Global health symposium 2006 at Simon Fraser University

"Preparing a new generation of public health workers for global health" was the theme of a Global Health Symposium at Simon Fraser University on 27-28 May 2006. Presentations encompassed the breadth of global health issues, including infectious and non-communicable diseases, mental health, and worker health.

Today's public health workers must "have an effective voice," asserted Kelly Lee, Co-Director of the Centre on Global Change and Health at the London School of Hygiene and Tropical Medicine. Changes in global health require a "new generation of public health workers capable of functioning on multiple levels, from local to global; across sectors and disciplines, including biomedicine, public health medicine, and social sciences; and with multiple stakeholders and vested interests, including advocates and lobbyists."

Ron Labonte, Professor of Epidemiogy and Community Medicine at the University of Ottawa, cited 5 global events that paved the way to the current global health environment-the economic recessions of the 1970s, the falloff the Berlin Wall in 1989, 1992s Rio Conference on the environment, the diffusion of information and communication technology in the 1990s, and today s realities of "SARS and beyond."

Drs. Lee and Labonte's observations set the stage for Sunday's presentations on emerging challenges and interdependencies in global health and current issues in global health education.

"We must think outside the box," suggested Sylvie Stachenko, Deputy Chief Public Health Officer, Public Health Agency of Canada, to decrease chronic diseases, which cause more people to die at an early age, affecting the labor force during its most productive years and impacting local and global economies. Dr. Stachenko highlighted three successful initiatives that represent "outside the box" thinking to address chronic disease. In York, UK, the City Council adopted a transportation policy establishing new priorities for decision making, with disabled pedestrians given the highest priority, followed by pedestrians and cyclists, and with automobiles given the least priority. In Denmark, the government has banned virtually all trans fats from domestic and imported foods.

The UN s Global Urban Observatory identifies best practices in areas such as housing, urban development, and government, "providing us the opportunity to learn from each other how bold we can be."

According to Bruce Alexander, SFU Professor Emeritus and author of "The Globalization of Addiction: A study in poverty of the spirit," addiction is "not a disease of the very poor. As communicable diseases decline, addiction increases. Addiction is a democratic disease, affecting both the rich and the poor. Sadly, scientific medicine has made no progress on addiction." In addition to addictions to tobacco, alcohol, and other drugs, Alexander reminded attendees that other addictions that will increase with globalization include gambling, pornography, and shopping.

The health issues that result from global manufacturing and outsourcing of labor by transnational corporations to developing countries was powerfully demonstrated by Garrett Brown, Coordinator of the Maquiladora Health and Safety Support Network and Compliance Officer for the California Division of Occupational Safety and Health, whose photographs of working conditions in factories and other worksite settings in developing companies documented work conditions that contribute to poor health.

The centrality of the health workforce and its invisibility in the policy agenda was explored by Tom Hall, Executive Director of the Global Health Education Consortium. "Most of our attention is given to high-level personnel, like doctors, but not nurses, community health workers, and other auxiliary workers who represent our central resource," he said. Brain drain occurs on two levels--drain from developing to developed country, and from rural to urban settings within countries. To quell external and internal migration we need to address the needs of health professionals, he said, and often monetary and prestige rewards are less important than "feeling like professionals, being able to heal patients, having opportunities for advancement, and being recognized for their contributions."

David Butler Jones, Chief Public Health Officer, Public Health Agency of Canada, reported that one of the main themes of the recent World Health Assembly was that "appropriate technologies are essential." He urged global health professionals to "work with communities in ways that improve their own abilities and demonstrate our underlying respect, not our belief that we have the answers and want to impart them to others."

Primo Madra, Chair of the Scientific Research Sub-committee of the Uganda National Association of Community and Occupational Health, reviewed the status of diseases that have been controlled in one area of the world that may reappear as a result of poor control elsewhere. Health workers in developing countries are increasingly treating chronic noncommunicable diseases that were previously rare. They also deal with unfamiliar health threats and with international patients with unfamiliar behaviors and cultures."

Sladjana Jovic, health promotion department, Federal Institute of Public Health in Belgrade, Serbia, presented an intervention model that Serbia has adapted from one developed in Slovenia to address depression and suicide, rates of which in both countries are among the highest in the world. Serbia has also implemented successful campaigns to address cardiovascular health, physical nutrition, and tobacco control. Highway signs posted by the Serbian government now state "Welcome to Serbia, here tobacco is undesirable too."

The symposium s final discussion explored ways in which universities are addressing global health. Speakers from Simon Fraser University, University of Toronto, and University of Alberta described their institutions global health curricula and the unique challenges of global health studies, such as field placements.

Recurring throughout the symposium was the key role of knowledge sharing, with an emphasis on tacit knowledge and the wisdom of the community. Vic Neufeld, National Coordinator of the Canadian Coalition for Global Health Research, emphasized that "the generation and application of knowledge are increasingly understood to be a key and central driver of good health in the world. We need to share success stories and learn what s working from local initiatives. Most important, we need to recognize local contributions. What can we learn from other countries that can help make us better? How can we import their expertise? What best practices from other countries can we link to our own problems?"

Arun Chockalingam, Director of SFU s Global Health Program and Chair of ProCor's International Advisory Council, concluded by noting that "More than funding and more than anything, you could account for 80% of the benefits of health in other countries from knowledge diffusion. Critical to this is teaching people how to ask questions, how to analyze things from a population point of view."

--------------------

Jeffrey Sachs on prevention, communication, and action

The effectiveness of low-cost prevention, the potential of communication technology in remote regions of the world, and the urgency of taking action were the themes of a keynote address by economist Jeffrey Sachs at the symposium. The theme of the symposium was "Grooming a public health workforce for globalization." Simon Fraser University, which is celebrating its 40th anniversary, is launching a Master of Arts in Global Health degree in January 2007.

Dr. Sachs is Director of the Earth Institute at Columbia University and Special Advisor to UN Secretary-General Kofi Annan. Transcribed from my notes, here are some of Sachs observations relevant to the efforts of our global community promoting cardiovascular health.

Effectiveness of low-cost prevention
"Thirty thousand people die each day of extreme poverty because they can t provide themselves with basic nutrition, health services, or drinking water. The horrific side of that--and the stupendously positive side of it--is that these are preventable deaths. It s in the huge interest of the world to prevent them because as long as this is going on, the world suffers from the obvious tragedy but also from the burden of this extreme poverty, which leaves countries in disarray and in conflict, in harm s way or susceptible to the manipulation of terrorists. So it s really important that we do something about this and the world is starting to stir.

"I was recently in a Tanzanian village with the poorest of the poor, a hungry impoverished place whose residents eat only one meal a day consisting of maize gruel. Life expectancy is about 40 years of age, about half that of the rich world. I asked people what their biggest problem was and they responded that they desperately needed a clinic. Twelve kilometers away, reachable only after hours of walking through the hills, the nearest dispensary had no physician, no running water, no electricity, no diagnostics, and the monthly governmental shipment of basic medications only lasted a little more than one week. I met with a group of between 200-300 people in the village and all of them had had had malaria but not one of them had a bed net. I asked how many of them knew about bed nets and wanted bed nets and every hand went up

To buy a bed net, transport it to a village, distribute it to a household, and provide follow-up by trained volunteers would cost a total of US$10. The bed net will last 5 years and typically two children sleep under it so the protection is about US$1 per child per year. It would cost about $1.5 billion to buy bed nets for all of Africa-this is what the US spends every day on the military. The mismanagement of life on this planet is that we can t figure out how to get one day s worth of military spending to purchase bed nets. In partnership with Yahoo, I m about to launch a massive public awareness campaign on malaria control and try to get each person to spend $10 to get a bed net to a child. The lack of this low-cost intervention is claiming more than 2 million lives each year. We know a tremendous amount about low-cost effective interventions that can change the life of a village like this."

Reach and potential of communication technology
"This village in Tanzania was remote but during my stay I could make and receive calls on my Blackberry. We can build on these technologies. We could provide wireless devices so villagers could call a person with a truck who could provide emergency transport to a hospital. Look at this videoconferencing technology we are using today--we could do this in a village in Africa, we could use it for teaching so people could be trained and then train others. And we could use it to learn from other countries what they are doing to respond to public health issues. With innovation we could do a tremendous amount more. Cell phones are being used to input data on epidemic surveillance. We could provide Blackberries to communities and the internet could create a new kind of politics, a grassroots global democracy."

Urgency of taking action
"With knowledge and inexpensive materials, food yields can be tripled, safe water points can be established, and internet connectivity can change the life of impoverished communities. We have all the pieces of what it will take to make this possible."

Date Posted: 6 June 2006