Doctor brain drain costs Africa $2 billion

It is very unfortunate and somewhat ironic that the areas that need health care workers the most are the areas where health care is not only lacking, but also getting worse. With high prevalence of deadly diseases like HIV, TB, and malaria, doctors are of great necessity in sub-Saharan Africa. However, successful doctors that originate from sub-Saharan Africa often leave the continent and search for better opportunities in developed countries like Britain, Australia, and the US. This leaves sub-Saharan Africa with an ever increasing need of physicians and also short on funding as the governments spend thousands of dollars to train each doctor.

On one side, it could be argued that the doctors are at fault for leaving their region that is in dire need of help. On the other hand, the doctor’s right to migrate must also be considered. Being a physician in sub-Saharan African can be very challenging, thus there is a push for the physicians to find a new place to practice with better reward. The medical facilities in Africa are often lacking and because of the limited amount of health care workers, the workload can be very draining. In addition, funding is short so they are likely not to be well financially rewarded.

A way to remedy the cost of the doctor brain drain in Africa is by somewhat modeling the medical school finances of the US. Aspiring physicians in Africa should be required to fund medical school on their own, or sign a contract with the government for several years in a certain region if they would like their medical school to be paid for. This way, physicians in Africa are at least incentivized to serve their nations once they are done with their education.

The article can be found here: http://www.reuters.com/article/2011/11/25/us-african-doctors-migration-idUSTRE7AO00O20111125?ca=moto

Emerging Infectious Diseases: Security Implications, Lecture by William Laegreid, Professor of Pathobiology UIUC

Emerging diseases are “infections that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range”. Human emerging diseases include previously unobserved diseases like SARS, disease agents that have acquired new properties like MDR Mycobacterium tuberculosis and E. coli, and diseases that are increasing in prevalence and range like Lyme disease and West Nile virus. The dangerous outcomes of emerging infectious diseases prove to be more dangerous than ever now due to globalization.

In his presentation, Laegreid included a chart of international travel from 1950 to 2010. Up until 1960, there were less than 100 million international tourist arrivals per year. It has grown exponentially since and in 2010, international tourist arrivals reached 1000 million per year. International travel has such a significant impact with the spread of infectious disease now that there are computer systems that calculate flight paths to predict where certain infectious diseases originated and would show up next. For example, with the SARS epidemic, it was determined that it originated from Hong Kong and then predicted to China, US, Australia, Canada, the UK, and Germany quickest, in under 6 weeks. From there, these systems can use probability to predict where the virus would end up next based on flight paths so that the respective countries can prepare ahead of time for the epidemic.

It has been almost a decade since the SARS epidemic and tourist rates are still on the rise, meaning the chances of new emerging diseases spreading even quicker is very high. Using creative systems like this allows nations to plan ahead and becomes an essential factor in reaching adequate public health measures for an infectious disease outbreak.

Policies, Barriers, and Incentives for Skilled Labor Migration

On Wednesday, November 9th, I attended the workshop “Policies, Barriers, and Incentives for Skilled Labor Migration and Immigration: Healthcare as a Special Case”. Many notable individuals coming from universities and institutes around the country came together to discuss the case of skilled worker immigration in healthcare. In this specific workshop, the individuals are considering the issues, barriers, challenges, opportunities, and ethical considerations for recruiting and retaining immigrant health care workers. One of the biggest debates throughout this workshop was the importance of skilled health care worker migration vs. immigration.

The speaker that touched greatly on worker migration vs. immigration was Diana Vellos Coker. She discussed the possibilities of migration for doctors and nurses and visa limitations. Most of the visas that are available to nurses are in the form of temporary visas. The process to get a green card, however, is a very long, drawn out process. There is initially a visa screening process to ensure that the nurse’s credentials are appropriate. First, they must have a visa that is valid for 5 years and this must stay current. They also must pass and English requirement, and finally be able to prove that they have a certain skill set to bring into the US. Then, depending on the country of origin, many nurses must wait 8-15 years to receive their green card. However, during this time, they are recommended not to leave the US because then their visa status can get reevaluated which would not qualify them for the green card anymore. The barrier to leave the US can prove to be very difficult if they have other family members in their country of origin, but if went against it, they would lose their chance of immigrating. In the past, this green card process has taken only 3 months, so much has changed throughout the years.

Another argument that was brought forward regarding immigration practices is the necessity of these immigrant health care workers. Currently, it is not a shortage of nurses that cause the problem of health care within the US, but rather a geographic misdistribution. There is a severe lack of health care workers in medically underserved areas, or rural areas, and also in long term care facilities. This is due to poor work environments, high turnover rates, and a lack of faculty to prepare nurses. If immigration laws were to provide a green card incentive for working in such areas, then it is likely that this health care issue can be mended. Otherwise, many of these immigrant nurses are just going into areas that don’t necessarily need the extra work force. Unfortunately, putting in place any sort of immigration incentive is a very abstract idea and is not likely to pass, so immigrants will still have to withstand long immigration processes and their immigration will not be used to solve the health care maldistribution issue.

Global health fund uncovers $20 million more in losses through corruption in new probes

The Global Fund to Fight AIDS, Tuberculosis, and Malaria, the international financing organization founded by Bill Gates, has now uncovered over $73 million in losses due to corruption across several countries. Three recent cases, in Nigeria, India, and Mauritania, has raised overwhelming concern about the accounting practices exercised by the countries that have been receiving grants. For example, in the case of corruption of India, at least $872,000 of the Global Fund grants have been transferred to another corporation and used to rent and renovate an official’s home.

The Global Fund is a highly reputable organization that has saved 7.7 million lives. Since its creation in 2002, governments globally have pledged $28.3 billion. Unfortunately, when a high proportion of the money is sent directly to countries with corrupt governments, the amount of corruption with the funds that has been found is not too much of a surprise.

Unfortunately, with the findings of the millions of dollars that has been lost through corruption, many governments have or considered withholding their pledges to the Global Fund. Germany had initially withheld their pledge of $285.7 million. Without those funds, the Global Fund calculated that to lead to the deaths of 43,000 people. The European Commission and Denmark have still withheld their pledges. Spain, Italy, Japan, and Ireland are also conflicted with a decision about their pledge, and have withheld a proportion of it.

With such a high amount of funds being lost to corruption every year, these countries have every reason to doubt their pledge to the Global Fund as their funds are not being distributed as intended. However, without such funds, many individuals will die due to the treatment that this organization is able to bring to individuals. It is clear that monitoring policies need to be enforced more, directly where the funds are being sent; otherwise an essential financial component of international health will be missing and many lives will be lost to preventable diseases. Unfortunately, such a large change of monitoring policies can be very difficult to instate since the funds are distributed across all different regions across the world.

The article can be found here: http://www.washingtonpost.com/world/europe/global-health-fund-uncovers-20-million-more-in-losses-through-corruption-in-new-probes/2011/11/01/gIQA0NW7cM_story.html

Search for malaria and tuberculosis vaccines put on fast track by UN partnership

Thanks to a newly developed partnership launched between the United Nations and pharmaceutical companies, the search for malaria and tuberculosis vaccines has been made easier, with hopes of speeding up its development. The UN World Intellectual Property Organization (WIPO) has a virtual global health research community, WIPO Re:Search, which allows the sharing of intellectual property. Through this virtual community, pharmaceutical companies, non-profit BIO Ventures for Global Health (BVGH), and public and private sector organizations will be able to share intellectual property pertaining to the research and development on malaria, tuberculosis, and other neglected tropical diseases.

Because the vaccines of such diseases, once developed, must be distributed at such a very low price without a profit margin, the research towards its development will also be made royalty-free. As of right now, there are over 10 organizations that are involved in this research community, one of which includes GlaxoSmithKline, the pharmaceutical company that developed the first viable malaria vaccine in major trials. The WIPO Re:Search community serves to connect these organizations so that they are working together in developing vaccines that are vital in developing countries. Hopefully, this collaboration will still encourage such companies to work with the same fervor they’ve had before, rather than create a bystander effect.

The development of vaccines for malaria, tuberculosis, and other tropical diseases has the potential to save over billions of lives in this generation and future generations, and also has the potential to eradicate the diseases altogether. With such a large search initiative put into place with the UN, there are hopes that we have come a lot closer to such a globally vital development.

The article can be found here: http://www.un.org/apps/news/story.asp?NewsID=40205&Cr=malaria&Cr1=

World's first malaria vaccine works in major trial

In just this past week, it has been announced that the first ever malaria vaccine is successful against clinical and severe malaria in five to 17 month olds in sub-Saharan Africa through major trials. This vaccine, which has been in development for 24 years, has shown to halve the risk of infection in a study in Africa. Through the success of the study, it becomes more likely that there will be a version available to the world by 2015.

One of the major barriers of making a vaccine effective, cost, will be minimized as well. The cost of the vaccine will only be the cost of manufacturing and an additional 5% to go back into tropical disease research, so the company is not expecting to make any money from this project. The altruism of this company provides a positive outlook towards pharmaceutical companies, who normally get a bad reputation for marking up vaccines and medication. Unfortunately, even with the barrier of cost eliminated, accessibility will still hold as a barrier and will be more difficult to minimize.

However, once the vaccine is put into use worldwide, the risks of getting malaria will be greatly minimized. Because mosquito bites are inevitable, malaria is one of the most difficult diseases to prevent. Although there have been uses of pesticides, mosquito nets, and other methods of prevention, the use of a vaccine is undoubtedly the most effective method.

There are about 300-500 million cases of malaria each year, and 1 million annual deaths due to malaria, making malaria a high incidence disease, and thus a target towards goal 6 of the Millennium Development Goals. With the development of the malaria vaccine, we are finally going in the right direction towards reaching this goal.

The article can be found here: http://www.reuters.com/article/2011/10/18/malaria-vaccine-gsk-idUSL5E7LI4O020111018

Food Safety and Biosecurity Lecture by Dr. James M. Slauch, Dept of Microbiology UIUC

Food and water have always been culprits of many lethal illnesses globally. As the world moves to more industrialization and globalization, a wider spectrum of food-borne illnesses have emerged. In this lecture, Dr. Slauch introduced the nature of some of the organisms that cause food-borne diseases, possible remedies, and new emerging infections.

One of the oldest diseases that come from food consumption is typhoid and cholera. These diseases are transmitted through water, a vital component to food preparation. Dr. Slauch presented research that had been done tracing back to the 1800s in Philadelphia. At that time, there were 1,000 cases/year, and by 1906 the number of cases had reach 10,000 per year. However, once filtration and chlorination processes had been added to the water systems, numbers dwindled in just one or two decades to almost no cases. With historical evidence of the effects of filtration and chlorination, developing nations should use these methods in their water systems to prevent many unnecessary cases of deadly diseases that end up being more costly to care for than a change in basic infrastructure.

A new emerging issue with food production that Dr. Slauch presented is the role of globalization and food production and distribution. Food now is shipped all around the world. Just with food items in the US, 80% of fish/shellfish, 45% of fruits, 15-20% of vegetables, and 50% of nuts are imported. Over 99% of this food is left uninspected and untested, which can raise great concerns for food safety. In the 2007 E. coli outbreak in burgers, 940 people in the US became infected. When tracing back the production of these burgers, it was found that there were parts of the burger that came from 3 different states within the US, but there was also a part of the burger that was processed in Uraguay, making the E. coli source very difficult to determine.

The food industry has undoubtedly become a global entity, which makes it even more difficult to govern and ensure safety during consumption. The most easily applied method to lower the risk rate of most infections in all nations, however, is proper food handling and preparation, and this must be conveyed by furthering education on such procedures.

The Power of 1%: What Americans Get for Investments in Global Health

High level officials from U.S. agency for International development and other government officials have met to discuss the impact of U.S. investment in foreign aid. This investment is supposed to have an effect on improving the lives of people, developing new foreign markets and protecting the U.S. from infectious disease. It supposedly believed by the American people that about twenty-five percent of the federal budget is invested into foreign aid. However the accurate figure is actually to be less than one percent. Leaders from different organizations have met to launch the power of 1%, which is meant to give people a better understanding how U.S. investments in foreign aid will help Americans back at home.

By investing in foreign aid to help improve the health of the international population, there is shown to be a correlation in growth of the economy and security. This is due to higher productivity levels, which saves money and ultimately benefits American Companies. Also by investing in reducing the spread of infectious diseases in other countries, this will help Americans from these diseases as they are less likely to spread across borders.

This article emphasizes the correlation of global health with the global economy, a correlation that many Americans may not recognize. However, it has been proven in the past that genes and germs follow our trade and travel routes. By using money from the US funds to prevent AIDS in Africa, we are essentially reducing the risk that AIDS will travel to the US. This correlation is true for many other dangerous infections abroad like malaria, TB, and H1N1, just to name a few. As more Americans recognize “The Power of 1%” and how it directly affects them, there is the expectation of greater support towards global health investments.

The article can be found here: http://www.marketwatch.com/story/the-power-of-1-what-americans-get-for-investments-in-global-health-2011-10-03

Denmark Institutes Fat Tax

Today marks a monumental step in global health, using money as a weapon against the crisis of obesity. In the past, “sin tax” has been heavily associated with alcohol and tobacco, but starting today in Demark, it will also begin to include a “fat tax” on staple items like butter, ground beef, and other saturated fats. Overall, the government is levying a tax of 2.5 Euros per kilogram of saturated fat, or $1.60 per pound. Because this is the first time a ”fat tax” has been levied, new data is expected to arise from this to see whether this rise in the cost of fats will make an impact in combating obesity like the “sin tax” has been effective against cigarette consumption.

Obesity is an ever growing concern, as the WHO announces that since 1980, worldwide obesity has more than doubled. The total number of those who are overweight is 1.5 billion, which is about 22% of the entire world population. This disease of obesity is also highly correlated with some of the world’s most deadly diseases like Type 2 Diabetes, heart disease, hypertension, and the list goes on.

The newly instated “fat tax” is now taking a new, passive route in targeting this preventable disease. If it is proved to be successful, it will be much easier to pass laws globally that will increase the price of obesity causing foods, rather than trying to make health outreach initiatives that reach the global population. On the flip side, this could just negatively impact the economy and drive the prices of other goods up as well. To see the effectiveness of this approach, we will have to wait several years for results.

The article can be found here: http://www.globalpost.com/dispatch/news/regions/europe/110930/denmark-health-fat-tax

Leaders vow to cut deaths from chronic disease

The World Health Organization has plans to target the leading causes of death globally - cancer, diabetes, and heart and lung disease. 36 million of the 57 million global deaths in 2008 were due to these diseases and of them, 9 million individuals were under 60. Out of the 9 million, 80% of the deaths were in developing countries. What the article also states is that many countries are already taking action to address these health issues by taking actions against the lifestyle habits that cause the diseases like smoking, excessive drinking, lack of exercise, and unhealthy diets.

These statistics just go to show how poverty is a causation for poor health conditions, as such a high number of individuals face death under 60. Also, although many countries have taken action to address the health issues, it is more than likely not the developing countries that have enforced such actions. The more developed countries have health resources, preventative health measures like cancer screenings, enforced legislation like minimum smoking ages, and many other health initiatives in place to combat these diseases. With these factors together, we can extrapolate that there is a greater chance that individuals can live to an older age even with these deadly diseases in a developed country over a developing country.

World leaders are now trying to take more initiatives in both developed and developing countries to address this crisis. Developing countries are taking legislative actions that developed countries have taken already and developed countries are giving aid to developing countries to ease this process.

The article can be found here: http://www.businessweek.com/ap/financialnews/D9PSV7E01.htm

Tackling pneumonia in Liberia

Pneumonia in developing countries is the leading cause of death for children, which can be seen in the video clip "Tackling pneumonia in Liberia". This video helps those from more developed countries visualize the poor living conditions and struggles faced in developing countries. What is considered a home to many Liberians would probably be classified as uninhabitable in developed countries. The ordinary things that many people in developed countries take for granted, like a sturdy roof, are the things that are lacking in developing countries, which is why curable diseases can result in high fatality.

Liberia has high hopes for curbing these diseases, not through changing infrastructure, but by administering a pneumoccal vaccine against pneumonia for infants. Although this vaccine will undoubtedly help save a few lives, its effectiveness is still uncertain. One major problem that Liberia will face is spreading the vaccine throughout its population. Many villagers lack viable access to health clinics, and those who do have access may not understand the concept behind the vaccine. Ensuring that an adequate population of Liberia receives the vaccine will be a major hurdle.

The video clip can be found here: http://www.guardian.co.uk/global-development/video/2011/jun/10/liberia-pneumonia-vaccine-video

At risk: Millennium Development Goal 4-Reducing Child Deaths by Two Thirds

The Millennium Development goals are a series of goals set by the UN that address the world's major issues and steps towards solving them in the start of the 21st century. Goal 4, specifically, is addressed towards reducing the child deaths by 2/3 from 1990 to 2015. This parallels one of the major issues with the developing world that has been discussed throughout class. The article states that although efforts due to this goal has helped increase the likelihood of survival for young children, lack of access to neonatal care is causing a high proportion of deaths among babies less than four weeks old.

It seems as if solutions to this problem is simple - provide improved hygiene, breastfeeding, and warmth to babies. In the developing world, however, many families don't have the resources to provide these simple solutions of care for their child, nor are they educated to take such measures.

Although the solutions are clearly identified, what seems to be lacking is specific plans of actions to help facilitate the achievement of this goal in just under 4 years. It will be interesting to see how the UN plays a roll in pushing to reach this goal internationally in this short time period.

The article can be found here: http://www.guardian.co.uk/global-development/2011/aug/31/millennium-development-goals-newborn-deaths