Lunch Topic Table: Sex and Gender

November 14, 2011

By: Laura Pascoe, GHEC Student Advisory Committee

During the lunch hour on Sunday, students, faculty, and other conference participants had the opportunity to discuss a topic that is fundamental to global health work and research, but often not discussed: Sex and Gender.

We broke up across four tables and three themes to discuss how to think about theoretical approaches to sex and gender; empirical methods for researching them; and how to get the word out about the importance of understanding the impacts and implications of sex and gender (knowledge transfer).  One of the important questions that came up in the in terms of theoretical approach was whether we need to study gender in global health, or if we need to mainstream gender (and understand the implications) in global health. The answer, which received wide agreement, was that we need both.

There was also a valuable discussion about the critical nature of understanding a local context before making assumptions about how gender and sex influence life in that environment, and the need for local conceptualisations of gender and feminism to inform our work. It is imperative that we incorporate sex and gender in our work, many agreed, but we must be careful not to perpetuate imperial assumptions of what is ‘best’ for men and women.  

The importance of engaging men and understanding masculinity in our pursuit of promoting gender equality was raised in a few groups. Discussions around empirical methods brought up the challenges of asking people to tick potentially overly simplistic male/female boxes in our data gathering, as well as the importance of doing both quantitative and qualitative research in order to truly understand the complex dynamics of sex and gender that impact daily life in all parts of the world. 

We then finished up with a discussion of knowledge transfer, which raised some great points about how gender is not traditionally given its due place in global health and medical curricula. We need to advocate for greater incorporation of sex and gender on our various campuses and highlight its value in global, public health and medicine, not just because many people are interested in it, but because the impact and implications of sex and gender are integral to improving the health and well being of men, women, and children.


Debas, Deckelbaum, Wotton Receive Lifetime Achievement Awards

November 14, 2011

Lifetime Achievement Awards were given to three very deserving global health leaders Sunday night. 

Consortium of Universities for Global Health Lifetime Achievement Award: Haile Debas

Haile Debas

Haile Debas of Univ of California-San Francisco.  A native of Eritrea, Debas is recognized internationally for his contributions to academic medicine and is widely consulted on global health issues. Through his leadership and vision, Debas has driven the conceptualization and creationof UCSF Global Health Sciences, the Univ of California Global Health Institute and the CUGH.

He has held numerous leadership positions throughout his distinguished academic career, including Chancellor and Dean of the Univ of California, San Francisco School of Medicine, and chair of the Dept of Surgery.

GHEC Lifetime Achievement Award: Richard Deckelbaum

Richard Deckelbaum

Richard Deckelbaum is President of the Global Health Education Consortium and Director of the Institute of Human Nutrition at Columbia University. Early in his career he was a physician in Zambia, and helped establish the first children’s hospital in the West Bank of Jordan. He now directs the Columbia side of the Medical School for International Health.

CSIH Lifetime Achievement Award:  Kay Wotton

Kay Wotton is community health specialist with the University of British Columbia and community health educator with Frontier Health Care in NWFP Pakistan and Healthy Child Uganda.  Wotton was not in attendance Sunday evening because she is on assignment in Uganda.


Session 15: Global Health and the Media

November 14, 2011

Dan Green

By: Mathura Thevarajah

Media Panel

The sobering perspectives of the speakers in this session regarding global health and media aroused an artillery of questions at the end, all the while keeping the audience engaged, humoured, and informed. 

Dan Green from the Gates Foundation began his talk by comparing global health coverage to the broccoli of news. The media landscape is changing with a greater number of voices constituting more opinions and less facts, he explained. In essence, reporting is expensive, talk is cheap.

“Accountability in journalism is in serious jeopardy and the solution is that philanthropists and experts have to step up to the plate.”  One example he gave was how The Guardian puts out a newslist of potential topics for the day on their website and asks for experts in the field to send input for the pending paper. We have to make sure that “informed and engaged citizen who are doing really great work are getting their voices elevated within the media framework,” he said.

Donald J. McNeil of the New York Times began his talk with endearing self-deprecating humour that quickly turned searingly honest. Usually inundated with global health stories that just don`t have a chance of being published, he cried out for an angle, “something I don`t already know”. He clarifies, though, that he`s not that cold, otherwise he wouldn`t stick to it. 

Next, Andre Picard of the Globe and Mail illuminated the idea that even though the Globe and Mail is one of the 10 biggest newspapers in North America, with a foreign bureau that is continuously increasing, and a largely multicultural audience, global health is often just an afterthought. Global health coverage is reactive and responds to crisis where writers are dispatched on-demand. Part of the problem is that most reporters don`t have a health or medical background and comprise of a younger technology -savvy, albeit “green behind the ears” generation of journalists. Another problem is bridging the gap between health care professionals and journalists. Health care workers see reporters as “ill-informed and intrusive” and reporters see health care workers as “obstructive, prickly and unhelpful”.  There needs to be open dialogue and more understanding between the two groups in order to foster a healthy symbiotic relationship.

According to Green, global health coverage in the media is like symphonies in small towns; someone has to pay for it out of pocket because ticket sales just won`t cut it. Despite the lack of coverage for the vast array of important global health topics,  the take home point of the panel was that health care workers should never lose their passion and drive for their work. Afterall, as Picard jokes, “it may be broccoli but you can always put a lot of cheese sauce on it.”


Poster Presentation: The Montreal World Health Organization Simulation: Simulating the WHO to foster a new generation of Global Health Leaders

November 14, 2011

By: Mathura Thevarajah 

The Montreal World Health Organization Simulation was founded under the name McWHO (McGill World Health Organization Simulation) in 2007 by Martin Smoragiewicz, a McGill Medical Student, who was deeply concerned by the lack of recognition by his colleagues of the social determinants of health. Equally aware of the many professionals both in and out of health care who influenced health outcomes, the mandate of McWHO was to provide an event that allowed those passionate about health care issues and policies to challenge their assumptions, broaden their perspectives, and to develop inter-professional relationships. McWHO was based on the concept of a simulation of the World Health Organization with the idea in mind that it would offer participants the opportunity to step out into the world as a citizen of the global village while discussing health issues in a political, social, and economical context. In 2009, McWHO’s name was changed to MonWHO to reflect the population of students who participated in the conference and who was a part of the Secretariat. Today, MonWHO welcomes delegates from other parts of North America and Europe as well.

As a bit of history, the first MonWHO Simulation in 2007 was on “Access to Essential Medicines”. In 2008, resolutions passed at the simulation on “Migration of Healthcare Workers” were developed into a policy statement that was adopted by the International Federation of Medical Students Association. In 2009 the MonWHO simulation on “Environmental Health” welcomed Maude Barlow, a political activist and Senior Advisor to the president of the UN on water at the time. In 2010, resolutions passed at the MonWHO simulation on “Pandemic Preparedness” were brought to the Pan American Health Organization by keynote speaker Dr. Gina Tambini. MonWHO was also the recipient of the prestigious Forces Avenir Award in the category of Health. In 2011, the MonWHO simulation on “Maternal Health” officially launched its “Media Team”, a fully integrated and interactive press core, adding a new dimension of realism to the conference.

This year’s MonWHO theme is “Refugee Health” and the simulation will take place in Montreal from March 23-24th, 2012. This edition will give participants the opportunity to enter into the role of major players in global health policy. According to D. Hayek, current Executive Director, it is the hope of the MonWHO Secretariat that the March 2012 Simulation will not only develop interprofessional relationships between future healthcare workers and advocates, but also offer a profound learning opportunity for health-minded students in different fields.


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.


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