Health Care Teams Addressing Poverty and Determinants of Health

March 16, 2016 Maria Wilson Leave a Comment

The Dalhousie Global Health Office, in collaboration with the Healthy Populations Institute, The National Collaborating Centre for Determinants of Health and Upstream, hosted the “Health Care Teams Addressing Poverty and Determinants of Health” event on March 3^rd. This event featured three speakers, who shared stories of addressing the social determinants of health in their work, and participated in a panel discussion.

Dr. Hamilton-Hinch, Dr. Forbes and Dr, Meili, our panel for the Healthcare Teams Addressing Poverty and Determinants of Health event.

Dr. Ryan Meili, the Executive Director of Upstream and a family doctor in Saskatoon, shared his experience as both a doctor treating patients in inner city Saskatoon affected by poverty, and as an advocate for health equity. Dr. Cindy Forbes talked about her experiences in advocating for health equity as the President of the Canadian Medical Association. Dr. Barb Hamilton-Hinch provided local context to this global issue, by discussing the barriers to healthcare faced by the African Nova Scotian population. All three speakers had common themes in their work: the need for policy change, the importance of story sharing to drive impact, and of course, the priority of addressing the social determinants of health in healthcare.

Dr. Meili speaking at the Healthcare Teams Addressing Poverty and Determinants of Health event.

Dr. Meili sharing stories from his work with Upstream at the Healthcare Teams Addressing Poverty and Determinants of Health event.

Dr. Meili shared the story of one of his HIV-positive Aboriginal patients who was facing several barriers to proper healthcare access. “She’s not sick with HIV,” Dr. Meili said after introducing us to her story, which was initially puzzling. However, if you take a moment to ponder this statement, it makes a lot of sense. By listening to her story, we learned that his patient has been sick with poverty, historic marginalization, poor living conditions, low education and addictions throughout her life. These factors have contributed to her HIV infection, and subsequent difficulty accessing care. This way of thinking is the fundamental to addressing the social determinants of health, and to the upstream approach. For a refresher on the social determinants of health in Canada, see our blog post from January. To learn about the upstream approach, check out this video created by Upstream, where Dr. Meili acts as the Executive Director. Upstream thinking requires us to reframe the public discourse around addressing the social determinants of health. We should be focusing more resources on the things that have the greatest influence on our health, including income, education, housing and nutrition, rather than pouring our resources into the healthcare system down the line.

Dr. Cindy Forbes, President of the Canadian Medical Association, at the Healthcare Teams Addressing Poverty and Determinants of Health event.

Building a body of evidence, and sharing these findings are both important pieces to guiding policy change. But as Dr. Forbes noted “evidence doesn’t make people feel empathy.” Upstream also aims to share stories through a variety of media in order to creatively engage citizens, showing them they have a personal stake in the social determinants of health. Citizen engagement can lead to a political push for evidence-based, forward-looking policy innovations to address these determinants so people can live longer, fuller and healthier lives.

Dr. Hamilton-Hinch highlighted the importance of not only addressing policy change, but ensuring that power dynamics shift to reflect the diverse makeup of our Canadian population. Dr. Hamilton-Hinch is involved with PLANS (Promoting Leadership in Health for African Nova Scotians) at Dalhousie. PLANS seeks to improve health outcomes within the African Nova Scotian community (about 2.3% of the NS population), while creating mentoring and outreach opportunities. In order to facilitate access to healthcare for African Nova Scotians, Dr. Hamilton-Hinch discussed the need for change in our healthcare system. Change to the way healthcare professionals are educated by challenging curriculum, change to the way healthcare professionals practice in order to reflect cultural proficiency, and most importantly, change in the disparity between the small numbers of African Nova Scotian healthcare professionals and the much larger population they serve.

Dr. Barb Hamilton-Hinch of Dalhousie University, discussing the health of African Nova Scotians at the Healthcare Teams Addressing Poverty and Determinants of Health event.

The Global Health Office would like to thank Dr. Meili, Dr. Forbes and Dr. Hamilton-Hinch for sharing their stories with over 80 attendees. The stories you have shared will go on to impact the way that we approach our learning, practice and advocacy.

World Tuberculosis Day Part III – Treatment & Drug Resistance

March 8, 2016 Maria Wilson Leave a Comment

The World Health Organization (WHO) has declared March 24, 2016 as World Tuberculosis (TB) Day [1]. Over the month of March, the Global Health Office will be publishing a series of blog posts about TB in hopes of raising awareness of its worldwide impact. WHO’s “End TB Strategy” has a goal of ending the TB epidemic by 2030, by targeting poverty, improving testing and treatment, ending stigma and discrimination, and driving research and innovation. Put simply, TB is not yet a disease of the past, but if we unite and focus our efforts, we can make TB history.

Last week we talked about diagnosing TB, and the importance of determining an appropriate treatment course along with that diagnosis. But how is TB treated, and why is drug resistance an issue with TB in particular?

Although those with latent TB infection do not present symptoms, and cannot spread TB bacteria to others, treatment can still be provided to stop them from developing TB disease. This step is important in eliminating and controlling TB around the world, but should only be initiated once the possibility of TB disease has been excluded. In the United States, four treatment regimens are approved, using combinations of isoniazid, rifampicin and rifapentine. Treatment for latent TB can last anywhere from 3 months to 9 months, necessitating between 12 and 270 doses (minimum) of anti-TB drugs [2].

Treating those with active TB disease is a much more pressing matter, as they have the potential to spread the disease to others. Treatment regimens for active TB disease can last between 6 and 30 months depending on resistance, a process which burdens patients and treatment providers alike [3]. With a treatment course this long, some patients inevitably fail to complete the full regimen, for many reasons including finances, social pressures and inadequate access to proper treatment. To provide a glimpse at the financial burden of TB, each case in Canada cost the healthcare system $47,290 [4]. This can lead to acquired drug resistance, which can then be passed on to others when the infected person, coughs, sneezes or spits, releasing TB bacteria into the air [5].

There are two types of drug-resistant TB: multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). MDR-TB bacteria does not respond to (at least) the two most widely used and powerful first line TB drugs: isoniazid and rifampicin [6]. XDR-TB involves resistance to isoniazid and rifampicin, in addition to resistance to any of the fluoroquinolones (ofloxacin, etc.), and to at least one of three injectable second-line drugs (amikacin, capreomycin or kanamycin) [7]. Both MDR-TB and XDR-TB take longer than regular TB to treat (at least 18 months) and have lower treatment success rates. Furthermore, patients often experience more harsh side effects from treatment, leading to increased hospitalization [8]. In order to maximize the potential for positive treatment outcomes, it is important that further tests are undertaken after initial diagnosis to determine whether bacteria is drug-resistant, and provide appropriate treatment [7].

According to the WHO Global TB Report, in 2014 an estimated 3.3% of new TB cases and 20% of previously treated cases had MDR-TB. More than half of these cases occur in India, China and the Russian Federation. Additionally, an estimated 190,000 people died of MDR-TB in 2014. As of 2015, XDR-TB had been reported in 105 countries. The map below shows the number of patients in these countries with laboratory-confirmed XDR-TB who started treatment in 2014 [9].

Map of the world, showing the number of laboratory-confirmed cases of XDR-TB receiving treatment by country, 2014. (Source: World Health Organization).

In response to treatment non-adherence, and to combat the spread of drug-resistant TB, the directly observed therapy, short-course (DOTS) strategy was developed by WHO in 1994. Health workers meet with patients regularly to help with treatment, adherence, and to provide support and education. This strategy also advocates for increased allocation of domestic and international funding and resources to combat TB [10]. Tuberculosis is also highlighted in two recent worldwide strategies, the WHO End TB Strategy, and the UN Sustainable Development Goals (SDGs), which will be discussed in our next post.

Community interventions: what is mHealth, and how can it help to improve maternal and newborn child health in developing countries?

November 10, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

From November 5-7, 2015 Montreal hosted the Canadian Conference on Global Health. A delegation from Dalhousie participated in the many opportunities, and we will be publishing a series of blog posts from the students who attended.

Before I begin this blog post, I must disclose something to everyone reading – until November 5^th 2015, I had never heard of the term “mHealth.” In fact, if you go look at my Twitter feed from earlier this week (shameless plug @_marianicole), I improperly stylized it as “MHealth.” Somebody had already re-tweeted my tweet (thanks @QueensGlobalHealth) by the time I recognized my error, so I didn’t want to delete and correct it. Fun fact: you cannot edit a tweet.

Sure, I had (briefly) heard of using mobile technology to address global health issues in one of my classes; however, mHealth as a concept is new to me. But hey, that’s what conferences are for: learning new things and gaining new perspectives. On the off chance that you, the reader of this post (if there are any of you out there), also have no idea what mHealth is, let me attempt to enlighten you! Because hey, conferences are also for sharing ideas and information (essentially, conferences are full of benefits).

Last Thursday at the Canadian Conference on Global Health (CCGH), there was a group of oral presentations on mHealth interventions geared toward improving maternal and newborn child health (MNCH) in developing countries. For this post, I’ve tried my best to blend information from this session, along with background information from a brief literature search on the topic of mHealth to pass along one of the many useful things I learned today, to all of you (hi mom, thanks for reading).

The first question that I know is burning in your mind: WHAT DOES THE M STAND FOR?!?! I may have spoiled that earlier in this post (sorry), when I talked about mobile technology to address global health issues, because the “m” is for “mobile.” The large photo of various mobile devices at the start of this post also probably gave that away (again, sorry).

mHealth is an emerging field of global health in which mobile and wireless devices are used to generate, aggregate and disseminate health information. Around the world, mobile networks are keeping people connected daily, even in the most rural of areas. mHealth is particularly important in the context of developing countries, where cost-effective solutions are necessary to improve healthcare systems and delivery.

One of the presentations, given by Kristy Hackett, at the CCGH outlined community health workers’ (CHWs) motivation during an mHealth intervention trial to improve MNCH in Singida, Tanzania. CHWs, who have enormous potential to improve MNCH in hard-to-reach communities, were provided with either a smartphone or paper-based protocols to use in household visits. The smartphone used an application that would guide and support CHWs throughout each visit with prompting questions, tools to help calculate important indicators such as gestational age, and help them decide if a clinical referral was necessary. Findings from qualitative interviews indicated that mobile phones initially incentivized and simplified the CHWs’ work, but difficulties arose with charging and airtime. The study findings highlight the need to continue to refine and improve mHealth approaches in order to move toward more efficient health delivery and better health outcomes.

Some of the many other applications of mHealth include reminding patients to take medications through notification systems and conducting disease surveillance. The 2015 mHealth Summit is currently underway in Washington DC (November 8-11). You can check out their website here: http://www.mhealthsummit.org/.

Look for more blog posts from Dalhousie delegates at the 2015 CCGH over the next few weeks. As always, for more information on the Global Health Office you can check our Twitter, Facebook and Website. We have also recently started an Instagram account, and I am going to shamelessly and directly ask (beg) you to follow us because (a) we have been and will be posting some really awesome pictures and (b) we currently only have 13 followers, which is an increase of 225% since Thursday when we only had 4. Happy Tuesday everyone!

Dalhousie delegates taking social media by storm at the 2015 Canadian Conference on Global Health

November 10, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

From November 5-7, 2015 Montreal hosted the Canadian Conference on Global Health. A delegation from Dalhousie participated in the many opportunities, and we will be publishing a series of blog posts from the students who attended.

Missed us on social media this weekend? No problem! You can check us out on Twitter, Facebook and (NEW(ish)!!!!) Instagram. Here are a couple of highlights from the Dalhousie delegates at the 2015 CCGH.