Yesterday in globalhealthU, we discussed issues concerning malaria in response to World Malaria Day, which was observed on April 25th. We watched a video which compared the amount of money being put into malaria research with the amount spent on research for eyelash-enhancing products. The capitalist incentive is obvious for these eyelash products because of the high demand. The video suggests that malaria drugs would also benefit capitalists, but they are too short-sighted to invest in such a long-term venture. We next watched a UNICEF video describing the effectiveness of mosquito nets on reducing cases of malaria. Although they have been shown to reduce prevalence by as much as 60%, one member pointed out that mosquitoes have been adjusting to the nets in some areas. Since the nets are placed over beds while people sleep, mosquitoes have begun feeding earlier in the evening before the people have gone to bed. This fact, combined with the increasing resistance of the malarial parasite to anti-malarial drugs, emphasizes the need for further research in malaria containment. The nets, which have a lifespan of 3 years and must be replaced afterward, will only provide a temporary solution, and a more permanent one must be found.

History and Overview of LGBT and Global Health

This month’s topic is LGBT issues and how they relate to global health.  In general, the LGBT community is one that has only relatively recently been recognized by the rest of society and one which is particularly vulnerable to discrimination and persecution worldwide.  People had lots of comments in tonight’s discussion as we considered what gay, lesbian, bisexual, or transgendered people in rural Peru and might deal with in their lives and what health issues they may face that others don’t.

Ilan Meyer’s Why Lesbian, Gay, Bisexual, and Transgender Public Health? describes the importance of having health care policies and resources which target LGBT populations.  Meyer discusses how LGBT communities are hard to define since they are geographically dilute and sociodemographically variable.  Transgendered individuals are especially rare, and concentrated efforts to improve their health are difficult to undertake.  We talked about the specific health concerns that come with certain sexual orientations and risks which are not specifically related to a person’s orientation, but may become problematic as a result of prejudice and discrimination.  These risks include depression, physical violence, and a general lack of access to health care as a result of discrimination.  The inability of a person to give medical consent for a same sex partner in some states was also brought up in discussion.

Henry Armas’s Exploring Linkages Between Sexuality and Rights to Tackle Poverty argues that sexual rights are directly related to educational, health, and labor rights.  Oftentimes, these rights are relegated as secondary to those latter issues, which are termed “more important.”  Sexual rights refer to the rights to: sexual healthcare services, sexuality education, respect for bodily integrity, choice of partner, consensual marriage, decision to be sexually active or inactive, decide whether or not—and when—to have children, among other rights related to sexuality.  While many individuals struggle with violations against their sexual rights, LGBT individuals are particularly prone due to discrimination and persecution within society.  We discussed the effects on mental health, economic life, and education that being an LGBT individual can confer, and how the idea of heteronormativity, while obviously having effects on LGBT individuals, can also affect those who choose to be single and those who are single due to uncontrollable circumstances.  Specifically, we talked about single mothers, especially those in their teens, who are particularly at risk for exclusion from society when they need society most.  In addition, the lack of job opportunities drives many LGBT individuals into prostitution, their only available source of income.  Herein lies the irony: those who try to take control of their body are forced into selling it.

This week’s lesson was particularly great because of everyone’s participation and sustained discussion.  It also brought up a social justice topic that we might sometimes overlook, LGBT issues of health.

Interesting points that were brought up:

  • Members of the LGBT community have many different needs but often share the same social stigma.
  • There are many health issues related to discrimination and vulnerability that are not inherently related to sexual orientation itself.
  • There are a number of issues related to economics and education that the LGBT community in Latin America (and much of the world) faces as a result of being ostracized by peers, employers, and family, and this may ultimately lead to health issues related to poverty.

If you have anything to add to our discussion, please leave a comment!

Health as a Bridge for Peace

This week’s topic involved a case study of the World Health Organization’s “Health as a Bridge for Peace” (HBP) program. The concept is built off of the idea that health concerns can only be met in areas which are free of major conflict and that healthcare infrastructure can actually be used to facilitate the peace-building process. The article by Gregory Hess and Michaela Pfeiffer, Comparative analysis of WHO “Health as a Bridge for Peace” case studies, begins its analysis by defining three different sub-categories of peace-building: political, structural, and social. Political peace-building is achieved through the formation of agreements and political arrangements between leaders of the conflicting factions. Structural peace-building involves the implementation of institutions, like hospitals and educational programs, which promote an environment in which peace is attainable. That is, if health care is more widely available, discontent is less likely to be prevalent. Social peace-building is the facilitation of relationships between individuals and groups on opposing sides of the conflict. The role of the HBP program is more involved with structural peace-building because the program is mostly involved in medical work, and the people involved in the program are mostly medical professionals.

CCC-UNSCH, our partner, is involved in building community amongst the elderly of the Ayacucho region and is proposing to build a social meeting center in order to facilitate discussion of local issues. In this respect, CCC-UNSCH is a social peace-building organization.

We also discussed the role of WHO’s HBP and whether it should continue to only pursue structural peace or if it needs to branch out to the other aspects of peace-building. On one hand, there is the idea that in order to truly create peace, all three aspects are necessary. The WHO should seek to develop itself in those peace-building areas. On the other hand, a health organization needs to remain politically neutral in order to provide care for the greatest amount of people. Focusing solely on structural peace-building as opposed to politics or reconciliation would allow the organization to continue its important work without alienating either side of the conflict.

Conflict and Health

This month’s globalhealthU theme is conflict and health. In today’s meeting, we talked about how issues of health are often augmented during times of war. Ronald Waldman, in his article Public Health in War – Pursuing the Impossible, explains that war has turned into a guerilla conflict that impacts urban centers and causes massive civilian casualties. He discusses how the nature of war has changed from an attempt to gain territory to an attempt to disrupt society, and this, of course, has terrible repercussions on health care and hospitals.

The large amounts of people that war displaces require access to health care in addition to even more basic needs like food and water, and when these are lacking, mortality rates rise. Humanitarian aid can only act as a bandage, preventing a bad situation from getting worse but never solving it. Waldman concludes with the statement, “The most important lesson to learn for the future—one that has already been learned but forgotten many times in the past—is that war and public health are fundamentally incompatible pursuits.” Take some time to read the article, and learn more about the interrelatedness of health and war.

Some questions to consider include:
Is humanitarian aid a solution to conflict?
How can we improve health care systems torn by warfare?
Is it possible to have political and social strife without affecting the health care system?

To consider ideas for policy on how to handle issues of public health in the face of war, we also took a look at the article From Conflict to Pandemics by Eugene V. Bonventre and James B. Peake. Chapter 3, Preserving and Improving Civilian Health in Conflict-Affected Nations, specifically addresses the impact of war on civilian health.

The CSIS Global Health Policy Center has been discussing ways in which an international coalition of militaries can support global health. Emphasis is placed on the importance of military agencies to engage in conversation with civilian agencies to better care for health issues. The article calls for interaction between military health care facilities and civilian facilities, such that patient referrals should be made between the two systems in order to provide the best possible health care to all citizens, whether civilian or military. Ultimately, we need to look at broken health systems as a matter of national security to make actual change

“An outbreak in Indonesia can reach Indiana within days, and the public health crises abroad can cause widespread suffering, conflict, and economic contraction… [T]he world is interconnected, and that demands an integrated approach to global health.”
—President Barack Obama, Global Health Initiative, May 5, 2009