as health care.

Organ Donor Crisis: The Need for New Solutions

by Gregory Tyson, PhD student

In 1950 Dr. Richard Lawler performed the first human kidney transplant in Chicago. This was the first of many pioneering procedures that led to transplantation of livers, hearts, and other organs into human patients. As immunosuppressive drugs were developed and the techniques required for successful transplants were mastered, it was thought that no one needing an organ would be left waiting. Sadly, even as we have progressed into the 21st century, this has not been the case.

Due to such issues as congenital defects, hypertension, and diabetes, organs can stop functioning properly. Modern science has resulted in the invention of dialysis machines, which filter the blood and eliminate waste as functioning kidneys are supposed to do. However, these and other products designed to prolong life are only temporary fixes that do not fully replace the function of healthy organs. As a result, transplantations are needed, which allow the replacement of a failing organ with a functioning one from a living or deceased donor. These transplantations save lives, as half of transplant recipients live at least ten years after receiving a new organ[1].

Unfortunately, organs cannot be transplanted from any one person to another. Instead, donors and recipients must be matched based on blood type and other genetic factors. If the donated organ is not matched properly, the recipient’s immune system recognizes the transplanted organ as foreign and rejects it. This results in destruction of the organ and sometimes death of the patient. Even well-matched organs need to be transplanted with caution, as rejection can still occur and immunosuppressive drugs are usually required. Despite these risks and difficulties, however, organ donations save a considerable number of lives.

Over 120,000 people are currently waiting for organs in the U.S[2]. As just 28,000 transplants are performed annually and over 50,000 people are added to the list each year, the number of people waiting has skyrocketed[2]. This led to the deaths of over 6,500 people waiting for organs last year, and an additional 5,000 people were removed from the transplant list because they became too sick to receive an organ[3]. With so few organs available, the average wait time for a transplant is now over three years[2].

What has caused this organ shortage? It’s simple: there are not enough people donating. One of the reasons is that people have to opt-in to become organ donors, which requires filling out paperwork or signing up online. This requirement likely contributes to the U.S. having an organ donor consent rate of just 40%[1]. The problem is compounded by the fact that when someone’s donation status is unknown, by default they are not organ donors. Switching to an opt-out system, where people are presumed to be organ donors, could drastically increase the donation rate. People would still have the right to choose their donation status, but the default option has a strong pull on a person’s decision to become an organ donor[4]. In fact, all of the European countries that have implemented an opt-out system have organ donor consent rates of at least 85%, whereas those with opt-in policies have consent rates below 30%[4]. In addition, switching to an opt-out system would not require large changes to the current organ donation system that prioritizes need, match of organ, and wait time for organ recipients.

Although switching to an opt-out system would increase the number of available organs, it may not be enough to overcome the current organ shortage. One potential solution would involve permitting a regulated organ trade to increase donation rates among living donors. Family members are rarely matches to their loved ones who require organs, but they would donate if they could. This fact could be used to help willing donors donate to another family in need. The recipient’s family could then donate to the original donor’s family, with these combined donations saving two lives. Due to the complications of organ donor matching, it is unlikely that two families could mutually donate. Nonetheless, computer algorithms could determine if a network of ten people and their relatives could all donate to each other and therefore save ten lives in the process (Figure 1). Although this approach has not been tried in other countries, it could be a practical and safe alternative to the growing black market selling of organs[5].

Figure 1. A potential organ exchange solution. Circles with lines through them are people requiring organs, with nearby circles indicating family members willing to donate. Circles with like colors can donate to each other.
Figure 1. A potential organ exchange solution. Circles with lines through them are people requiring organs, with nearby circles indicating family members willing to donate. Circles with like colors can donate to each other.

In summary, the current organ supply in the U.S. is extremely limited, leaving thousands dying and many others barely clinging to life. Switching to an opt-out donation system and creating a regulated organ trade could immediately increase the organ supply, but these are only short-term answers. As the demand for organs continues to climb, government investment into long-term solutions is needed. These include stem cell research to grow organs in vitro, or limiting rejection from poorly matched donors. Given the current status of the system, we have to hope such scientific advances can help the 21st century solve for millions what the 20th century could only do for a few.

References:

[1] organdonor.gov

[2] http://optn.transplant.hrsa.gov/

[3] Centers for Disease Control and Prevention

[4] Johnson EJ and Goldstein D. Do Defaults Save Lives? Science. 2003 Nov 21;302(5649):1338-9.

[5] Mendoza RL. Price deflation and the underground organ economy in the Philippines. J Public Health (Oxf). 2011 Mar;33(1):101-7.

Public Health in the News – March 23rd

Global

U.S.

  • A new analysis indicates that saturated fat may not be so bad for your heart after all.
  • Kids who have experienced traumatic events are more likely to have behavioral problems. However, new programs such as Head Start Trauma Smart are teaching caregivers how to help children work through intense emotions.
  • A new study shows that the reason some people develop Alzheimer’s may be due to a defective response to stress in the brain.
  • President Obama and staff have been appearing everywhere in the media lately, pushing for people to sign up for health insurance on HealthCare.gov.
  • Drug experts discuss new ways to help combat addiction – they advocate for everything from decriminalization to giving people a drug that combats overdose to actually helping people take drugs within a safe environment.
  • Patients with chronic diseases often take to support groups, and this has become even easier with social media. However, researchers conducting clinical trials should consider that crosstalk between people on the same trial may undermine these trials.
  • Access to drugs used for lethal injections is decreasing. Texas has a new supply, but won’t say where they’re from.

Chicago

  • Researchers at UIC released a large study about the health of Hispanics in Chicago and three other large cities. They found that many people were at risk for, or had, diseases like diabetes and did not know it. Researchers now think that they will be better able to help this population become healthier.
  • Presence Health is selling one of their hospitals on the Northwest Side, Our Lady of the Resurrection Medical Center.

Northwestern

  • NU Professor Paloma Toledo talks about health disparities with Hispanics, both when it comes to pain management and access to health care.
  • “Many nursing homes are bastions of elder abuse and neglect and need to be shaken up and turned around.” NU professor Dr. June M. McKoy talks about abuse in nursing homes.

Public Health in the News – March 16th

Global

  • Rice was genetically modified to contain Vitamin A. Many groups opposing genetically modified foods stopped this “Golden rice” from being introduced to countries around the world. Many people have died or have gone blind since then due to Vitamin A deficiencies.
  • The World Health Organization is making new recommendations for how much sugar adults should be consuming, which many US companies are expected to fight.
  • England is downgrading the importance of doing practical science within schools, while other countries are increasingly emphasizing it.

National

  • Federal officials are proposing sweeping new requirements for American health care facilities — from large hospitals to small group homes for the mentally disabled — intended to ensure their readiness to care for patients during disasters.
  • Registration for the insurance under the Affordable Care Act fell in February for the second month in a row, though the Obama administration anticipates a surge toward the end of March, when the open enrollment period ends.
  • Do activity tracking gadgets really work? and are they worth the money? A New York Times reporter tests 11 different models and shares his experience. Recent research also shows that these devices are better at capturing some types of activity over others.
  • A New York Times opinion piece advocates for drug testing medical professionals.
  • A new blood test may be able to identify Alzheimer’s before symptoms appear.

Northwestern