Another Perspective: Infant Mortality and Micronutrition

November 14, 2011

By Mathura Thevarajah

This eye opening talk focused on zinc, the largest micronutrient deficiency of the developing world that has the greatest impact on infant mortality.

The first speaker, Dr. Robert Black, spoke of the unmet potential of micronutrients. He revealed that time after time, studies show that zinc supplementation can decrease mortality by 15-30% in infants 6- 35 months.  Furthermore, 178 million children suffer from stunted growth, and zinc supplementation has a positive effect on such anthropometric measures. Zinc supplementation also curbs infections disease rates. One study in India showed that zinc supplementation reduced the incidence of diarrhea by at least 20% and even when zinc is given as a treatment of diarrhea during an acute bout, it decrease future prevalence of diarrhea by 34%.

Dr. Black was followed by Dr. C Larson, a McGill Medical Graduate and specialist in paediatrics and public health. He spoke of international efforts to scale up zinc treatment in an effort to curtail the insidious effects of childhood diarrhea. So far international efforts have achieved a 10% coverage in rural areas. The greatest challenge he claims is that such initiatives must have sustainability and it is difficult to distribute resources to the mouths of those who are most in need without creating disparity.

Next, Dr. S Horton stepped up to the microphone to speak of the economics behind micronutrients. She discussed the Copenhagen Consensus of 2008, which she describes as the “olympics for economists”. Occurring every 4 years, it is a meeting where ten of the most eminent economists in the world meet to answer the questions of how to best advance global welfare supposing there was $65 billion at disposal over a four year period. The last meeting in 2008, which included five Nobel laureates, concluded that micronutrient supplementation for children, specifically vitamin A and zinc, would have the most impact. According to Dr. Horton, the international community is making an effort to prioritize these interventions and implement changes as part of a broader international policy effort. Such efforts are funded in increasing order by the international private sector, the domestic privates sector, domestic governments, and mostly importantly by international donors.

Dr. Mark Fryars, Vice President of the Micronutrient Initiative wrapped up the session on the importance of strengthening in-country capacity to scale up micronutrient interventions.  He started his powerful presentation with a quote by Richard Kohl; “start with the end in mind”.  Scaling up is not simply about  “coverage or about products,” he said. “It’s very much about impact. There has to be a constant and major focus on those truly in need”.

One of the conditions that are implicit in this is that sustainability is vital and that coverage needs to encompass those truly in need, and not just those in reach. He discussed the important lasting capacities and capabilities needed to implement a scale-up program. The road for such projects seems clear cut; scientific evidence –> show proof of concept –> scale up –> sustain long term; but in practice is not so straight forward. In essence, political commitment, distribution, proper uptake and utilization, affordable prices, accessing the right people, proper providers, promotion, business processes for engaging conversations between providers and consumers, and finally complexity and diversity of partnerships are all crucial factors. He particularly stressed the need of secure partnerships which in and of itself is a discipline, a skill, a science even, requiring a wide array of interdisciplinary efforts and collaborations. 

To summarize, zinc supplementation in areas that have a high rate of deficiency has positive, significant benefits in reducing mortality and improving quality of life yet the path to going upscale is complex and takes time. The most important point is that in the process of up-scaling we do not lose sight of the ultimate goal which needs to always be people-centered.


Session 2: Infant Mortality and Micronutrition

November 14, 2011

By: Lindsey Lenters, RD, University of Toronto

As a Dietitian and Masters of Public Health student, the session on infant mortality and micronutrition was on the top of my list of break-out sessions! Much of the discussion centered on the treatment of childhood diarrheal disease using zinc supplementation and oral rehydration. Zinc was recognized as an essential nutrient many decades ago. Yet it’s only in recent years, through the work of the panelists and other researchers that we have begun to understand the impact of zinc on child development and diarrheal disease.

Perhaps the most captivating aspect of this session lay in the discussions that stemmed beyond zinc, to look at the challenges faced in scaling-up and sustaining nutrition initiatives. Sue Horton pointed out that nutrition interventions have not benefitted from increased funding for global health initiatives to the same extent as issues such as HIV/AIDS and TB, despite an established evidence-base of effective nutrition interventions, as well as compelling cost-benefit arguments. Charles Larson touched on the need to better understand decision-making processes at the household level in order to see the uptake of micronutrient interventions. Mark Fryars spoke to the need to apply an equity lens to scale-up efforts, in order to ensure that interventions cover those in need, not just those in reach.

The issues surrounding malnutrition are complex and will require long-term, sustained attention from the public and private sectors.  There is a long road ahead, yet this session beautifully captured the growing momentum and energy around nutrition in global health.

The lingering thoughts in my mind revolve around the issue of the “medicalization” of nutrition, and what might be lost if we do not seek to understand the daily contexts and personal meanings of food and nutrition.


Session 17: Equity and Maternal and Child Health: From Epidemiology to Human Rights

November 14, 2011

By: Jennifer Kitts, Consultant

Three speakers participated in the session “Equity and Maternal and Child Health: From Epidemiology to Human Rights” on Sunday afternoon. The session was moderated by Janet Hatcher Roberts, Executive Director of the Canadian Society for International Health.

Dr. Zulfiquar Bhutta, of the Aga Khan University in Pakistan, and Dr. Ian Pett, of UNICEF, both discussed the importance of equity in achieving better health outcomes for women and children. Although we are making progress in reducing child and maternal mortality, success is not spread evenly across countries and within countries. Dr. Bhutta pointed out that most of the world’s approximate 350,000 maternal deaths annually occur in sub-Saharan Africa andSouth Asia. The 10 countries of the world that account for the majority of maternal deaths also account for the majority of newborn deaths and stillbirths.

Great discrepancies can be found within countries. Some parts ofPakistanhave maternal and child health indicators that “are as good asMontreal, while other parts have similarities to sub-SaharanAfrica,” said Dr. Bhutta. There is a significant difference between what interventions are available for the rich and for the poor. “We know what works,” he said, “the big challenge is how to reach the unreached.” Similarly, Dr. Pett said that, whileBrazilhas had success in the area of child mortality, when the statistics are analyzed by state and by municipality, pockets of higher mortality are evident -“getting interventions to the most marginalized is key.” The service delivery model must be assessed to determine whether it rationally, equitably and efficiently addresses the nation’s burden of disease.

Greater support is needed for prioritized interventions on the basis of the evidence. Dr. Bhutta spoke of the need for more attention to family planning. “It is impossible to produce the impacts in maternal and child health that we would like to see without greater attention and resources to family planning”. Dr. Pett suggested that more support should be given to key issues such as diarrhea, pneumonia, postpartum sepsis.

Community-based approaches were also emphasized, which have been shown to reduce up to 30% of neonatal deaths and 25% of maternal deaths. Moving forward, Dr. Pett said that it is useful to consider countries that have achieved success in sub-Saharan Africa andSouth Asia. Peer-to-peer influence is increasingly important. Also, there is a need to pursue equitable ways to remove financial and other barriers to access and use of services.

Sandeep Prasad, of Action Canada for Population and Development, brought a different approach to the issue in his presentation of how civil society organizations around the world have been working, with great success, to put the issue of maternal mortality and morbidity on the human rights agenda. They have helped to ensure that 3 resolutions were adopted on the issue by the UN Human Rights Council, the primary intergovernmental body mandated to protect and promote human rights. The most recent resolution (September 2011) recognized that maternal mortality and morbidity is underpinned by 7 human rights principles: accountability; participation, transparency, empowerment, sustainability, international cooperation, and non-discrimination. Giving effect to these principles is the core of a human rights approach to eliminating maternal mortality and morbidity.

Prepared by Jennifer Kitts, a Canadian consultant, working in the area of global health and human rights.


Session 20: Canada’s Strategic Role in Global Health

November 13, 2011

By: Jennifer Kitts, Consultant

Peter Singer

Peter Singer

Peter Singer, CEO of Grand Challenges Canada, and Director of the McLaughlin-Rotman Centre for Global Health at the University of Toronto, gave a presentation on a new report of the Canadian Academy of Health Sciences, entitled “Canadians Making a Difference”.

 

An expert panel was convened to assess Canada’s strategic role in global health and its comparative advantages in this area. The report begins with a celebration of the many successes of Canadians making a difference in global health. These areas include the areas of micronutrients, HIV/AIDS, maternal health, tobacco control, and women’s and children’s health. The experts agreed that there is a compelling rationale for Canada to play a more strategic role in global health, and that there is a need for a more coordinated all-of-Canada approach.

The panel determined that three principles should guide Canada’s strategic role in global health: equity, effectiveness, and engagement. Canada has many strengths in global health including the strong value it places on universal access to health care, its strong health and foreign policy, its world class education system, and the fact that Canada has many global leaders in the areas of indigenous health research and the social determinants of health.

However, some of the barriers preventing Canada from leveraging its strength include: a lack of a unifying vision for global health; poor coordination among Canadian global health actors; the fact that career paths in global health at institutions of higher learning are not clear; and also, that there are limited avenues to mobilize interest in global health.

Areas of comparative advantage and opportunities for leadership include: (1) indigenous and circumpolar health research; (2) population and public health; (3) community-oriented primary health care; (4) smart partnerships in health education and research; and, (5) global health innovation.

Next, there will be a phase of continued listening and encouraging more voices to join in the conversation. The report can be found at www.facebook.com/CanadiansMakingADifference, and comments on facebook and twitter are encouraged.  There will be another session tomorrow afternoon (Monday) that will look at the report in more detail.


Session 5: Injury and Global Surgical Education

November 13, 2011

By: Sarah Lombardo, Duke University

In Rwanda, 47 surgeons and 12 anesthesiologists must struggle to meet the surgical needs of its 11.3 million citizens.  I am confident that my medical school alone, one of six in a US city of 1.6 million, employs a surgical physician workforce in excess of 59 individuals. 

The disparities in the availability of surgical care and training took center stage today during a late morning session of 2011 Global Health Conference in Montreal. Chaired by Dr. Haile Debas of UCSF, a diverse panel of physician and student researchers outlined the importance of surgery as a global public health priority.  Dr. Debas began the discussion by describing the global burden of surgical disease (11% of worldwide annual DALYs), before moving into a thoughtful summary of the barriers to improving surgical access and quality of care (brain drain, urban/rural mal-distribution, budgetary and infrastructure shortfalls, lack of administrative capacity, etc.).

Successive presentations by Drs. Kayibanda and Jani described fruitful yet limited efforts in training programs aimed at increasing surgical capacity in Africa.  Dr. Jani offered the most poignant point of the session, drawing attention to a list of highly technical advanced surgical training programs currently ongoing in Africa, and asking the audience to consider the true value of minimally invasive neurosurgery to those 11.3 million Rwandans.


Call to Action: Get Involved, Be Heard

November 13, 2011

Following  a warm welcome by conference host, Tim Brewer, an outstanding of panel chaired by Jody Heymann focused on the intersection of government and global health.

Keith Martin, a Canadian member of Parliament and physician, noted one of the greatest challenges in global health is gaining the ability to scale up the knowledge we have to address the gross inequities that exist in the world. He implored universities to take the leadership role in addressing inequities by bridging the gap between knowledge and practice. 

He encouraged the audience to be heard and to influence the beast of government by becoming social entrepreneurs and focus on the rate of return to save lives. One way to accomplish this is for global health advocates to build partnerships with the private sector and to use social networking tools to form alliances.  “You must appeal to hearts and minds of the public and political leaders.  No one has ever been motivated by a pie chart.”

Ambassador Eric Goosby, US Global AIDS Coordinator, US Department of State presented data showing the unprecedented progress of PEPFAR to save lives.  New infections in key African countries have plummeted due to PEPFAR.  He restated Secretary Clinton’s recent comments that treatment for prevention is the key for further reductions in HIV, and is a major priority for PEPFAR.

He also discussed the need to build the health workforce through partnerships with US and international medical schools and universities. Through the MEPI (medical education partnership initiative) initiative, medical institutions throughout sub-Saharan Africa are leading efforts to redesign medical education curricula and programs.   

Ambassador Goosby also discussed a plan between PEPFAR and the Peace Corps to accept US clinical educators as volunteers in order to provide training to expand medical capacity in developing countries.  Potential partners that could contribute to such a public private partnership could include foundations, professional associations, and US and partner country universities.

“We are in a moment globally where global health is on everyone’s radar screen,” Goosby said.  “Your voice is different because you have evidence-based research on how our work is making a difference for people in developing countries.  The time to break down barriers between academic and political world is now.”

Finally, Lieutenant General Romeo Dallaire provided inspiring remarks about the realities of genocide and the need to have humanitarian efforts to save lives and manage conflicts throughout the world.  The outlined the massive scale of abuses throughout the world, from war to slave labor to genocide. He challenged the audience to treat all humans equally.  “Why is a Canadian child’s life worth saving and not a child in Sudan?”   He argued that unrest and conflict impacts stability and health internationally, and the use of force is necessary to protect the world. 

“The will to intervene is the crux of the problem.  Global health is part of the solution.  Put humanitarianism before self interest and get involved.”


Welcome to the 2011 Global Health Conference

November 13, 2011

The 2011 Global Health Conference is in full swing.  The Conference kicked off with an inspirational call to action from panelists in The Role of Governments in Global Health.  (Look for a summary soon.)

We have a great Blog Team capturing summaries of many of the sessions so watch the blog for more posts later today. If you want to follow up real-time, follow along on Twitter @CUGHNews and #2011GH.

For those attending the conference, watch Global Health TV on hotel channel 55 and on monitors throughout the conference facility.  Starting tomorrow watch coverage online at www.globalhealthtv.com

Stay tuned for more…


The Montreal Global Health Invasion

November 10, 2011

More than 1,300 global health leaders from 60 countries will be arriving in Montreal over the next few days to learn, teach, network and collaborate.  Hosted by the Canadian Society for International Health, the Consortium of Universities for Global Health, and the Global Health Education Consortium, the 2011 Global Health Conference features provocative sessions on topics like ethics, capacity building, advocacy, accountability and much more.

The Scientific Program features illustrious leaders from government, academia, media and corporations in Uganda, South Africa, Kenya, Barbados,  Ghana, Pakistan, Cameroon, Rwanda, Canada and the US.  Subscribe to the blog for summaries and breaking news from these plenary sessions.

Organizers have partnered with Global Health TV to produce  “Conference News.”  This is a daily program of conference highlights, featuring behind the scenes interviews, coverage of conference events, and reactions to the day from attending delegates.  Look for links to this daily report right here on the blog!

Join the Conference Blog Squad! 

We’re looking for a few more volunteers to blog during the conference.  Email globalhealth@duke.edu today to add your voice!


Global Health Leaders Convene in Montreal to Discuss Advancing Health Equity in the 21st Century

November 9, 2011

FOR IMMEDIATE RELEASE

Global Health Leaders from Canada, the United States and around the World to Convene in Montreal to Discuss “Advancing Health Equity in the 21st Century”

More than 1,300 people from 60 countries are expected to convene in Montreal, Canada on November 13-15 for a joint meeting of three major academic global healthorganizations in North America: the Canadian Society for International Health, the Consortium of Universities for Global Health, and the Global Health Education Consortium. The three-day 2011 Global Health Conference, whose theme is “Advancing health equity in the 21st Century”, will be attended by government leaders from Canada, the US and around the world who shape global health policy, as well as university faculty and students who conduct cutting-edge research across a spectrum of health and non-health disciplines.

This unique gathering is designed to both address the multiple and complex factors that impact health equity and to facilitate discussion around potential solutions to some of the world’s most pressing health issues.

“It has never been more important for universities and other global health partners to come together to address health equity around the world,” says Timothy Brewer, MD, MPH, Co-chair of the 2011 Global Health Conference and Director of Global Health Programs at McGill University. “Funding for global health from government programs and other sources of development aid is decreasing due to the worldwide economic crisis, and this threatens progress in programs around the world that are making strides toward reducing health inequities in some of the most challenging environments.”

Six plenary sessions, 36 breakout sessions, 14 workshops and 500 posters will focus on a wide breadth of global health-related topics, including climate change, ethics, policy, engineering and innovation, and the media.

On Sunday, US and Canadian government leaders will participate in a session entitled “The Role of Governments in Global Health” in which they will discuss their agencies’ impact on global health policy and implementation, including on science, advocacy and security. Keith Martin, MD, who served as a Canadian Member of Parliament for 17 years, will speak about the vital role of universities in Mainstreaming conservation initiatives for health equity, environmental security and conflict prevention. Ambassador Eric Goosby, MD, who serves as the United States Global AIDS Coordinator, leading all US government international HIV/AIDS efforts, will speak about PEPFAR (President’s Emergency Plan for AIDS Relief) and engaging governments to use science to save lives.

Not all presenters at the 2011 Global Health Conference will be health professionals, however.  A defining aspect of the global health discipline is the multi-disciplinarity of the faculty and students who cross traditional academic boundaries and partner with NGOs and government agencies to jointly develop solutions to deeply engrained problems. This is also a community with a strong commitment to human rights and to understanding the many factors that lead to health disparities, which can result in the destabilization of an entire community or country.

For example, on the government panel, Martin and Goosby will be joined by Romeo Dallaire, Senator, Lieutenant-General of the Canadian Armed Forces (retired), who commanded the United Nations Assistance Mission for Rwanda (UNAMIR) in 1993. In that postDallaire and his troops witnessed the killing of more than 800,000 Rwandans in a period of just three months.

“Failing states and imploding nations where massive abuses of human rights are prevalent are ideal hotbeds of extremism and pandemics,” says Dallaire, whose talk is titled Child soldiers and security forces: ensuring adequate preparation for peacekeeping.  “The use of children as child soldiers to sustain these conflicts remains a source of instability as well as being a crime against humanity.”

Also on Sunday will be an afternoon panel on global health and the media that will feature some of the top health journalists and communications professionalsworking in North America today: Nancy Snyderman from NBC News, Donald McNeil, Jr. from The New York Times, André Picard from the Globe and Mail, and Dan Green, from the Bill & Melinda Gates Foundation.

Other notable speakers include Peter Singer, Chief Executive Officer of Grand Challenges Canada and Director at the McLaughlin-Rotman Centre for Global Health, University Health Network and University of Toronto, who will discuss Canada’s strategic role in global health.

On Monday, the Delivering Transformational Change with Simple Solutions breakout session will explore why some innovative ideas thrive and others fail in resource-limited environments.

Featured speakers include Maxim Budyansky, a Johns Hopkins student who was on the winningteam of the Be the Change: Save a Life Maternal Health Challenge<http://abcnews.go.com/MillionMomsChallenge/GlobalHealth/save-life-maternal-health-challenge-johns-hopkins-students/story?id=13575157>, sponsored by ABC News, the Duke Global Health Institute, and the Lemelson Foundation. Maxim and his team from the School of Engineering designed a pen-sized device that can help screen pregnant women and newborns in developing countries for life-threatening conditions. The team spent months in Nepal field testing the device before winning the $10,000 award. This panel will open with representatives from USAID and the National Collegiate Innovators and Inventors Alliance who will discuss the funders’ perspective, and representatives from frogdesign and GE Company, who will discuss product design.

Of the 1,200 attendees expected at the conference, 450 will be students from US and Canadian universities. The number of global health programs in North America has surged in the past decade. Student demand has driven much of this growth, with enrollment in undergraduate and graduate courses doubling in recent years, according to the Consortium of Universities for Global Health.

“My desire to learn about medical practices beyond the borders of my community was my main drive to become involved in global health,” says Helene Retrouvey, a second-year medical student at McGill. “This will be a great opportunity to develop professional bonds with members of the global health community. It will enable me to develop the skills and knowledge to improve the lives of others worldwide. ”

Global Health TV will be on hand to film sessions of the conference, conduct interviews and provide daily reporting. Also, a team of volunteers will be blogging, tweeting and using other social media tools to share perspectives on the conference as it is happening.

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For more information on the 2011 Global Health Conference, visit the website at http://www.2011globalhealth.org/ .


2011 Global Health Conference… five days away

November 7, 2011

The 2011 Global Health Conference is almost here. The premier meeting of global health leaders, practitioners, faculty and students begins Sunday, Nov. 13 in Montreal and continues through Tuesday, Nov. 15. 

Hosted by the Global Health Education Consortium, Canadian Society for International Health and the Consortium of Universities for Global Health, the conference has attracted nearly 1,400 people. 

Can’t make it to Montreal?  The CUGH Blog will post daily updates, session summaries, photos, videos and more.  Subscribe to the blog and encourage your friends to do the same.  Also follow along on Twitter at #2011GH.

Coming to Montreal and want to be part of the action?  Become an official conference blogger!  Contact Geelea Seaford, gseaford@duke.edu to volunteer.   

See you in Montreal (and online!)


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