Global Health Ideas

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Archive for the ‘Food for thought’ Category

Of Pandemics, Fear, the Facts and You

It seems that an influenza virus can survive on money for up to 10 days, and the New York Times has an interesting article on modeling virus spread on dollar bills.

But one thing remains true: “People have a very weird perception of large numbers,” [Dr. Brockmann] said. “If you have 2,000 cases of flu in a country of 300 million, most people think they’re going to be one of the 2,000, not one of the 299,998,000.”

I think people have a wierd perception of risk, and that is often influenced by media attention. Which reminds me of a memorable article from the New York Times Op-Ed page in 2003 – remember West Nile Virus? “Never Bitten, Twice Shy – The Real Dangers of Summer” by Ropeik and Holmes.

Never Bitten, Twice Shy - The Real Dangers of Summer (2003)

Never Bitten, Twice Shy - The Real Dangers of Summer (2003)

Yes, the graphic is not perfect (see this critique at Edward Tufte’s blog), but does get across the idea that risk perception is not always influenced by the facts. And is expanded in this article in Health Affairs “Dealing with the Dangers of Fear: The Role of Risk Communication” by Gray and Ropeik.

Ok, but what about the facts? The fast moving breaking news often plays fast and loose with the truth, and can spread alarming information. Early reports of the swine flu in Mexico seemed to have extremely high mortality reports, especially among young adults. Now, with new evidence of confirmed cases, the virus is looking alot milder. When I first read that influenza virus could survive for 10 days on money, I thought it was another casualty of the truth, as the avian-human-swine flu reported in a press briefing by the CDC. However, in this case, the facts seem to check out (Survival of Influenza Virus on Banknotes, Thomas et al), unlike the potluck origins of the swine flu which ProMED reported to be, upon closer examination – just swine flu.

More on risk perception:

Here’s a conversation with David Ropeik in the New York Times, and he wrote a book with George Gray – Risk: A Practical Guide for Deciding What’s Really Safe and What’s Really Dangerous in the World Around You

Reckoning with Risk: Learning to Live with Uncertainty – Gerd Gigerenzer

Can’t get enough of risk? Check out the Risk-0-meters and calculate your own health risk at the Harvard Center for Risk Analysis

Written by farzaneh

May 4, 2009 at 10:44 am

Graphic Stats: How to (Mis)Tell a Story

How one communicates a message is critical to what you are trying to accomplish. It amazes me how little upfront investment some organizations/campaigns put into this kind of thing. This recently came to mind when I saw the work of Toby Ng, who has “used information graphics to re-tell the story in another creative way” with the commonly used theme – if the world was 100 people then…Some examples below:
badstatsq1
HT (The Atlantic)

Cautionary Note and Counterpoint
The comment thread at Flowing Data suggests an alternate critical argument about using this  technique  because it is not a “serious attempt to convey information” and it is easy to distort data when you manipulate in such a manner. I am not a graphic design expert and I haven’t read Tufte but this is certainly a fundamental principle (don’t distort the data). Given this warning, this specific style is attractive and can be useful depending on the audience and the goals you have. There is a lot more that can be said on this theme and it would be great to have global health folks brainstorming different ways of communicating messages beyond doom and gloom.

For some inspiration and ideas check out sites like Flowing Data and Jaspal’s previously related post on “Why Bad Presentations Happen to Good Causes“. For audio visual storytelling the talk by Hans Rosling at TED 2006 is a global health classic that pushes us to be more creative story tellers. This has to be one of the best global health videos I have ever seen (which we posted 2 years ago):

Written by Aman

April 21, 2009 at 9:37 pm

Internet: Revolutionizing the Detection of Disease Outbreaks

First, a bit of housekeeping – we are tinkering with the look of the blog and considering moving it to another platform, if you have any feedback about what you like and don’t like, let us know.

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Published today in the CMAJ, Early detection of disease outbreaks using the Internet, is worth skimming:

“The Internet…is revolutionizing how epidemic intelligence is gathered, and it offers solutions to some of these challenges. Freely available Web-based sources of information may allow us to detect disease outbreaks earlier with reduced cost and increased reporting transparency. Because Web-based data sources exist outside traditional reporting channels, they are invaluable to public health agencies that depend on timely information flow across national and subnational borders. These information sources, which can be identified through Internet-based tools, are often capable of detecting the first evidence of an outbreak, especially in areas with a limited capacity for public health surveillance.”

The limitations section includes the below list, but I wish they went into much more detail about what the internet is not good for (probably detecting trends among the elderly for example) and more examples of misinterpreting the data. On a related note to using ICTs for surveillance, Jaspal wrote a fairly detail post on Google Flu Trends that you should also check out.

disadvantages

Written by Aman

April 14, 2009 at 9:48 pm

Art for Global Health

art_condom-dressesI recently discovered the UCLA Art|Global Health Center, the mission of which is to “unleash the transformative power of the arts to advance global health“. The arts have the ability to capture issues and tell a story in a way that can make a profound impact on our (social) consciousness and is not something we talk about enough as a tool. One of the more famous examples of this is the AIDS quilt which was conceived of in 1985 by an AIDS activist in memory of Harvey Milk. That quilt has had over 14 million visitors and is the largest community arts project in the world.

The UCLA center has some ongoing projects and last year opened “Make Art | Stop AIDS” that featured traditional art as well as things like condom dresses. Make Art/Stop AIDS “is organized around a series of seven interconnected and at times overlapping concerns expressed in the form of open-ended questions, some of which include direct art historical references to the epidemic: What is AIDS?; Who lives, who dies?; Condoms: what’s the issue?; Is it safe to touch?; When is the last time you cried?; What good does a red ribbon do?; Are you angry enough to do something about AIDS?; and, finally, Art is not enough. Now it’s in your hands.”

Creative art projects have the ability to move the human mind unlike the constant barrage of issues, numbers and headlines that desensitize us over time. If you have seen or heard of any interesting arts based global health projects let us know.

More Sources
Adriana Bertinin’s condom dresses

Addressing HIV/AIDS-Related Grief and Healing Through Art

History of the AIDS Memorial Quilt

Condom fashion show, China

Written by Aman

April 13, 2009 at 9:49 pm

Vote for mHealth Project: ClaimsMobile in Uganda

Please vote for Ben’s mobile payment for health systems project. Voting closes Friday.

VOTE – NETSQUARED: By introducing a smartphone and web-application system for submitting and reviewing claims, we hope to reduce the delays and errors, increase clinics’ profitability and improve communication. Below is a related post by Melissa Ho who is working with Ben on this project which fills a critical gap. Cross posted from ICTDCHICK:

First HealthyBaby Birth

The mother receives the baby from the nurses at the clinic.

The mother receives the baby from the nurses at the clinic.

As I have been pre-occupied with writing lectures for my class, and setting up my research, my collaborating partners at Marie Stopes International Uganda have been busy launching a new phase of the output-based aid voucher program, financing in-hospital delivery of babies, in addition to the in-clinic treatment of sexually-transmitted infections (STIs). The new program, called HealthyBaby is eligible to mothers who qualify under a specific poverty baseline and covers four antenatal visits, the delivery, and a postnatal visit. Last week they just started distributing vouchers, and this past weekend was the delivery of the first baby whose birth was covered by the program.

Like the HealthyLife program, the mother purchases a voucher for 3000 USh (approximately 1.50 USD, the HealthyLife program charges 3000USh for a pair of vouchers treating both sexual partners). The voucher then can be broken into several sticker stubs, one of which is submitted with a claim form on each visit.

The first mother puts her thumb print on the HealthyBaby claim form

The first mother puts her thumb print on the HealthyBaby claim form

The hospital then submits the claim form with the voucher to the funding agency (my collaborating organization), who then pays the hospital for the cost of the visit – labs, any prescriptions given, the consultation fee, etc. You can see in the picture to the right the nurse filling out the paper form and the mother putting her thumbprint on it. Filling out the forms can be tedious and error prone – this particular clinic had almost 18% of their STI claims rejected for errors last October. In the same month another clinics had 38.6% of their claims rejected. I am trying to work on digital systems that can help improve communications between the clinics and the funding agency, and also decrease the cost and burden of claims administration.

The Claim Mobile project actually focuses on the HealthyLife program – the STI treatment program, rather than the HealthyBaby program, but I hope to demonstrate the sustainability and replicability of the system that I’m developing by training the engineers here to retool my system for HealthyBaby – so by the time I leave, I am hoping it will be in place for both programs.

By coincidence, this first birth occurred in one of the two clinics where I’m running the pre-pilot of the Claim Mobile system.

Written by Aman

April 8, 2009 at 10:07 pm

World Health Day: The Future of Global Health

The WHO has decided to focus this World Health Day on hospital infrastructure during times of emergency. The folks over at Global Health Progress have a good round of what some bloggers are saying and include health journalism folks as well as thoughts from the AvianFlu diary. I thought I would go off theme and briefly throw out some thoughts on the bigger picture and encourage you to use this day to think about what is the future of global health? In this context of thinking about the future in 10, 20 or 30 years, the world is in turmoil and we are questioning the fundamental nature of market driven economies, why not use this as an opportunity to do the same for global health in a forward looking way? Think about where we are and whether we are prioritizing the right things and moving in the right directions?

Approximately 10 (only TEN!) years ago there was no Google, Kiva, Gates Foundation or knowledge about the cost differences between generic and brand name drugs (see this great talk on the Future of Global Health by Jim Yong Kim and his discussion of how they reduced the price of treating MDR TB patients by 80-90% in 1999) amongst major care organizations (absolutely stunning). Mobile phone penetration was less than 1% in developing countries and social entrepreneurship wasn’t hot, the vast majority of us probably hadn’t even heard of that term.

Where we were ten years ago is arguably a profoundly different world from where we are today and per the video below “we are living in exponential times“. To give you further inspiration to think differently today definitely watch the below (via 2173):

The acceleration of technology for social change and global health is going to increase, in this decade alone the convergence of movements in philanthropy, entrepreneurship and technology all enabled by the internet and mobile phone revolution have allowed people to collaborate, innovate and communicate on an entirely different level. I don’t know what the future of global health is – but I wonder how open source collaborations will contribute to solutions and whether twittering for global health will be around in five years and for whom and what purpose? Or will we just be doing more of the same. I wonder if we will be doing entire marketing and health education campaigns via mobile phones and how this will evolve. Will there be convergence of people and ideas working on global and domestic health? Will the flow of innovation and products from “South” to “North” become the next hot topic? I wonder if we will have a TED just for Global Health?

We might face a global crisis in 2030 but we will also be better equipped to face that crisis.Today is a day we should be thinking about what all the possibilities are and how we can get there in the fastest way possible.  The last idea I will throw out as food for thought is to think about what have been the top 10 biggest developments in global health in the last decade and how will these shape the future?

Other thoughts on World Health Day:
UN Dispatch, link
Human Rights Watch, link
The Lancet Student, link
Global Institute Blog, link
Charity Navigator, link

Written by Aman

April 7, 2009 at 9:05 pm

Quote of the Day – g20 in perspective

“In London, Washington and Paris, people talk of bonuses or no bonuses…in parts of Africa, South Asia and Latin America, the struggle is for food or no food…the greatest price for incompetence at the summit will be borne by the poorest people in the world.

Oxfam has calculated that financial firms around the world have already received or been promised $8.4 trillion in bailouts. Just a week’s worth of interest on that sum while it’s waiting to be deployed would be enough to save most of the half-million women who die in childbirth each year in poor countries.”

Nicholas Kristoff, NY Times, At Stake are More than the Banks, April 1, 2009

A different more pro-active spin on the above comes from Lynne Twist:
“This is a time that I think history will look back on and say, ‘These are the people, this is the generation of humankind that went through a transformation that made the future of life possible. These are the people who had the courage to make profound changes in the way they were thinking, as well as in the way that they were behaving, that gave the future to life itself.”

Written by Aman

April 2, 2009 at 8:00 pm

The Girl Who Silenced the UN

This video has been floating around recently, I thought it was worth sharing. This took place 16 years ago, I wonder where this girl is now? Hat tip Humanity in Focus.

Written by Aman

March 22, 2009 at 6:02 pm

Posted in Food for thought

The End of the Era of Generosity? Global Health Amid Economic Crisis

If you only read one thing this week, the below article deserves your attention. I have excerpted only bits and pieces, the full piece is worth reading. Co-authored by Laurie Garrett, this is a much better, more cohesive and articulate encapsulation of the current economic crisis than what I wrote last week (if I only had 1/4 of the writing ability of Garrett!).

The End of the Era of Generosity? Global Health Amid Economic Crisis
Kammerle Schneider email and Laurie Garrett
Philosophy, Ethics, and Humanities in Medicine, Jan 2009
Global Health Program, Council on Foreign Relations

For too long, the international community has responded to global health and development challenges with emergency solutions that often reflect the donor’s priorities, rather than funding durable health systems that can withstand crises…The global health community must now objectively evaluate how we can most effectively respond to the crises of 2008 and take advantage of this moment of extraordinary attention for global health and translate it into long term, sustainable health improvements for all. Over the past eight years global health has taken center stage in an era of historic generosity as the wealthy world has committed substantial resources to tackle poverty and disease in developing countries…there has been a massive swell in the number of nonprofit organizations (NGOs), faith based groups, and private actors contributing to this boon.

Past is prelude
The emergence of HIV/AIDS fundamentally transformed the way in which the world engaged global health. It shook world leaders…It awoke the average citizen to gross disparities… The fight against HIV/AIDS rallied tremendous financial support for global health, while at the same time, moving investments in health from infrastructure: clinics, roads, sanitation, and personnel, to funding disease specific initiatives with emergency, short term targets, and often unsustainable results.

International institutions and governments heavily reliant on steady inflow of foreign donor funding are now frantically trying to resolve how to continue the operations of their health programs… Undoubtedly, the economic crisis will crimp humanitarian aid, and international efforts to fight disease and alleviate poverty.

The special challenge of HIV
Increased focus on the urgent management of specific diseases has weakened the ability of health systems to respond to crises
. To respond to the AIDS epidemic, the share of global health aid devoted to HIV/AIDS more than doubled between 2000 and 2004 – reflecting the global response to an important need, yet, the share devoted to primary care dropped by almost half during the same time period...In many of the countries hardest hit by the pandemic, a large portion of their funding for AIDS medications come from outside donors. For example, in Mozambique, 98 percent of all funding for the country’s HIV/AIDS programs comes from outside donors…the nation’s extraordinary dependence on external support begs questions about the efforts’ sustainability, and country ownership and control… As we enter an economic downturn, the sustainability of emergency initiatives, such as PEPFAR, that are 100 percent dependent on a never ending supply of donor dollars, are called into question.

Moral hazard amid complexity
Instead of making things simpler and more efficient on the ground, in many cases, the rapid increase in funding and number of global health players has made the mechanisms for delivering aid even more complex. At the developing country level, hundreds of foreign entities are competing for the attention of local governments, civil society interest, and the desperately short supply of trained healthcare workers…

A moral path forward
Given the scale of the world’s healthcare workers deficit, no progress can be made in the creation of universal primary care systems if models continue to be doctor-based.
Even if the world committed today to the most massive medical training exercise in history, the deficit would not be overcome for more than two generations. Only a substantial commitment to building genuinely viable health infrastructures centered on community based workforces, coupled with local profit incentive systems, and global scale supply and inventory management…The crises of 2008 have brought together committed government officials, UN agency leaders, NGOs, faith-based groups, and corporate actors to collectively think about new ways to break out of patterns of charitable giving and move towards real sustainable investments in health…A number of promising initiatives are beginning to emerge. In this time of financial catastrophe, the onus sits squarely on the shoulders of global health advocates living in the wealthy nations: push your governments and philanthropic institutions to not only maintain their technical and financial commitments to the poor nations of the world, but actually increase the scale of investment to reflect the rising costs of doing good in a troubled world. It is conceivable that 2008 will mark the beginning of the end of the Era of Generosity. But it is equally probable that the economic crisis will usher in a bold new era of investment in the public goods of poor and emerging market nations worldwide. Successful navigation of these turbulent waters will require a shift from the morality of “charity,” to that of “change”…

Written by Aman

March 16, 2009 at 8:30 pm

Video Games for Health: Tetris Therapy for Trauma?

Very early fascinating research, which will hopefully be developed further. This is not a top 10 list you want to be on, but considering the global burden of disease projections for 2020 include depression (#3) and war (#8) in the top 10 contributors to disability, greater understanding of the mind and brain function is desperately needed. Additionally, considering mental health is such a complex and difficult issue, it’s great to see potential innovation in this area. Source: BBC News

(sorry I cannot find the blog I read this on, send me a note and I’ll add your link in):
tetris


Previous related posts:
Where are the games (to educate on HIV/AIDS risks)? Link
Donate computation time …on your PS3? Link
Free Rice Word Game. Link

Written by Aman

March 11, 2009 at 10:03 pm

How will the Economic Crisis Change Global Health?

I feel compelled to throw out some slightly disjointed thoughts about the global economic meltdown, especially since the discussion with respect to global health is just beginning. One of the other voices discussing this is Lucy Bernholz, she has a series of fantastic posts on the impact of this downturn on philanthropy and I link to some of her posts below which is must reading.

Backdrop
Global wealth has been destroyed to the tune of 50%; Microsoft and NPR are laying off people for the first time in a long time; Google, Disney, WSJ and the NY Times are laying off and NYC Mayor Bloomberg is suggesting he might have to cut 20,000 city workers; the nation of Iceland has declared bankruptcy and tens of millions have been laid off in China where they are facing a gargantuan commercial real estate bust in Beijing coupled with dwindling job prospects. And if you think the US is in bad shape, Europe is facing a whole lot more pain. The point is that the economic meltdown is having an impact far beyond the usual suspects; this economic crisis is wide and deep and no one knows how long it will last. There is no question that we are entering a fundamentally different world on many levels – dialogue is needed now on what can be done and how this will reshape giving, accountability, fiscal responsibility, priority setting, and of course what counts at the end of the day – health and poverty. The global health community should have discussions on how we can all be more accountable and how we are using funding. We need to be aware of the coming impact on global health funding and beyond.


Pillars of the Global Health Complex

Capital flows and financial support for global health comes from a spectrum of actors (governments, foundations, NGOs, private donations, and many others – see our previous post here on R&D funding flows). These agents are the threads that provide patchwork netting for funding and capital injections through a range of channels, whether that is via medical donations, immunization campaigns, pilot projects, research, education, training programs or remittances. Make no mistake, all of these channels have been or will be impacted. “CGD fellow David Roodman has shown that after each previous financial crisis in a donor country since 1970, the country’s aid declined…“Aid for health is no exception.” But don’t expect governments to announce cuts in foreign assistance; the contraction will be invisible, with disbursements quietly dragged out and a contracting seeing a slowdown…” (Source: Global Health Magazine). With regards to US based foundations, a March 2009 research report found that “of the largest 100 foundations ranked by total giving, only two with announced intentions to grow their funding in 2009–the Gates Foundation and the MacArthur Foundation…six of the largest 100 foundations have so far announced plans to reduce their giving in 2009.” (Source Foundation Center).

I have blogged previously on the University based global health bubble (?) and I would like to see some hard numbers on global health jobs placement, impact on these new programs, whether the programs are halting building construction and staff hiring (as many universities are). Endowments at top universities in the US have taken a beating, so much so that some are considering selling prized art collections. Even one of the world’s richest business schools, with a $1 billion endowment, is cutting back. What will be the impact on schools of public health or all the newly opened schools of global health? Will all this promised global health funding actually materialize? Will students rethink spending tens of thousands on graduate programs in global and public health? Will there be scholarship funding for international fellowships and the development of new ideas and products for global health populations? The university system is of course just one corner of the global health complex but an important one – one that is a foundation for research into neglected diseases or developing human resource capacity in developing countries through education and exchange programs. Steven Davidoff, a professor at the Univ. of Connecticut, has a must read breakdown of why schools like Harvard are cutting back and are facing a worsening economic picture in 2010 and beyond (NY Times, 3/3/09, Harvard, Private Equity and the Education Bubble). In short, below are five obvious trends to watch, by no means is this a comprehensive list.

Impact on pillars of the global health/development sector:
1. Foundations/Philanthropy – many will suffer due to unprecedented (poor) investment returns and reduced donations.
2. Corporate Sector – reduced giving and less leverage to engage in partnerships or development of new products (drugs, etc).
3. Government Aid – some countries rely on massive amounts of aid for even basic things like immunization programs.
4. Remittances – with global job losses this will continue to erode.
5. Universities – endowments have been drastically reduced, classes cut and hiring freezes implemented.

Reorientation to Infrastructure Spending
This crisis is an opportunity to recognize bigger picture global health issues and perhaps with the relatively recent shift in thinking and the push to reshape the global health agenda to emphasize health system infrastructure and workforce development, there may be more interest in funding long range macro level projects (as with some of items included in the US stimulus package for infrastructure). Even small amounts of money for infrastructure can have large impacts, like building bridges to reduce malaria, for example.

And let’s not forget, that one of the best things Cuba did for population health after its economy collapsed was to invest in its health system. Obama has called for massive infrastructure spending and I am wondering if poor economies will be able to do the same. There is some hope for this because low income nations know they must continue to build roads, bridges, and highways in order to continue “development”. Hopefully this will largely be positive for global health efforts (especially if some of that includes public health and medical infrastructure). Perhaps this economic meltdown will be an opportunity to take stock and shift some funding towards long term capacity building.

Reason for Hope
On the positive side, the Gates Foundation is actually increasing their payout, not decreasing it by $300 million as we first discussed a few months ago. Additionally the new center of gravity for global health (Seattle) is going to be adding 2400 global health jobs over the next few years. The World Bank is going to double their health loans and as of now very few ministries of health are reporting they will cut back on health spending (although I am not sure I believe this entirely). There is also some evidence that giving actually rose through the depression, perhaps because people still give to causes that are part of their core belief sets (as opposed to nixing discretionary spending like holidays or eating out).

Conclusion
I believe the pain is going to be severe (with 2010 being worse) and we are already seeing major cracks in the social fabric in various locations. The velocity and violence of this global economic downturn will have serious widespread impacts. Over the past decade the Gates Foundation along with others have brought unprecedented financial resources that helped fuel a boom in certain sectors and innovation in the development of appropriate technology, social ventures and the growth of areas like microfinance, all of which generated tremendous energy and buzz. We have now entered a new era with a drastically different macroeconomic backdrop, yet we are equipped with these new tools (think Kiva) developed during what might be have been a golden age of global health funding/philanthropy in comparison to what might happen over the next decade. A discussion is needed on how to prepare for the worst, how to fund and spend more wisely, how to allocate resources, and how to spot vulnerabilities (e.g. what areas or diseases are especially sensitive to funding flows). I welcome your thoughts and discussion on this.


Additional Reading

1.  Some nonprofits can’t touch their money, link
2.  Global Financial Crisis, Global Issues
3.  How to Get Funding for Your Global Health Activity, Change.GlobalHealth.Org (my new favorite blog)
4.  Economic crisis fueling social unrest, link
5.  Aid Agency Budgets Go Bye-Bye, Change.org
6.  Global Health tv: Global Economic Downturn, video
7.  Philanthropy in a Global Economic Crisis, link
8.  The Economic Crisis: A Generation of Reproductive Health “Horror Stories”, RH Reality Check
9.  Migration in light of the economic crisis, NextBillion
10. Hard Times for Health Charities, link
11. WHO on the crisis, WHO
12. The global financial crisis: an acute threat to health, Lancet
13. No relief: Red Cross hit with tough times, ChemistsWithoutBorders
14. World Bank offers dire forecast for world economy, link

Written by Aman

March 9, 2009 at 8:19 pm

Global Obesity Diagram

BMI is far from a perfect measure of obesity and can be misleading – but you get the picture below (via Miscellanea). Also check out our previous obesity related posts:

A Massive Wave of Chronic Disease in China and India, link

The 88 Worst Fast Food Items, link

Scientific American on Food, Fat and Famine, link

2007-05-06-world-fatness

Written by Aman

March 8, 2009 at 6:12 pm

Microbicides – Where are they Now? How much have we spent?

I was just sent this information (thanks to Becky!) about a new round of funding for microbicides, which comes on the heels of promising results from a trial of the PRO2000 microbicide candidate. We covered this a couple of years ago and at the time I said – the potential of this drug is revolutionary. With microbicides there was great excitement and hope, then there was failure and now there is some maturity. Okay, maybe I am overstating the case, the take home point is that we still don’t have a product and this is not cheap, easy, or quick. Developing a drug is complicated, involves huge risk, can take decades and is highly uncertain. Let’s review the drug development time line again for those of you not familiar – the graph below gives the most simplistic picture:

rx_development_timeline_crude

The early microbicide discussions took place almost 15 years ago (International Working Group on Vaginal Microbicides, source). Over half that amount of time, from 2000-2007, $1.1 Billion has already been invested in microbicide R&D! It takes anywhere from $200M to $1 Billion to bring a single novel drug to market. Let’s hope one of these compounds works and makes it through phase III. But how much will we have spent? $2 Billion, $3 billion? If it works, it will have been worth the money, however, we must ask if we took the most efficient financial route to get to the end point and if there were better financial models – that is a valid question.

Moyo to Bono: Africa Needs U like a Fish Needs a Bicycle

Economist Dambisa Moyo is on the interview circuit promoting her new book (Dead Aid). Dr. Moyo is at odds with celebrity spokespeople (the title is a play on lyrics from a U2 song). Fantastic set of quotes below from a couple of interviews. Her criticism of Bono might be a bit harsh, for another take, see MinneAfrica which discusses some of the limitations of Moyo’s thinking.

NY Times, Questions for Dambisa Moyo – The Anti-Bono Feb 19, 2009
NYT: As a native of Zambia with advanced degrees in public policy and economics from Harvard and Oxford, you are about to publish an attack on Western aid to Africa and its recent glamorization by celebrities. ‘‘Dead Aid,’’ as your book is called, is particularly hard on rock stars. Have you met Bono?

MOYO: I have, yes, at the World Economic Forum in Davos, Switzerland, last year. It was at a party to raise money for Africans, and there were no Africans in the room, except for me.

NYT: You argue in your book that Western aid to Africa has not only perpetuated poverty but also worsened it, and you are perhaps the first African to request in book form that all development aid be halted within five years.

MOYO: Think about it this way — China has 1.3 billion people, only 300 million of whom live like us, if you will, with Western living standards. There are a billion Chinese who are living in substandard conditions. Do you know anybody who feels sorry for China? Nobody.

Financial Times
“She is venturing into a debate that has to date been colonised by white men – be they rock stars such as Bono, politicians such as Tony Blair or the academics Jeffrey Sachs and Bill Easterly…”

FT: So what of the rock and Hollywood stars, who have appointed themselves advocates of making poverty history? She is withering:

MOYO: “Most Brits would be irritated if Michael Jackson started offering advice on how to resolve the credit crisis. Americans would be put out if Amy Winehouse went to tell them how to end the housing crisis. I don’t see why Africans shouldn’t be perturbed for the same reasons”…

Written by Aman

February 26, 2009 at 9:22 pm

Posted in Food for thought

Global Health at the Oscars part II: Global Slums – The Places We Live

Purely as entertainment I enjoyed Slum Dog Millionaire and because of the Oscar victory people have become more curious about global slums. How do I know this? The hits on this blog have increased in the past two days with people specifically drawn to a previous post we did: Dharavi: Mumbai’s Shadow City. Take the following with a grain of salt, but note the increase in interest:

“Movies have a powerful ability to evoke a sense of the exotica about the locations in which they are filmed. They are widely acknowledged to inspire travel to those destinations….According to Expedia sources, post ‘Slumdog Millionaire’, Mumbai now tops the chart of global tourist destination.” Source Yahoo News

Additionally, OneWorld Health has decided to explicitly use the movie as a avenue to educate people more about global health needs:

The Institute for OneWorld Health, the non-profit pharmaceutical company that develops drugs for people with neglected infectious diseases, announced it is launching a new awareness campaign inspired by the highly acclaimed Oscar-winning film, Slumdog Millionaire…OneWorld Health is running a full-page ad in the New York Times on Monday, Feb. 23. Slumdog Millionaire, an underdog story about poverty, love and hope, won eight Oscars at last night’s Academy Awards ceremony, including Best Picture. For the full story see OWH here.

A by product of Slum Dog is that tens of millions of people who previous had very little knowledge about global poverty got a little glimpse into that world. Picking up on this curiosity, another place to learn more is a fantastic multimedia project by Magnum Photos that is well worth your time (hat tip to TinkuB) :
placeswelive

Other Perspectives:
Does Hollywood spotlight risk slumsploitation? The Business of Giving
A Hollow Message of Social Justice. RaceWire

Written by Aman

February 25, 2009 at 5:23 am

R&D Funding for Global Health Diseases

1. HIV/AIDS, TB, Malaria Account for 80% of Disease Funding in Developing Countries, Report Says
2. More funds needed for lesser known tropical diseases, Link

The above two headlines on global health funding flows and allocation caught my attention. The original study was published in PLoS Medicine. The article has some great figures (some of which I have reproduced below). A few things immediately stick out – the amount concentrated on HIV/AIDS, TB and malaria is astounding. Second the US is providing 70% of the funding and on the surface one could argue that other countries really could be pitching in more. On that note, the Gates Foundation by itself is out funding the European Commission almost 4 to 1 – if that isn’t embarrassing I don’t know what is. Finally, the US Department of Defense is high on the list (surpassing USAID). Interesting stuff:

“HIV/AIDS, tuberculosis and malaria initiatives accounted for about 80% of the $2.5 billion that was spent on research and drug development for developing countries in 2007… However, pneumonia and diarrheal illness, which are two major causes of mortality in developing countries, received less than 6% of funding.”
gh_fundingflows

gh_fund2

Original Sources:

  • PLoS Medicine – Neglected Disease Research and Development: How Much Are We Really Spending? Link
  • WHO Top 10 Causes of Death, Link

Next Trends: Generosity in Tough Times?

For Feb 2009 TrendWatching.Com focuses on “generation G” – the giving, generous generation that they think is baked in due to the ubiquitous development of online culture. I don’t agree with everything they have spotted, but it’s a really interesting piece worth checking out:

GENERATION G | Captures the growing importance of ‘generosity’ as a leading societal and business mindset. As consumers are disgusted with greed and its current dire consequences for the economy—and while that same upheaval has them longing more than ever for institutions that care—the need for more generosity beautifully coincides with the ongoing (and pre-recession) emergence of an online-fueled culture of individuals who share, give, engage, create and collaborate in large numbers.”

In fact, for many, sharing a passion and receiving recognition have replaced ‘taking’ as the new status symbol. Businesses should follow this societal/behavioral shift, however much it may oppose their decades-old devotion to me, myself and I.”

Here is the outline of the piece:

1. Recession and consumer disgust
2. Longing for institutions that care
3. For individuals, giving is already the new taking and sharing is the new giving

8 Ways for corporations to join Generation G: co-donate, eco-generosity, free love… read the rest here.

Additional Commentary:

  • Generation G: Wired to Care, Wired to Share , Link
  • Goodness And Happiness – Why Generosity Is The Future Of Marketing Strategy, Link
  • Generations Generosity, Link

Written by Aman

February 17, 2009 at 10:52 pm

Play it Forward

From Giving in a Digital World, read their full detailed post, excerpt below:
“Play It Forward (named after the movie, presumably) is a start-up that plans to launch a new online giving platform next month, offering individuals or groups of individuals the opportunity to fund specific projects around the world.

Ok. Sounds just like another Global Giving? However, Play It Forward looks like it’s going to have some special aspects to it that could make it stand-out as a distinctive player in the online nonprofit project crowdfunding world…” More here.

Written by Aman

February 16, 2009 at 2:15 pm

Arab Healthcare Delivery

Guest post by Khizer Husain, Owner of Shifa Consulting (see also previous post on healthcare in the Emirates)

Three Observations in Arab Healthcare Delivery

I attended the 34th annual Arab Health Congress in Dubai last week. This is the largest regional conference on healthcare. The event was massive: it drew more than 50,000 visitors and 2,300 exhibitors which span all facets of healthcare including care delivery, technology, consulting, staffing. According to the medical director in Abu Dhabi’s Sheikh Khalifa Medical City, ‘Our institution looks forward every year to Arab Health as a means of reviewing the latest technology; networking with suppliers and vendors and to update medical knowledge. The increased participation and attendance at Arab Health is of value to all of us in the healthcare field.’ Here are some observations on the delivery of healthcare in this part of the world:

Economic Downturn Putting Projects on Hold

The global financial meltdown has not spared the Middle East and the UAE in particular. There are many sites that are empty pits with cranes standing idle. Hospitals have put on ice new expansion plans. Overall, it is estimated that 8% of the labor force in Dubai has left the country in the last four months due to the worsening economic climate. I heard a couple of people talk about the thousands of cars that were left abandoned at the Dubai airport as people could not pay their loans and thought it best to flee the country. Up until last year, healthcare expenditures in the region were growing 16% per year and exceeding $74B.

The silver lining here is that global steel prices are down 75% and smaller construction projects at well-capitalized institutions can for the first time gain traction. A notable exception to the economic dip is Qatar. According to ArabianBusiness.com, Qatar’s economy (http://www.arabianbusiness.com/541046-qatar-economy-could-grow-by-10-in-2009) could grow 10% in 2009 as it expands exports of liquefied natural gas, making it the world’s fastest growing economy.

Thirst for World-class Standard of Healthcare

There is a strong desire in the Gulf to catch up to the healthcare levels of the industrialized world. Until just a few years ago, the only way to bridge the gap between what national populations desired and what was offered in their native countries, was to open the doors (wide open) to medical tourism. The UAE reportedly spent over $2B per year to ship its citizens to foreign countries for medical treatment. Not only were these expenditures unsustainable, but they put these countries at a competitive disadvantage for recruiting highly skilled expatriates. The only way to turn down the medical tourism spigot was to invest locally in building healthcare expertise. Due to poor perceived quality in local healthcare, stymied access to care, and perverse financial incentives to go abroad for care, medical tourism is still a powerful force.

Enter Multinational Healthcare Corporations

The landscape for international healthcare providers with business in the Middle East is becoming increasing crowded with the major players hailing from the US, Europe, and Canada. There seem to a few dominant models:

a. Market Destination Hospital: A number of institutions have outposts in the Middle East that they use to run clinics and make the necessary arrangements to funnel patients to the flagship entities. Mayo, Washington Hospital Center, University of Chicago follow this model. The Great Ormand Street Hospital in London sends in a rotational team of pediatric specialists to run clinics close to the patients.

b. Secure Management Contract: This is where the cash is. Running a tertiary hospital in the UAE can yield $6M per annum. The big players in this sector include Cleveland Clinic—which runs Sheikh Khalifa Medical City and will run the new Cleveland Clinic Abu Dhabi when it finishes in a few years. Johns Hopkins International has three affiliate hospitals in the UAE and a hospital in Beirut. UPMC runs the gamut of managing whole hospitals to managing individual departments like the emergency room. The Methodist has teamed up with property development company Emaar to create an outpatient clinic which they will manage—the Burj Medical Centre. Emaar has aggressive plans to expand clinics and hospitals throughout the Middle East and North Africa.

c. Joint Venture: South African Mediclinic obtained ownership share of Emirates Healthcare in 2007 for $53M. With two hospitals and three clinics in the pipeline, they are the largest private provider of healthcare in Dubai. Mediclinic derives nearly half of its profits from overseas ventures (in the Middle East and beyond).

While it is quite exciting to see all this development in healthcare, everyone agrees that the only way to have real, sustainable progress in region is to build an army of indigenous healthcare workers. Unfortunately, the curse of petrodollars is that it leaves little incentive for nationals to aspire to become nurses and doctors, let alone outstanding clinical managers. In the meantime, India and the Philippines serve as the golden geese.

Written by Guest Contributor

February 4, 2009 at 7:59 pm

389 Years Ago…

Click for the bigger picture:

389_yearsago

Written by thd

January 25, 2009 at 9:57 pm

Posted in Food for thought

Pharmaceutical Waste Dumped at Record Levels

We are generally focused on solutions and here, but I couldn’t help but post this news story on pharmaceutical “waste” being dumped into the water supply in India and what the subsequent impact might be (drug resistance, unknown clinical damage to those who consume the water, environmental destruction):

rx_waste
World’s highest drug levels entering India stream
AP News, Jan 25 (see full story here or here)

PATANCHERU, India –When researchers analyzed vials of treated wastewater taken from a plant where about 90 Indian drug factories dump their residues, they were shocked. Enough of a single, powerful antibiotic was being spewed into one stream each day to treat every person in a city of 90,000.

And it wasn’t just ciprofloxacin being detected. The supposedly cleaned water was a floating medicine cabinet — a soup of 21 different active pharmaceutical ingredients, used in generics for treatment of hypertension, heart disease, chronic liver ailments, depression, gonorrhea, ulcers and other ailments.

Those Indian factories produce drugs for much of the world, including many Americans. The result: Some of India’s poor are unwittingly consuming an array of chemicals that may be harmful, and could lead to the proliferation of drug-resistant bacteria.

In India, villagers near this treatment plant have a long history of fighting pollution from various industries and allege their air, water and crops have been poisoned for decades by factories making everything from tires to paints and textiles. Some lakes brim with filmy, acrid water that burns the nostrils when inhaled and causes the eyes to tear… “I’m frustrated. We have told them so many times about this problem, but nobody does anything,” said Syed Bashir Ahmed, 80, casting a makeshift fishing pole while crouched in tall grass along the river bank near the bulk drug factories. “The poor are helpless. What can we do?”

Written by Aman

January 25, 2009 at 9:43 pm

Obama’s Organic Farm?

DC is going through the post-election post-inaugural blues. Now the real work begins and there is plenty of buzz around all sorts of issues. One that is receiving some attention is a push to influence food policy. The guys over at WhoFarm.org (White House Organic) have been traveling across the country in an organic farm bus to show that you can do this anywhere. Additionally, leading celebrity chefs are pushing the issue as well. Did you know that the White House did have its own garden before? The Victory Garden planted by Eleanor Roosevelt inspired the rest of the country, so don’t doubt the impact this could have if Obama ripped up the White House lawn. Check out the below video and if you are inspired sign the petition below the video:


obama_farm

Other Sources:
- San Francisco City Hall already has their own Victory Garden, Link
– American Victory Garden, Past and Present, worth checking out, Link
– A lengthy post over at BlogHer debating the issue, Link

Written by Aman

January 24, 2009 at 10:47 am

Public Health Needs a Rockstar: Paging Dr. Gupta for Surgeon General

As you may have heard by now, Obama might be seriously considering Sanjay Gupta of CNN to be the US Surgeon General. Two good friends had an initially negative reaction to this – “but he is just another TV anchor!”. Well Gupta is much more than that. In addition to his proflic duties as a medical correspondent for CNN where has done in-depth assignments on Iraq and Katrina, he practices surgery on a weekly basis, is the associate chief of neurosurgery at a major university, has traveled the country and the world witnessing first hand major health issues giving him a global sensibility. Also along with his government experience ( as a White House fellow), he knows how to reach mass audiences and will be a media savvy.  Clearly he can handle high pressure situations and his celebrity is a huge plus (how many people can remember the name of the last or current surgeon general or know of any significant issues they have tackled?).

For better or worse we are already far down the path of celebrity endorsed causes (what impact this has, I really don’t know, but it certainly commands some attention in a world with lots of noise and information overload). We have Bono, Bill Gates, and Bill Clinton – all rockstars for global health. Even NextBillion is advocating for rockstars in public health, which I do agree with. Sanjay Gupta is extremely smart and talented and can be a celebrity for public health on a national scale. And actually much more than a rockstar, public health in this country and globally needs an ambassador, a champion and an activist. This pick is good for both domestic and global health, and the two have never been so intertwined (not just with the migration of infectious diseases across borders but also with the explosion in chronic disease (and see here Jan 2009)  in developing countries and issues like brain drain). You would have someone who has appeal beyond the experts and policy wonks, he has strong credibility with the American public. As such, this is a great media strategy by the Obama team – they have found someone who is well known, a media professional (and as some criticize – a propaganda machine), and can deliver complex health policy messages.

As with any candidate there are drawbacks and deficiencies, with Gupta, these will all come out in due time. I understand that some in public health circles and others will consider this pick to be more style than substance, but my main point is that is time for us to think creatively beyond our traditional notions and perhaps take a risk with someone who doesn’t have a strong public health background, but who has the potential to have a major positive impact.  Gupta is someone who can link both local and global health causes together and that is rare and signficant skill. The envirionmental movement over the last decade has made tremendous strides in melting the division and lines between local and global into something that can be grasped at all levels and into something where people understand the connection. Granted health is a very different animal, but as a community and movement we are light years behind the environmental folks – perhaps Gupta helps to push this in another way.

Other sources:

- Krugman on the Trouble with Sanjay Gupta, link
- See Abel and Jake over at Science Blogs on their differing views
– WSJ health blog on Gupta, link
– Read the comments over at Daily Kos, link
- Huff Post on Gupta, link
– Questions about Gupta at KevinMD, link

Written by Aman

January 6, 2009 at 11:43 pm

IOM to Obama: Get a Mapping Tool 4 Global Health

The prestigious Institute of Medicine (IOM) came out with their policy proposals for global health. I ripped this off from the Science blog site, they put it well:
Funding has been “heavily skewed” toward HIV/AIDS, the committee stressed…The Obama Administration and Congress should “create balance in the traditional portfolio of global health aid…”

In one of its most blistering passages, the committee complained that the government doesn’t have a good handle on who is doing what. “To date, the committee is not aware of any efforts to broadly coordinate and quantify U.S. actions in global health across even the major government agencies… The tools available to track U.S. government global health funding are limited, and their results are often piecemeal, subject to double counting. As a result, the total U.S. government commitment to global health is not known with any certainty; the United States can neither measure the positive impacts nor justify the level of its investments in global health.” To better coordinate the U.S. government’s global health effort, the report recommends that Obama create a White House-level interagency committee, chaired by a senior White House official, “to lead, plan, prioritize, and coordinate…” via the Science blog.
There are a ton of issues here. One that came straight to my mind, probably as a result of my own cognitive bias (see my previous post) is that Obama needs a donation like mapping tool (only half joking)! What I mean by this is that perhaps he needs to borrow technology available from a variety of sources like the PQMD donation mapping tool or ZocDoc to map, track and coordinate. Again this might be another example of the global health community being behind the curve with regards to tech adoption…

Written by Aman

December 18, 2008 at 6:01 am

Market Turmoil Hits Gates Foundation: Reducing Grants by 300 Million+

I have been hearing ancedotally (based on very few data points) that charitable giving is not going to be that impacted by the current economic crisis. I don’t agree with this view, but apparently there is some evidence for this line of thought when looking at past recessions (according Philanthrophy2173). This time things are very different and there could be a fairly substantial impact on giving in general and on global health charities. There were two stories in the WSJ this week about the impact of the global economic meltdown on philanthropic giving. The first article states that even the Gates Foundation will be reducing donations by approximately 10% (they provide about $3 billion in funding per year which is how I came up with the $300 million figure).

The impact of this economic crisis will be widespread and will impact health in developing countries in the short run (we have already seen massive inflation in food prices and staples such as rice). Decreased funding flows will not only come from reduced giving, but from governments being forced to cut budgets (France is already cutting funding to NGOs), and also from worldwide layoffs of migrant workers who send hundreds of billions of dollars in remittances back home to support their families (on forecasts and drops in remittances see more here, here, here and here).

Below are a several articles you should check out if you care about this issue and about what the funding environment might look like over the next 12-18 months:

1. Gates Foundation Feels Pinch From Market Turmoil, Wall St. Journal 11/24/08, Link
2. Big Players Scale Back Charitable Donations, Wall St. Journal 11/25/08, Link
3. John Holmes – Impact of the Financial Crisis on Humanitarian Funding, Link
4. Comment on the MIT Course blog: Health in a Global Crisis, Link
*5. For a special review see a great post by Lucy Bernholz, Link

Written by Aman

November 26, 2008 at 9:53 pm

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