Saturday, November 13, 2010

Cornel West speaks to American Public Health Association about health and social justice



Part 2 (click here)
Part 3 (click here)

Some highlights:
-"There's too much moral constipation: you know what's right, but you just can't get it out"
-"the unexamined life is not worth living...and the examined life is painful. To acknowledge the conditions of truth is to allow suffering to speak"
-‎"there is a deep connection between socratic questioning and loving - and I use the word love explicitly - a steadfast commitment to the wellbeing of others."
-"Justice is what love looks like in public"

Friday, November 5, 2010

What's Happening in Haiti? A Report from the Cuban Medical Brigade

By Emiliano Mariscal, Argentine doctor, Graduate of the Latin American School of Medicine (Cuba) and member of the Cuban medical brigade in Haiti

To view the Spanish original of this item is at the ALBA-TCP website, click here.
To view a pdf of the English translation by Norman Girvan, click here.

To my friends and family,

These lines are meant to provide information on the health situation in Haiti, as a result of the concern of many friends who have written asking about conditions here.

The first thing I can say is that we have a disease, cholera, which has not been reported in this country for over 100 years. Secondly, that it is one of the most dreaded diseases here, given the ideal conditions that exist for its persistence and spread.

Briefly, my first experience of the disease was this: two days before its presence in Haiti was confirmed, we accompanied an epidemiologist, a microbiologist and an entomologist to Mirebalais, a community in the Centre Department where the Cuban medical brigade stationed at a hospital had reported an outbreak of diarrhea of such unusual severity that it had already killed three people. During the tour of the community we frequently had occasion to recall the work of Dr. John Snow, the forerunner of modern epidemiology, because when we visited the locations from which the deceased originated, they all had a common element--proximity to the Artibonite River. People have no piped water supply, so they obtain water from the river, whether for drinking, washing utensils, personal hygiene, etc. Another common element is the absence of latrines, so it is usual for them to relieve themselves outdoors.

We also observed overcrowding, extremely poor housing conditions, small garbage dumps scattered throughout, malnutrition, a low educational level, helplessness and resignation. Patients admitted to hospital had watery diarrhea, whitish, accompanied by profuse vomiting; the most severe cases arrived with dehydration. There were three deaths. Water samples were taken, as well as feces and vomit samples on behalf of the authorities of the Ministry of Health of Haiti. Our conclusion: the source of infection is contaminated water, by reason of clinical characteristics indicating an extremely aggressive bacteria that is spread by water, the existence of environmental conditions for its persistence and spread, an incubation period of around 24 hours, and the fact that in the space of a few hours it can result in complications, which, if untreated, can cause premature death.

Cholera having been absent for one hundred years, we could not be sure that this was what we were dealing with until there was laboratory confirmation. The report was turned over to Haitian authorities and the next day, the outbreak occurred in Saint Marc. Soon after came the confirmation that this is indeed a Vibrio cholerae. 16 days have elapsed from the beginning of the epidemic; to date, Haitian authorities have reported 330 deaths and approximately 4600 inpatients. There are several international institutions such as PAHO and the CDC who are advising the Haitian Ministry of Health, but the lead role, although you don’t hear about it in the mass media, is played by Cuba in close coordination with the health institution in Haiti. (1) The reality is that the action of the Cuban Medical Brigade has delayed the spread of the epidemic to Port au Prince (which is the most feared, as there are 1 500 000 people living in settlements there in extremely precarious conditions).

The town of Arcahaie (part of the West Department) leads directly to Artibonite (and especially to Saint Marc). Our brigade provides medical care in two institutions as part of the strategy for reconstruction and strengthening of the health care system developed together with Ministry of Health of Haiti. They have been turned into Cholera Care Centers. Up to October 30, the two institutions had treated 1182 patients, confirming at the same time, the presence of transmission in the sub-communities of Arcahaie, finding in them the conditions described in the first focus control area in Mirebalais. You don’t need to be a health specialist to work out that if the 1,182 patients had not been referred to these centers, they would have sought assistance in Port au Prince; and that's exactly the way the epidemic spreads (described extensively in the literature)--sick people come in search of health institutions and others who are not yet sick, but are in the incubation period, move away from the place for fear of contracting the disease. As a result many people would have moved to Port au Prince where there are no conditions to contain the influx sick people.

The fundamental tasks are to carry out health education and to provide safe sources of water supply for the population. Both elements are difficult to achieve, the first because it is difficult to change long ingrained habits in the population; the second, because although there are resources (grants), establishing the organizational capacities needed to bring it about is a complex matter. The work is going forward. The Cuban Medical Brigade is ready to continue contributing to the fight against this terrible epidemic together with the Haitian authorities. Their presence in the community through health education activities linked with community leaders and Cholera care centres are high expressions of the principles of solidarity and internationalism. Fifty-one young graduates of the Latin American School of Medicine are now in the forefront of this hard battle, working arm in arm as one with their Cuban brothers and teachers. The others continue working in positions throughout the country, many of them ready to go to the front line as necessary. The prospect is that the disease will remain in the country for several years, with outbreaks happening as water sources are polluted. A hurricane is now approaching, which is forecast to reach Haiti today. No doubt this will aggravate the situation, providing conditions for the further spread of the disease to places where it had not reached. There are also areas of high flood risk.

Cuba has been here for 12 years. Since the earthquake, the commitment is to rebuild and strengthen the health care system. Cuba will be here during the cholera epidemic and in the wake of the Hurricane. Just ask any citizen of this country about the Cuban doctors and you will see their faces blossom.

Proud to be part of another page of the many pages of Cuban internationalism; proud to be a member of the Cuban Medical Brigade; proud to be a child of the Americas, committed above all to my homeland that is Latin America and to my compatriots who are the children of this soil.

(1) Translator’s note: it is not clear if this refers to the Haitian Ministry of Health. The Spanish reads “la institución sanitaria de Haiti”.

Thursday, November 4, 2010

Identifying the source of Haiti's cholera outbreak

(AP) PORT-AU-PRINCE, Haiti -- Researchers should determine whether United Nations peacekeepers were the source of a deadly outbreak of cholera in Haiti, two public health experts, including a U.N. official, said Wednesday.

The U.S. Centers for Disease Control and Prevention found that the strain of cholera that has killed at least 442 people the past three weeks matches strains found in South Asia. The CDC, World Health Organization and United Nations say it's not possible to pinpoint the source and investigating further would distract from efforts to fight the disease.

But leading experts on cholera and medicine consulted by The Associated Press challenged that position, saying it is both possible and necessary to track the source to prevent future deaths. "That sounds like politics to me, not science," Dr. Paul Farmer, a U.N. deputy special envoy to Haiti and a noted expert on poverty and medicine, said of the reluctance to delve further into what caused the outbreak. "Knowing where the point source is - or source, or sources - would seem to be a good enterprise in terms of public health."

The suspicion that a Nepalese U.N. peacekeeping base on a tributary to the infected Artibonite River could have been a source of the infection fueled a protest last week during which hundreds of Haitians denounced the peacekeepers.

John Mekalanos, a cholera expert and chairman of Harvard University's microbiology department, said it is important to know exactly where and how the disease emerged because it is a novel, virulent strain previously unknown in the Western Hemisphere - and public health officials need to know how it spreads. Interviewed by phone from Cambridge, Massachusetts, Mekalanos said evidence suggests Nepalese soldiers carried the disease when they arrived in early October following outbreaks in their homeland. "The organism that is causing the disease is very uncharacteristic of (Haiti and the Caribbean), and is quite characteristic of the region from where the soldiers in the base came," said Mekalanos, a colleague of Farmer. "I don't see there is any way to avoid the conclusion that an unfortunate and presumably accidental introduction of the organism occurred."

To read more, click here.

Tuesday, October 26, 2010

PAHO Responds to Cholera Outbreak in Haiti



Washington, Oct. 26, 2010 – The MSPP (Ministère de la santé publique et de la population) is leading the response to the cholera outbreak and has prepared the National Response Strategy to the Cholera Epidemic. This strategy is organized around thrree levels

    1. Protection of families at the community level;

    2. Strengthening of the 80 centers of primary health care in the metropolitan area;

    3. Reinforcement of the network of 10 Cholera Treatment Centers (CTC) and 8 hospitals for the management of severe cases.

Work has also started on establishing community rehydration centers that provide oral rehydration by community workers. This will be introduced in phases using priority areas identified by the MSPPP.

      Technical Information

    1. The Global Task Force on Cholera Control [English]
    2. Acute diarrhoeal diseases in complex emergencies: critical steps [English] [French]
    3. First steps for managing an outbreak of acute diarrhoea [English] [French]
    4. Cholera fact sheet [English] [French] [Spanish]
    5. Cholera outbreak: assessing the outbreak response and improving preparedness [English]
    6. Management of Dead Bodies after Disasters: A Field Manual for First Responders [English] [French] [Spanish]

    7. Click here for more information from PAHO

      Friday, October 22, 2010

      Cholera outbreak in Haiti

      Saturday, October 16, 2010

      Joel Gutierrez: Cuba's Health System and Global Health Innovations

      Joel Gutierrez: Cuba's Health System and Global Health Innovations from chris keefer on Vimeo.


      Joel Gutierrez, Chair, Clinical Neurophysiology Dept and Deputy Research Director of the Cuban Institute of Neurology and Neurosurgery Professor at the Havana Medical University.

      Since the 1959 revolution Cuba has developed one of the most successful healthcare systems in the world, particularly considering its low-income status. Cuba has accomplished this feat through a focus on primary preventative care integrated within the community as well as incorporating a public health lens into its general policy making. Remarkably Cuba's impressive health indicators have weathered the contraction of its economy following the collapse of the Soviet Union and the ongoing hardships faced by the island in the face of the current global economic crisis and the ever-present economic blockade imposed by the USA.

      In addition to these domestic accomplishments Cuba has developed and maintained an unprecedented capacity for medical solidarity sending tens of thousands of health professionals to countries across the global south including most recently Venezuela, Pakistan, Bolivia and Haiti. Finally Cuba is reversing the brain drain suffered by countries of the global south by educating tens of thousands of low-income international medical students on full scholarships through its flagship program the Latin American School of Medicine.

      Monday, October 11, 2010

      Debating the future of Canada's health care system

      Debate organized by Students for Medicare on October 4th, 2010 in Toronto, Ontario.

      "Would Canada benefit from greater privatization of health care?"
      YES: Dr. William Orovan, Urologist, Professor and Chair of the Department of Surgery, McMaster University

      vs.

      NO: Dr. Danielle Martin, Family Physician, Board Member and Founder of Canadian Doctors for Medicare.

      Debate: Would Canada benefit from greater privatization of health care? Part 1 of 4 from Students For Medicare on Vimeo.

      Saturday, October 2, 2010

      No time to quit: HIV/AIDS treatment gap widening in sub-Saharan Africa


      New therapies have had great benefits for people living with HIV/AIDS, but looming funding cuts could undo many of the gains. To learn more, visit aids2010.msf.org. And for a brief MSF (Medicines Sans Frontiers) report on the growing funding gap, click here.

      Thursday, September 16, 2010

      Tackling acute and chronic disasters: Lessons from Haiti

      Partners in Health (PIH) holds its 17th Annual Thomas J. White Symposium this September 25th, 2010. The event is live-streamed via the PIH website beginning at 3:00pm EDT, and can be viewed at www.pih.org/symposium. Each year this event brings together PIH staff, family, friends, and fellow advocates for health and social justice. This year's Symposium features keynote speeches from

      -PIH co-founder Dr. Paul Farmer
      -PIH Executive Director Ophilia Dahl
      -PIH leaders from around the world

      "For over 20 years, PIH has worked to tackle the chronic but devastating disasters that stifle the lives and hopes of millions of people - lack of access to medical care, food, clean water, decent housing, schools and jobs. This year's Symposium will explore how acute disasters like the earthquake in Haiti impact communities already ravaged by poverty and disease, and how our commitment to breaking this vicious cycle has enabled us to respond effectively to the need for both emergency relief and long-term recovery."

      Thursday, August 19, 2010

      Flooding and public health crisis in Pakistan

      "More than two weeks of floods in Pakistan have left well around 2000 people dead and more than 20 million displaced. And the country is set for more troubled times ahead. The UN has warned that up to 3.5 million children are at risk of contracting water-borne diseases. As many as 300,000 people could contract Cholera - a disease that can spread quickly in areas where the water is contaminated. The first case has been reported and a failure to contain the disease could spell further disaster for Pakistan. So just what will it take to avert this and how are relief efforts being hindered by the growing health crisis?"

      For updates, visit the website of the WHO in Pakistan
      WHO Technical Hazard Sheet - Flooding

      Monday, August 16, 2010

      Debating The Spirit Level: "Smaller income differences result in better health"

      by Andrew Bresnahan

      In their recent book "The Spirit Level: Why More Equal Societies Almost Always Do Better", epidemiologists Richard Wilkinson and Kate Pickett marshall the evidence on income inequality and a range of different health and social problems - including physical health, mental health, drug abuse, education, imprisonment, obesity, social mobility, trust and community life, violence, teenage births, and child well-being. Across all 11 of these indicators, outcomes are substantially worse in more unequal societies, and substantially better in more equal societies.

      Perhaps the book's biggest achievement is it's popularity in the UK, which Wilkinson and Pickett hope is a move towards a more "evidence-based politics". The authors hope their research will shift inequality from being seen only as a left-wing issue, and make addressing it a key metric for success across the political spectrum.

      But their book has also produced a backlash from a few writers, often associated with right-wing institutes, who have positioned themselves as "professional idea wreckers". Their idea isn't so much to produce counter-evidence as it is to plant doubt, making it more difficult to build alliances across partisan lines. As Wilkinson and Pickett explain in response, "It was inevitable that these attacks would appear sooner or later. But it is important that people are aware of how ill-founded and easily rebuffed they are. That three sustained attacks from those opposed to greater equality can be dealt with in relative ease should increase our confidence in the case for a more equal society."

      Wilkinson and Pickett engage these challengers head on, and if anything, offer a chance for all of us to strengthen our fluency with the evidence. There are two great places to look if you want to get more aquatinted with the critiques and Wilkinson and Pickett's responses. First, Wilkinson and Pickett respond brilliantly in the FAQ section of The Equality Trust website, and in a comprehensive response to three most influential critiques, published by right-wing think tanks.

      Also, in recent months the British RSA (Royal Society for the encouragement of Arts, Manufactures and Commerce) has hosted two excellent talks on the Spirit Level. The first features Wilkinson and Pickett introducing their book. The second features a live debate between Kate Pickett and Richard Wilkinson, co-authors of The Spirit Level, and Peter Saunders, author of the Policy Exchange report Beware False Prophets: Equality, the Good Society and The Spirit Level and Christopher Snowden, author of The Spirit Level Delusion. The RSA debates on the Spirit Level are available for download here.

      If we're committed to learning from them, these debates will help strengthen our fluency with the evidence. And the better we're able to marshall the evidence on health inequalities and social wellbeing, the closer we'll be to becoming the social movement that evidence calls for us to become.

      Thursday, August 12, 2010

      The Cost of Care: What quality of care, for who, financed how?

      "The United States spends more on medical care per person than any country, yet life expectancy is shorter than in most other developed nations and many developing ones. Lack of health insurance is a factor in life span and contributes to an estimated 45,000 deaths a year. Why the high cost? The U.S. has a fee-for-service system - paying medical providers piecemeal for appointments, surgery, and the like. That can lead to unneeded treatment that doesn't reliably improve patients health. Says Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health who studies health insurance worldwide, 'More care does not necessarily mean better care'" - Michelle Andrews, National Geographic, January 2010

      Sunday, August 8, 2010

      A Worker's Speech to a Doctor

      When we come to you

      Our rags are torn off us
      And you listen all over our naked body.
      As to the cause of our illness
      One glance at our rags would
      Tell you more. It is the same cause that wears out
      Our bodies and our clothes.

      The pain in our shoulder comes
      You say from the damp: and this is also the reason
      For the stain on the wall of our flat.
      So tell us:
      Where does the damp come from?

      -Bertolt Brecht

      Charity or social justice? Financing global health

      by Andrew Bresnahan

      In August 2010, Bill Gates and Warren Buffet, two of the richest people in the world, revealed they had persuaded 40 US billionaires to sign the "
      Giving Pledge", an agreement to use a majority of their wealth for philanthropy. So is there anything wrong with such an extraordinary act of charity?

      Perhaps quite a lot. As Reinhold Niebuhr pointed out in the 1930's, "philanthropy combines genuine pity with the display of power, which explains why the powerful are more inclined to be generous than to grant social justice." Healthy systems of social welfare depend on equitable financing and coherent investment - and there are convincing arguments that charity tends to deliver neither. Many of these arguments are explored in a brilliant piece on the BBC's website reviewing ethical arguments against charity.

      As response to the January 12th earthquake in Haiti demonstrated, questions of financing and accountability are of urgent importance for global health delivery, especially when acute disasters are layered on top of "the chronic but devastating disasters that stifle the lives and hopes of millions of people - lack of access to medical care, food, clean water, decent housing, schools, and jobs". In the face of these real needs, Partners in Health (PIH) has established a 20-years tradition of working alongside local Ministry's of Health. While so much of their work is made possible through private fundraising, PIH frame their practices not as charity but as "'pragmatic solidarity - a commitment to struggle alongside the destitute sick and against the economic and political structures that cause and perpetuate poverty and ill health."

      Another example of global health solidarity in action is the March 2010 agreement between Cuba, Brazil, and Haiti to build a public health care system in Haiti. The agreement builds on Cuba's long-term commitment to medical internationalism in Haiti which predates the January 12th earthquake, and is based on an $80 million funding commitment from Brazil to set up a network of primary care and epidemiological surveillance facilities staffed by Haitian, Cuban, and Latin American personnel trained at the Latin American School of Medicine in Cuba.

      In the context of the global financial crisis and fiscal austerity in Europe and North America, questions of financing primary health care are all the more important. Proposals for a "windfall tax" for environmental and social justice, a global "Robin Hood tax" on international financial transactions, and better progressive taxation are suggestive of the innovative alternatives to a dependence on charity for financing health and human development.

      We shouldn't shy away from questions of financing global health. Indeed, they are essential not only for ensuring access to essential medical services, but also to broader systems of social welfare capable of addressing the social determinants of health. Every disease has a biological story and a social story, and our solutions to disease need to be both medical and social. As British epidemiologist Geoffrey Rose writes in the closing words of his Strategy for Preventative Medicine: "the primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart." The challenge of global health financing is to discover how best they can be brought together.

      Saturday, August 7, 2010

      Global Justice and the Social Determinants of Health


      Sridhar Venkatapuram - Ethics & International Affairs, Volume 24.2 (Summer 2010)


      Sridhar Venkatapuram is an ESRC-DFID Research Fellow at University College London and an affiliated lecturer in sociology at Cambridge University. He has written on social and global justice theories, ethics of health inequalities, human rights, and health sociology, and has worked with Human Rights Watch, Open Society Institute, and the Population Council. He is currently writing a book on health justice and the capabilities approach.

      Click here for the full text of his most recent article, Global Justice and the Social Determinants of Health.

      Friday, July 23, 2010

      Health gap in Britain "wider than in great depression"


      Saturday, July 17, 2010

      African Medical Corps launched by African Students of the Latin American School of Medicine


      The Organization of African Doctors’ (OAD) African Medical Corps presents the Yaa Asantewaa Medical Brigade that will be dispatched to Ghana, West Africa from August 15 – September 5, 2010. This medical-research brigade will collaborate with Cuban doctors working in rural Ghana to conduct a baseline health assessment where access to healthcare and infant mortality rates present outliers far below the national statistics. The assessment will focus its investigation on the access to medical facilities in rural areas, community infrastructure, malnutrition, and infectious diseases; including HIV, AIDS and malaria that contribute to almost half of all deaths reported in Ghana (World Bank 2002; World Development Indicators Database 2003). Using a series of qualitative and ethnographic methods for data collection, the brigade will obtain a practical picture of the communities’ epidemiological profile that will include documenting the role of Traditional African Medicine (TAM) in primary care delivery. The Health Brigade, composed of medical students and professionals trained in Cuba, will work under the training of Cuban doctors stationed in the region in order to accurately evaluate the health status of the community. Students will participate in a critical praxis model that includes identification of an urgent problem, conducting research, developing a solution-based plan, implementing the plan, and evaluation the plan, in hopes to use the healthcare model developed in Ghana´s in other African communities with even greater disparities.

      The Organization of African Doctors is a group of medical students and doctors founded in 2009 on the campus of the Latin American School of Medicine in Havana, Cuba with the goal of developing a new breed of African doctors, with a high level of discipline, consciousness, and dedication. The mission of OAD is to develop programs, projects and institutions with the objective of producing an organized, politically-conscious and socially-responsible medical body able to meet the needs of African people suffering from health related issues throughout the African World. The African Medical Corps, is the central program of OAD linking the ideological development of African doctors with the practical training necessary to meet the health needs of African people within our communities. OAD is composed of 160 students, interns, and residents trained in Cuba currently representing over 35 countries.

      The African Medical Corps represents the best sons and daughters of Africa from around the world, united in our mission to expand our capacity to sustain Africa from the grasps of the healthcare crises that is confronting the continent. OAD’s commitment to service is the fundamental basis for the work that the Yaa Asantewaa Brigade will implement this summer 2010.

      Wednesday, June 30, 2010

      A New Way of Ranking Medical Schools: Social Mission


      "In the June issue of the Annals of Internal Medicine, Fitzhugh Mullan, Candice Chen, Stephen Petterson, Gretchen Kolsky, and Michael Spagnola, mostly from the Department of Health Policy at the George Washington University (and one from the Robert Graham Center) report on “The social mission of medical education: ranking the schools”. This study, sponsored by the Josiah Macy, Jr. Foundation as part of the Medical Education Futures Study (MEFS) is the first report to look at this area, and should be eye-opening to those who assume that “good” medical schools are “good” at everything. Most ranking systems, most notably those of US News and World Report, are based on NIH research funding, grades and test scores of entering students, “competitiveness” (how low a percent of applicants they accept) and reputation. Obviously, the grades and test scores are related to competitiveness and reputation is a tautology, because it reinforces itself. It should depend upon what you are looking at, of course. I addressed this in “Rankings of Medical Schools: Do they tell us anything?” (September 25, 2009), and observed that what they tell us is who does well in what is measured, and that this should only be important to us if those are the outcomes we value.

      Mullan and colleagues evaluate different outcomes, the degree to which medical schools meet their “social mission”, or to put it another way, the degree to which they produce the physicians that will take care of the American people. More to the point, since it can be argued that most medical school graduates take care of some American people, physicians who will take care of those people who need it the most because they don’t already have doctors. This means largely those in poor communities, rural communities, and minority communities (and especially those communities that are two or three of these). They look at 3 characteristics of graduates: 1) what percent of their graduates are practicing primary care, 2) what percent of their graduates are practicing in designated Health Professions Shortage Areas (HPSAs), and 3) what percent of their graduates are members of underrepresented minority groups? This is pretty straightforward, and they take two other steps to try and ensure that this is an accurate reflection..."

      To read more, visit Dr. Josh Freeman's brilliant site Medicine and Social Justice

      Friday, June 25, 2010

      Video: What G20 Leaders Will Not See in Toronto

      Scott A. Wolfe, Health and Social Policy Advisor with One World Partners
      As world media attention turns to Toronto and many important issues of global concern, perhaps what's receiving least attention is Canada's own local and national stories of human crisis. This video from the Toronto Star provides images and stories from the "Toronto" that G20 leaders and international media are unlikely to see. Below the video are some statistics and points of information that might surprise many non-Canadians and Canadians alike.




      -As of 2009 Canada ranked 18th out of 30 wealthy (OECD) countries in terms of equitable income distribution

      -Canada has the 2nd highest increase in income inequality among OECD countries, from the mid-1990s to mid-2000s

      -Canada has the 12th highest overall poverty rate among the world's 30 wealthy (OECD) countries, and 10th highest child poverty rate

      -While poverty in Canada actually declined from the mid-1980s to mid-1990s, Canada has the 2nd highest increase in poverty rates among OECD countries from the mid-1990s to mid-2000s

      -Canada has the 5th lowest level of public social spending among 30 OECD countries. Only the United States, Turkey, Korea and Mexico spend less, as a percentage of national income

      -Despite this very low overall social spending, Canada ranks 8th in terms of health care spending. This means that while Canada provides very low investment on social programs compared to other wealthy countries, it provides an especially low level of investment on social supports outside of health care (ie, housing, child care, employment benefits, other social programs).

      -The impact of poverty, and this low social spending has a particularly serious impact on a number of sub-population groups in Canada, including Aboriginal people, other racialized groups and recent immigrants. For instance, while Canada ranks high overall on the United Nations Human Development Index, First Nations people in Canada rank 63rd according to these UN indicators.

      Sources: Society at a Glance 2009 - OECD Social Indicators and Assembly of First Nations

      Tuesday, June 15, 2010

      Who will care for the underserved? The role of off-shore medical schools

      Josh Freeman June 2nd, 2010


      I have written in several previous posts (most recently Universal Coverage and Primary Care: The US needs both, May 27, 2010) about the challenges facing American medicine, particularly regarding specialty choice (= not primary care, not rural, notunderserved) of US allopathic graduates, and the problems this has already created in providing health care to the American people, which is only likely to worsen as this trend continues. I have noted that, in the production of physicians as in any other process, the outcome results from variables in inputs (who is admitted in this case), the process itself (in education, the curriculum, both formal and informal), and output variables (in the case of physicians, what the practice environment is: reimbursement, work load, quality of life, respect and regard within the profession and community). I have argued that, while output variables may be the most important in terms of specialty choice and practice location, it is the one over which medical educators have the least control. While the curriculum, the process through which we educate medical students, is critical (see Are we training physicians to be empathic? Apparently not., Sept 12, 2009), it is likely that the characteristics of the students selected is most important in determining practice location, particularly for rural areas, but also for urban underserved settings (Medical Student Selection, Dec 14, 2008). Selecting students who grew up in the suburbs of major cities (what Robert Bowman, MD, who has done much research in this area, calls “major medical centers”) in homes with high socioeconomic status and excellent high school and college educations (which is what is mainly done) will result in students with excellent test performance and is likely to produce skilled physicians, but not ones likely to practice in rural or underserved areas.

      Students from rural areas, from underserved communities, from low socioeconomic status backgrounds, and from underrepresented minority groups are much more likely to serve these populations, as are students who are older at the time of matriculation. But their lower grades and MCATs, may make them less likely to be accepted, and to have difficulty with the pre-clinical medical curriculum. Students, even from privileged backgrounds, whose prior life history includes significant service are also more likely to work in urban underserved settings; less so (although more than their colleagues without these characteristics) in rural areas. But what about schools of other types or medical schools not in the US?

      Click here to read more

      Health-related events at the 2010 Peoples Summit in Toronto, Canada


      1. Creating Health for All - From the Ground Up
      June 20th, 10-noon
      Ryerson University, Student Campus Centre - Room G. 55 Gould St.

      Despite Canada's perceived 'universal' health care system, thousands of people residing in Canada are actively excluded from health care access on the basis of 'immigration status'. This interactive participatory workshop facilitated by the local migrant justice group Health For All explores the causes of forced migration and discusses the systemic denial of healthcare access to migrants in Canada. The workshop will highlight how local community based campaigns, such as Access Without Fear, are fighting back to create health for all from the ground up.


      2. Emancipatory Healthcare: Local Resistance to Global Neoliberalism
      June 20th, 1-2:50pm
      Ryerson University, VIC 209- Victoria Building, 285 Victoria St.

      This panel explores the ground level impact of neoliberal economics on the health of communities within this country. From moves to privatization of medicare, to cuts in the Special Diet Allowance in Ontario, to the systemic denial of healthcare access to migrants- the deep and broad undermining of public services to further profit motives is being met by significant resistance from an emerging radical left health sector within Canada. Join local organizations- Health Providers Against Poverty, Justicia For Migrant Workers, Health For All and Students For Medicare in a discussion on local community resistance against neoliberal attacks on health.

      3. Globalization, the G20, and the Attack on Healthcare as a Human Right
      June 19th, 10 am - 12 pm
      Ryerson University, VIC 204- Victoria Building, 285 Victoria St.

      This panel focuses on the impact of globalization and the policies of the G20 as they link to forces supporting privatization. We will further discuss why privatization can lead to negative consequences in our health system,
      and what better solutions we can find within the public system, as well as how best to organize around these issues.
      with Gareth Blair, Ontario Health Coalition Research Director, Pam Beck, activist, Ritika Goel, Students for Medicare

      Monday, June 14, 2010

      Red Cross declares opposition to Israeli blockade of Gaza


      On Monday, June 14th, 2010, the International Committee of the Red Cross (ICRC) declared their opposition to the Israeli blockade of the Gaza Strip. Noting the blockade's devastating effects on the social determinants of health, the prevalence of disease, and the availability of health care, the ICRC recognized the blockade as a form of collective punishment and a violation of the Geneva Conventions.

      The ICRC statement, entitled "Gaza Closure: not another year!" reads: "Humanitarian aid cannot address the hardship faced by Gaza's 1.5 million people. The only sustainable solution is to lift the closure. The blockade imposed on Gaza is about to enter its fourth year, thwarting any real chance of economic development. As Gazans endure unemployment, poverty and warfare, the quality of their health care has reached an all-time low."

      To read the ICRC's full statement on their website, click here.

      Friday, June 4, 2010

      Social Medicine as Human Rights Praxis


      As HR activists working in health, we face a double challenge. We must work for fundamental economic, social and political changes underlying what we know as the social determinant of health and, at the same time, we must work on changes in the specific field of health where additional localized resistance (often by doctors) is to be reckoned with. We thus need to set-up networks –not forgetting the health workers, organized or not– to integrate our health and our human rights (HR) aims in what will inevitably become a political challenge.

      Actually, it is the HR-based framework that contains the powerful ideas; ideas that are at odds and counter neoliberal ideology, ideas that are a counter-power to the prevailing market forces –and, let’s face it, that is why the spreading of the HR idea is opposed. The powers-that-be fear HR as they entail an emancipatory praxis, a praxis that eventually is a counter-hegemonic force against globalization. The HR-based framework legitimizes power in the hands of claim holders, away from male, adult, middle and upper-class property owners. In so doing, the HR framework confers on rights holders a legitimate claim on the resources necessary to fulfill specific HR –and that is feared. HR are ultimately the legal expression of a collective will –and that is feared. Moreover, the HR-based framework prioritizes dignity and solidarity over accumulation, over competition, and over the market, as well as the inclusion of environmental rights –and that is feared. (I think I am not being harsh in my analysis here; I am just calling a spade, a spade)

      To read the rest of the article, click here to visit the Social Medicine Portal


      Ideas and Action for Global Maternal Health


      The Lancet: Special-themed issue on Maternal-Child Health
      "Large numbers of the public remain unaware of the health issues facing women and children. Women and girls make up 60% of the world’s poorest and two-thirds of the world’s illiterate. Yet with education and empowerment, they can lead healthy lives and lift themselves and their families out of poverty. This week a themed issue of The Lancet covers a range of global issues on maternal, child, and newborn health."

      Women Deliver: brining together voices for global maternal health
      "Launched at a groundbreaking conference in 2007, Women Deliver works globally to generate political commitment and financial investment for fulfilling Millennium Development Goal #5 — to reduce maternal mortality and achieve universal access to reproductive health. The initiative builds on commitments, partnerships, and networks mobilized at the conference, fighting to end the deluge of preventable deaths that kill between 350,000 - 500,000 girls and women from pregnancy-related causes every year. Women Deliver’s message is that maternal health is both a human right and a practical necessity for sustainable development."

      Monday, May 31, 2010

      Israel attacks Gaza aid fleet

      Israel attacks Gaza aid fleet


      Al Jazeera's report on board the Mavi Marmara before communications were cut

      Israeli forces have attacked a flotilla of aid-carrying ships aiming to break the country's siege on Gaza.

      At least 19 people were killed and dozens injured when troops intercepted the convoy of ships dubbed the Freedom Flotilla early on Monday, Israeli radio reported.

      The flotilla was attacked in international waters, 65km off the Gaza coast.

      Avital Leibovich, an Israeli military spokeswoman, confirmed that the attack took place in international waters, saying: "This happened in waters outside of Israeli territory, but we have the right to defend ourselves."

      Footage from the flotilla's lead vessel, the Mavi Marmara, showed armed Israeli soldiers boarding the ship and helicopters flying overhead.

      Al Jazeera's Jamal Elshayyal, on board the Mavi Marmara, said Israeli troops had used live ammunition during the operation.

      LIVE BLOGGING

       Aftermath of Israel's attack on Gaza flotilla

      The Israeli military said four soldiers had been wounded and claimed troops opened fire after "demonstrators onboard attacked the IDF Naval personnel with live fire and light weaponry including knives and clubs".

      Free Gaza Movement, the organisers of the flotilla, however, said the troops opened fire as soon as they stormed the convoy.

      Our correspondent said that a white surrender flag was raised from the ship and there was no live fire coming from the passengers.

      Before losing communication with our correspondent, a voice in Hebrew was clearly heard saying: "Everyone shut up".

      Israeli intervention

      Earlier, the Israeli navy had contacted the captain of the Mavi Marmara, asking him to identify himself and say where the ship was headed.

      Shortly after, two Israeli naval vessels had flanked the flotilla on either side, but at a distance.

      IN DEPTH

       

       Focus: On board the Freedom Flotilla
       Focus: 'The future of Palestine'
       Focus: Gaza's real humanitarian crisis
       Outrage over Israel attack
       Tensions rise over Gaza aid fleet
       'Fighting to break Gaza siege'
       Aid convoy sets off for Gaza
       Programmes: Born in Gaza
       Video: Israel's Gaza PR offensive
       Video: Gazan's rare family reunion abroad
       Video: Making the most of Gaza's woes

      Organisers of the flotilla carrying 10,000 tonnes of humanitarian aid then diverted their ships and slowed down to avoid a confrontation during the night.

      They also issued all passengers life jackets and asked them to remain below deck.

      Al Jazeera’s Ayman Mohyeldin, reporting from Jerusalem, said the Israeli action was surprising.

      "All the images being shown from the activists on board those ships show clearly that they were civilians and peaceful in nature, with medical supplies on board. So it will surprise many in the international community to learn what could have possibly led to this type of confrontation," he said.

      Meanwhile, Israeli police have been put on a heightened state of alert across the country to prevent any civil disturbances.

      Sheikh Raed Salah,a leading member of the Islamic Movement who was on board the ship, was reported to have been seriously injured. He was being treated in Israel's Tal Hasharon hospital.

      In Um Al Faham, the stronghold of the Islamic movement in Israel and the birth place of Salah, preparations for mass demonstrations were under way.

      Protests

      Condemnation has been quick to pour in after the Israeli action.

      Mahmoud Abbas, the Palestinian president, officially declared a three-day state of mourning over Monday's deaths.

      Turkey, Spain, Greece, Denmark and Sweden have all summoned the Israeli ambassador's in their respective countries to protest against the deadly assault.

      Worldwide outrage has followed the deadly Israeli attack of Gaza aid convoy [AFP] 

      Thousands of Turkish protesters tried to storm the Israeli consulate in Istanbul soon after the news of the operation broke. The protesters shouted "Damn Israel" as police blocked them.

      "(The interception on the convoy) is unacceptable ... Israel will have to endure the consequences of this behaviour," the Turkish foreign ministry said in a statement.   

      Ismail Haniya, the Hamas leader in Gaza, has also dubbed the Israeli action as "barbaric".

      Hundreds of pro-Palestinian activists, including a Nobel laureate and several European legislators, were with the flotilla, aiming to reach Gaza in defiance of an Israeli embargo.

      The convoy came from the UK, Ireland, Algeria, Kuwait, Greece and Turkey, and was comprised of about 700 people from 50 nationalities.

      But Israel had said it would not allow the flotilla to reach the Gaza Strip and vowed to stop the six ships from reaching the coastal Palestinian territory.

      The flotilla had set sail from a port in Cyprus on Sunday and aimed to reach Gaza by Monday morning.

      Israel said the boats were embarking on "an act of provocation" against the Israeli military, rather than providing aid, and that it had issued warrants to prohibit their entrance to Gaza.

      It asserted that the flotilla would be breaking international law by landing in Gaza, a claim the organisers rejected.

       Source:Al Jazeera and agencies