Archive for April 2007
“As Mumbai booms, the poor of its notorious Dharavi slum find themselves living in some of India’s hottest real estate...Few homes have running water or toilets, but a household without a television is uncommon in Dharavi.” (FP Blog)
National Geographic has a great feature on Dharavi, one of the largest “slums” in the world (hat tip to the FP Blog and Roger for sending this my way). The photo essay and multimedia are definitely worth checking out. I am guessing that there are many individual health projects going on in Dharavi but I was not able to find much information; check out NextBillion.net for their coverage last year on a pilot health insurance scheme. Next year a majority of our global population will live in urban areas, with urban slums being the fastest growing human habitat. Dharavi has 1 Million people packed into a square mile and generates over $500 Million worth of goods per year, or as BBC has put it, this shadow city has over $650M in annual business turn over. There is supposedly 1 toilet for every 1400 people there with most of those being non-functional.
Unfortunately National Geographic has not offered many opportunities in the way of options on helping those in need, but you can see the two charities they selected here: how to help.
-Waste not, want not. Observer coverage, another excellent piece. Photo essay, article
-Trival Matters blog, coverage of various industries in Dharavi, link
-NPR coverage from 2004, link
The Council on Foreign Relations is organizing an upcoming Global Health Roundtable Series, May-July about putting effective health technologies to work in developing countries. In each session, a specific technology will be explored that appears to offer life-saving benefits, and ask why that innovation is under-utilized, poorly funded, even controversial. Topics include:
– Male circumcision
– Eye glasses
– HPV and HIV vaccines
– Single use syringes
I would suggest several more: misoprostol for treatment of postpartum hemorrhage (one of the leading causes of maternal death in low-income countries), relatively simple cataract surgery (think Aravind eye care), fistula repair, cleaner burning cook stoves, and resilient point-of-use water filters.
More important than any particular technology, and getting directly to the question of utilization, effective finance strategies are needed. In much the same way that US food aid is being reframed as a local demand issue, these technologies will only be successfully scaled when local demand is strong. Perhaps nothing demonstrates this more clearly than male circumcision. It requires choice and volition. Strategies like the use of subsidized vouchers for circumcisions at accredited providers empowers the patient or patients’ parents to find a high quality circumcision provider. New voucher projects in Uganda and Kenya offer lessons for management of voucher programs for health services.
Insecticide Treated Nets (ITN) are currently a key intervention against malarial mosquitos and have been shown to reduce all cause mortality in children under five by 20%. (Lengeler C, Cochrane Review, 2002.) Pregnant women are also vulnerable to severe complications of malaria and recommended interventions are ITNs and intermittent preventative treatment with SP (sulfadoxine-pyrimethamine).
Despite the proven successes of ITNs in preventing malaria, the distribution of bed-nets is not universal. Baseline levels of ITN measured between 1997 and 2001 were as low as 2-3% in most African countries. It was decided that improving ITN distribution could be a quick win for the Roll Back Malaria initiative. Key barriers to distribution included: a lack of funding for ITNs, inadequate distribution channels, and the cost of nets. In addition, ITNs need to be retreated with insecticide to maintain effectiveness, so insecticide must also be supplied. Several countries consider ITNs textiles, and not essential medical supplies, so they are subject to import taxes, which further increases their price.
One promising innovation in ITNs is led by a group from the University of Leeds, who are developing a non-insecticide bednet that will kill mosquitos based on the material structure. They have received significant funding from the Gates Foundation. If successful, this will help with the loss of effectiveness of existing nets, where insecticides wash out after about 20 washes, as well as the increasing resistance to insecticides that mosquitos are developing.
Here are some news reports on the progress of ITN Distribution, but I wasn’t able to find a comprehensive report on distribution.
Another reason for the inadequate coverage of ITNs has been a lack in funding. This is primarily an international health investment issue, but civil society has been getting into the act and a new grassroots initiative Malaria No More caught my eye. Malaria No More personalizes your role in the effort against malaria – Donate $10 and buy a bed-net! This is a small and do-able effort for most people, who want to see a tangible benefit from their donation. Malaria No More is sponsoring a wide range of fundraisers including Music to End Malaria which was created to get college students involved in the fight against the disease. More than 50 colleges and universities around the country have signed on to raise money and in the lead up to the first US Malaria Awareness Day, campuses will organize bed net demonstrations, T-shirt sales, BBsQuito cookouts, film screenings, festivals, informational sessions with public health experts, and more. Joining with major recording artists, Music to End Malaria will culminate with awareness-raising concerts on campuses in Atlanta (April 25), Geneva, NY (April 28), and New York City (April 30).
On Monday I was lucky enough to be on a conference call with the heads of the four organizations below. In a nutshell, the organizations seemed to be truly interested in a collaborative effort and are willing to do what it takes to get the message out and get more people involved. In short, I was impressed, the call was very interesting and I will put up a digest of the conversation later this week. Today is Africa Malaria Day, please spread the word to your networks. Additionally, April 25th is the first ever US Malaria Awareness Day. Some basic facts about a treatable disease:
350,000,000 new cases/yr (think the entire US & UK population)
1-2 Million children dead annually
3000 African children die every day
$1 to treat children under five
Malaria No More
Engages individuals, organizations, and corporations in the private sector to provide life-saving bed nets and other critical interventions to families in need. Check out their involvement page.
Medicines for Malaria Venture (MMV)
A nonprofit organization created to discover, develop and deliver new antimalarial drugs through effective public-private partnerships. MMV is managing over 30 projects (pipeline-PDF), the largest portfolio of antimalarial drugs in history. Four new artemisinin combination therapies could be approved for use within the next two years.
ExxonMobil-Africa Health Initiative
The ExxonMobil Foundation established the Africa Health Initiative in 2000 to fund and support activities related to the prevention, control and treatment of malaria in Africa. The Foundation has donated approximately $40 million to help fund programs at an individual community level, to promote the research and development of new drugs, and projects to advocate for awareness and support internationally.
President’s Malaria Initiative
In June 2005, President Bush launched PMI. He pledged to increase U.S. malaria funding to $1.2 billion over five years to reduce deaths due to malaria by 50% in 15 African countries. PMI is a collaborative effort led by USAID, in conjunction with the CDC, the Department of State, the White House, and others.The PMI goal will be achieved by reaching 85 percent of the most vulnerable groups with proven prevention and treatment measures. See also White House Summit on Malaria.
Here Sachs talks at the Norte Dame Forum on Malaria and tries a different approach to getting people involved. He argues that people in the US should care about malaria because one day it could impact everyone. I like his use of different tactics here, but it is also a bit on the scare tactic side.
The hype around a variety of global issues (microfinance, climate change, sustainability) continues to grow and based on the coverage this also seems to be true for global health. There must be something in the water this past year as there have been announcements by several universities about starting new global health divisions, departments or courses. Many schools of public health are leading the charge and are being backed up by real money in some cases. While there have been some universities that have had international health tracks, this set of developments is certainly a new phenomena that is widespread and not restricted to the typical large public health institutions (such as Hopkins). I hope that these schools are thinking outside of the typical public health box in how they develop their curricula, but that hope may be foolish on my part. Please find below a summary of recent news in this area, if I have missed any schools/programs I would be happy to add them. The amount of money and activity listed below is unprecedented for public/global health programs at the higher education level:
1) $110M for Emory Global Health, Jan 2007, & their $786M windfall, April 2007
2) $50M for UNC school of Global Public Health, Feb 2007
3) $30M for Duke Global Health, Sept 2006, Feb 2007
4) $30M with $100M more sought for UWashington Global Health, Sept 2006, Feb 2007
5) $4M for Oxford Global Health Sciences, April 2007
In addition to the above it looks like Harvard or Harvard affiliated clinicians will receive a total of $120M from Eli Lilly to tackle TB, read the story here. University of Washington wants to start a Health Metrics Institute and Emory will have an initial focus on vaccine and drug discovery, so there will be a large roll for measurement/evaluation and technology. There is a potential $324 million in funding for these new institutes, all announced mostly within the past 6 months. I did not have time to dig too much deeper into the list below, but you can see there is quite a bit of recent activity at many other schools:
–Colorado State Micro Rx, “MicroRx, a first-of-its-kind enterprise to speed the transition of life-saving research on infectious diseases from the academic world into the global marketplace.”
–U of Virginia public health/global health minor
–UCSF, Debas’ Bold Vision for the Future of Global Health
–DMU, new global health program
Before we get excited about all this movement, let’s not forget about things that plague many organizations: academic inertia, fiefdoms, turf wars, and major political battles. Some of these new initiatives may be revolutionary and some should be taken with a grain of salt. Without naming names, there are some universities with THREE or more, not one, but three centers for global health all at the same institution. These announcements, however, do indicate a very strong expanding interest in global health issues. In addition to this, a Feb 2007 commentary by Fitzhugh Mullan in the Journal of the American Medical Association calls for a sort of global health professional peace corps to tackle HIV/AIDS: “HIV/AIDS is “essentially the black death of the 21st century, killing on a massive scale and threatening to cripple economies and topple governments…the US should mobilize health workers ready to commit to working abroad in the long-term battle against HIV/AIDS.” It is a fascinating time for global health education, we will have to keep an eye on what happens with these investments.
The first Oxford Conference on Innovation and Technology Transfer for Global Health will address the challenge of Bridging the Gap in Global Health Innovation — From Needs to Access, examining emerging international systems of innovation and their implications for the management of technology transfer for global health. Attendance is by application only.
There are a variety of video hosted websites covering various lectures at conferences or other venues I wanted to remind folks about. I am not sure any of these have taken off, but there are a fantastic way to catch up on interesting topics. The individual links are as follows: Scribe Media, KarmaTube, Fora TV, IET. IET is focused on technology but they have relevant videos, just do a search on “health” on their website. Considering the popularity of YouTube it would be cool if they had a section devoted to social causes/international health. If you know of any other worthy outlets please email us.
On a related note, Starfish is coming to DISH network soon. “The Starfish Television Network’s programming objective is to tell the stories of the nation’s philanthropic community in an entertaining and cost-effective fashion.” Other video or audio sites of interest are below:
BOP Videos at Michigan, link
Doctors without Borders podcasts, link
PRI’s The World: global health podcast, link
New England Journal of Medicine audio interviews, link
Columbia global health seminar series, link
University of North Carolina global health seminar series, link
2007 Univ of Wisconsin Global Health Symposium, link
University of Washington School of Public Health podcasts, link