What is Global Health? Towards an Updated, Universal Definition

April 5, 2016 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

Global Health is an attractive and high profile field. We encounter global health issues on a daily basis, often without even realizing. In 2014, the West African Ebola outbreak was sensationalized in the media for months, featured heavily on every major Canadian media outlet. Several of the world’s largest charitable organizations – which you may work with, donate to, or benefit from – target global health issues. Poverty and health inequities continue to affect both our local and global communities. Students are being encouraged more and more to engage in international experiences in order to become well-rounded “global citizens.” Global health is all around us.

But what does “global health” really mean? If we asked five experts in the field to define global health, chances are each would provide a different response. Why? Because global health has grown over the years to encompass a variety of ideas and notions, including interdisciplinary cooperation, infectious and non-infectious disease, international development, social justice, food security, maternal and newborn child health, and environmental issues…and the list goes on. Global health is broad in scope, and each one of us may approach our work in slightly different way.

Academics have tried to define global health in past. Perhaps the most well-known and widely accepted definition of global health is that of Koplan et al. from 2009:

“Global health is an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide” [1].

While this definition touches on many important aspects of global health like equity, and a worldwide reach, it fails to address the “how.” We can study, research and practice global health, but what are the best ways to engage in our work? How do we find common ground?

I must admit, I don’t have the answers to these complex questions (yet), but I’m hoping that in the near future the global health community comes together to arrive at a solution. Until then, these are questions we should all be cognizant of when we approach our work in global health. Just like Koplan et al. called for the adoption of a common definition in global health in 2009, I am calling for an updated, universal definition of global health in 2016.

Why is it important to come to a consensus on what global health means? As global health continues to grow and become a part of our everyday lives, we must come together to determine a more clear purpose, and path for the future. With everyone working with a common framework in mind, towards shared goals, we will achieve the best outcomes moving forward.

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.

The History Behind the Holidays

December 29, 2015 Maria Wilson Leave a Comment

By: Maria Wilson

Global Health Office Outreach Assistant

The Global Health Office (GHO) would like to wish the Dalhousie community, as well as all of our partners and blog readers, a Happy Holidays! For students, we hope your exams went well, and that you will be able to take this time to relax with your loved ones. If you are interested in becoming more involved with the GHO in the New Year, please contact us at gho@dal.ca.

It wouldn’t be a holiday post from the GHO without profiling some of the holidays celebrated in different countries, cultures and religions around the world in December and early January.

Kwanzaa (December 26-January 1)

Dr. Maulana Karenga, professor and chairman of Black Studies at California State University Long Beach created Kwanzaa in 1966. Dr. Karenga was searching for a way to bring African-Americans together as a community to celebrate family, community and culture. The name Kwanzaa is derived from the phrase “matunda ya kwanza”, which in Swahili means, “first fruit.” It is based on the year-end harvest festivals that have taken place throughout Africa for thousands of years [1].

Celebrations vary from family to family, but often include songs and dances, African drums, storytelling and a large traditional meal. The celebration lasts seven nights, one for each Nguzo Saba (seven principles in Swahili) that contributes to building and reinforcing community among those of African heritage [2]. The Nguzo Saba are values of African culture: Umoja (Unity), Kujichagulia (Self-determination), Ujima (Collective Work and Responsibility), Ujamaa (Cooperative Economics), Nia (Purpose), Kuumba (Creativity) and Imani (Faith). There are also seven symbols of Kwanzaa, often used to decorate one’s table: kikombe cha umoja (the unity cup), kinara (the candleholder), mazao (fruits, nuts and vegetables), mishumaa saba (seven candles to represent the seven principles), mkeka (placemat), vibunzi (ear of corn), and zawadi (gifts). Kwanzaa’s colours are red, black and green, symbolizing the bloodshed in the struggle for freedom, the colour of the people and the fertile land of Africa, respectively [3].

Though created and primarily celebrated in the United States, the holiday has also spread to Canada and to descendants of Africa who reside outside of the continent [1].

Christmas (December 25)

Christmas has been celebrated for two millennia with traditions and practices that are both secular and religious in nature. For Christians, Christmas Day is celebrated as the anniversary of the birth of Jesus Christ. Easter was the main holiday in the early years of Christianity; however, in the fourth century, Pope Julius I chose December 25 to celebrate the birth of Jesus, as a date for the event is not mentioned in the Bible. By holding Christmas at the same time as winter solstice celebrations, church officials increased the chance that the holiday would be popularly embraced. In Greek and Russian orthodox churches, Christmas is celebrated on January 6^th and is called the Epiphany. People celebrate Christmas by exchanging gifts, decorating a Christmas tree, sharing meals with family and friends, and attending church [4].Additionally, there is the story of Santa Claus who brings gifts in his sleigh (if you’ve been good of course)! The legend of Santa Claus can be traced all the way back to 280 A.D., when a monk named St. Nicholas was born. He was admired for his piety, giving away all of his inherited wealth while traveling the countryside helping the poor and the sick. Since the 19^th century, Santa’s gift giving centered mainly around children has been a staple of Christmas celebrations. This generous gift giver is known by many different names worldwide, Christkind, Kris Kringle, Babouschka, La Befana, Père Noël and, of course, Santa Claus [5].

Las Posadas (December 16-24)

Las Posadas, celebrated in Mexico, commemorates the journey that Joseph and Mary made from Nazareth to Bethlehem. Joseph and Mary sought shelter in a stable in Bethlehem, where Jesus Christ was born.On each evening of the festival, a child dressed as an angel leads a parade through the streets of towns and cities where the celebration occurs. The procession visits selected homes and asks for lodging for Joseph and Mary, and they are traditionally refused. However, the hosts often provide refreshments, read passages of scripture and sing Christmas carols. After the procession, mass is held, and children break open piñatas filled with candy and toys [6].

Mawlid Al-Nabi (December 23)

Mawlid Al-Nabi celebrates the birthday of the Prophet Muhammad, the founder of Islam. The celebration date varies on the Gregorian calendar, with the occasion being marked twice in 2015 (most recently on December 23^rd). It is fixed as the 12^th day of the month of Rabi al-Awwal on the Islamic calendar [7]. This celebration goes back to the early days of Islam, when the Tabi’in would hold sessions to compose songs and poems to honour the Messenger of Allah and recite them to crowds in major cities in Islamic Civilization [8].

Festivities include keeping with the tradition of reciting devotional songs and poems and handing out sweets and candies. Mawlid Al-Nabi is considered a spiritual occasion, where Muslims who choose to celebrate are encouraged to revisit the Sirah (the life story of the Prophet) [8].

Bodhi Day (December 8)

Buddhists around the world celebrate the enlightenment of Buddha on December 8^th each year. After trying different methods, practices and religions unsuccessfully, Siddhartha Gautama vowed to sit under a peepal tree in Bodh Gaya until he achieved the full enlightenment he was looking for. He sat in meditation for 49 days under what is now known as the Bodhi tree, with the last 8 days spent in deep meditation. On the final day he achieved enlightenment. Since then, he was known as the Buddha (Awakened One) [9]. Buddhists mark this day by meditating, studying the Dharma, chanting sutras (Buddhist texts) and performing acts of kindness [10].

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