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Public Health in the News- August 28th, 2016

 

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Oral polio vaccine being administered to a child in Nigeria (courtesy of CC).

Global

  • Nigeria was set to celebrate being polio-free for two years this August. Despite efforts to eradicate this disease, two children in  different parts of Borno state caught the virus and were left paralyzed.Vaccination campaigns have resumed this year after the disease resurfaced and is directed toward areas that may have previously been missed.
  • Responding to the number of violent attacks on physicians in China, researchers organized an initiative to rebuild patient-physician trust with recommendations published in a new article.

 

National

  • Is sitting the new smoking? You may want to get out of your chair to readthis new study published in the American Journal of Public Health. This is the first documented study indicating that standing desks can slow the increase of your body mass index (BMI, a key indicator of obesity) over a long period of time.
  • Attention all contact lens wearers! A recent report published in CDC’s Morbidity and Mortality Weekly Report (MMWR) reveals that nearly 1 in 5 contact lens-related eye infections resulted in serious, sometimes even permanent, eye damage.

 

Chicago/Illinois

  • Health insurance premiums could rise up to 43% on average in 2017 for Illinois residents who buy insurance on the state exchange. Stayed tuned as official coverage rates will be announced October, 2016. Illinois residents can find information about the coverage plans and apply for insurance here.
  •  Fatal Legionnaires’ outbreak in Illinois veterans’ home worsens. State officials have confirmed a third new case of the disease since an outbreak there last year killed 12 people and sickened 54.

 

Northwestern 

  • Lyrica- the Pfizer drug making the grade for Northwestern University. Royalties on the nerve pain and seizure medication have boosted the school’s $10 billion endowment.
  •  SMH..*shaking my head* in disbelief- new research from Northwestern University reveals text messaging improves diabetes prevention in India.

 

Caitlin Pegg, PhD Student at Northwestern University 
Blog Manager


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Design as a Tool for Public Health Innovation

By Amy Schwartz, PhD

Editor’s Note: This blog post was originally published as an article in the new 2016 Summer edition of the NPHR! Our theme for this issue is Design, and how it affects public health. Amy Schwartz, cognitive psychologist and a Director at design firm IDEO, has some ideas on how we can use design to encourage behavioral change.

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Amy Schwartz, Ph.D.

Public Health challenges require systemic solutions that drive change at the individual, community, and societal levels. Design Thinking can help create innovative solutions by inspiring new ways of framing problems and expanding the public health armamentarium with new tools and methods. Design thinking is a problem-solving approach used across design disciplines from product design to architecture. This approach leads to human-centered solutions by direct engagement with end users throughout the process, blending research, design, and prototyping in iterative cycles. Design Thinking has been applied to a wide range of complex problems and helps multidisciplinary teams balance technology, desirability, and feasibility to achieve integrated and effective systemic solutions (see Brown, 2008).

Several conceptual areas from the design domain are especially relevant to Public Health: Visualization and Affordances, Design for Healthy Behavior Framework, and Design Research Methods. I’d like to introduce Public Health practitioners to these concepts to start a dialogue about how we can partner in creating and sustaining innovative solutions to achieve better public health.

 

Visualization and Affordances

John Snow was a physician and is credited with being the father of epidemiology. I would say that he was also a designer. His famous map was an incredibly effective visualization that revealed an important insight into the relationship between cholera cases and drinking water pumps in London. This visual design convinced the city of London that there could be a link between the Broad Street pump and the disease. Visualization is an effective way to present quantitative information so that anyone—even those without scientific training—can take it in. It is a way to tell a story about relationships, and visual storytelling is an act of design.

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John Snow’s Map (1854)

But while visual design was great at getting the city’s attention, it was not enough to change behavior. This required an intervention. It was a simple and effective intervention that did not require a change in belief for the users or an acceptance of germ theory by the scientific community. They removed the pump handle. This uncomplicated intervention was also an act of design.

Door Handle

Poor design requires further explanation

Snow started with a visual design that told a story (the map) and then went to modifying a design affordance (the pump handle). A design affordance is a property of a physical design that engenders a behavior “naturally” – i.e., with little or no learning or instruction.  Don Norman, in his important book The Design of Everyday Things, uses the example of a door that opens in only one direction. If the door has a fixed handle, then it is asking to be grasped and pulled to open the door. This affordance is so strong that we pull rather than push on a door that has the natural design wrong—even if we use the door all the time. (Thus, the need for signs on doors that have the affordance wrong.)

 

 

Odenplan Subway Stairs

Piano stairs at the Stockholm Odenplan subway station!

Thoughtful application of design affordances in the built environment can help drive healthy behaviors. Consider the example of a stairway in the Stockholm Odenplan subway station. Stepping on the stair plays a musical note to encourage use of the stairs over the escalator. This creates a design affordance for walking up the stairs, rather than riding the escalator.

 

Another interesting example of a design affordance was created to address a problem with Alzheimer’s patients. Alzheimer’s patients can wander, get confused, disoriented, and agitated. Many facilities place patients in locked areas or put electronic tracking devices on them. The Benrath Senior Center nursing home in Germany used the affordance of a bus stop as a waiting place in an attempt to solve wandering in a more humane way. They designed an affordance for controlled wandering. Patients can wander around the grounds, but end up sitting at the bus stop as a natural resting place. They are safe to stay there until the staff brings them back to their rooms.

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“Bus station” at the Benrath Senior Center

Design for Healthy Behavior Framework

Visualizations and affordances are relatively simple design tools that help us tell a story about relationships and foster behavior change. But not all behavior change challenges are addressed as easily as taking a pump handle off. Below is a design framework that has been used to develop innovative interventions for more complex behavior change challenges ranging from medication adherence to saving money to preventative health screenings.

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Design for healthy behavior framework (adapted from Klein, Wustrack, and Schwartz, 2006)

This framework is useful for both diagnosing and generating potential solutions to behavioral challenges. Behavior change challenges will differ in where the sticking points are in terms of both the specific challenge and the individual.

Consider a simple example like flossing your teeth. You probably believe that flossing your teeth leads to better health—both dentally and beyond. You have a mental model or frame about how flossing does this. You know what to do. (How many times has the hygienist demonstrated this to you?). You prompt yourself to floss when you brush your teeth by leaving the floss out right next to your toothbrush. But the problem with flossing is with the act. It is awkward and kind of unpleasant. When we do it, it does feel good afterwards, so there is some reinforcement here. But if we want to get more people to floss their teeth more regularly (and not just the week before they go to the dentist), we need to tackle the design of the flossing act itself—not better prompting or evidence that it is important.

Flossing is a relatively simple example. Most health challenges need design responses for many, if not all, of the links in this framework. We want people to get into a virtuous loop of healthy behavior that becomes habit. The Bedsider system to prevent unplanned pregnancy used this framework to drive research and design activities. The final design thoughtfully addresses all of the links through a website, a text messaging system, and print materials.

This design framework can be useful for analyzing public health stories – both successful and unsuccessful ones. Consider the success of the reduction in smoking in the US that has been achieved in the last 50 years.

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Smoking reduction intervention components

Belief that smoking led to health problems was addressed through the 1964 Surgeon General’s report linking smoking to lung cancer. Warning labeling on cigarette packs also drove belief. Additionally, evidence about the dangers of secondhand smoke was important here. Legislation preventing advertising on television helped attack the prompt link. Advertising messaging can be an effective prompting mechanism to drive people to certain behaviors—either healthy or unhealthy. The act link was addressed in multiple ways, through legislation against smoking as well as creation and promotion of smoking cessation methods and medications. Reinforcement is given to non-smokers through lower life insurance.

This framework can help drive better holistic design consideration of all the elements in the creation of new public health interventions. We can also look at unsuccessful interventions and gain insight into where we went wrong.

Design Research Methods

Design research methods inspire new ways to learn about and engage individuals and communities in their health. These methods are mostly qualitative and are adapted from diverse fields like psychology, anthropology, and journalism.

Some relevant design research methods include:

  • Behavioral Archeology: looking for evidence of people’s activities inherent in placement, wear patterns, and organization of places and things
  • A Day in the Life: participants catalog the activities and contexts they experience throughout an entire day
  • Draw the Experience: participants visualize an experience through drawings and diagrams
  • Behavior Sampling: participants record and evaluate their current situation whenever they get a text

These methods can be especially useful when we want to explore and develop a wide range of early design ideas for new interventions. Assessment of the interventions through quantitative research studies should be a later step in the process.

Mad Libs

“Mad Libs” example from Flint community meeting

The US Surgeon General’s Office is currently experimenting with design research and innovation methods. Shown here is an example from a community meeting that was recently held in Flint, Michigan. As community members entered the meeting, they were asked to fill out a “MadLibs” sheet. This was a simple way to “break the ice” and get some input from each community member to feed smaller group discussion and education sessions. Many design research methods engage through participation and can complement the Community Based Participatory Design methods used in public health, expanding the public health toolkit.

 

Partnering to Innovate in Public Health

Public health challenges represent some of the most complex and important issues in any society. There have been many successes, but there is a long way to go. Viewing these challenges through a design lens can lead to new ways of engaging individuals and communities, new insights, and new interventions. Designers are passionate about making change in the world and are eager to partner with public health practitioners to drive innovation.

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2016 (c) Molly Huttner, UIC Biomedical Visualization Graduate Student

Amy Schwartz’s current focus is to bring human-centered design thinking to health and wellness problems today. Amy holds a PhD in cognitive psychology from Yale University.

References:

1. Brown, Tim. Design Thinking, Harvard Business Review, June 2008.

2. Snow, John. On the Mode of Communication of Cholera, 2nd Ed, John Churchill, New Burlington Street, London, England, 1855.

3. Norman, Don. The Design of Everyday Tings, 1988.

4. Klein, D.E., Wustrack. G., and Schwartz, A. Medication Adherence: Many Conditions, A Common Problem. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2006.


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Public Health in the News- August 7th, 2016

pollution NPHR

(image courtesy of CC).

Global

  • A global public health crisis- the end of mercury pollution?? The Australian based laboratory of chemistry professor, Justin M. Chalker, may have a solution. His lab has discovered a novel rubber material- get this… made entirely from waste byproducts-that can filter mercury from polluted air and water supplies.
  • National wealth may not be an indicator of national health. New analyses highlight weaknesses in countries that would otherwise indicate an adequate “wealth-to-well-being coefficient.” 

National

Chicago/Illinois

  • To date there are now 3 confirmed pregnant women of the 46 Zika cases reported in Illinois this year.
  • Even though we may not want to admit it, Chicago summer is nearing an end. Likewise, as are days spent at your local pool; however, public safety in community pools may need to be brought into question. Inspection reports from Chicago Health Department reveal that half (yes, half!) of the Chicago Park District pools have not been inspected yet this year.

Northwestern 

  • In the past two weeks, two major hospital ratings were released for Northwestern Memorial Hospital…. and the conclusions are not in agreement. The question is- how much should the ranking status of a hospital influence a patients selection when choosing a hospital?
  • Northwestern University marketing professor weighs in on new GMO labeling law for small businesses- how much is too much?
Caitlin Pegg, PhD Student at Northwestern University 
Blog Manager


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On the 2016 Olympic schedule: a public health match

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Olympics 2016 banner (courtesy of CC).

by Claire Vernon

Athletes and sports fans around the world­ are preparing for the 2016 Olympic Games which begin this Friday in Rio de Janeiro, Brazil [1] but as we look toward the imminent competition, “off-the-field” issues are at the forefront of the discussion. Public health has risen as a primary concern for Rio 2016 among the more usual speculation on whether the facilities, housing, and the host city itself will rise to support the massive tourism influx of the world’s top athletes and their fans. These public health concerns have been varied, swinging from Zika virus to contaminated water, both in competition waters and at the iconic Rio beaches. While the WHO does not expect the Games [2] to significantly increase the already wide spread of the Zika virus [3], top athletes in golf, basketball, and tennis have decided not to compete in Rio [4] citing both general health concerns and worry over the potential impact of Zika on their own and their families’ health.

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Pollution seen at Cunha canal which flows into Guanabara Bay in Brazil, the venue for the sailing events in the 2016 Rio Olympics (courtesy of CC).

Alarm over water quality has risen as it has become clear that clean water promises have not been achieved as planned. The city’s failure to fully achieve its water sanitation goals presents risk not only to rowers, sailors, and swimmers who practice in and will compete in contaminated waters, but also to athletes and fans planning to visit Rio’s famed beaches as part of their Olympic holiday.

Though unfortunate, public health concerns surrounding major international events are not new. Last year, the NPHR featured a story on the international public health concern over typhoid in Chicago [5] leading up to the 1893 World’s Fair, a story that mirrors the water sanitation dysfunction and public health problems facing Rio. Contention over the methods of quantifying water cleanliness are present in both stories: over a century ago in Chicago, chemical estimates of human waste were being used as an inaccurate proxy for bacterial load; today in Rio, reliance on bacterial chloroform levels as a proxy for pathogenic bacteria and viral load represents a major difference between groups expressing gentle notes of caution and those sounding alarm bells. Use of different testing methods has lead to opposing opinions [6] on the safety of both competition and recreational waters around Rio, and the lack of consensus seems to have only fanned the fire of concern over the potential public health risk from water-borne disease.

We know that Chicago successfully cleaned its water and the organizers took additional precautions in and around their fairgrounds—no typhoid cases were attributed to travel for the 1893 World’s Fair. A secondary benefit was drastic reduction of typhoid among city residents, an outcome that might well have taken years had the international community not publicly chastised Chicago for its inadequate water sanitation infrastructure. As the current international community turns its eyes to Rio de Janeiro for this pinnacle of athletic achievement, we also wait with anticipation for this impending public health event. We certainly hope that improvement is evident both in Zika prevention and water cleanliness for the city’s visitors and its residents; after months of speculation, we will have our answer soon.

References:

[1] Official Rio 2016 Olympic Games website: https://www.rio2016.com/en.

[2] WHO statement on Zika risk at the 2016 Olympic Games: http://www.who.int/mediacentre/news/releases/2016/zika-health-advice-olympics/en/. Accessed 1 August, 2016.

[3] CDC report of Zika cases in the US: http://www.cdc.gov/zika/geo/united-states.html. CDC Zika travel warning for Miami, FL: http://www.cdc.gov/zika/intheus/florida-update.html. Both accessed 3 August, 2016.

[4] Several high-profile golfers pull out of 2016 Olympics citing Zika concerns: http://www.theatlantic.com/news/archive/2016/06/olympic-zika-jason-day/489113/. Top athletes not attending the 2016 Olympics and their stated reason: http://sports.yahoo.com/news/top-athletes-who-are-skipping-the-rio-olympics-142955670.html. Both accessed 3 August, 2016.

[5] Dr. Bronwyn Rae, Water, Typhoid Rates and the Columbian Exposition in Chicago in the Northwestern Public Health Review: http://www.publichealth.northwestern.edu/nphr/2015-v2i2/3-rae.html. Accessed 3 August, 2016.

[6] WHO statement on Rio water pollution and bacterial versus viral testing: http://www.who.int/water_sanitation_health/bathing/statement-rio-water-quality/en/. Viral levels in Rio July 2016 and prior: http://www.independent.co.uk/sport/olympics/rio-2016-water-pollution-virus-risk-danger-swimming-sailing-rowing-chance-of-infection-almost-a7165866.html.

Caitlin Pegg, PhD Student at Northwestern University 
Blog Manager


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Public Health in the News: May 8, 2016

Global

National

Illinois/Chicago

Northwestern

Brian Cheng, B.A. Student at Northwestern University 
Blog Manager


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NPHR Public Health News May 1st 2016

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Image: Courtesy James Gethany   (CC)

Global News

Local News

  • Free timed races coming soon. Whereas timed races in the city have traditionally cost $50.00 a person, this summer, runners won’t have to sweat paying to lace up for a series of new runs at three Chicago neighborhood parks.
  • The Illinois Department of Public health this week confirmed the tenth case of Zika virus in Illinois.
  • A recent study  by Professor Ruchi Gupta of Northwestern published this week in Pediatrics found that food-allergic children from households that earn less than $50,000 a year incur 2.5 times the cost of emergency room visits and hospital stays compared with their peers from families that are in a higher-income bracket.

By Osefame Ewaleifoh


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The Role of Biomedical Visualization in Medicine and Health

By John Daugherty, Program Director for BVIS at UIC

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Cover art for the Spring 2016 Print Edition of the NPHR. 2015 © Wai-Man Chan (UIC Biomedical Visualization graduate student)

Visual Communication for Public Health

Healthcare providers, patients and their families, the public, the media, governments, and non-government organizations all need to be able to converse during a public health threat, but these diverse groups do not necessarily “speak the same language.” A good translator mediates between speakers of different languages, and biomedical visualization specialists can use visualization as a common language to help bridge the gap. A picture is a universal language that transcends not only every cultural boundary but also every conceptual boundary.

In response to reports of Ebola hemorrhagic fever in West Africa in 2014, the Centers for Disease Control and Prevention (CDC) fully participated in an international response to the outbreak. This included educating the general public in the nations of Guinea, Sierra Leone, Liberia, and Nigeria about how to avoid Ebola infection; educating healthcare workers about taking the steps necessary to protect themselves and prevent the spread of the virus; and improving communications between everyone involved [1].

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Figure 1. Poster for Sierra Leone rural population. 2014 © CDC/Dan J. Higgins (2000 UIC Biomedical Visualization graduate)

Visual information specialist Dan J. Higgins, Division of Communication Services for the CDC, was called upon to assist emergency response officials in Sierra Leone. There was a need for posters and handouts showing small care facilities that had been established in local communities, so people could get treated as quickly as possible. Community Care Centers (CCC) had been set up to provide suspected Ebola patients with food, water, oral rehydration solution, antipyretics and analgesics while undergoing tests for Ebola virus disease. Patients who tested positive for the virus were transferred to larger Ebola Treatment Centers [2].

Higgins created a poster depicting a typical CCC unit (Fig. 1). This simple, isometric perspective view of the camp is accurate, yet simple and straightforward. It was created in a hand-done style using bright colors to be easily read by the Sierra Leone rural population (D. Higgins, personal communication, June 3, 2015).

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Figure 2. Illustration for emergency response healthcare workers. 2014 © CDC/Dan J. Higgins (2000 UIC Biomedical Visualization graduate)

The same view of the CCC unit was re-colored and repurposed for healthcare workers (Fig. 2). Camps are divided into red zones and green zones, and the way traffic flows within the camp is very important. The light red zone is where patients enter and are housed while being treated. The darker red zone is for patients who are extremely sick. Healthcare workers in full personal protective equipment (PPE) enter the light red zone through the gate behind the blue building and are required to travel through the “less sick” section to the dark red, “more sick” section. The green zone is where staff work and rest and where the healthcare workers don their PPE and dry them (D. Higgins, personal communication, June 3, 2015).

Biomedical Visualization

Biomedical visualization is a multidisciplinary field that draws upon and integrates subject matter from a variety of disciplines including the life sciences, learning science, medicine, graphic arts, computer animation, immersive multimedia, and computer science. Biomedical visualization specialists use compelling and effective visual language to take complex data and abstract ideas and make them easily understood and tangible.

Information sharing among public health professionals and between those professionals and the public is critical to meeting the health needs of individuals and populations. Key stakeholders in public health may not “speak the same language,” but meaningful conversation can occur with the help of skillful biomedical visualization specialists, who are able to translate complex biomedical information into a visual story that explains and teaches.

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Figure 3. Editorial illustration for The Synergy of Public Health and International Criminal Law in Post-Genocide Rwanda. 2015 © Christine Cote (current UIC Biomedical Visualization graduate student)

While didactic medical illustration is used to teach, the power of editorial medical illustration lies in the way it uses visual imagery, and sometimes visual metaphor, to engage the reader and guide understanding. Editorial illustrations used to support an article in a public health publication can take complex concepts and make them accessible. Captivating images can be used to either illuminate subtleties in the text or boldly reinforce one or more of the main concepts in an article accompanied by the illustration. A medical illustrator is able to extract the “essence” of the text and give the article a visual personality.

Using Figure 3 as an example, the illustrator adopts the symbol of Lady Justice to provide context for an article on international criminal law, public health and Rwanda. Traditionally, Lady Justice is depicted with a set of scales representing truth and fairness positioned above a sword representing the power held by those rendering decisions. Here the illustrator uses the sword to represent the crimes of genocide in Rwanda, which is shown as a flag in the shape of the country. Lady Justice, who grasps a set of scales representing a mechanism for the world’s restorative justice, is embracing Rwanda. The illustration provides a visual summary of the article, but it also evokes feelings of tenderness and compassion, establishing an appropriate tone for the discourse.

Biomedical Visualization at UIC

Founded in 1921 by Professor Thomas Smith Jones, the Biomedical Visualization graduate program (BVIS) at the University of Illinois at Chicago (UIC) is one of only four accredited graduate programs in North America providing professional training for careers in the visual communication of life science, medicine, and healthcare. The program’s unique curriculum attracts graduate students from a variety of disciplines such as medicine, life science, art, digital animation, and computer science.

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UIC East Campus. Credit: Onar Vikingstad

BVIS utilizes the academic resources of multiple departments throughout the UIC campus to support its interdisciplinary studies. A recently revised curriculum strongly emphasizes effective communication and problem solving and provides a solid foundation in medical science, learning theory, and innovative visualization techniques. In addition to illustration and design, course offerings in visualization technology have been expanded to include animation, interactive media, educational gaming, virtual reality, stereography, haptics, and augmented reality.

Close relationships between UIC BVIS and other prestigious Chicago universities and medical centers provide opportunities for student immersion experiences and effective collaboration with peers. For the second consecutive year, BVIS students have had the privilege of contributing editorial illustrations for public health to the Northwestern Public Health Review.

Visual Translators for the 21st Century

We are in the age of visualization. The accessibility of biomedical visualization via mobile devices and other visual displays has made its delivery revolutionary. As part of the healthcare team, biomedical visualization specialists embrace their role as visual translators for the 21st century, leveraging their scientific knowledge and artistic skills to convey complex information for the benefit of everyone in the medical and public health system.

References

1. Centers for Disease Control and Prevention (n.d.). Retrieved from http://www.cdc.gov/ vhf/ebola/outbreaks/2014-west-africa/index.html

2. Plan International (n.d.). Retrieved from https://plan-international.org/about-plan/ resources/news/how-ebola-community-care-units-are-helping-to-stop-the-spread-ofebola/

This article was originally published in the Spring 2016 print edition of the Northwestern Public Health Review. Find other articles from the issue here!


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Public Health in the News – April 24, 2016

Global

  • The Pan-American Health Organization is implementing many emergency relief measures to help build up public health infrastructure in Ecuador following the recent earthquake.
  • Vox has a good explainer of the concept of “R naught” – a number used by public health officials to estimate how many other people are likely to be infected by a sick person.
  • Nearly two-thirds of the world’s unvaccinated children live in conflict areas, says UNICEF.

National

  • What if your therapist wrote a book, and you recognized yourself as one of the psychological cases inside? A psychotherapist talks about betraying his patients’ trust.
  • A recent study looking for “genetic superheroes” who have a certain gene mutation, but not the matching disease, has been widely reported. But this study has one big caveat – researchers couldn’t contact most of the individuals they identified as being resilient because of lack of consent forms.
  • A lot of data from cancer research can’t be reproduced, but there are measures we can take to help this issue.

Illinois/Chicago

  • A mysterious bacterial infection is popping up in Illinois, and has so far resulted in 6 deaths.
  • Would a merger between two large Chicago-area healthcare providers provide consumers with lower healthcare costs or reduce competition in the market? An FTC case against the merger provides an insight into the state of the region’s health systems.

Northwestern

Maureen McNulty, PhD Student at Northwestern University 
Blog Manager


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Finding The First Step: On Seeing Through the Lens of Students, Surprising Finds, and Finding a Way Forward Together

By Anna Maitland, J.D., Schuette Clinical Fellow in Health and Human Rights

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Access to Health students and faculty sit with the Federation Health Board to discuss findings about health issues in partner communities.

“How do you know if you have malaria?” “How often do people get burned in the community?” “How do you get clean water?”

The students lean in, their faces a study of interest, curiosity, and sunburn as they work to decipher the thick Nigerian English of the Health Team of the Nigerian Slum/Informal Settlement Federation, Lagos Chapter. The medical student has been taking copious notes – the diligence of his recordkeeping is later reflected in his report. One of the law students asks a question that she has made sure to ask across all focus groups – “Do women go for malaria testing or treatment when pregnant?” – which leads into a nuanced discussion of the interrelationship between infectious disease and maternal health in Nigeria. The business students keep clear records on perceived and real costs of supposedly free services, pointing out in post-meeting discussions the discrepancies and unpredictable costs of urgent care.

The Nigerian Slum/Informal Settlement Federation is a movement of the urban poor for dignity and development, made up of savings groups in informal settlements and slums in Lagos, Port Harcourt, and rapidly growing to other urban centers in Nigeria. The Federation’s Health Team – about 20 men and women from over 15 different Lagos informal settlements and at least 4 different language/ethnic groups, reflecting Lagos’s tremendous diversity – is fully invested, providing insightful answers while also asking pointed questions that show how hungry people are for information about their health. “Is it true that you can do family planning based on a woman’s flow?” “How do we stop measles?” “Why do I need to get a malaria test when I have the fever, aches, and sickness already?” “Vaccinations are dangerous and can kill us – why would we get them?”

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New friends from Northwestern, Federation, and JEI proudly show off their T-Shirt schwag

The Federation organizes communities through community-level economic empowerment, community-led data collection through participatory slum profiling and mapping, and strong inter-community solidarity and advocacy around shared challenges and priorities. This movement is supported by Justice & Empowerment Initiatives (JEI), a Nigerian NGO I co-founded with colleagues Megan Chapman and Andrew Maki in 2014, which provides grassroots legal empowerment to Federation member communities by training and supervising a network of community-based paralegals, providing free legal services and supporting community-led advocacy. During my years with JEI in Nigeria, I had spent a great deal of time with community leadership, women’s groups, savings groups and other stakeholders working on key community priorities such as stopping forced evictions, addressing police brutality, and helping communities access basic services such as water and electricity. However, while we at JEI understood that our partner communities face major health challenges – working to respond to and record the issues experienced by evicted communities, we had seen the brutal health consequences and deaths caused by displacement in already fragile health environments – responding to such challenges had never been possible as we lacked meaningful partnerships with health advocates. Thus, while I had a sense that health education was low, reliance on traditional medicine high, and access to hospitals was sporadic at best, deeply understanding and tackling these issues had never before been a focus.

In July of last year, I transitioned from Nigeria to Chicago for the inaugural Schuette Clinical Fellowship in Health and Human Rights at Northwestern Pritzker School of Law. The fellowship offered a unique opportunity to learn more about legal protections for health while supporting the work of the Access to Health Project (ATH). Co-founded by Prof. Juliet Sorensen and Dr. Shannon Galvin, ATH is an inter-disciplinary clinical program focusing on global health that was born from the realization that universities must help prepare students to become global citizens. Bringing together law students, business students and medical students, ATH partners with local NGOs and health-poor communities to research and together generate realistic, targeted, and innovative ways to address barriers to health.

From creative radio and alternative employment strategies in the struggle to stop female genital cutting in Mali, to conducting feasibility studies to help a resource-poor clinic stay open in Sudan, and working with health care providers in the Dominican Republic to form a coalition to streamline and enhance outreach efforts to bateys (neighborhoods made up predominantly of the Haitian-descendent minority), ATH has an impressive track record. From the moment I applied for the Schuette Fellowship, I hoped that ATH would be able to partner with and serve as a resource for Lagos communities.

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Bimbo Oshobe of the Federation explains why Access to Health is visiting, and asks people to share their stories.

And here I was, seven months later, in Lagos with ATH – Prof. Sorensen, Dr. Galvin, three law students, two business students, and a fourth year medical student – sitting in the JEI/Federation offices, talking to the newly constituted Health Team, and realizing with a shock just how little I had known about partner communities’ health issues. This was the last day of our trip, and I had learned a lot during our week in Lagos thanks to the inquisitive students and engaged community focus groups. Always game for what the day would bring, the students and professors had been enthusiastic, intrepid, and curious through 10-hour days in 90-degree weather, adjusting to the intense traffic and sometimes harrowing transportation of the largest city in sub-Saharan Africa (~23 million people).

Community members had been far more open in responding to sometimes deeply personal questions relating to HIV/AIDs, family planning, water/sanitation, fire safety, and diseases like malaria and measles than I had expected. I was even more amazed by the sheer number of people who made themselves available to discuss health issues, which spoke to the depth of their concern and interest in finding solutions. In the space of just six days, our team visited 10 different communities, engaged with at least 300 people through focus groups on different topics, and even found time to meet with the Lagos State Ministry of Health, the Provost of the College of Medicine at the University of Lagos, several health-related NGOs and doctors, traditional birthing attendants, and other health services providers. I felt an overwhelming gratitude and sense of honor to the number of people who had invited us into their communities, their homes, their lives, and their personal stories.

As the week had progressed, the focus groups had more and more often turned into basic health training sessions, with the health questions asked by the community conveying more than the answers to the questions we had asked. Watching as interviewees turned the meetings into a chance for them to get what they needed reminded me, again, of how resilient Lagosians must be to survive in this environment.

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Women from Otodo Gbame – a community that recently lost over 35 children to measles – get ready to discuss health and the things that prevent them from accessing health care.

We learned through these conversations that communities already understood that the extremely poor sanitation available in communities built on trash, with toilets hanging over the lagoon and limited access to clean drinking water and electricity, was directly related to their poor health outcomes. However, they struggle to find tenable solutions in the face of government threats of eviction, marginalization, and absence of most public services. It quickly became clear that hidden costs, fake medicines, and wrongly diagnosed illnesses were doing as much to harm access to health care as poor infrastructure, low education rates, and discriminatory doctoring. And, while I was not surprised by community member’s mix of correct and incorrect knowledge (yes, some people believe malaria is brought on by the sun, but they also know it is brought by mosquitos and that nets would be a good idea), I was unprepared for some of the misconceptions (e.g. HIV/AIDs could be transmitted with a hair comb or by mosquitos) and the general bias against formal medicine (e.g. vaccines kill children).

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After a long morning discussing HIV/AIDs transmission, family planning, fire, sanitation and infectious disease, we prepare to go tour local pharmacies in Tarkwa bay.

As I listened, I expected everyone – students, professors, Federation members, JEI – to become discouraged, to see these seemingly insurmountable odds and wonder how to even begin. After my time with JEI, I knew that sometimes you just have to start – take one thing, start working and then take on another, taking strength from small successes along the way. However, addressing barriers to health seemed different from the other work I had supported, with more dire and immediate consequences. And for a moment, sitting and discussing the week’s outcomes, I felt overwhelmed, angered, frustrated, and deeply saddened.

Then, one of the members of the Federation’s health team stood up and asked a question about family planning and another member stood up and gave an answer they had learned during one of the focus group sessions earlier that week. Another person began talking about how better toilets could change things for their community – make it more formal, cleaner, healthier – and I remembered the ATH student who had researched water/sanitation asking focused questions about this issue all week long. And I saw a starting place – one that would take time to grow and mold, but the beginning of a series of new community-owned processes around education, development, and empowerment. A step supported by students learning the meaning of global citizenship, a University invested in global health, and an NGO and Federation ready to make it happen. And I knew this had been a successful week.

 


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Public Health in the News- April 17th, 2016

Global 

  • Will yellow fever gain a foothold in Asia? “… if it does it would be a public-health disaster,” says an expert on mosquito-borne diseases at Duke-NUS Medical School in Singapore.
  • Starting today, 155 countries around the world will switch to a new polio vaccine in an attempt to make polio the second human disease eradicated.
  • Is a water shortage in our not too distant future? Recent studies reveal a startling conclusion– by the year 2050, half of the world’s population may be facing what scientists are calling a “high risk of severe water stress.”

National

  • CRISPR-Cas9 genomic editing: from bench to supermarket shelves. The USDA will not regulate a mushroom genetically modified with CRISPR to resist browning.
  • The quest to uncover novel compounds intended to prevent and treat Alzheimer’s disease is an increasingly pressing public heath concern. A recent NOVA documentary provides a glimpse inside the lives of both patients and caregiver’s.
  • Porn- a private matter or a public health crisis? Scientists take a health-focused view of porn illustrating that “exposure to and consumption of porn threaten the social, emotional and physical health of individuals, families and communities.”

Chicago/Illinois

  • Mayor Emanuel announces plans to work with Covenant House International to expand shelter for homeless youth in Chicago.
  • A water-testing program will be re-instated as a proactive measure to protect the health and safety of Chicago residents.

Northwestern 

  • As of Fall Quarter 2016, Counseling and Psychological Services (CAPS) will be lifting its current 12-session limit.
  • Northwestern researchers have developed a tool to protect coral reefs around the world from climate change
Caitlin Pegg, PhD Student at Northwestern University 
Blog Manager
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