Video: Taking Care of the Globe

I happened to come across this video as I was browsing through Ted Talks and I could not stop thinking about everything he was saying in relation to global health promotion programs. After listening to the video the first time, I felt that it was good summary of some of the things I learned in class and made me realize that my idea of global health promotion is much different than it was before I took this course. I learned many new things and am looking forward to continuing to increase my knowledge in global health.

One point I would like to highlight from the video is when he discusses gardening.

“One thing I have learned is I can’t make plants grow. I can give them the best soil, I can fertilize them, it helps, but grow they must do on their on. I have learned that all I can do is to create the conditions for the plants to grow and flourish through good care. And so it is with community, we can’t create community but we can create the conditions to help communities flourish.”

I really liked this point that he made and I thought of global health promotion in the sense that we cannot simply step into a disadvantaged or corrupt area and begin to create a new community that we imagine for them. To build a better community everyone needs to be involved. Like he mentioned with gardening, he can provide soil and fertilizer but they must grow on their own. Similarly, we can provide foreign aid to those in need but they must take action to really grow and sustain on their own.

Charitable Status Revoked for Charity Intelligence Canada

The Who and the What
Charity Intelligence Canada performs intensive research to seek out exceptional charities to help donors find the best charities that reflect their interests. Their research methodology consists of various forms of evaluation. To summarize a few:

1) Transparency Rating
A charity must make their audited financial statements available to donors in order to be open and transparent. Assessment is based on their transparency in providing complete audited financial statements.

2) Program Cost Coverage
Assessing a charity’s need for funding. Assessment includes the comparison between funding reserves and program costs. The program cost coverage is calculated by dividing the year-end funding reserves of the most recent year by the program costs for the year.

3) Spending Breakdown
Looking at how the charity allocates its revenues received between costs.

4) Fundraising Costs
Presented as a percentage of donations rather than total revenues and are a result of the costs of soliciting the public for voluntary donations.

5) Financial Notes
Explain adjustments made to the financial numbers to provide a consistent basis for comparison.

6) Salary Information
Sourced on the charity’s most recent T3010 filings with the Canada Revenue Agency.

Charity Data Reported:
1) Program Data
Presents information that is specific to the charity’s operations (i.e. number of clients, volunteer hours, etc)

2) Charity Analysis
Provides funders insight into a charity by providing relevant ratios for charity’s cost efficiency, the scope of service, and sources of inputs (Charity value).

3) Audited Financial Statements
Contains key aspects of the charity’s finances.

The article and why is this important?
The article ”Table turned on Charity Intelligence as charitable status revoked” by the Globe and Mail highlights an incident with Charity Intelligence (CI) where they failed to file an annual financial report with the tax agency. For this reason, the Canada Revenue Agency revoked their charitable status. This can lead to adverse affects since a reapplication can take several months and during this time they cannot issue any tax receipts. This doesn’t look good for CI given the irony that their work is to review and highlight shortcomings in other charities. The CI would consider failing to file “a lack of effective management, or a lack of transparency” (Waldie, 2012). This incident has brought upon a negative outlook on the CI, Ms. McManus (chair of the Association of Fundraising Professionals) expressed her opinion after looking into the CI’s work, “while the foundation has raised donor awareness, its analysis can be misleading” (Waldie, 2012).

We can conclude that the methods of evaluation conducted by the CI are not as reliable for an appropriate analysis as they were before the incident. Although despite this bump in the road for CI, their work is still valuable in providing important information regarding the veracity of charities.

In relation to Global Health Promotion:
Adequate and appropriate evaluation of charity and global health promotion work is necessary to ensure a proper program/project analysis. Evaluation allows us to assess and improve quality as well as determine the effectiveness of the work being done.

Similar to the CI, health promoters must understand evaluation concepts, the sequence of evaluation, appropriate evaluation designs and methodology, and how to analyze and report evaluation data. With that being said, it’s clear that your credibility as a health promoter is linked to your ability to perform these evaluation tasks appropriately. (McKenzie, Neigher & Thackeray, 2009).

All global health programs should perform proper evaluation and research to ensure the program is meeting their goals, to determine financial accountability, identify the possibility of harm, and to determine the ‘best’ practice.

Charity Intelligence Canada. (2013). Our Methodology. Retrieved from: http://www.charityintelligence.ca/research/our-methodology

McKenzie, F., Neigher, B., & Thackeray, R. (2009). Evaluation. Health Promotion Programs. (pp. 336-337). San Francisco, CA: Pearson Education Inc.

Waldie, P. (2012). Tables turned on Charity Intelligence as charitable status revoked. The Globe and Mail. Retrieved from: http://www.theglobeandmail.com/report-on-business/tables-turned-on-charity-intelligence-as-charitable-status-revoked/article4564354/

Child Cured of HIV

http://www.guardian.co.uk/society/video/2013/mar/04/hiv-baby-video

The article, by US Doctors Cure Child Born with HIV the Guardian, tells us about a Mississippi state child who was born with HIV and effectively cured.

The mother was unaware that she had HIV until it was too late. The Doctors began treating the newborn within 30 hours after birth. They provided the traditional treatment to try and prevent further transmission. A week later, blood was drawn that showed the child was infected. At this time the doctor expected the child to be taking drugs for life.

For the next year the mother and baby continued visits to the clinic for treatment but then began to stop attending. The child had no medication for a year and did not see doctors again until it was nearly two years old. When they did return for care doctors expected that the baby would have a high viral load. They were stunned to see all the tests come back negative. The team believes that the child was cured because the treatment was so potent and given so soon after birth. The drugs were able to stop the virus from replicating. They also blocked the infection of long-lived white blood cells (CD4) that can harbour HIV for years. Therefore the treatment would not work in older children or adults because the virus will have already infected their CD4 cells.

The infant no longer needs medication and has a normal life expectancy. Doctors think that the therapy might be able to eradicate the virus among newborns.

In relation to global health promotion the article also mentions that in developed countries there are currently strategies, that are 98% effective, which stop the transmission of the disease from mother to child. With this new discovery we can apply these methods in attempt to cure those 2% who are still being born with HIV. In sub-saharan Africa, around 387,500 children aged 14 and under were receiving antiretroviral therapy in 2010 and many were born with the infection. This treatment can prevent further cases like these and can help end the life long use of medications. This is not only a disease of developing countries. In the UK and Ireland, about 1200 children are living with HIV that they contracted from their mother during birth. With this new development we can cure future cases all around the world.

We can learn many things from this medical phenomenon. With the successful treatment of HIV in newborns we can learn more about a newborn’s immune system and how it differs from an adult’s and what factors made it possible for the child to be cured. This case also highlights the importance of identifying HIV positive pregnant women and increasing access to treatments and antiretroviral therapy. This is just one step in curing HIV. From here we can discover and learn new ways to eliminate it completely.

Sample, I. (2013). US Doctors cure child born with HIV. The Guardian. Retrieved from: http://www.guardian.co.uk/society/2013/mar/03/us-doctors-cure-child-born-hiv

Improvements on the Effectiveness of Foreign Aid

“Aid agencies have long history of trying to “cocoon” their projects using free-standing technical assistance, independent project implementation units, and foreign experts – rather than trying to improve the institutional environment for service provision… They have neither improved services in the short run nor led to institutional changes in the long run” – World Bank, 1998

This is a powerful quote from the World Bank. They are addressing the inefficient use of foreign aid, which I believe made a great impact on the changes regarding foreign aid and its implementation.

In regards to humanitarian aid and disaster relief, more attention is being paid to the problems of organizations and coordination in addition to the long-existing tangible aid such as donations and supplies.

Example: Haiti’s earthquake in 2010
– Former US president Clinton facilitated humanitarian relief efforts through the ‘Clinton Foundation’
– This Foundation encourages private sector investments in various sectors, including energy, infrastructure, health care and agriculture
– Clinton helped rebuild their economy through the facilitation of several businesses
– Although, donations and contributions such as food have had a major impact, the future of Haiti will be determined on encouraging and sustaining the conditions for the private sector and the business community to invest and build a sustainable economy, and create enough jobs in the process

“Donors realized that simply providing more money was not enough – the money also had to be spent in a more efficient manner” (Seear, 2012).

5 Fundamental Requirements for Effective Aid:

• Ownership: Developing countries must be the leaders of their own development projects. Donors must invest in capacity for local people to have a voice.
• Alignment: Aid must be used for the benefit of the recipient, not the donor. Donors should try to use local resources to manage and monitor aid.
• Harmonization: Reduce the burden of the aid project (i.e. requirements).
• Results-Based Management: Accurately monitoring date in order to detect problems and improve the project as efficiently as possible
• Mutual Accountability: Accountability between the donor and recipient as well as the recipient government and its citizens.

Although it is difficult to measure the true impact that aid has had, we can ensure that without aid, life in regions such as Haiti, would be a lot worse. I believe that with continual improvements on the distribution of foreign aid we can continue along an uphill path to reduce worldwide poverty and increase our overall health.

Glickman, D. (2013). Haiti: A Hope, a Promise, and an Opportunity. The Huffington Post. Retrieved from: http://www.huffingtonpost.com/dan-glickman/haiti-a-hope-a-promise-an_b_2883732.html
Seear, M. (2012). An Introduction to International Health. Inc. Toronto, Canada. Chapter 11 (pp 251-280).

Imposed Austerity Measures in Greece

In 2010 and currently, the Greek Parliament has made cuts to pensions, public services and education spending. Greece is struggling with great poverty which has influence and concern for the socioeconomic status of the Greek and in turn, their health. The term used to describe Greece’s current poverty state is called “New poor”. This is a type of poverty caused by imposed nation austerity measures or high inflation – erosion of savings and income.

Austerity measures: Policies that the government put into place to cut deficits

Greece’s economic crisis was spiraling rapidly downwards and the European Union was pressuring the Prime Minister to take action. The EU stated that they couldn’t continue to provide them with loans and that they needed to restructure.

In a BBC news article in 2010, the Prime Minister of Greece said that “tough measures were needed in the face of such an “unprecedented crisis” including a 10% cut in wages and spending in the public sector, a higher retirement age and an increase in fuel prices”

It is clear that the effects of these new policies will have multiple implications for the citizens of Greece, including affects on health status.

The Outcomes:
Video at: http://www.cnn.com/2012/11/07/world/europe/greece-austerity

According to PeoplesWorld these policy changes have caused:
– An increase in people not using physician, dental, and hospital services
– Long wait times and travel difficulties in regards to medical services
– Diminished primary and preventative care services, which have led to high admission rates to public hospitals
– Depression figures have risen including suicide acts (increased by 25% in 2010, and in the first half of 2011 it increased by 40%)

In an article in the CNN they speak of the experience of a 50-year-old married businesswomen with two children, “as she looks around in Thessaloniki, Greece’s second-largest city, she sees real poverty affecting those who’ve had their incomes and pensions drastically cut, or suddenly lost their jobs. Despite paying for social security from her wages, getting a doctor’s appointment now takes months and medicines are costly”

Another article in the Guardian provides some astonishing points. For example, Dr Michalis Samarkos says, “When you see a diabetic unable to afford his insuling you know he is going to die.” He later adds, “There is no infrastructure to help these people. On every front the system has failed the people it was meant to serve”. The health of Greeks is diminishing due to the economic disaster. Rising poverty rates mean that people have less access to healthcare coverage through work and those who had coverage through private sectors are now using public services.

So now what? Countries like Greece will be struggling with the issue of poverty for years to come. But we must find new strategies and approaches to addressing the issue to break this cycle. The Guardian article says it best, “In an effort to finance debts, ordinary people are paying the ultimate price: losing access to care and preventive services, facing higher risks of HIV and sexually transmitted disease, and in the worst cases losing their lives. Greater attention to health and healthcare access is needed to ensure that the Greek crisis does not undermine the ultimate source of the country’s wealth – it’s people”.

BBC News. (2010). Greece unveils austerity programme to cut deficit. Retrieved from: http://news.bbc.co.uk/2/hi/europe/8494849.stm

Labropoulou, E., & Smith-Spark, L. (2012). Greek Parliament approves austerity cuts. CNN. Retrieved from: http://www.cnn.com/2012/11/07/world/europe/greece-austerity

Smith, H., & Boseley, S. (2011). Greeks pay for economic crisis with their health. The Guardian. Retrieved from: http://www.guardian.co.uk/world/2011/oct/10/greece-economic-crisis-health

Whitney, W. (2011). Austerity cuts in Greece cause suffering. People’s World. Retrieved from: http://www.peoplesworld.org/austerity-cuts-in-greece-cause-suffering/

The Theory of Intersectionality and Gender-Based Violence

Intersectionality defined according to McCall (2005), is a methodology of studying “the relationships among multiple dimensions and modalities of social relationships and subject formations”.

Intersectionality is an important contribution to feminist theory and our understanding of gender. It reveals that individual’s social identities are greatly influenced by one’s own beliefs of gender and their experiences related with gender.

ARTICLE: Intersectionality and Identity Politics

In the article by Crenshaw there are some key aspects that he presents of the intersectionality theory that I think are useful in applying to the issue of violence against women.

Intersectionality:
– Offers a means for analyzing and describing the experiences of individuals within a system of interlocking hierarchies
– Can help to understand how experiences of domination can change, and can vary for different groups and for different individuals within groups
– Provides a means of understanding the experiences of individuals within a context of hierarchical power relations, and is thus particularly useful in understanding the complexity of the lives of women who are victims of domestic violence.

Structural Intersectionality
– Major Determinants: High incidence of poverty and the lack of available networks that can provide necessary financial support to help women leave their abusers
– Immigrant women also face additional problems, especially when their immigration status is dependent upon their relationship with their abuser
– Therefore, particular social locations of women can shape their experiences of domestic violence and reduce the available options for dealing with their situations
– Understanding the means to provide intervention strategies to victims of domestic violence thus requires an understanding of the ways in which race, class, gender, ethnicity, immigration status interact in women’s lives

Political Intersectionality
– This occurs when political movements that should address the particular concerns of poor women and women of colour are marginalized
– Political movements that fail to take into account the multiple intersecting identities of those they seek to empower end up marginalizing all but those in the dominant category
– Therefore, movements that could address the concerns of poor and minority women who are subject to domestic violence have failed to recognize the specific concerns of these women

Crenshaw, K. (1997). Intersectionality and Identity Politics: Learning from Violence Against Women of Color. Reconstructing political theory: Feminist perspectives (pp. 48-67). University Park, PA: Pennsylvania State University Press.

McCall, L. (2005). The Complexity of Intersectionality. Journal of Women in Culture and Society. 30, 1771-1800.

Links to Articles:
http://www.tandfonline.com/doi/pdf/10.1300/J134v06n01_01

Click to access The%20C1624ca2bd29bb34483e2ea48273f8a21.pdf

Cultural Issues Within the World of Health Promotion

In the lecture regarding cultural issues we discussed two terms:

Cultural competence: Successfully reaching and mastering cultural status. Thus suggesting that there is a process and an end to becoming part of another’s culture.

Cultural humility: Placing yourself in the role of an ongoing learner rather than someone who can become an expert. It is an ongoing engagement of lifelong learning and reflection.

As a healthcare professional working in a community under a different culture I think that it is best to take on cultural humility as oppose to cultural competence. Cultural humility allows for mutual respect between partners. Instead of one side holding the majority of the power it allows for it to be distributed evenly between both groups.  Cultural humility allows for learning and growth on both sides, and I think that this is crucial to sustain a positive partnership.

Entering the Land of Unknown and Developing a Non-Judgmental Attitude
I think that it is possible to develop a non-judgmental attitude toward others and even an empowering one.

When I was in the Dominican Republic teaching English to children I experienced a big culture shock. Before I had arrived I was given a package to read that had rules and regulations. For example, in the community I was working in, it was mandatory that all women wear pants or skirts that pass their knees. There were many other rules just like this that I had to follow. I thought that I was more than prepared because I had read the package and done my research.

In reality, I was really not prepared to jump right into living in their culture. The true identity of one’s culture is not apparent until you are living in it. To develop a non-judgmental attitude you must be very open-minded to understanding a lifestyle that is different from yours. All cultures have different norms and it is important to remember that despite the difference in beliefs, values, and practices, we are all human, humans who have the right to equal health opportunities.

From my experience, I’ve learned not to focus on the differences but to focus on the similarities. Respect from both partners allows the opportunity to forget the differences and work collaboratively towards a common goal. The key for a health worker in the field of health promotion is to develop knowledge of the culture but to ALSO change our attitudes and approach when working with diverse patients.

Here is an image of day one of myself and some of the children of the community I was working in.

I was taking a walk around the neighbourhood with a friend when these kids came running with arms wide open. This is one big cultural difference; American children are told to stay away from strangers and to never walk the streets alone. Dominican children are independent from such a young age and when they see a new face they cannot wait to greet it with hugs and smiles. Despite this difference being an obvious positive one, I learned to adapt and respect that this is part of their way of life.

It’s important to note that there are other influences that may have been at play besides cultural differences. The Dominican children have learned that “Outreach” people are very caring and friendly and have labelled us as people they enjoy being around. Due to the fact that I was wearing an “Outreach” t shirt it identified be as one someone that they could approach and welcome with open arms. They related me (the t shirt) to all the other volunteers that have visited in the past who have provided fun and positivity in the community.

I think that the Dominicans’ attitudes towards volunteers is definitely influenced by this exposure to international aid efforts. Outreach 360 had already been established and integrated into the community by the time I volunteered with them. I can imagine near the beginning that some of the Dominicans were hostile towards this type of aid but when the project became to unfold they could see the positive influence that this organization was having on their children and the community.

Awareness of cultural differences has shaped my work as a health professional because it has shown me a different perspective into aiding others and to appreciate others’ way of life. As oppose to working with the problem I have now shifted to working with the people.

Ideology of Health as a “Choice”

There are many flaws within health promotion, a big one being the ideology of ‘choice’. Health promotion relies on the individual making lifestyle changes (i.e. Exercise everyday! Eat well!). It places less emphasis on the importance of society and government. This ideology causes things such as Victim Blaming.

Victim Blaming: Easy way to place the accusation on the individual for their
             own health condition and ignoring other factors.

Ideology of choice and its consequences:
– Requires a relatively privileged position in society where it is assumed that you have access to appropriate resources to make “choices”
– Excludes the role of the government
– Ignores other important factors for ‘cause’ of disease
– Creates a social stigma for individuals with illnesses
– Blaming the individual for what happened because they could have ‘chosen’ differently

Reflection:
The concept of ‘choice’ and victim blaming create barriers to solving the underlying issue. I believe that we need to go beyond implementing health promotion programs and provide resources and greater access to services and make the healthy choice the ONLY choice. There is an individual component, but it is important not to ignore the role of the government. There are times where individuals are helpless and simply cannot make the appropriate lifestyle choices for reasons of access and availability, education and knowledge, financial barriers, etc. If we removed the idea of victim blaming we can focus on the problem as oppose to the individual being the problem.

Global Health Perspective:
In the article “Defining Equity in Health” by P Braveman and S Gruskin it discusses the issue of inequity in health. I believe that there is a clear presence of health inequities all over the world. It is evident that in most developing countries there are systematic disparities in access and availability of health services in comparison to the developed world.

The importance of addressing the issue of inequity can be seen in this statement from the article, “Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage.”

It is important to consider these inequities when looking at international health issues. I believe that it is even more imperative to disregard the notion of victim blaming in these situations. Equity means equal rights to the opportunity of being healthy and it is more than obvious that this is not the case all over the world.  Global health promotion programs should focus mainly on society and economic issues to allow all individuals the chance at health.

Braveman, P., Gruskin, S. (2003). Defining equity in health. J Epidemiol Community Health,
57:254-258

Mental Health For ALL by Involving ALL

http://www.ted.com/talks/vikram_patel_mental_health_for_all_by_involving_all.html

I came across this video on TED talks and found that it touched on many aspects of Global Health as well as the importance of Mental Health.

Vikram Patel explains that mental health is a problem all over the world. Even in the more developed countries, roughly only 50% of individuals affected by mental illness receive treatment.

Facts:
– Mental illness can kill, one evidently being suicide and suicide is at the top of the list for the leading cause of death for young people in ALL countries of the world
– Mental illnesses are amongst the leading cause of disability around the world
– Depression is the 3rd leading disability alongside diarrhea and pneumonia
– All mental illnesses combined account for 15% of the total global burden of disease

The Problem:
From a global health point of view, the vast majority of affected individuals are not receiving the care that exists that can transform their lives. There are shortages of mental health professionals all around the globe, typically more problematic in the developing world.

New Idea:
Vikram Patel introduces the idea of Task Shifting to address this problem.

Task Shifting – When you are short of health care professionals use whoever is available in the community and train them to provide health interventions.

Findings:
Uganda – 90% of people using the intervention delivered by other villagers recovered in comparison to the 40% in other villages
Pakistan – 75% of mothers recovered from depression with the help of villagers compared to 45% in other communities
India – Locals were trained to deliver interventions for depression and anxiety leading to a 70% recovery rate compared to the 50% in primary health centres

How to Implement the Idea:
SUNDAR
– Simplify the message
– UNpack the treatment
– Deliver it where people are
– Affordable and available human resources
– Reallocation of specialist to train and supervise

Global Affect:
It is clear on how task shifting can help the developing world but it is also a helpful for well resourced countries. Health care has become so professionalized that it is lacking the “care” component and has been removed from local communities.

Conclusion:
Task shifting allows health care to be more accessible and affordable. It also allows people to become empowered by taking care of those in their own community and becoming a guardian of their own health.

Global Health Education Consortium

I thought this video really provided a basic introduction into what Global Health is. In addition to its importance and what we can do in the future. It begins by discussing the difference between international and global health:

International Health – Historically seen as developed countries helping poorer countries.
Global Health – Looking at things from a different point of view; seeing the whole population of the world as one as oppose to the division of “us” and “them”.

This video taught me that global health is not only about transcending national borders but working in our own backyards. A major health issue is health inequity which is evident overseas but is also present in our own homes. It also expands on the importance of Global Health Education and bringing together a variety of people to share their expertise and knowledge into addressing the issues of Global Health.