The spread of infectious disease can wreak havoc on a society’s organization and economy. For example, the economic impact of a flu pandemic in the US would be at minimum $71 billion. [1] It follows that in order to ensure a society’s function and economy, the public must be protected from infectious disease. However, defensive measures, and the extent to which public health can use them, are debatable issues.
When health officials think an infectious disease is present in a population, they can either quarantine or isolate individuals. Though in everyday terms quarantine and isolate seem interchangeable, they are actually distinct. Quarantine applies to those who have been exposed to an infectious disease but are not yet sick; isolation applies to those who are already sick.
For example, if during a flight someone has a particularly contagious infectious disease, then those around him would be quarantined (probably asked to stay indoors, treated and observed for early signs of illness.) The sick person would be isolated and given special care, and his caregivers would be protected to prevent infection by the disease. In general, the idea with quarantine and isolation is to “prevent further potential spread of the illness.”[2] However, these methods require restricting the freedoms of people, putting the safety of the community above freedoms of an individual.
What becomes hot debate, then, is who has the power to decide whether an individual’s freedoms should be restricted (or whether this individual should be quarantined.) The legislative branch dictates laws, and public health law is warranted under the police power of a state, which must take measures to protect the general welfare and health of the state. Public health laws set up agencies that make regulations to achieve a well and healthy state; these regulations have the force of law.
Sometimes these regulations state that an infected person must be quarantined and isolated from society. The health agency, doctors and the patient are involved in deciding whether such actions must be taken. However, it is complex when one considers questions such as to where? and is this necessary to protect public health?, questions that could involve judicial review. An example is the 1909 case Kirk v. Board of Health, in which Miss Kirk, a sufferer of leprosy, fought the board (the agency) that ordered her to vacate her home and temporarily move into a “pesthouse,” awaiting construction of a “comfortable cottage outside of the city” for her.
It was decided that the pesthouse was a health hazard in itself, and that “even temporary isolation…would be a serious affliction and peril to [Miss Kirk].” Instead, the court preferred to wait for the cottage to be built. The court also addressed the necessity of sending Miss Kirk to the pesthouse. Since Miss Kirk’s form of leprosy was found to be hardly dangerous, the court deemed the pesthouse as an unnecessary measure. So, even though public health laws guarantee the health of a state, and agencies go about to ensure these laws are met, courts can become involved in checking to make sure agency actions are rational.
I feel that judicial review, given accurate and adequate evidence, should balance the individual’s rights against the community’s rights. The only exception would be when a disease is clearly contagious/dangerous and requires immediate action. This would favor the community’s rights in the worst-case situation; this is exactly what is needed because in a worst-case situation, one mistake could be deadly for the community.
Friday, October 29, 2010
Friday, October 22, 2010
Global Health: Can it continue?
Global health takes on big issues that are often complex and multifaceted. To tackle these issues, more than simply money is required, as Laurie Garrett’s The Challenge of Global Health explains.
Garrett’s article discusses several issues that prevent global health efforts from being effective. To begin, she talks about aid being “tied to short-term numerical targets,” which means that aid often focuses more on particular diseases than on broad measures that would address general well-being. Garrett argues that narrowly focused programs are unsustainable, and that agencies/donors should “integrate their infectious-disease programs into general public health systems.” Such integration would allow for treatment and prevention to be addressed, making aid programs more effective.
But how would one distinguish the effectiveness of healthcare systems? Garrett proposes two important markers that are telling: maternal mortality and life expectancy. Maternal mortality data would reflect the “overall status of healthcare systems:” the conditions of facilities, along with the training and amount of personnel. Life expectancy data tells about “child survival and essential public health services,” essentially the broad-spectrum services that allow for survival through childhood (e.g. safe water, mosquito control and immunization). These markers are critical because they can contribute to a feedback loop where weaknesses of systems (issues that a system doesn’t address) are identified and improved upon.
Garrett also argues that despite the enormous monetary aid, global health continues to decline. There are several reasons including narrow spending and corruption and bureaucracy trapping money. Corruption and bureaucracy seem to be common among developing countries. The World Bank estimated that “about half of all funds” for sub-Saharan Africa never reached the clinics and hospitals they were intended for. Instead, the funds were misspent and even involved in the black market and sale of counterfeit medications. But even following legal routes, funding still gets lost in the maze of “financing bureaucracy,” severely hampering health-delivery systems by a least 15%. However, even if aid does reach a program, the narrowly defined goals can prove detrimental to global health.
Referred to as “stovepiping,” these goals tend to reflect the interests of the donors instead of those of the recipients- the people in need of help. This causes phenomena that we see every month: a disaster or epidemic breaks out, and massive donations are made. These diseases and health conditions bask in “a temporary spotlight,” which draws attention away from other broader and more statistically important killers (i.e. maternal death during childbirth and pediatric respiratory and intestinal infections.) Garrett points out that stovepiping also causes a shift in the interests of health-care workers, as more move towards the money and abandon other programs that “lack activist constituencies.”
Therefore, there is a strong need for integrated programs that can “prevent, recognize, control, and treat infectious diseases.” The beauty of such a model, as Garrett proposes, is that the ideal model can be generalized to include chronic diseases. Initially, steady funding and lasting support are needed, but attention to execution is also important.
Current donor practices need to be improved; faulty programs that lack effectiveness and sustainability are likely to be detrimental to public health. For example, failed tuberculosis programs that poorly handled tuberculosis treatment (the majority of patients did not complete antibiotic therapy) led to the emergence of XDR-TB. Other examples include mass vaccination campaigns gone wrong when lack of funding forced health-care workers to reuse needles, leading to a spread of HIV.
There’s enormous opportunity in this era to make a difference in global health, and Garrett’s got the right idea. If we can make smart programs that provide local infrastructure and address the big picture, instead of focusing on narrow goals and relying on donor support, then we can make sustainable programs.
Eric Wan
Garrett’s article discusses several issues that prevent global health efforts from being effective. To begin, she talks about aid being “tied to short-term numerical targets,” which means that aid often focuses more on particular diseases than on broad measures that would address general well-being. Garrett argues that narrowly focused programs are unsustainable, and that agencies/donors should “integrate their infectious-disease programs into general public health systems.” Such integration would allow for treatment and prevention to be addressed, making aid programs more effective.
But how would one distinguish the effectiveness of healthcare systems? Garrett proposes two important markers that are telling: maternal mortality and life expectancy. Maternal mortality data would reflect the “overall status of healthcare systems:” the conditions of facilities, along with the training and amount of personnel. Life expectancy data tells about “child survival and essential public health services,” essentially the broad-spectrum services that allow for survival through childhood (e.g. safe water, mosquito control and immunization). These markers are critical because they can contribute to a feedback loop where weaknesses of systems (issues that a system doesn’t address) are identified and improved upon.
Garrett also argues that despite the enormous monetary aid, global health continues to decline. There are several reasons including narrow spending and corruption and bureaucracy trapping money. Corruption and bureaucracy seem to be common among developing countries. The World Bank estimated that “about half of all funds” for sub-Saharan Africa never reached the clinics and hospitals they were intended for. Instead, the funds were misspent and even involved in the black market and sale of counterfeit medications. But even following legal routes, funding still gets lost in the maze of “financing bureaucracy,” severely hampering health-delivery systems by a least 15%. However, even if aid does reach a program, the narrowly defined goals can prove detrimental to global health.
Referred to as “stovepiping,” these goals tend to reflect the interests of the donors instead of those of the recipients- the people in need of help. This causes phenomena that we see every month: a disaster or epidemic breaks out, and massive donations are made. These diseases and health conditions bask in “a temporary spotlight,” which draws attention away from other broader and more statistically important killers (i.e. maternal death during childbirth and pediatric respiratory and intestinal infections.) Garrett points out that stovepiping also causes a shift in the interests of health-care workers, as more move towards the money and abandon other programs that “lack activist constituencies.”
Therefore, there is a strong need for integrated programs that can “prevent, recognize, control, and treat infectious diseases.” The beauty of such a model, as Garrett proposes, is that the ideal model can be generalized to include chronic diseases. Initially, steady funding and lasting support are needed, but attention to execution is also important.
Current donor practices need to be improved; faulty programs that lack effectiveness and sustainability are likely to be detrimental to public health. For example, failed tuberculosis programs that poorly handled tuberculosis treatment (the majority of patients did not complete antibiotic therapy) led to the emergence of XDR-TB. Other examples include mass vaccination campaigns gone wrong when lack of funding forced health-care workers to reuse needles, leading to a spread of HIV.
There’s enormous opportunity in this era to make a difference in global health, and Garrett’s got the right idea. If we can make smart programs that provide local infrastructure and address the big picture, instead of focusing on narrow goals and relying on donor support, then we can make sustainable programs.
Eric Wan
Friday, October 15, 2010
Vaccinations: Necessary or just a hassle?
A month ago, I blogged about the controversy surrounding vaccines, specifically the MMR vaccine which was wrongly accused of causing autism. A couple weeks later, the Washington Post published an article about whooping cough and its vaccines, the histories thereof, and whether people should get immunized.
Whooping cough is caused by the Pertussis bacterium, which attacks the cells in our lungs. Before vaccines were available, the number of cases was near 150,000 people annually. However, when vaccinations became widely used, the number of cases dropped to a low of 1,000 in 1976. Since then, the number of cases has increased to a peak of 25,000 in 2005. The article addresses several reasons why this might be case.
In some states like California, it is “legal and quite easy” to refuse being vaccinated or getting your child vaccinated. This forms groups of unvaccinated people throughout communities, and these clusters undermine a fundamental purpose of vaccinations: herd immunity. Herd immunity works by diluting the number of cases in a community by giving a large population within the community resistance to disease. It is a method to protect the whole population from disease, by simply protecting a majority.
However, it only works when there is an immunized “herd,” meaning people have to get immunized for herd immunity to work. But there always seems to be reasons why people aren’t getting immunized. Reasons might include a patient or parent’s fear of side effects from the vaccine (see MMR-Autism post), or their ignorance of the dangers of the disease. Since whooping cough rarely occurred several decades ago, young parents might not remember the threat it poses.
Reasons could also have nothing to do with patients; their doctors could be foregoing vaccination because it is perceived as “a disease of the past,” or because they feel that evidence for a vaccine’s effectiveness is lacking. Reasons could also orginate from the healthcare system itself; if the healthcare system doesn’t feel that immunizations are an effective intervention, then it is likely that more emphasis will be placed on treatment (which of course doesn’t help to prevent disease.) Also, pharmaceutical companies are hugely important to the healthcare system, and may be reluctant to develop vaccines because of low cost-effectiveness. All of these reasons may attribute to a lack of immunization in the community, but they do not fully explain why whooping cough cases are increasing.
Other contributing factors discussed by the article include mutation of Pertussis and the low effectiveness of the new vaccine compared to the old one. There’s quite a bit of science behind each of these, and for vaccines, different types can have different efficacies.
However, in the grand scheme of things, this doesn’t mean that one shouldn’t get vaccinated. Vaccinations won’t protect you fully but certainly it will offer a significant degree of protection (compared to having no protection). But in order to increase vaccination, I think a few priorities have to be tackled: firstly, there must be better campaigns for vaccination for diseases that are re-emerging (emerging diseases are new, but re-emerging diseases are often forgotten by the public). Secondly, I feel strongly that states should mandate vaccinations for all eligible. Since not everyone is eligible (e.g. newborns often aren’t), herd immunity has already been impaired to a degree. Having those eligible but not vaccinated is weakening herd immunity more. Thirdly, I feel that more emphasis should be placed on federal vaccine research. Pharmaceuticals tend not to share their data, even if it is good data that could help the population. So if they deem a good vaccine as not cost-effective based on a poor (low profit) market for a certain vaccine, then the federal government can provide those vaccines.
Eric Wan
Whooping cough is caused by the Pertussis bacterium, which attacks the cells in our lungs. Before vaccines were available, the number of cases was near 150,000 people annually. However, when vaccinations became widely used, the number of cases dropped to a low of 1,000 in 1976. Since then, the number of cases has increased to a peak of 25,000 in 2005. The article addresses several reasons why this might be case.
In some states like California, it is “legal and quite easy” to refuse being vaccinated or getting your child vaccinated. This forms groups of unvaccinated people throughout communities, and these clusters undermine a fundamental purpose of vaccinations: herd immunity. Herd immunity works by diluting the number of cases in a community by giving a large population within the community resistance to disease. It is a method to protect the whole population from disease, by simply protecting a majority.
However, it only works when there is an immunized “herd,” meaning people have to get immunized for herd immunity to work. But there always seems to be reasons why people aren’t getting immunized. Reasons might include a patient or parent’s fear of side effects from the vaccine (see MMR-Autism post), or their ignorance of the dangers of the disease. Since whooping cough rarely occurred several decades ago, young parents might not remember the threat it poses.
Reasons could also have nothing to do with patients; their doctors could be foregoing vaccination because it is perceived as “a disease of the past,” or because they feel that evidence for a vaccine’s effectiveness is lacking. Reasons could also orginate from the healthcare system itself; if the healthcare system doesn’t feel that immunizations are an effective intervention, then it is likely that more emphasis will be placed on treatment (which of course doesn’t help to prevent disease.) Also, pharmaceutical companies are hugely important to the healthcare system, and may be reluctant to develop vaccines because of low cost-effectiveness. All of these reasons may attribute to a lack of immunization in the community, but they do not fully explain why whooping cough cases are increasing.
Other contributing factors discussed by the article include mutation of Pertussis and the low effectiveness of the new vaccine compared to the old one. There’s quite a bit of science behind each of these, and for vaccines, different types can have different efficacies.
However, in the grand scheme of things, this doesn’t mean that one shouldn’t get vaccinated. Vaccinations won’t protect you fully but certainly it will offer a significant degree of protection (compared to having no protection). But in order to increase vaccination, I think a few priorities have to be tackled: firstly, there must be better campaigns for vaccination for diseases that are re-emerging (emerging diseases are new, but re-emerging diseases are often forgotten by the public). Secondly, I feel strongly that states should mandate vaccinations for all eligible. Since not everyone is eligible (e.g. newborns often aren’t), herd immunity has already been impaired to a degree. Having those eligible but not vaccinated is weakening herd immunity more. Thirdly, I feel that more emphasis should be placed on federal vaccine research. Pharmaceuticals tend not to share their data, even if it is good data that could help the population. So if they deem a good vaccine as not cost-effective based on a poor (low profit) market for a certain vaccine, then the federal government can provide those vaccines.
Eric Wan
Friday, October 8, 2010
Second-hand smoking: How dangerous is it really?
A 1981 study in the British Medical Journal examined the effects of husbands’ smoking habits on their wives.
The study, conducted in Japan, was a prospective cohort study; the study groups was tracked forward for 14 years, and the researcher started off knowing exposures and ended with outcomes (exposures included smoking habit and occupation; outcomes were risks for diseases including lung cancer.)
When the researcher examined the relationship between smoking habits among husbands and the risk of their wives dying from lung cancer, the researcher found that wives of heavy-smoking husbands were two-fold more at risk than their counterparts with non-smoking husbands. Interestingly, the researcher found that the risk was dose-dependant (wives’ risks increased when husbands smoked more.)
The researcher also age and occupation adjusted; this adjustment revealed that the relationship was “particularly significant in agricultural families” with husbands between 40 and 59 years of age. This finding was interesting because wives in agricultural families are more in contact with their smoking husbands than their urban counterparts. Are societal roles at play; do more agricultural wives follow tradition than urban wives? That is an interesting question not addressed in this study.
But how did the researcher deal with confounding variables and other possible outcomes? Since the study was a cohort study, there were many advantages that allowed for such questions to be answered. One advantage is that cohort studies allow common exposures to be examined. In addition to examining the relationship between husbands’ smoking and wives’ disease risks, the researcher also compared husbands’ drinking to wives’ disease risks. The researcher concluded that husbands’ drinking habits did not affect wives’ death from lung cancer, so certainly alcohol was not a confounding exposure.
Another advantage is that cohort studies can examine multiple outcomes and an exposure. For example, the researcher compared husbands’ smoking habits to risks for various diseases (lung cancer, asthma, cervical cancer, etc). The researcher found that only husbands’ smoking habits were strongly associated with wives’ death from lung cancer. So we wouldn’t expect something like cervical cancer to be affected by husbands’ smoking habits.
But what is the importance of this study? One reason why this study is important is because of an on-going debate about second-hand smoke and whether it is an environmental health issue. I think it is, and I think that this study supports that because the study clearly shows that the wives’ environments (husbands’ smoking) can affect their risks of dying from lung cancer.
An analogy would be working in an office building in which the floors below had smokers and the floors high up didn’t. (Let’s also assume that smokers don’t know that nonsmokers are above them, and vice-versa.) Since air vents circulate from bottom up, smoke is carried to the nonsmokers above, causing second-hand smoking in the nonsmokers. In this case, the environment of the office building is contaminated by smoke, and air quality and occupational health alarms are triggered. And in short, environmental health is called in to deal with the work-environment crisis.
But is it even a health issue? Association does not mean causation, but it sure can be a strong hint to causation. I think this study does support second-hand smoking being a cause of lung cancer; there is clearly a significant increase in risk of dying from lung cancer in women whose husbands are heavy-smokers.
One has to remember that this study was prompted by “sharply increasing [mortality rates] for men and women in Japan” even though “only a fraction of Japanese women with lung cancer smoke cigarettes.” So the question was, can second-hand smoking account for some of these deaths? Evidently, yes it can.
Eric Wan
The study, conducted in Japan, was a prospective cohort study; the study groups was tracked forward for 14 years, and the researcher started off knowing exposures and ended with outcomes (exposures included smoking habit and occupation; outcomes were risks for diseases including lung cancer.)
When the researcher examined the relationship between smoking habits among husbands and the risk of their wives dying from lung cancer, the researcher found that wives of heavy-smoking husbands were two-fold more at risk than their counterparts with non-smoking husbands. Interestingly, the researcher found that the risk was dose-dependant (wives’ risks increased when husbands smoked more.)
The researcher also age and occupation adjusted; this adjustment revealed that the relationship was “particularly significant in agricultural families” with husbands between 40 and 59 years of age. This finding was interesting because wives in agricultural families are more in contact with their smoking husbands than their urban counterparts. Are societal roles at play; do more agricultural wives follow tradition than urban wives? That is an interesting question not addressed in this study.
But how did the researcher deal with confounding variables and other possible outcomes? Since the study was a cohort study, there were many advantages that allowed for such questions to be answered. One advantage is that cohort studies allow common exposures to be examined. In addition to examining the relationship between husbands’ smoking and wives’ disease risks, the researcher also compared husbands’ drinking to wives’ disease risks. The researcher concluded that husbands’ drinking habits did not affect wives’ death from lung cancer, so certainly alcohol was not a confounding exposure.
Another advantage is that cohort studies can examine multiple outcomes and an exposure. For example, the researcher compared husbands’ smoking habits to risks for various diseases (lung cancer, asthma, cervical cancer, etc). The researcher found that only husbands’ smoking habits were strongly associated with wives’ death from lung cancer. So we wouldn’t expect something like cervical cancer to be affected by husbands’ smoking habits.
But what is the importance of this study? One reason why this study is important is because of an on-going debate about second-hand smoke and whether it is an environmental health issue. I think it is, and I think that this study supports that because the study clearly shows that the wives’ environments (husbands’ smoking) can affect their risks of dying from lung cancer.
An analogy would be working in an office building in which the floors below had smokers and the floors high up didn’t. (Let’s also assume that smokers don’t know that nonsmokers are above them, and vice-versa.) Since air vents circulate from bottom up, smoke is carried to the nonsmokers above, causing second-hand smoking in the nonsmokers. In this case, the environment of the office building is contaminated by smoke, and air quality and occupational health alarms are triggered. And in short, environmental health is called in to deal with the work-environment crisis.
But is it even a health issue? Association does not mean causation, but it sure can be a strong hint to causation. I think this study does support second-hand smoking being a cause of lung cancer; there is clearly a significant increase in risk of dying from lung cancer in women whose husbands are heavy-smokers.
One has to remember that this study was prompted by “sharply increasing [mortality rates] for men and women in Japan” even though “only a fraction of Japanese women with lung cancer smoke cigarettes.” So the question was, can second-hand smoking account for some of these deaths? Evidently, yes it can.
Eric Wan
Friday, October 1, 2010
Globalization: Pros and Cons
A recent 2010 publication in the New England Journal of Medicine focuses on global noncommunicable diseases. The publication discusses noncommunicable diseases that are affected by “globalization, urbanization, and demographic and lifestyle transitions.” Basically, chronic diseases such as obesity and cardiovascular diseases are beginning to appear in areas of “poverty and socioeconomic disparity,” following the trends of globalization.
To elaborate, globalization and its economic and political policies place industry before health. This leads to flooding of industry (processed foods, tobacco, couch-potato items, etc) into a country at the expense of the people’s health. The results of globalization and industry are many risk factors for death that are common among low, middle and high-income countries. The list includes: high blood pressure, high blood glucose level and tobacco use. Why the similarities? Well, since people are beginning to eat the same foods and use the same technologies, globalization can have similar impacts around the globe as lifestyles cross borders.
At first, it surprised me that there were overlaps among the three economically different categories. Even the title seemed a bit strange to me; noncommunicable diseases in developing countries? I had read so much about infectious disease and malnutrition in developing countries that I never stopped to think about high blood pressure, obesity or tobacco use.
However, when I consider the possible reasons (previously explained) for this effect, it isn’t surprising at all. From the mass marketing of McDonalds in China to the building of village-destroying dams into Haiti, globalization takes its toll on population health; and usually in the name of profit and industry.
But there’s a silver lining to all this; the publication suggests that globalization can “unite” high, middle and low-income countries into campaigns against these diseases. Through global cooperation, various individual and population level interventions can be implemented. On the population level, global medicine can benefit from a shift from “curative [systems]… to more integrated primary care systems.” Global cooperation can also benefit individuals (and whole societies) by enhancing scientific discovery: “combination pills” that could lower costs and control multiple risk factors; and new screening methods for cervical cancer are just some examples.
However, global cooperation necessitates the assurance that intervention strategies will be effective. (A preventative or curative solution that isn’t culturally sensitive may not be as effective as one that is.) We haven’t discussed HIV/AIDS very much, so we can take that as an example.
Prevention occurs on three levels: primary, secondary and tertiary. Primary prevention is preventing risk factors from happening; in the case of HIV/AIDS, this could be educated sex (wearing condoms) and preventing people who have HIV/AIDS from donating blood. In the early years of AIDS, bathhouses were shut down as well. Secondary prevention is the treating of risk factors and early detection of the disease; this could be screening of HIV status and administration of HAART (sometimes, nutrition and lifestyle changes can benefit as well.) Secondary prevention would be preventing diseases like cancer from developing in AIDS patients. Tertiary prevention is preventing death and minimizing disability; in AIDS patients it could be surgical or radiation treatments for Kaposi’s.
The effectiveness of these prevention strategies would have to be tested globally (if we were to have global cooperation). In more developed countries with enough resources, the AIDS intervention examples above would work (though civil liberties may be debated.) In less developed countries, resources would be a big issue; trying to find clinics could be difficult, and governments could be in denial (S. Africa).
The publication puts forth many good ideas about the advantages of globalization in terms of improving public health; however, these ideas must be tested in the countries they’re intended for, regardless of how much global cooperation there is.
Eric
-------
Update: Recently, there's been big news about Guatemala. http://www.hhs.gov/1946inoculationstudy/
To elaborate, globalization and its economic and political policies place industry before health. This leads to flooding of industry (processed foods, tobacco, couch-potato items, etc) into a country at the expense of the people’s health. The results of globalization and industry are many risk factors for death that are common among low, middle and high-income countries. The list includes: high blood pressure, high blood glucose level and tobacco use. Why the similarities? Well, since people are beginning to eat the same foods and use the same technologies, globalization can have similar impacts around the globe as lifestyles cross borders.
At first, it surprised me that there were overlaps among the three economically different categories. Even the title seemed a bit strange to me; noncommunicable diseases in developing countries? I had read so much about infectious disease and malnutrition in developing countries that I never stopped to think about high blood pressure, obesity or tobacco use.
However, when I consider the possible reasons (previously explained) for this effect, it isn’t surprising at all. From the mass marketing of McDonalds in China to the building of village-destroying dams into Haiti, globalization takes its toll on population health; and usually in the name of profit and industry.
But there’s a silver lining to all this; the publication suggests that globalization can “unite” high, middle and low-income countries into campaigns against these diseases. Through global cooperation, various individual and population level interventions can be implemented. On the population level, global medicine can benefit from a shift from “curative [systems]… to more integrated primary care systems.” Global cooperation can also benefit individuals (and whole societies) by enhancing scientific discovery: “combination pills” that could lower costs and control multiple risk factors; and new screening methods for cervical cancer are just some examples.
However, global cooperation necessitates the assurance that intervention strategies will be effective. (A preventative or curative solution that isn’t culturally sensitive may not be as effective as one that is.) We haven’t discussed HIV/AIDS very much, so we can take that as an example.
Prevention occurs on three levels: primary, secondary and tertiary. Primary prevention is preventing risk factors from happening; in the case of HIV/AIDS, this could be educated sex (wearing condoms) and preventing people who have HIV/AIDS from donating blood. In the early years of AIDS, bathhouses were shut down as well. Secondary prevention is the treating of risk factors and early detection of the disease; this could be screening of HIV status and administration of HAART (sometimes, nutrition and lifestyle changes can benefit as well.) Secondary prevention would be preventing diseases like cancer from developing in AIDS patients. Tertiary prevention is preventing death and minimizing disability; in AIDS patients it could be surgical or radiation treatments for Kaposi’s.
The effectiveness of these prevention strategies would have to be tested globally (if we were to have global cooperation). In more developed countries with enough resources, the AIDS intervention examples above would work (though civil liberties may be debated.) In less developed countries, resources would be a big issue; trying to find clinics could be difficult, and governments could be in denial (S. Africa).
The publication puts forth many good ideas about the advantages of globalization in terms of improving public health; however, these ideas must be tested in the countries they’re intended for, regardless of how much global cooperation there is.
Eric
-------
Update: Recently, there's been big news about Guatemala. http://www.hhs.gov/1946inoculationstudy/
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