Collaboration is Needed to Enhance Georgia’s Leadership as a Global Health Hub

By Russell Medford, MD, PhD, Managing Partner, Salutramed Group

Russell Medford, MD, PhD, Managing Partner, Salutramed Group, is working with stakeholders, including The Task Force for Global Health and the National Health Museum, to explore the development of an alliance of Georgia's global health organizations.

Russell Medford, MD, PhD, Managing Partner, Salutramed Group, is working with stakeholders, including The Task Force for Global Health and the National Health Museum, to explore the development of an alliance of Georgia’s global health organizations.

Georgia has a remarkable number of internationally recognized, top-tier organizations working in global health from the government, academic, non-profit, and private sectors. These organizations are helping to end diseases and improve health and well-being for people in Georgia, nationally, and abroad. Collectively, these organizations have a significant economic impact on both metro Atlanta and the state that likely exceeds tens of billions of dollars annually.

Georgia has the potential to have an even greater impact on global health through leveraging the collective strength of the Georgia-based organizations that contribute to the global health mission. Collaboration is absolutely critical in global health. The problems are far too large and costly for any one organization to solve on its own.

A multi-sector group of more than 30 stakeholders is currently developing an alliance of Georgia’s global health organizations to provide a framework for collaboration within the sector that will be key to its development. This alliance would not only educate policy makers and the broader community about the importance of global health research and programs, but also provide a mechanism for the creation of new partnerships between sectors, including government, non-profits, academic institutions, and private industry.

An alliance of Georgia's global health organizations would help facilitate collaborations among organizations in the state working on mosquito-borne diseases such as malaria. Photo credit CDC/James Gathany

An alliance of Georgia’s global health organizations would help facilitate collaborations among organizations in the state working on mosquito-borne diseases such as malaria.
Photo credit CDC/James Gathany

One of the priorities of an alliance of Georgia’s global health organizations will be to map the sector. This will help build an identity for Georgia’s global health sector and provide a vital resource for identifying new partnership opportunities. A mapping also would also quantify the impact of Georgia’s global health sector, as well as identify business opportunities for Georgia and out-of-state companies in global health. These metrics would allow for better promotion by showing the health and economic impact of the global health sector on Georgia and around the world.

For Georgia, an alliance would have benefits across multiple sectors, including the life sciences where a number of Georgia companies are working to “do well by doing good.” These mission-driven companies have developed products to improve health and well-being, but they lack the expertise or resources to bring them to scale or get them approved. To succeed, they have to collaborate with organizations from other sectors working in global health.

One of these companies is LivFul that has developed AKIVA (formerly known as CleanOFF), an enhanced mosquito repellant and antiseptic wipe that could help reduce malaria transmission in developing countries. To determine how to get its product to the people who need it, the company has been trying to forge partnerships with non-governmental organizations (NGOs) in Georgia that have malaria expertise and experience working in countries where the disease is endemic. “We’ve had to do a lot of work to find these NGOs,” said LivFul President Andy Mahler. “An alliance could help us identify relevant Georgia organizations working in malaria and bring us together with them.”

GeoVax is another Georgia company that sees significant value in a global health alliance. The Smyrna-based company has developed a promising HIV vaccine that is poised to move into phase 2b clinical trials. At least $25-50 million, however, will be needed to fund the trial. GeoVax has been actively seeking philanthropic and governmental support, but they have yet to raise enough money to get the trial started. “There’s a huge global need for an HIV vaccine,” said GeoVax CEO Robert McNally, PhD. “Even with a promising candidate, it’s very expensive to conduct a clinical trial. We really need a Georgia-based group that can help advocate for the global health sector with foundations and other potential funders.”

An alliance of Georgia’s global health organizations is expected to play a strong advocacy role for the global health sector by articulating the value of this sector, shaping public policy that’s favorable to its growth and development, and building effective national and international partnerships with sister organizations such as the Washington (Seattle) Global Health Alliance. While providing a framework for collaboration, a Georgia alliance will also help organizations work better together and aid in identifying traditional and non-traditional sources of funding.

An alliance of Georgia’s global health organizations is crucial for the state to enhance its reputation and recognition as a global health hub that leads the country and the world with innovative models of collaboration, funding, and finance to solve global health problems.

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Focusing on Early Infancy Can Create Sustainable Societies and Prevent Chronic Disease

By Dr. Jose Miguel De Angulo, Regional Director for Latin America, MAP International & Luz Stella Losada, Bolivia Community Health Specialist, MAP International

Dr. Jose Miguel De Angulo, Regional Director for Latin America, MAP International & Luz Stella Losada, Bolivia Community Health Specialist, MAP International

Dr. Jose Miguel De Angulo, Regional Director for Latin America, MAP International & Luz Stella Losada, Bolivia Community Health Specialist, MAP International

Health paradigms keep evolving through history.  In the 21st Century we are witnessing the emerging of a new health Paradigm.  Neuroscience is showing how the brain architecture of the person is established during the intrauterine period and the first two to three years of life. This brain architecture is what determines the capability of the organism to self-regulate its biological, emotional, cognitive, and interactional processes with the environment. The more robust this brain architecture is in an individual, the more potential and capability that individual has to enjoy physical, emotional, and mental health at the personal level as well as his/her capacity to contribute through his/her life to the health and wellbeing of others. The new understanding of the key determinants of the development of infant brain architecture is generating a profound shift toward focusing on early infancy as the best strategy to invest resources to foster development of healthy and sustainable societies. The emergence of this health paradigm to achieve healthy and successful societies is making a shift from what is happening on systems to what is happening in a very specific arena: early infancy development.

To see the critical role that infants´ experiences play not only in their future life, but also in the wellbeing and health of society, it’s important to read J.P. Shonkoff’s The Foundations of Lifelong Health.  Through research and after reviewing a broad spectrum of the evidence accumulated in the last decade Shonkoff says it best.

moms“A vital and productive society with a prosperous and sustainable future is built on a foundation of healthy child development. Positive early experiences provide a foundation for sturdy brain architecture and a broad range of skills and learning capacities…  Advances in neuroscience, molecular biology, and genomics have converged on three compelling conclusions: Early experiences are built into our bodies, creating biological “memories” that shape development, for better or for worse. Toxic stress caused by significant adversity can produce physiological disruptions that undermine the development of the body’s stress response systems and affect the architecture of the developing brain, the cardiovascular system, the immune system, and metabolic regulatory controls. These physiological disruptions can persist far into adulthood and lead to lifelong impairments in both physical and mental health.

This new paradigm implies that governments and society will need to focus on infants and how families and society can better care for and protect them.  Because brain architecture is constructed during pregnancy and especially during the first two years of life, parents play a critical role in the generation of a robust brain architecture. Now parents need to understand and be equipped for a new radically different way of seeing, listening to and interacting with their infants. Early childhood is the most vulnerable period of human life, as well as the period with the largest potential for development. On top of that, research is showing how the infant’s brain powerfully transforms the parent´s brain and equipping them to become sensible and responsive to the infant`s brain expressions of need for her development.

Dr. Jack P. Shonkoff, the Chair of the National Scientific Council on the Developing Child, made a presentation to Westchester Children’s Association in, New York on March 24, 2006. In this presentation, “No Time to Lose: Closing the Gap between What We Know and What We Do,” he presented the conclusions of multiple years of research into the science of early childhood development. These were his main points:

“The healthy development of all young children benefits all of society by providing a solid foundation for responsible citizenship, economic productivity, lifelong physical and mental health, strong communities, and sustainable democracy and prosperity. Relationships are the “active ingredients” of early experience. Nurturing and responsive relationships build healthy brain architecture that provides a strong foundation for learning, behavior, and health. When protective relationships are not provided, elevated levels of stress hormones (i.e., cortisol) disrupt brain architecture by impairing cell growth and interfering with the formation of healthy neural circuits.”

moms2Research conducted and published by the CDC on “The Relationship of Adverse Childhood Experiences to Adult Health Status” pushes us to completely rethink the traditional way of understanding the “history of diseases” (from the moment of exposure to causal agents until recovery or death). This research is opening the door to a new way of understanding why diseases are present in society. Dr. Vincent J. Felitti and Robert F. Anda are the authors of The Adverse Childhood Experiences (ACE) Study. This was the largest study of its kind ever done to examine the health, social and economic effects of adverse childhood experiences over the lifespan (18,000 participants). The findings showed that an individual’s childhood experiences shape the epidemiological profile of that child in his/her adult life, as well as the epidemiological profile of the entire nation. Some of their conclusions are:  “Adverse childhood experiences determine the likelihood of the ten most common causes of death in the United States;” “Adverse childhood experiences are the most basic cause of health risk behaviors, morbidity, disability, mortality, and healthcare costs;” and “Many chronic diseases in adults are determined decades earlier, in childhood.”

Adverse childhood experiences are also clearly related to mental health. For example the conclusion of this study related to prescribed psychotropic medications in adults states: “The strong relationship of the ACE Score to increased utilization of psychotropic medications underscores the contribution of childhood experience to the burden of adult mental illness. Moreover, the huge economic costs associated with the use of psychotropic medications provide additional incentive to address the high prevalence and consequences of childhood traumatic stressors.”  Empathy underlies virtually everything that makes society work, such as trust, altruism, collaboration, love, and solidarity. Failure to empathize is a key part of most interpersonal and social problems, including-crime, violence, war, racism, child abuse, inequity, among others. Empathy is associated with prosocial behavior, and this relationship has been found to be mainly due to environmental effects through the expressions of sensitivity and responsiveness of parents. Empathy is experienced and developed through secure attachments with the father and mother. Insecure and disorganized attachments seriously obstruct the cultivation of empathy, which—on a broad social level—can easily lead to a society in which no one would want to live because of the cold, violent, chaotic, and terrifying interactions of all against all. Parental sensitivity. Responsiveness and proactive involvement with infants and toddlers play a key force in their capability to express empathy and prosocial behaviors in future stages of their lives.

global healthAppropriate interactions with infants cannot only generate changes at the society when they will become productive citizens, but they also generate changes in the brains of the father and mother, bringing plasticity and new way of thinking, interacting and engaging with the world.  For example, research show the importance of paternal caring behaviors to establish strong bonds, and how this is dependent on appropriated postnatal offspring interactions. In bi-parental mice this has been associated with increased neurogenesis in the paternal olfactory bulb and hippocampus.  These male mice can even recognize their offspring as adults if they interacted with their infant pups.  Research today presents exciting new ways of understanding parenting as this research conclusion:  “The brains of parents are clearly different from those of non-parents, having been changed by the presence of offspring and corresponding hormonal fluctuations. Available evidence suggests that structural reorganization occurs in the hippocampus and PFC of mothers and fathers”. The book `Sex and the Brain the Neuroscience of How When Why and Who We Love´ clearly shows how the baby’s brain interaction with the father “rewires the daddy brain” and how “Love spurs the very growth of the parental brain and even causes new brain cells to develop… Those parental impacts on your brain begin long before birth, setting into motion major factors for your future relationships.”

We must focus on children in early infancy to change society and create sustainable societies with less chronic disease.  MAP International’s uses this cutting edge evidence based approach to comprehensive Early Childhood Development in all their Focus 1365 Early Childhood Development Programs in Bolivia and Ecuador.  This new concept of care, cognitive development, freedom and autonomy for children and their caregivers is changing the marginal, rural and urban communities that we work in.

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The Road to Zero

By Charles Stokes, president and CEO of the CDC Foundation

Charles Stokes, president and CEO of the CDC Foundation

Charles Stokes, president and CEO of the CDC Foundation

Last year at this time, the World Health Organization had just announced a cumulative total of 844 cases of Ebola and 518 deaths from Guinea, Sierra Leone, and Liberia. One year later, there have been 27,609 cases of Ebola in West Africa, and 11,261 deaths.

The U.S. Centers for Disease Control and Prevention (CDC) released an Ebola One Year Report that highlights the stories, faces and facts behind CDC’s one-year anniversary of when the agency activated its Emergency Operations Center for the response. The international public health response to this epidemic is unprecedented for the agency, with more than 1,200 CDC employees that have traveled to Guinea, Liberia and Sierra Leone to assist with efforts on the ground. While the CDC’s report has many incredible stories, I found several quotes to be particularly pertinent in recapping the response to date:

  • “We’re learning in this outbreak that Ebola is not always a death sentence. We’re learning how to care for patients so more people can live through it. Getting to people early before they are so sick that they can’t be treated will not only improve survival rates but also prevent the virus from spreading.” –Dan Martin, CDC responder, Sierra Leone
  • “Burial teams told me over and over how they had to sit and talk to families for hours before the family would let them take the corpse away for safe burial. And they would sit and talk for hours just to make a family understand why it was helping the whole community to allow their loved one to be buried without the usual ritual.” –Leisha Nolen, CDC responder, Sierra Leone
  • “I learned a powerful lesson during my Ebola work, and that is the power of fear. Fear is a natural emotion; it’s supposed to protect us from injury or infection. When you see that lion, you run! But too much fear can be a bad thing. It was our responsibility to understand the science behind Ebola and use that to encourage positive action, not panic.” –John Brooks, lead for CDC’s Ebola Response Medical Care Task Force
There is still a long road ahead, but CDC’s tremendous response is helping bring West Africa closer to zero cases of Ebola.

There is still a long road ahead, but CDC’s tremendous response is helping bring West Africa closer to zero cases of Ebola.

The CDC Foundation continues to support CDC’s response efforts in West Africa, as new cases continue to be reported in all three countries affected. There is still a long road ahead, but CDC’s tremendous response is helping bring West Africa closer to zero cases of Ebola.

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South Sudan Marks Four Years of Independence but Few Find Cause for Celebration

July 9 marks South Sudan’s fourth birthday. After decades of war, the break from Sudan was celebrated across the country. From tiny villages to the new capital Juba, expectations were high.

Today the country remains mired in conflict that has displaced more than 2 million people and left more than 7 million without enough food.

Below, two CARE staffers describe their expectations for independence, and their hopes for their country’s future.

Mary Andrew Ladu

Mary Andrew Ladu

My name is Mary Andrew Ladu. On Independence Day in 2011, I was at home, six months pregnant with my daughter, Amito. It was too hot to join the crowds celebrating in the streets of Juba, but I was just as excited and just as happy.

I didn’t always live in Juba. We had a university in the south, but the war made it difficult to stay in school. Like many South Sudanese, I went to Khartoum to complete my degree, which is in food and nutrition. After I graduated, I joined CARE as a Nutrition Coordinator, and since have worked in South Darfur, and in camps that serve refugees around Khartoum.

When the vote for independence came, I knew it was time to return to Juba — which I did.  I knew I was home, that I was safe and no longer the second-class citizen I felt I had been in the north.

We had our own country at last. There would be no more suffering, and good things were coming. We had our own leader, one of us who understood the pain and suffering it took to make us free.

The future looked bright.

But I was wrong.

Gone are those hopes of a better life, better health services, better education for our children. The future of this country is once again dark. We are fighting ourselves, killing each other. Where will all this fighting, this death,  this destruction lead us?

Chol Majok

Chol Majok

My name is Chol Majok. On Independence Day in 2011, I was in Panyagor in Jonglei state where I worked as a Health Officer with CARE. It was one of the most exciting days of my life.

I thought then that all of South Sudan would be free, that we would have a better life. I had been a child soldier growing up during the war, and I didn’t want my children to grow up the way I had. We had our own country now, the promise of a better future – no more insecurity.

Now there are no hopes, the future is so bleak. People are dying – from war, disease, hunger. I didn’t think this could happen again. I fear we are no longer a nation, that tribalism and ethnicity are all that matter.

This is not the South Sudan we had at Independence. We need to think of our future and not be stuck in the past. We need to know our rights and to act on them. We need leaders who will take us forward. We are looking now at the international community, because our leaders will not find peace.

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What an International NGO does when the Disasters Fade

By Katie Pace

- Katie Pace, MAP International Public Content Specialist

Katie Pace, MAP International Public Content Specialist

While headlines about Ebola in West Africa and the earthquake in Nepal have faded, the need for relief to those areas has not. Global health relief organization MAP International continues to provide critical medical supplies to those in need in Africa and Nepal, as well as the Middle East and South America. Supplies range from bandages and pain relievers to vitamin B and antibiotics. In May and June alone, the value of the shipments to those in need totaled more than $13 million in Wholesale Acquisition Value, impacting the lives of hundreds of thousands of people.

“Major disasters and disease outbreaks capture the public’s attention and generate a strong donor response, but in between those high-profile events, the need to supply medical relief around the world doesn’t stop,” said Steve Stirling, president and CEO of MAP International. “A $1 donation allows us to ship $60 worth of essential medicines and supplies to those in most need.”

DSC01032Stirling notes that the nonprofit’s pharmaceutical partners, which include Johnson & Johnson, AbbVie, 3M and many more, donate medicine and supplies or provide them at reduced cost, which allows any donation to go much further.

In the Middle East:

For the first time, MAP is partnering with United Palestinian Appeal (UPA) to provide medical aid to more than 625,000 people in Gaza. The 6,000 lb. shipment left the U.S. on June 18 and is funded through an ongoing partnership with nonprofit International Relief Teams. It is expected to arrive in mid-July and includes bandages, respirators, eye drops and antibiotics. The shipment is valued at $1.3 million (wholesale acquisition cost).

DSC01031In Asia:

MAP continues to provide assistance to those injured in the April 25th earthquake in Nepal. So far, more than $1 million in assistance has been sent to the area. The supplies sent include antibiotics, oral rehydration salts and first-aid items that will treat an estimated 95,000 people.

In Africa:

Over $3 million in general medical relief to Ethiopia left MAP’s Brunswick headquarters in mid-June and will arrive in late July. The Central African Republic has received 90 MAP Medical Mission Packs that will treat 60,000 people in this devastated region, this $2 million shipment was sent in partnership with nonprofit American Leprosy Missions. MAP continues to restock clinics in West Africa that saw their supplies of medicines exhausted during the Ebola outbreak.

ALM Packs for CARIn South America and the Caribbean:

MAP’s partner, Hope for Haiti received a shipment of 35 MAP Medical Mission Packs. Each pack will treat 700 people with antibiotics and other essential items. Honduras has received $4.3 million (wholesale acquisition cost) in medicines and general medical needs from May through July. While an additional $1.3 million in medicines and other medical needs has been shipped by sea to El Salvador and will reach those in need by mid-July.

U.S.:

More than $114,000 in personal hygiene supplies were provided to partners in the United States for use at shelters and other areas in critical need.

16375830107_3ced140cf4_oAbout MAP International: MAP International (www.map.org) is a global health and humanitarian organization that delivers medicines, medical supplies and health services around the world. Each year, MAP International provides more than $330 million in essential medicines to 10 million people in more than 100 countries. The organization has 10 offices worldwide, serving people in the United States, Africa, Asia and Latin America.

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Global Health Means Health At Home Too

By Mark Rosenberg, President & CEO of The Task Force for Global Health

Mark Rosenberg, president and CEO of The Task Force for Global Health

Mark Rosenberg, president and CEO of The Task Force for Global Health

Traditionally, there has been a dichotomy between U.S. health (“health at home”) and global health (“health over there”). The pervasiveness of American exceptionalism drives much of this belief that the United States is better and separate from the rest of the world, despite glaring evidence that our health system performs poorly on many measures, especially cost, compared to health systems in other countries. But as the world has flattened and become more interconnected, we can no longer afford to approach global health with an “us” and “them” mentality. Our experiences with infectious diseases such as HIV and most recently, Ebola, have demonstrated that global health does not stop at U.S. borders.

We are now in a golden age for global health. Unprecedented levels of resources are being devoted to global health programs that are providing new opportunities for health improvements. Improved health, in turn, has led to increases in life expectancy and quality of life for people in the developing world, helping to fuel economic development. Over the next three years, six of the 13 fastest growing economies will be in Africa. Programs to arrest the HIV epidemic, reduce deaths from malaria, and improve maternal and newborn survival have succeeded in part because of innovative approaches to health. But despite clear evidence of their potential applications for “health at home,” these approaches have not yet been imported back to the United States.

Healthcare workers in 49 developing countries are using specially equipped smart phones to collect and analyze data about the prevalence of neglected tropical diseases. Photo courtesy Neglected Tropical Diseases Support Center.

Healthcare workers in 49 developing countries are using specially equipped smart phones to collect and analyze data about the prevalence of neglected tropical diseases. Photo courtesy Neglected Tropical Diseases Support Center.

Mobile devices, particularly smart phones, offer powerful solutions to challenging global health problems. Programs in African and South Asian countries are using a technology as simple as text messaging to report new cases of infectious diseases, births and deaths, and even health facility utilization statistics. In 49 developing countries where people are threatened by neglected tropical diseases, the Decatur-based Task Force for Global Health has deployed more than 1,000 smart phones to aid healthcare workers in the field as they collect and analyze data about the prevalence of these diseases. Smart phone applications also are being developed that will alert to outbreaks of diseases that could affect people globally such as Ebola, Severe Acute Respiratory Syndrome (SARS), and Middle East Respiratory Syndrome (MERS). Mobile technologies are low-cost tools that could support an improved global disease surveillance network and also help strengthen our domestic surveillance network.

Mobile devices also have the potential to capture important health data that can be used to inform better health choices and assist public health professionals in responding to problems. An estimated 90 percent of Americans own cell phones and among those 64 percent were smart phones. Smart phone adoption continues to increase worldwide. However, the developing world and European countries have already taken leads in showing how these technologies can be used to prevent the spread of diseases, empower individuals to make healthy choices, and demand effective government. Best practices and lessons learned from these experiences could be used to improve “health at home.”

Georgia organizations have the potential to help make “global health at home”–a concept developed by Dr. Howard Hiatt, a former dean of the Harvard School of Public Health–a reality. Diverse global health approaches could be applied to help address at least two urgent public health issues facing Georgia today–high maternal mortality and HIV infection rates. In 2011, Georgia had the highest rate of maternal or “pregnancy-related deaths” and the fifth highest rate of new HIV diagnoses, levels on par with some developing countries. A Georgia Global Health Alliance could bring to bear members’ expertise and solutions that have worked in other countries to address these health issues in Georgia. The Washington Global Health Alliance has been sharing their experiences with the program “Global to Local” with Georgia as it works to build its own global health alliance–and I look forward to sharing with you more updates about its development.

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CDC Releases New 2016 Yellow Book for International Travelers

By Gary Brunette, M.D., M.S., chief of CDC’s Travelers’ Health Branch and editor-in-chief of the Yellow Book

Gary Brunette, M.D., M.S., chief of CDC's Travelers’ Health Branch and editor-in-chief of the Yellow Book

Gary Brunette, M.D., M.S., chief of CDC’s Travelers’ Health Branch and editor-in-chief of the Yellow Book

In the past decade, global travel has grown dramatically, and any traveler—human, animal or pathogen—can cross the globe in less than 24 hours. Recent health events, such as the Ebola outbreak in West Africa, the spread of chikungunya in the Western Hemisphere, and the emergence of Middle East Respiratory Syndrome (MERS) have piqued public interest in travelers’ safety. In the United States, we’ve seen vaccine-preventable diseases such as measles and tuberculosis imported by international travelers as well. These changes in the global health landscape have highlighted the importance of accurate, up-to-date travel health information. The Travelers’ Health Branch of the U.S. Centers for Disease Control and Prevention (CDC) works to provide this critical information to ensure the health and safety of US travelers abroad.

Amid recent changes in global health, public interest in travelers’ safety has never been greater.

Amid recent changes in global health, public interest in travelers’ safety has never been greater.

For international travelers and the health professionals who care for them, CDC Health Information for International Travel (more commonly known as the Yellow Book) is the reliable resource for preventing illness and injury in a globalized world. The book provides expert recommendations for healthy travel, including vaccine and drug information, disease maps and country-specific disease information, advice for conducting a complete pre-travel consultation, detailed precautions for specific types of travelers and advice for returning travelers. The Yellow Book is produced biennially, with input from hundreds of travel medicine experts and is published through a unique collaboration between CDC, the CDC Foundation and Oxford University Press.

Written by a team of CDC experts on the forefront of travel medicine, the Yellow Book provides a user-friendly, vital resource for those in the business of keeping travelers healthy abroad.

Written by a team of CDC experts on the forefront of travel medicine, the Yellow Book provides a user-friendly, vital resource for those in the business of keeping travelers healthy abroad.

CDC has recently released the new 2016 edition of the Yellow Book. The 2016 edition offers the U.S. government’s most current health recommendations for international travel, as well as a variety of new features, including:

  • Updated information on emerging global diseases such as Ebola, MERS, and chikungunya
  • Expanded, specific guidelines for travel to 16 select destinations, including Brazil, Cambodia, Dominican Republic, and Haiti
  • Commentary on the cost analysis of travel medicine
  • Discussion of complementary and alternative health approaches to travel medicine
  • Comprehensive advice for health care workers traveling to provide care overseas
  • Country-specific malaria risk maps for 15 countries
  • Yellow fever risk maps detailing vaccine recommendations in 10 countries

The Yellow Book provides a user-friendly, vital resource for those in the business of keeping travelers healthy abroad. The 2016 edition is available in print from Oxford University Press and will soon be available as a mobile app for iOS and Android and online on CDC’s website.

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No guarantees in South Sudan’s deadly conflict

By Aimee Ansari, Country Director, CARE South Sudan

Aimee Ansari, Country Director, CARE South Sudan

Aimee Ansari, Country Director, CARE South Sudan

Walking into the CARE supported clinic in Pariang, I see a little girl with edema – her belly is swollen because she hasn’t got enough to eat. It’s been a long time since I’ve seen a child with edema, and I certainly didn’t expect to see one in this part of the country. Of all the places that CARE supports health care, Pariang, in Unity state, has traditionally been the least food insecure.

But we’re seeing more children with edema these days, especially in the three states most affected by the conflict: Unity, Upper Nile and Jonglei. Here in Pariang, malnutrition rates among children have reached critical levels, as they have elsewhere in Unity.

It’s a reminder of how deadly this conflict has become, even if you manage to escape from the fighting, there are no guarantees. The latest figures estimate around 3.8 million people were food insecure in April. In simple terms, it means 3.8 million South Sudanese – almost a quarter of the population here – didn’t have enough to eat and require humanitarian assistance. These figures are expected to rise to 4.9 million by July. These numbers are bad, but without the work of organizations like CARE, they’d be a whole lot worse.

A woman and her child wait to be seen outside the Pariang Health Center in northern South Sudan, which was established by CARE to support the local communities. Credit: Josh Estey/CARE

A woman and her child wait to be seen outside the Pariang Health Center in northern South Sudan, which was established by CARE to support the local communities. Credit: Josh Estey/CARE

Around 500,000 of these people live in Unity state. The Pariang nutrition team explains to me that they are struggling to help explain to people where to get nutritious food; many of the fruits and vegetables that were previously available in the market here are no longer sold. The old trade and transportation routes have collapsed, replaced by new ones that sporadically make their way into rural communities, ceasefires permitting.

South Sudan’s economy is starting to buckle under the weight of 17 months of conflict and plunging oil prices. Costs are soaring, especially for food, but because of the conflict, there’s less food to buy, and not a lot of cash to buy it with. Shortages are everywhere. As I write this, the capital Juba has a bread shortage, drinking water is difficult to find and fuel lines are long. For ordinary South Sudanese, who spend around 80 percent of their income on food, this is life-threatening.

The role of humanitarian organizations in this crisis is more critical now than ever before, yet CARE has been forced to close programs because we no longer have the funding to run them. The need is still there, but the cost of running programs is high.

So we’re focusing our efforts, reducing the number of sectors and locations in which we work. We’re now making cuts to our health and sanitation programs in order to provide food and nutrition assistance in the coming months. That’s more than 160,000 South Sudanese we’re no longer able to help.

I asked an economist what can be done to stop the collapse of the economy.  “Simple,” he said, “stop the war.”

But peace seems a long way off. Until it happens, it will be the NGOs, the UN, committed local authorities and the resilience of the South Sudanese people that will help to make the country work.  We are building for the future…but we need both the leadership of the country and those outside the country to support our efforts and work to finding peace.  In the meantime, we will continue to provide services as best we can.

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Medicines and food go hand in hand in humanitarian aid

By Katie Pace, MAP International

-Katie Pace, Communications Officer, MAP International

Katie Pace, Communications Officer, MAP International

It’s estimated that 805 million people across the world suffer from hunger and malnutrition. That means one in every nine people on our planet go to bed hungry each night. Hunger kills more people each year than AIDS, malaria and tuberculosis combined and nearly 3.1 million children are dying each year from poor nutrition. MAP International is partnering with Stop Hunger Now to drop this staggering death rate.

Untitled

As a medical aid organization it’s obvious that we are providing antibiotics and emergency relief items in times of crisis, but something that isn’t so obvious is the impact of vitamins on those that are malnourished. Worldwide, over 136,000 women and children die due to iron-deficiency anemia and 450,000 children under five die due to zinc deficiency.

When partnered with fortified food from organizations like Stop Hunger Now, we have the ability to combat both the causes of malnourishment and save more lives. Healthy and nutritious food is essential to a child’s mental and physical development, by providing fortified foods and vitamins we are giving each child the chance to reach their full potential.

The top three ways to resolve the global malnutrition issue is by eating more of better nutritious food, fortifying food staples and vitamin supplements for those who need them most.

MAP International, Dominican Republic.  Child is eating Stop Hunger Now meal at a school with a MAP supported clinic.

MAP International, Dominican Republic. Child is eating Stop Hunger Now meal at a school with a MAP supported clinic.

Stop Hunger Now meets the top two solutions by providing prepacked meals that are nutritiously sound. Every dehydrated rice/soy meal is fortified with 23 essential vitamins and nutrients. By partnering with MAP International, Stop Hunger Now also takes essential vitamins and medicines with them that they can use to provide additional vitamin supplements to the most vulnerable.

Our vitamins provide children in third world countries with the ability to absorb the nutrients from their food, while our medicines treat those that are sick so that they can recover with the help of proper nutrition.

This is why we partner with Stop Hunger Now, together, our medicines and their food are more impactful together. This week, thanks to this partnership, a shipment of 278,000 volunteer packed meals and medical supplies are on their way to impact lives in Honduras.

Stop Hunger Now, Honduras

Stop Hunger Now, Honduras

Stop Hunger Now is driven by the vision of a world without hunger. Their mission is to end hunger in our lifetime by providing food and life changing aid to the world’s most vulnerable and creating a global commitment to mobilize the necessary resources. www.stophungernow.org

MAP International is a global Christian health organization that partners with people living in conditions of poverty to save lives and develop healthier families and communities. www.map.org

 

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An Alliance of Georgia’s Global Health Organizations Could Help Address the Emerging Crisis of Noncommunicable Diseases

Mark Rosenberg, president and CEO of The Task Force for Global Health

Mark Rosenberg, president and CEO of The Task Force for Global Health

By Mark Rosenberg

Much progress has been made in recent decades in reducing deaths from infectious diseases such as HIV/AIDS, malaria, and tuberculosis. But around the world in countries of all income levels, there is a smoldering epidemic of noncommunicable diseases (NCDs) that threaten to lower life expectancies and undermine social and economic development. In 2012, NCDs such as diabetes, cancer, heart disease, and respiratory diseases accounted for 68 percent of the world’s deaths. By 2030, NCDs are expected to become the most common causes of deaths globally, with most of these deaths occurring in low- and middle-income countries.

Despite the statistics that NCDs are reaching crisis proportions, the issue has not yet attracted very much attention from governments, the private sector, or civil society. The U.S. government, for example, currently spends 2,000 times more foreign aid dollars each year on HIV/AIDS than it does on NCDs. Continued low investment in NCDs will have significant consequences for global health and the global economy. NCDs saddle individuals, families, communities, and countries with costly healthcare costs and afflict needless suffering. They are also barriers to poverty alleviation and sustainable development. A 2011 estimate by the World Economic Forum projected that the five leading NCDs will cost the global economy a staggering $47 trillion over the next 20 years, which will divert scare resources that could be better invested in education and other development programs.

Complex social, economic, and environmental factors drive NCDs. Growing income of the developing world, for example, has provided more people with access to tobacco and unhealthy processed foods, raising the risks for respiratory diseases, obesity, diabetes, and heart disease. The cruel irony of NCDs, however, is that they can actually worsen poverty by burdening people with diseases that are costly to treat, reduce their productivity, and shorten their life expectancies. NCDs often develop over many years as a result of poor diet, physical inactivity, tobacco and alcohol use, and other modifiable risk factors. Comprehensive approaches to addressing NCDs will be needed that cover the spectrum from prevention to treatment, and engage all sectors of society.

More people in the developing world are smoking, which is contributing to the rising global prevalence of noncommunicable diseases such as cancer and respiratory diseases.

More people in the developing world are smoking, which is contributing to the rising global prevalence of noncommunicable diseases such as cancer and respiratory diseases.

The sheer scale of the NCD issue also means collaborations will be absolutely critical. In 2012, the United Nations (UN) General Assembly passed a resolution outlining steps that need to be taken to prevent and control NCDs globally. The resolution urged “international cooperation, including collaborative partnerships” and called on “non-health actors and key stakeholders to promote health and to reduce NCD risk factors.” It highlighted the need for “alliances and networks that bring together national, regional, and global actors, including academic and research institutes, for the development of new medicines, vaccines, diagnostics and technologies, learning from the experiences in the field of HIV/AIDS, among others.”

Several of Georgia’s global health organizations are already working and collaborating to address NCDs through programs that focus on prevention, research, and advocacy. The Centers for Disease Control and Prevention (CDC) is partnering with the Pan American Health Organization and Atlanta-based American Cancer Society to prevent cervical cancer through screening programs in Latin America and the Caribbean. CDC is also focusing on the growing issue of uncontrolled hypertension in low- and middle-income countries, which is the leading cause of cardiovascular disease. Through the Global Standardized Hypertension Treatment Project, CDC is drawing on its experiences from the mass scale-up of HIV and tuberculosis treatment to provide more people in the developing world with access to hypertension treatment. The Emory Global Diabetes Research Center is working to understand the causes and consequences of diabetes, strokes, hypertension, and heart disease, investigate prevention methods, and inform policies related to NCDs. Most recently, the Rollins School of Public Health at Emory University partnered with the All India Institute of Medical Sciences New Delhi, the London School of Hygiene & Tropical Medicine, and the Public Health Foundation of India, to build India’s capacity to prevent and control NCDs.

Any global health effort to address NCDs will require a comprehensive strategy that includes prevention as a cornerstone. In the United States alone, smoking cessation and other prevention measures could reduce annual cancer deaths by half. Vaccines are a powerful tool for preventing cancers caused by Human Papillomavirus (HPV) and Hepatitis B. The widespread availability of HPV vaccine is expected to significantly reduce the prevalence of cervical cancer in high-income countries, but this vaccine has been priced out of reach for most developing countries. One of the exceptions is Rwanda, which has demonstrated the potential for even low-income counties to undertake successful NCD prevention initiatives. Using an existing robust vaccination system and a donation of two million doses of HPV vaccine from the pharmaceutical company Merck, Rwanda successfully rolled out HPV vaccine nationwide in 2011. An estimated 95% of eligible girls received the vaccine during the country’s first vaccination campaign.

In mounting this unprecedented prevention effort, Rwanda recognized that cervical cancer, which is the most common cancer among women in the country, and other NCDs threaten its economic development and poverty reduction goals. Other low- and middle-income countries could develop similar immunization programs with adequate resources and support from donors and the global health community. The Decatur-based Task Force for Global Health is exploring how its strength in working with pharmaceutical companies and other governmental and civil society partners to deliver donated vaccines and medicines to the developing world could be useful in developing large-scale prevention programs for cervical and liver cancers, cardiovascular disease, and other NCDs. The expertise and capacity of other Georgia global health organizations could be extremely beneficial to the development of large-scale NCD prevention and control programs.

NCDs threaten to erode the major health gains that have been made in recent years in countries around the world. Durable alliances of many partners are needed to sustain the efforts that will be needed to address NCDs. Many of Georgia’s global health organizations are already working on NCDs and could leverage their expertise and resources to affect the issue both globally and locally through an alliance. NCDs will necessarily become a greater focus of the global health community in the coming decades if the issue continues to grow unabated. But there is great urgency now to address NCDs – and alliances must be part of the solution. I look forward with great optimism to supporting Georgia’s global health organizations in working together to address NCDs and other large-scale global health issues through a Georgia Global Health Alliance.

– Co-authored by Poul E. Olson

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