What is Global Health?

Yasmine’s guest today, is Heather Hall:
Heather has a wide range of expertise in the field. She has a Graduate degree in global public health nursing, previously worked as a nurse in Kenya, did consulting public health work in Kenya and a few other African countries, is a former Program Coordinator for the Tuberculosis/Refugee/Immigration Programs at a health department in Ohio, and recently did COVID-19 policy work for a local health department in Oregon.

Yaz and Heather discuss the definition of Global Health, the Sustainable Development Goals and their relationship to Health, and dispel the three main misconceptions about global health.

Transcript

What is Global Health
Optimistic Voices 
Season 1, Episode 3
Release Date: July 39, 2022

Transcript

00:00:00 Yasmine Vaughan - Yasmine Vaughan

Second, welcome to HCW Optimistic Voices podcast.

00:00:10 Yasmine Vaughan

I'm your host, Yasmin Vaughn.

00:00:12 Yasmine Vaughan

Today's episode is all about global health.

I'm here with Heather Hall, a  global public health nurse.

00:00:17 Yasmine

Heather thanks for joining us.

00:00:20 Heather Hall

Yeah, thanks so much.

00:00:20 Heather Hall

For having me.

00:00:22 Yasmine

In order to talk about what is global health, we think.

00:00:25

It would be useful to.

00:00:26 Yasmine

First, define global health and when it comes to the field.

00:00:30 Yasmine

Of global health

00:00:31 Yasmine

I think most.

00:00:32 Yasmine

Of the people who don't work in this discipline, believe that global health is about transnational issues like pandemic control, emerging infectious diseases, diseases.

00:00:42 Yasmine

That had the potential to cross borders.

00:00:44 Yasmine

Those sorts of things.

00:00:45 Yasmine Vaughan

If I could.

00:00:46 Heather Hall

Kind of maybe summarize.

00:00:47 Heather Hall

I would maybe break it down, but there are three main misconceptions about global health that people tend to have.

00:00:55 Heather Hall

First of all, I think people often have an US versus them mentality.

00:01:00 Heather Hall

And with the, with the mindset that you know global health and global health issues, that's something that happens to.

00:01:06 Heather Hall

Those people over there.

00:01:08 Heather Hall

You know, I'm not really included in that.

00:01:09 Heather Hall

That doesn't happen to me, another I think thought that people tend to have is that global health issues are rich versus.

00:01:17 Heather Hall

Poor, you know it's.

00:01:18 Heather Hall

We'll discuss more about this later.

00:01:21 Heather Hall

But a lot of times eight you kind of.

00:01:23 Heather Hall

I think that.

00:01:24 Heather Hall

If you're a rich country, you know.

00:01:25 Heather Hall

You're not really going to have global health issues.

00:01:27 Heather Hall

That that's something.

00:01:28 Heather Hall

That happens in poorer countries or less developed countries.

00:01:30 Heather Hall

But it's actually not always right to think that just because the country is rich and that they have maybe one of the best health care systems in.

00:01:38 Heather Hall

The world that.

00:01:39 Heather Hall

They necessarily automatically have the healthiest people.

00:01:42 Heather Hall

That's actually not the case.

00:01:43 Heather Hall

And then one final thing is that often with global health, people tend to think of global health as something that happens or occurs during an emergency.

00:01:51 Heather Hall

Really a lot of what global health.

00:01:53 Heather Hall

Entails has to.

00:01:54 Heather Hall

Do with non emergent times.

00:01:56 Heather Hall

Obviously the pandemic that just happened is a big example of an emergency, but there is a lot in global health and global health issues.

00:02:05 Heather Hall

That involve the.

00:02:06 Yasmine

Everyday health of.

00:02:07 Heather Hall

People every day health and well-being of people.

00:02:10 Heather Hall

All around the world so.

00:02:11 Heather Hall

Yeah, these are a couple of things that I.

00:02:12 Heather Hall

Would I would add.

00:02:14 Yasmine

I I completely agree.

00:02:15 Yasmine

The stance of thinking that things are an emergency.

00:02:19 Yasmine

I'm really glad.

00:02:19 Heather Hall

You highlighted the US versus them.

00:02:21 Yasmine

And you know this.

00:02:22 Yasmine

Is something that only happens to poor?

00:02:24 Yasmine

People this mentality is really how the field of global health emerged that historically in the 19th century European powers gathered together and they would discuss epidemics across borders and quarantine requirements around diseases like cholera, big emergency.

00:02:39 Yasmine

There's a cholera epidemic.

00:02:40 Yasmine

They would come together and discuss how they were going to do quarantine.

00:02:44 Yasmine

And this 19th century like mindset is of course around the same time as imperialism.

00:02:49 Yasmine

The scramble for Africa, the colonial period, and that's what led to the emergence of this term called colonial medicine.

00:02:57 Yasmine

And over time, this term transitioned to Tropical Medicine, which was characterized by the study of diseases like yellow fever, malaria diseases that are usually found in the tropics after World War Two.

00:03:10

You know, at the.

00:03:10 Heather Hall

End of this sort of colonial period.

00:03:12 Yasmine

We see the term international health emerge and it's used to describe the prevention.

00:03:17 Yasmine

And treatment of infectious diseases.

00:03:19 Yasmine

Is around the same time.

00:03:20 Yasmine

After World War Two, The Who.

00:03:22 Yasmine

Forms in 19.

00:03:23 Yasmine

48 and they began the work of identifying ways to treat and control infectious diseases, so they began massive campaigns on the smallpox eradication. We see really big attempts in eradicating malaria. But by the 1980s, this term international.

00:03:39 Yasmine

Health kind of fell out of favor.

00:03:41 Yasmine

A lot of it has to do with this colonial history and how it was applied.

00:03:45 Yasmine

So international health was often a tool for reinforcing authority over people groups.

00:03:50 Yasmine

Even today.

00:03:51 Yasmine

A lot of people that work in the field of global health don't use the.

00:03:54 Yasmine

Term because of its association with colonialism.

00:03:58 Yasmine

And hegemony also, during this time, you know in.

00:04:00 Yasmine

The 80s we see the Dibuat show the World Health organizations.

00:04:03 Yasmine

Falling under criticism.

00:04:05 Yasmine

Because it was.

00:04:06 Yasmine

Focusing on infectious diseases, but it wasn't bringing in a focus on health care, delivery or infrastructure, or other things like that.

00:04:15 Yasmine

They contribute to the burden of disease.

00:04:18 Yasmine

Because of this negative history, this colonial history, this rich versus poor mentality.

00:04:24 Yasmine

And the limited scope of work that.

00:04:26 Yasmine

The show is.

00:04:26 Yasmine

Doing in the 1990s, the term global health.

00:04:30 Yasmine

Began to be used.

00:04:32 Yasmine

Global health is really a field of work that begins with the work of international health that work of treating and preventing infectious diseases.

00:04:40 Yasmine

Things like improving hygiene and water supply, promoting child and maternal health, but.

00:04:45 Yasmine

Global Health is a field brings in what the.

00:04:47 Yasmine

Dibuat Show was was.

00:04:49 Yasmine

Criticized for not having a focused on National Health.

00:04:52 Yasmine

Systems it puts the spotlight on health financing with.

00:04:55 Yasmine

Problems universal health coverage.

00:04:57 Yasmine

Access to health care in rural.

00:04:59 Yasmine

Areas and other local and regional.

00:05:01 Yasmine

Challenges, which we'll talk about some of them today.

00:05:04 Yasmine

Global Health also brings in the discipline of public health, public health, I know, is a term that many of you probably heard used and have some basic understanding of public health.

00:05:13 Yasmine

Is this upstream?

00:05:14 Yasmine

Approach to health care.

00:05:15 Yasmine

It focuses not just on disease.

00:05:18 Yasmine

Burden and treatment but on.

00:05:20 Yasmine

Social determinants of health and illness and health inequality.

00:05:24 Yasmine

And how these inequalities are due to unequal distribution of social, political, economic opportunities?

00:05:30 Yasmine

In summary, a lot of global health does have that focus, like we talked about before this focus on mass mobilization around new and emerging diseases.

00:05:39 Yasmine

But it also brings in these other approaches of looking at health from a social.

00:05:44 Yasmine

And from a systems.

00:05:45 Yasmine

Approach the most common definition of global health is that it is an area for study, research and practice that prioritizes on improving health and achieving HealthEquity for all people worldwide.

00:05:58 Yasmine

And that is because global health.

00:06:00 Yasmine

Is not just a focus on cross-border health problems, it's an approach that seeks to ensure the health of all people.

00:06:06 Yasmine

It's everyone, it's all hands on deck.

00:06:09 Yasmine

That's what global health?

00:06:10 Yasmine

Is you know, so we're done, we don't.

00:06:11 Yasmine

Need to talk anymore.

00:06:13 Yasmine

I'm sure most.

00:06:13 Yasmine

Of you guys know?

00:06:14 Yasmine

That the way something is defined is often very.

00:06:17 Yasmine

Different from how it's applied.

00:06:18 Yasmine

In the fields.

00:06:19 Yasmine

So that's why we brought Heather on to talk with us.

00:06:21 Yasmine

About what global?

00:06:22 Yasmine

Health looks like Heather has a graduate.

00:06:25 Yasmine

Degree in global public health nursing.

00:06:27 Yasmine

She's previously worked as a nurse in Kenya and done some consulting public health work in Kenya and a few other African countries.

00:06:34 Yasmine

She is the former program coordinator for tuberculosis refugee immigration programs at the Health Department in Ohio and recently did some COVID-19 policy work for a health department in Oregon. So Heather again. Thanks so much for joining us.

00:06:47 Heather Hall

Thanks so much for having me.

00:06:48 Heather Hall

I'm glad to be here.

00:06:49 Heather Hall

I love talking about global.

00:06:51 Yasmine

Public health, so how that?

00:06:52 Yasmine

Before we really get into.

00:06:54 Yasmine

A deep discussion of this topic I.

00:06:56

Think it would.

00:06:56 Yasmine

Be really useful for those who are listening to go through.

00:06:58 Yasmine

A few of the key.

00:07:00 Yasmine

Terms in the field of.

00:07:01 Yasmine

Global health for people you know who have been.

00:07:03 Yasmine

Working in the.

00:07:03 Yasmine

Field, it's really easy to start throwing around vocabulary.

00:07:06 Yasmine

And I want to make sure that our.

00:07:07 Yasmine

Listeners have a clear.

00:07:07 Yasmine

Understanding of what we mean when we say certain.

00:07:10 Yasmine

Terms I think I'll begin with a term that is really important in this field, which is chronic versus infectious diseases chronic.

00:07:17 Yasmine

Uses also are called non communicable diseases, which means that you can't spread them between people, and they're usually defined as conditions that last for one year or more.

00:07:27 Yasmine

They require ongoing.

00:07:28 Yasmine

Medical attention and they can limit the activities of.

00:07:31 Yasmine

Daily living when we think chronic.

00:07:33 Yasmine

Diseases we think of diseases like.

00:07:34 Yasmine

Diabetes heart disease, cancer those are the.

00:07:37 Yasmine

Top three most common diseases that are noncommunicable or chronic infectious diseases.

00:07:43 Yasmine

These are diseases that spread from person to person.

00:07:46 Yasmine

Things like the flu or malaria or measles or chicken.

00:07:49 Yasmine

Box those are infectious diseases.

00:07:52 Heather Hall

And it's also important to note that while you do have things that are chronic diseases versus infectious diseases, it's important to note that there are occasions where you know the line between infectious diseases and chronic.

00:08:04 Heather Hall

Diseases can actually blur.

00:08:05 Heather Hall

You know, just because something is considered an infectious disease doesn't mean that.

00:08:10 Heather Hall

It can't then lead to a chronic condition or chronic disease state, so so take COVID-19 for example.

00:08:16 Heather Hall

We've all probably.

00:08:17 Heather Hall

Heard about what's called long haulers or it's also termed by the CDC Centers for Disease Control and Prevention based in the United States.

00:08:25 Heather Hall

Long hose is also called long COVID or post COVID.

00:08:29 Heather Hall

Options this is when someone who has been infected with COVID experiences long term effects from their infection.

00:08:36 Heather Hall

They can go until last weeks, months or even years, and some of us maybe even know.

00:08:41 Heather Hall

Some of these people.

00:08:42 Heather Hall

And in other words, you may no longer have an active COVID infection, but you're still experiencing the lasting effects.

00:08:50 Heather Hall

From that initial infect.

00:08:51 Heather Hall

Action wrong COVID includes a wide range of effects such as the T cough, difficulty, breathing, even things like depression or autoimmune conditions, heart issues or other multi organ effects.

00:09:04 Heather Hall

We're still learning a lot about COVID, and even now researchers are still learning about all of the different types and severity.

00:09:11 Heather Hall

Of the different long term COVID effects.

00:09:14 Heather Hall

Another example, where kind of that?

00:09:16 Heather Hall

That line between infectious disease and chronic disease can.

00:09:19 Heather Hall

Be blurred is HIV.

00:09:21 Heather Hall

HIV actually turns from an acute or initial infection into a chronic infection.

00:09:26 Heather Hall

So once you get it, you have it for life and then with HIV it also then has the potential to transition from HIV into AIDS if it's left untreated with treatment.

00:09:37 Heather Hall

Many people are able to remain in watts.

00:09:40 Heather Hall

Photo chronic state of HIV infection.

00:09:43 Heather Hall

Where they have.

00:09:44 Heather Hall

The HIV infection and they're still able to transmit it to others, but they they may not really even be having any symptoms so they can remain in this chronic state to where the virus never actually then developed into AIDS.

00:09:56 Heather Hall

AIDS of the kind of final stage or the third stage of HI.

00:10:00 Heather Hall

B and if if that person with HIV is able to have treatment, has access to treatment or resources, most people are able to live a long and healthy life.

00:10:08 Heather Hall

However, if that person does not have access to treatment once HIV turns into AIDS, the individuals immune system becomes severely weakened and that person can then become very susceptible.

00:10:20 Heather Hall

To what we?

00:10:20 Heather Hall

Call opportunistic infections, or which are essentially infections that are waiting for an opportunity to kind of wreak havoc.

00:10:28 Heather Hall

Some examples of these type of opportunistic infections are pneumonia, tuberculosis, various types of cancers.

00:10:34 Heather Hall

Once a person develops aids and then has one of these opportunistic infections, the the prognosis is usually very poor, so the outcome unfortunately is not is not a desirable outcome.

00:10:45 Yasmine

Thank you mother.

00:10:46 Yasmine

I'm glad you brought that up.

00:10:47 Yasmine

A lot of people either have a focus on chronic diseases and no focus on infectious diseases or vice versa, but the two fields really are aligned.

00:10:57 Yasmine

Well, together you see that people who.

00:10:59 Yasmine

Of infectious diseases can lead to chronic conditions and even having a chronic condition can make you susceptible to an infectious disease.

00:11:07 Yasmine

They do work in.

00:11:08 Yasmine

Tandem together and I'm glad that we discussed that a.

00:11:10 Yasmine

Little bit.

00:11:11 Yasmine

Terms of how chronic disease and infectious diseases have changed over the course of the global health timeline.

00:11:19 Yasmine

We see that chronic diseases are on.

00:11:21 Yasmine

The rise and infectious diseases are trending down, which I'm sure many of you listening.

00:11:25 Yasmine

Are aware of that.

00:11:27 Yasmine

Worldwide few people are dying from infectious diseases and.

00:11:30

People are living.

00:11:31 Yasmine

To be older and then dying of chronic diseases, diseases like diabetes, cancer or heart disease.

00:11:37 Yasmine

Are collectively responsible.

00:11:38 Yasmine

For over 70% of deaths worldwide, which amounts to about 41 million people, so most people are dying from chronic diseases now. But the battle against infectious diseases has not really been won yet. Still 17 million people die from infectious diseases worldwide, and the reason that.

00:11:56 Yasmine

I bring this out.

00:11:57 Yasmine

The epidemiological transition.

00:11:59 Yasmine

Try saying that five times fast.

00:12:01 Yasmine

The reason that I bring up this trend.

00:12:03 Yasmine

Is that there are many countries that are in the.

00:12:05 Yasmine

Middle of this.

00:12:06 Yasmine

They have really high rates of chronic diseases rising, but they also still have really high rates of infectious diseases.

00:12:14 Yasmine

This is what we call the.

00:12:15 Yasmine

Double burden of disease and this.

00:12:17 Yasmine

Is important to talk about because when we hear.

00:12:20 Heather Hall

On the news.

00:12:21 Yasmine

About other countries in the majority world.

00:12:23 Yasmine

The focus tends to be on infectious diseases talking.

00:12:27 Yasmine

About malaria children.

00:12:29 Yasmine

Dying of diarrheal disease.

00:12:31 Yasmine

Things like that.

00:12:32 Yasmine

But the truth is, is that many of these places have really high rates of.

00:12:36 Yasmine

Both and in fact there's other.

00:12:38 Yasmine

In many countries there's what's called the.

00:12:40 Yasmine

Triple burden of.

00:12:40 Yasmine

Disease, which is where a country has really high rates of chronic diseases.

00:12:45 Yasmine

They have high rates of infectious.

00:12:46 Yasmine

Diseases and then the triple is.

00:12:49 Yasmine

Accidents, so things like Rd traffic, accidents, burns.

00:12:53 Yasmine

Things like that.

00:12:53 Yasmine

Yeah, people are dying at every life stage.

00:12:55 Yasmine

Of both chronic infectious and accidents, which makes tackling these issues and this.

00:13:01 Yasmine

This approach of taking all three together so important.

00:13:05 Heather Hall

You bring up really great point.

00:13:06 Heather Hall

Yes, mean that you can't necessarily isolate infectious diseases, chronic diseases, and things like accidents.

00:13:14 Heather Hall

You know they are all very intertwined and a lot of times they all have to be addressed simultaneously.

00:13:19 Heather Hall

People might be thinking wow, OK, you guys just covered a lot of different types of issues.

00:13:24 Heather Hall

Where do we even begin?

00:13:25 Heather Hall

You know everything is seems so complex and interconnected.

00:13:29 Heather Hall

And there are different things going on in all.

00:13:31 Heather Hall

Parts of the world so.

00:13:32 Heather Hall

How do we even begin to?

00:13:33 Heather Hall

Have any type of like strategic way to.

00:13:36 Heather Hall

Address all of these things.

00:13:37 Heather Hall

Well, you know, as some people might be aware there is an organization called the United Nations and the United Nations has actually been tasked with this this very thing.

00:13:49 Heather Hall

Addressing all of these global health issues and the United Nations specifically created essentially like a task force called the United Nations Development Program, and their purpose is to strategically help countries eliminate poverty and achieve sustainable economic growth and human development.

00:14:08 Heather Hall

Because, again, as we've you know said before, and we'll touch on quite a bit, all of these things are interconnected.

00:14:13 Heather Hall

You know somebody's health and well-being directly affect their their finances, their the economic health of their family. And so, again, you can't just address 1 issue.

00:14:23 Heather Hall

You know you have to kind of look at the whole picture and the sustainable development Goals, which we'll talk about.

00:14:28 Heather Hall

Here in a minute are designed to help do that, so a little bit of back story in the year 2000, the United Nation created something called the Millennium Development Goals, or MDG's.

00:14:40 Heather Hall

So if you're in the world of public health or global health or anything like that, you probably heard of that before.

00:14:45 Heather Hall

I mean, at the time in the year 2000.

00:14:47 Heather Hall

There were just eight goals.

00:14:49 Heather Hall

So, and these eight goals covered combating poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women.

00:14:59 Heather Hall

And there was.

00:15:00 Heather Hall

Actually, a timeline that was put on this, so there was a timeline of 15 years and so it was thought that we would work on all of these things collectively and that they would hopefully be accomplished by the year 2015. Well, as we all know.

00:15:13 Heather Hall

2015 world around and there's still a lot.

00:15:16 Heather Hall

Of these issues.

00:15:17 Heather Hall

At play, and so then in 2015, the UN development programme. They took those Millennium Development Goals and actually broadened them and then adopted them into what are now known as the Sustainable Development Goals. So which are essentially.

00:15:34 Heather Hall

It's a universal. They are a universal call to action to end poverty, protect the planet, and ensure that by 2030.

00:15:40 Heather Hall

30 All people will enjoy peace and prosperity now instead of eight like there were in the Millennium Development Goals, the Sustainable Development Goals or SDG's. There are now actually 17 goals in total.

00:15:54 Heather Hall

And they're all viewed from the understanding.

00:15:56 Heather Hall

Again, like I said that each goal is interconnected and so action.

00:16:01 Heather Hall

And one goal.

00:16:02 Heather Hall

Can affect the outcome in another goal.

00:16:06 Heather Hall

So like I said, there's 17.

00:16:07 Heather Hall

Of these goals, and.

00:16:08 Heather Hall

I'm actually going to.

00:16:08 Heather Hall

Read reading each one of them because I think it's really good to get a comprehensive picture of everything that global health entails and how all of these things.

00:16:20 Heather Hall

Again, how they all affect one another.

00:16:22 Heather Hall

So the first is the first sustainable development goal is no poverty.

00:16:26 Heather Hall

Number 20 hunger #3 good health and well-being #4 quality education #5 gender equality #6 clean water and sanitation.

00:16:39 Heather Hall

#7 affordable and clean energy #8, decent work and economic growth. #9 industry innovation and infrastructure. Number 10. Reduced inequality #11. Sustainable cities and communities number.

00:16:54 Heather Hall

Responsible consumption and production number 13 climate action.

00:17:00 Heather Hall

#14 life below water #15 life on land #16, peace, justice and strong institutions and finally #17 partnership.

00:17:11 Yasmine

For the goals.

00:17:12 Heather Hall

So hopefully all of our listeners are still here.

00:17:15 Heather Hall

With us 'cause I know that was a.

00:17:16 Heather Hall

Really long list, but again I think.

00:17:18 Heather Hall

It's important to read out each one of those.

00:17:20 Heather Hall

Things because peers, again, they're all interconnected and there.

00:17:23 Heather Hall

Might be things in there.

00:17:24 Heather Hall

There well that we maybe maybe don't necessarily think of as being associated with global health and with just, you know, the overall health and well-being of people all throughout the world.

00:17:35 Heather Hall

But it's really important that what we can.

00:17:38 Heather Hall

Name those things.

00:17:39 Yasmine Vaughan

A little bit more.

00:17:40 Heather Hall

About the dogs.

00:17:41 Heather Hall

The dogs were set to be accomplished.

00:17:43 Heather Hall

Again, by the year 2030.

00:17:45 Heather Hall

Which we're not.

00:17:46 Heather Hall

There yet, but as you can imagine, you know.

00:17:48 Heather Hall

We have just.

00:17:49 Heather Hall

Experienced a very long pandemic, the COVID-19 pandemic and again as you can imagine that pandemic has set back a lot of progress on these goals.

00:18:00 Heather Hall

More specifically, new research by the United Nations Development Programme shows that the long term social and economic impact of the pandemic will actually is actually set to widen the gap between people living in rich and poor countries.

00:18:15 Heather Hall

So you know.

00:18:15 Heather Hall

We all know that.

00:18:16 Heather Hall

There's this gap between kind of your rich levels of society.

00:18:19 Heather Hall

And in your poor levels of society.

00:18:21 Heather Hall

And because of the pandemic, it's just going to increase that gap, and unfortunately it's the poor countries that are increasingly bearing.

00:18:29 Heather Hall

The brunt of COVID-19 cases and the.

00:18:32 Heather Hall

Related mortality with that.

00:18:34 Heather Hall

Now for a few more specific examples of how the pandemic has affected the SDGS, let's go ahead and just take a quick look at the first SDG, which is no poverty.

00:18:43 Heather Hall

So before the pandemic, about 1 billion children, which is about the population of China.

00:18:49 Heather Hall

Lacked basic necessities such.

00:18:51 Heather Hall

As clean water and nutrition, however now due to Co.

00:18:55 Heather Hall

David, there are now 150 million more children experiencing this level of poverty. You know? So 100.

00:19:02 Heather Hall

And 15 million more.

00:19:03 Heather Hall

That is, that is significant.

00:19:04 Heather Hall

That is huge.

00:19:05 Heather Hall

So again, you can kind of see how that increase in.

00:19:08 Heather Hall

Number has really has really shifted.

00:19:11 Heather Hall

The progress towards.

00:19:12 Heather Hall

The goal of no poverty and then another one.

00:19:15 Heather Hall

Is again also related to the first SDG of no poverty.

00:19:19 Heather Hall

The pandemic has also increased the number of orphans involved.

00:19:22 Heather Hall

Well, children in the United States alone, more than 140,000 children lost a caregiver due to the pandemic per the CDC, and as you can probably imagine, losing a caregiver significantly increases a child vulnerability, especially to poverty, and especially if the country does not have an established child welfare system. So again, you know I don't need.

00:19:41 Heather Hall

To say anymore.

00:19:43 Heather Hall

The pandemic has definitely put us back with some of these with some progress towards these.

00:19:47 Heather Hall

Goals thank you, Heather.

00:19:48 Yasmine

I'm glad you've highlighted this interconnectedness of these issues.

00:19:52 Yasmine

You know, we said Goal 3 is good.

00:19:54 Yasmine

Health and well-being but.

00:19:55 Yasmine

I'm glad we mentioned all the others.

00:19:57 Yasmine

 It is all connected. Issues like poverty,

climate change, access to water and sanitation.

Clean energy.

00:20:03 Yasmine

These things all have an impact on health.
 For people who don't have the ability to afford healthcare, sanitation and water obviously have a big impact on health.

00:20:11 

Things like that, as you're saying before, global health brings in this interdisciplinary perspective of not just looking at how.

00:20:18 

To how to treat an illness.

00:20:20 

But looking upstream, what are the other things that are influencing

And playing into health?

00:20:30 Announcer

We'll be back in a Minute with more on this topic.

You're listening to optimistic voices Podcast with host Yasmine Bon and guest Heather Hall For more information on today's topic. Global health go to helpingchildrenworldwide.org Optimistic Voices Podcast season one, Episode three, 

We rejoin the conversation on strategic development goals.

00:21:02 Yasmine Vaughan

SDG Three has specific targets in the field and many of these dominate a lot of the work that is being done in global health.

00:21:09 

So Heather, let's let's talk a little bit.

00:21:11

About some of

The big targets in global health.

Some of the the big topics that are SDG, three is looking to tackle.

00:21:19 Heather Hall

I oftentimes we'll talk about the dogs as they relate to global health. You know, even though there are certain SVG's that may be a little more obvious than.

00:21:28 Heather Hall

Others, but again to me.

00:21:29 Heather Hall

As a global.

00:21:30 Heather Hall

Public health person.

00:21:31 Heather Hall

They're all again, like I said, interconnected.

00:21:33 Heather Hall

But more specifically, there are some dogs specifically.

00:21:37 Heather Hall

Rate relate to the topic of global health.

00:21:40 Heather Hall

The first one, which is pretty obvious is SDG. #3 and #3 is good health and well-being, and as you can imagine that can cover.

00:21:50 Heather Hall

A whole host of.

00:21:51 Heather Hall

Topics now we'll just cover a few of the major topics, but especially the ones that you often find in global health.

00:21:59 Heather Hall

So the first one is maternal child health, maternal and child health are two of the leading health indicators of a country.

00:22:06 Heather Hall

And as you can imagine, are very closely linked, so maternal health specifically refers to the health of women during pregnancy.

00:22:14 Heather Hall

Childbirth in the post Natal period.

00:22:17 Heather Hall

Now, the reason maternal health is an important indicator is because most maternal deaths are preventable as long as there's timely management by a skilled health professional, you know in in a supportive environment.

00:22:30 Heather Hall

Again, not having those things or having those things can really tell the story of the health of the infrastructure.

00:22:38 Heather Hall

Of a country.

00:22:40 Heather Hall

Now, maternal deaths are measured using the maternal mortality rate, and so a lot of times if you're talking about maternal health, this will be the most common statistic that you'll hear.

00:22:49 Heather Hall

So maternal mortality rate and per the WHL, which stands for World Health Organization, maternal mortality is unacceptably high, about 200.

00:23:00 Heather Hall

And 95,000 women died during and following pregnancy and birth in 2007.

00:23:05 Heather Hall

Team and I first just want to say.

00:23:07 Heather Hall

You know?

00:23:08 Heather Hall

Like OK, That's 2017, that's almost.

00:23:10 Heather Hall

Five years ago.

00:23:10 Heather Hall

But as you can imagine, it takes a lot of time to collect a lot of this information, so so some more recent statistics you know are probably still in development.

00:23:20 Heather Hall

Now again that out of those 295,000 women, the vast majority.

00:23:25 Heather Hall

Of these deaths.

00:23:26 Heather Hall

Which 94?

00:23:27 Heather Hall

Percent actually occurred in low resource settings, and again could have been prevented with sub-Saharan Africa and Southern Asia, accounting for approximately 86 of that 94% of deaths. So again, that's you know by far the majority. So again, keep it. Keep that in mind.

00:23:48 Heather Hall

And you know, just kind of as a real world example.

00:23:51 Heather Hall

Countries countries know how important maternal health is, and they've specifically put measures in place to try to improve maternal health.

00:24:02 Heather Hall

For a personal example, or something that I have seen first here.

00:24:05 Heather Hall

And when I was in Kenya working as a nurse there and again, Kenya is a sub-saharan African country.

00:24:13 Heather Hall

So if you're not quite sure where that is, if you look at Africa, it's it's on the eastern side on the eastern coast, and Kenya actually requires all of their nurses to be midwives and one time.

00:24:25 Heather Hall

When I was out with the immunization clinic and the antenatal clinic in Ken.

00:24:31 Heather Hall

Yeah, a woman actually came to the clinic in active labor again, you know, that wasn't the purpose of the clinic, but she knew that we were having a clinic there and and came to try to get some help.

00:24:43 Heather Hall

And because Kenyan nurses are already trained for this, thankfully, the nurse midwife who was already at the clinic, you know she already had.

00:24:51 Heather Hall

The supplies and skills to provide this woman with the access to health care that she needed at this crucial moment.

00:24:58 Heather Hall

So again, you know.

00:24:59 Heather Hall

The you know we weren't expecting to have anybody you know an active delivery but but they were prepared already again prepared with those skills and supplies and thankfully the woman had a successful delivery in birth and both mom and baby left the left the clinic healthy and well.

00:25:17 Heather Hall

So was we're very thankful that that.

00:25:19 Heather Hall

Was a positive story.

00:25:21 Heather Hall

And then moving on to child.

00:25:23 Heather Hall

Health and child health.

00:25:25 Heather Hall

Again, like I said, they're very interconnected, but maternal health and child health are very interconnected and you know.

00:25:31 Heather Hall

Child health is.

00:25:31 Heather Hall

Fundamentally important, and covers the span of a child's life. You know from from birth even before birth, up until they reach adulthood. But one of the most important global.

00:25:43 Heather Hall

Health focus is related to child health is the health of children under the age of five, and I'll go ahead and let you Yasmine talk a bit more about that.

00:25:53 Yasmine

Yeah yeah, under under 5 mortality is one of my I don't want to say one of my favorite topics because that sounds terrible, but it's a it's a topic is very close to my heart.

00:26:03 Yasmine

So under 5 mortality is the the measure of the likelihood a child will die before they reach their 5th birthday.

00:26:10 Yasmine

And like Heather said, with maternal mortality, it's an important measure of the health of the population and of the development level of a nation.

00:26:18 Yasmine

And this is because you know pregnant women and children are among the most vulnerable members of a population.

00:26:26 Yasmine

So with the Under 5 mortality and maternal mortality rifl.

00:26:30 Yasmine

Next is the strength of a health system to support its most vulnerable, and it's used as a measure of the social economic and, you know, environmental conditions in which communities live.

00:26:42 Yasmine

So you know, that's why, like these two measures in particular is so often used so worldwide.

00:26:49 Yasmine

You know we're seeing a lot of trends.

00:26:51 Yasmine

Down and and.

00:26:53 Yasmine

Under 5 mortality, so the total number of under 5 deaths has declined from 12.6 million in 1990 to 5,000,000 in 2020, so 7.6 million decline in the last 30 years, which is really wonderful.

00:27:08 Yasmine

But you know, still children in you know regions like sub-Saharan Africa tend to have the highest rates of under 5 mortality in the world, in fact.

00:27:18 Yasmine

Sub-Saharan Africa has 14 times higher the risk of children than Europe and North America and this is important because.

00:27:29 Yasmine

While sub-Saharan Africa and Southern Asia account for more than 80% of the Under 5 deaths, they only account for 53% of the global live birth rage.

00:27:41 Yasmine

So we see this tension.

00:27:42 Yasmine

There's more children dying than there are being born and.

00:27:45 Yasmine

Really, illnesses that cause deaths.

00:27:48 Yasmine

Of children under 5.

00:27:49 Yasmine

Are largely preventable.

00:27:51 Yasmine

Treffle treatable, and for the most part, relatively inexpensive and easy to do, and we'll do a whole other episode on Under 5 mortality and bring in some other speakers to talk about this, but it's a.

00:28:05 Yasmine

It's an important measure and it's.

00:28:07 Yasmine

Uhm, it's actually one of my favorite parts about the work that we do at Mercy Hospital.

00:28:14 Yasmine

So we have an Under 5 clinic every Thursday at Mercy Hospital.

00:28:17 Yasmine

Mothers and bring their children and they receive checkups.

00:28:21 Yasmine

Treatment for diseases?

00:28:23 Yasmine

There's a representative from the World Health Organization.

00:28:26 Yasmine

Who comes specifically On that day.

To give immunizations.

00:28:30

And it's.

00:28:31 Yasmine

It's really wonderful to.

00:28:32 Yasmine

Sit in on that, uhm.

00:28:34 Yasmine

I mean of course.

00:28:35 Yasmine

The children hate the immunizations part.

00:28:37 Yasmine

You know they get like 6 sticks.

00:28:39 Yasmine

In the arm when they're.

00:28:40 Yasmine

There, but it's so.

00:28:43 Yasmine

Impactful because you see that you.

00:28:46 Yasmine

Know after being at the clinic for maybe an hour and an hour and a half.

00:28:50 Yasmine

You know these kids get couple of vaccines if they have, you know, a diarrheal disease.

00:28:55 Yasmine

They get some antibiotics and then these kids are one step closer to seeing their 5th birthday, so building that infrastructure like we said is such an important an important part of global health and that's why these two measures are so important.

00:29:12 Heather Hall

Yeah yeah.

00:29:13 Heather Hall

And and and something that that really connects closely with child health is also malnutrition.

00:29:21 Heather Hall

Malnutrition more specifically includes undernutrition such as wasting stunting and under being underweight.

00:29:30 Heather Hall

It also includes inadequate vitamins or minerals, but malnutrition also includes overweight and obesity.

00:29:37 Heather Hall

And and non communicable diseases that are diet related.

00:29:43 Heather Hall

So I think a lot of times when people think about nutrition, they think of children who are underweight.

00:29:47 Heather Hall

But it actually also includes children and adults that are that are overweight.

00:29:53 Heather Hall

Now as you can, as you can guess, malnutrition has always been an important part of global health, and it's also a really great example, again, of how the SDG's overlap.

00:30:04 Heather Hall

So SDG #2, which is ending hunger, is then also linked to SDG #3 good health and well-being.

00:30:12 Heather Hall

Now you know this is a move that we all know. We all know that nutrition is important and foundational to good health and well-being and malnutrition you know can really for some people mean life or death.

00:30:24 Heather Hall

You know, especially for a child, and if you have a child that's malnourished and therefore you know they get sick.

00:30:32 Heather Hall

Because they are malnourished their their body is less prepared to fight.

00:30:37 Heather Hall

Or even easily bounce back from a major illness and sometimes even some. You know minor illnesses. So again that non nutrition or I'm sorry nutrition is foundational to just overall health and well-being in your ability to to handle other diseases or illnesses that might come your way.

00:30:55 Heather Hall

For a few statistics, the global the excuse me. The WHL reports that globally in 2020, a 149 million children under five were estimated to be stunted and stunted. Specifically, means.

00:31:09 Heather Hall

That they're too short for their age.

00:31:11 Heather Hall

And then there were 45 million children who were estimated to be wasted, which means that they're too thin for their height.

00:31:19 Heather Hall

And then there were 38.9 million who were overweight or obese. So again, just looking at those three statistics, the majority of of malnutrition in children has to do with stunting.

00:31:32 Heather Hall

Or wasting.

00:31:33 Heather Hall

Excuse me and then the the lower end has to do with children that are.

00:31:37 Heather Hall

Overweight or obese?

00:31:39 Heather Hall

Now also, around 45% of deaths among children under 5.

00:31:44 Heather Hall

Years of age.

00:31:45 Heather Hall

Are actually linked to undernutrition and these occur in low and middle income countries.

00:31:52 Heather Hall

However, at the same time in these countries, rates of childhood overweight children being overweight and.

00:31:59 Heather Hall

Obese are actually rising, so this touches again what Yasmine was talking about earlier that you know you kind of have this intersection of of issues so you have issues of children that are malnourished, but then at the same time you know that maybe are experiencing.

00:32:17 Heather Hall

Hey undernutrition, but then at the same time you may have an increasing rate of children who are overweight and obese, so especially as you have that, that widening gap between maybe the rich parts of society and the poorer parts of the society.

00:32:31 Heather Hall

So countries really have.

00:32:32 Heather Hall

To figure out how to address both of.

00:32:34 Heather Hall

Those so so again, as we've already discussed.

00:32:38

All of these.

00:32:39 Heather Hall

Issues are linked and with malnutrition.

00:32:41 Heather Hall

Poverty can really amplify their risks of and the risks from malnutrition.

00:32:47 Heather Hall

So like I just was talking about.

00:32:49 Heather Hall

And people who are poor are more likely to be affected by different forms of malnutrition versus maybe people who are rich, rich and then also malnutrition increases health care costs as well as reduces productivity and slows economic growth.

00:33:04 Heather Hall

Which again, if you are somebody who's living in, you know a situation of poverty.

00:33:10 Heather Hall

You know having issues with malnutrition and then the the the ending results can really be put in a cycle of poverty that can go on for years and years and even even potentially generations.

00:33:25 Heather Hall

When I worked in Kenya, I worked with a Community health and development program and specifically got to work with their wash program and what wash stands for is an acronym for water, Sanitation and Hygiene, and one of the.

00:33:40 Heather Hall

Of their program.

00:33:42 Heather Hall

Was for both schools.

00:33:44 Heather Hall

And individual homes to start their own garden.

00:33:47 Heather Hall

And not only did this help teach the children about healthy foods and what are good things for them to eat that can easily be grown in their area, but it also taught them a valuable skill that could not only help provide food for their family, but also you know it provided them with a skill that they could potentially maybe even make.

00:34:07 Heather Hall

Into a business opportunity in the future.

00:34:09 Heather Hall

So again, it's just a really great example of how all of those things are interconnected.

00:34:17 Yasmine

Yeah, Heather, thank you so much for that summary of malnutrition.

00:34:23 Yasmine

Another big topic in global health, ironically, is what are called neglected tropical diseases and and the reason that we call these diseases neglected is because unlike you know, big names in infectious disease like HIV and malaria, there's actually not.

00:34:43 Yasmine

A lot of.

00:34:44 Yasmine

Global funding or attention paid to these diseases come.

00:34:48 Yasmine

And these include conditions like.

00:34:50 Yasmine

Onchocerciasis, also known as river blindness, schistosomiasis, lymphatic filariasis, trypanosomiasis.

00:34:58 Yasmine

These are, you know, disease conditions that I'm sure many of you have never heard of and are currently trying to figure out how to spell.

00:35:04 Yasmine

Them so you can Google them.

00:35:06 Yasmine

But they're they're neglected because more than one.

00:35:08 Yasmine

Billion people, or you know about 1/6 of the world population suffer from at least one of these neglected tropical diseases.

00:35:17 Yasmine

And you know most of these diseases are not fatal.

00:35:21 Yasmine

They rarely lead to death, but what they do is cause significant disability.

00:35:26 Yasmine

So many of them lead to blindness or disfigurement, fatigue, you know these chronic conditions, and if you are disabled because of.

00:35:37 Yasmine

One of these diseases you know, then you're unable to work.

00:35:40 Yasmine

You're unable to provide for yourself, and this goes back to what we were saying before about the cycle of poverty for disadvantaged people.

00:35:47 Yasmine

If you can't.

00:35:48 Yasmine

If your your health impacts your economic ability, and again for.

00:35:53 Yasmine

Many of these diseases and conditions they can be prevented through surveillance and simple cost effective interventions.

00:36:01 Yasmine

And again, a lot of this ties back to access to health care for resource poor communities.

00:36:07 Heather Hall

Yeah great thanks Jasmine.

00:36:09 Heather Hall

I I always find it really interesting and fascinating to hear about the, you know.

00:36:15 Heather Hall

Neglected tropical diseases because because again when you go to some of these, these international places, global places where you see things that aren't in your maybe in your home country, it just really brought into your perspective on what people in other parts of the world might be dealing.

00:36:31 Heather Hall

With so now for a few diseases that people might be a little bit more familiar with.

00:36:36 Heather Hall

There is also obviously.

00:36:38 Heather Hall

HIV, malaria, and tuberculosis, which again are very prominent topics in global health.

00:36:45 Heather Hall

And you know, much can be said about each of them, so I'll just try to keep this brief.

00:36:50 Heather Hall

But again, these are three issues that you know have been major focuses in global health, and they probably will continue.

00:36:58 Heather Hall

To be for quite.

00:36:59 Heather Hall

A while and and one of the reasons that they're important is because they can be easily spread.

00:37:05 Heather Hall

And then of course have very serious consequences if people don't have access to treatment.

00:37:11 Heather Hall

So more specifically about HIV, which I know we've already touched on a bit, but it's important to remember that you know, while there have been significant advances in the treatment of HIV, and many people are still able to live long and healthy lives, there is still no cure for the disease.

00:37:28 Heather Hall

And while there are medications

00:37:31 Heather Hall

I hope you live a long and healthy life.

00:37:33 Heather Hall

You know, those medications don't really do you any good if you don't.

00:37:36 Heather Hall

Actually have access to them.

00:37:39 Heather Hall

In addition, there are still many cultural practices and beliefs in a lot of different parts of.

00:37:44 Heather Hall

The world that increase the risk of HIV transmission.

00:37:48 Heather Hall

And you know, if you think about it, if you have an increased risk of transmission and limited access to HIV therapies, then the results of these risky behaviors.

00:37:58 Heather Hall

Can actually have really significant impacts, not just on individuals, but whole communities.

00:38:04 Heather Hall

So for example, there are many places in the world where there are large amount of orphans due to losing their parents to AIDS.

00:38:11 Heather Hall

In 2020 there were estimated there was an estimated 15.4 million children, ages 0 to 17 who have lost one or both parents due to HIV. I'm sorry due to AIDS globally, per the United Nation aids.

00:38:27 Heather Hall

Again, these issues are very interconnected and progress or regression in one can mean progress or regression in.

00:38:35 Heather Hall

Now 2 diseases you know there might be a little a bit lesser known and are are more rare in the United States for malaria and tuberculosis.

00:38:44 Heather Hall

So you've probably heard about them.

00:38:46 Heather Hall

But you know, maybe really don't know much about them.

00:38:48 Heather Hall

So malaria is a actually a life threatening disease.

00:38:52 Heather Hall

Can be life threatening and is.

00:38:55 Heather Hall

Caused by parasites that are transmitted to people through the bites of infected mosquitoes.

00:39:00 Heather Hall

But again, thankfully, this malaria is a disease that is preventable and curable.

00:39:05 Heather Hall

In 2020, there were an estimated 241 million cases of malaria worldwide and 627,000 deaths in 2021. Very important in common initiative in global health to combat malaria is the use of bed Nets, so you can actually use.

00:39:26 Heather Hall

Treated bed Nets and some of you maybe have even seen or used these before, but these bed Nets are treated and put over somebody bed or sleeping place.

00:39:36 Heather Hall

And and obviously the goal is to help prevent people from being bitten by mosquitoes while they're asleep and and when, again, when.

00:39:44 Heather Hall

I worked in Kenya with the wash program.

00:39:47 Heather Hall

This is actually one of the requirements for people who are participating in their in their water program.

00:39:53 Heather Hall

And they they had to have bed Nets, and thankfully, most people you know, we're pretty accepting of that.

00:40:00 Heather Hall

But it is also important to to educate people on the use.

00:40:04 Heather Hall

You know it, you don't just pass out something and not educate someone on how to use it.

00:40:09 Heather Hall

You know I have.

00:40:10 Heather Hall

Heard stories before.

00:40:11

Or as.

00:40:12 Heather Hall

You know people using bed Nets for for uses other than what they were designed for, such as even like a fishing Nets.

00:40:18 Heather Hall

So it's really important that when you are using some of these public health interventions that it is accompanied by appropriate education, and again, that education may need to be reinforced now, moving on.

00:40:32 Heather Hall

To tuberculosis, many people think that tuberculosis is something that only happens in developing countries.

00:40:38 Heather Hall

Again, one of those things of, well, that just happens to them over there, but it's actually important to know that yes, while it is less common in the United States, it still does actually happen here.

00:40:50 Heather Hall

In the United States, as I'm imagining, most of our listeners are probably based in the United States.

00:40:57 Heather Hall

But tuberculosis also called TB, is caused by a bacteria.

00:41:01 Heather Hall

And is it most often affects the lungs, though it can actually occur in other parts of the body and TB that affects you in your lung.

00:41:09 Heather Hall

Times is most often spread through coughing, sneezing, or even in your spit, and it's actually estimated that one quarter of the world population is actually infected with TB because TB actually has two different phases has.

00:41:24 Heather Hall

What we call.

00:41:25 Heather Hall

A latent phase.

00:41:26 Heather Hall

Kind of like the TB infection is asleep in your body.

00:41:30 Heather Hall

And then it also has an active phase where you're actively sick and you can spread it to people so that one quarter of the world population who are infected.

00:41:39 Heather Hall

Some are probably, you know, having latent TB so they're not actually spreading it at the moment, but but they still are.

00:41:45 Heather Hall

Infected with it.

00:41:46 Heather Hall

And again, thankfully with tuberculosis like malaria, tuberculosis is preventable and curable.

00:41:53 Heather Hall

However, even though it is again preventable and curable.

00:41:58 Heather Hall

There are still 1.5 million people who die each year from tuberculosis, which actually makes tuberculosis the world top infectious killer.

00:42:07 Heather Hall

In addition, it's also the leading cause of people leaving cause of death for people with HIV, so again, you kind of put those two things together.

00:42:18 Heather Hall

You take a very vulnerable population of.

00:42:20 Heather Hall

People with HIV.

00:42:21 Heather Hall

And then the fact that tuberculosis is the world top infectious killer, you know.

00:42:28 Heather Hall

That you can see why TB is a very important global health issue.

00:42:34 Heather Hall

When I was in Ohio and I was a program coordinator for our tuberculosis program, so we we would take care of people who were actively sick with tuberculosis and as part of their care.

00:42:47 Heather Hall

The patients with TB would often be surprised to find.

00:42:50 Heather Hall

Out that we actually.

00:42:51 Heather Hall

Had to watch them take their TV medication.

00:42:54 Heather Hall

You know, and not just kind of.

00:42:56 Heather Hall

You know, watch them every once in a while.

00:42:58 Heather Hall

But we had to.

00:42:58 Heather Hall

Actually watch them take their medication every single time and document that.

00:43:02 Heather Hall

But what people didn't quite know at 1st and what a lot of people.

00:43:06 Heather Hall

Don't know about tuberculosis.

00:43:07 Heather Hall

Is that not finishing your TV antibiotics or you know most antibiotics for that matter, it can lead to what we call an increase.

00:43:16 Heather Hall

In drug resistant TB.

00:43:18 Heather Hall

And and that's actually a very scary thing to think about, because again, if you think about the world's top infectious killer and then the potential that all of the medications that we have to to fight that disease are no longer effective, you know that creates a very dangerous situation and can really affect a lot of people.

00:43:39 Heather Hall

Uhm, so again, back to these patients.

00:43:42 Heather Hall

In in Ohio we would actually go to their homes for months on end.

00:43:46 Heather Hall

You know, five days a week and go for months on end and watch them take their their TV meds.

00:43:52 Heather Hall

But thankfully again now with technological advances there are even options where.

00:43:57 Heather Hall

Patients can take their tuberculosis medication.

00:44:00 Heather Hall

You know, over some kind of video platform or even record it and then send it into their health care professionals so you know, once you're able to really explain that to people and why that's so important.

00:44:14 Heather Hall

Most people are willing to willing to comply, so.

00:44:17 Heather Hall

So yeah, so that's a little bit of interesting information about TV that a lot of people might not actually know.

00:44:24 Yasmine

Yeah, thank you Heather, for that summary of, I mean, these are three really big topics in global health.

00:44:31 Yasmine

You know there's a an organization called the Global Fund which is all about tackling HIV, tuberculosis, and malaria as those three big topics.

00:44:42 Yasmine

So you know, we're trying to go a mile.

00:44:45 Yasmine

Wide and an inch deep on each of this, and perhaps in future episodes, we'll do some focus on these topics.

00:44:52 Yasmine

More specifically, I want to circle.

00:44:54 Yasmine

Back to the point you made.

00:44:55 Yasmine

About antibiotic resistance we'll.

00:44:57 Yasmine

Talk about that again.

00:44:58 Yasmine

More in a minute.

00:45:00 Yasmine

How important that is globally and and I I appreciate what you said about how TV has this latent phase, which again goes back to this idea of chronic versus infectious diseases.

00:45:11 Yasmine

It's something you can have for a long time and not have any idea about and I, I really appreciate how you've highlighted that TB is something that is.

00:45:21 Yasmine

Seen in the United States, I actually had a conversation a few weeks ago.

00:45:26 Yasmine

I was talking about the tuberculosis situation in the Philippines with someone and they said, oh, I thought I thought we had eradicated tuberculosis.

00:45:34 Yasmine

You know, I thought we were done with that, like smallpox.

00:45:37 Yasmine

And you know, for a lot of the world, TB is again still the top infectious killer and is a really debilitating disease.

00:45:46 Yasmine

It's one of the oldest diseases we have to.

00:45:49 Yasmine

It's one of the one of the originals we like to say.

00:45:52 Yasmine

It's been around.

00:45:52 Yasmine

For a really long.

00:45:53 Yasmine

Time and efforts to eradicate it are are underway.

00:45:57 Yasmine

Uhm, I also want to highlight that HIV is still a big problem in the United States, especially among some of the most vulnerable populations it tends.

00:46:07 Yasmine

To you know.

00:46:07 Yasmine

When we think about it in a.

00:46:09 Yasmine

In African or an Asian context, we associate it more with mothers and children and when we think about it in the United States, we think about with drug users.

00:46:19 Yasmine

Men who have sex with.

00:46:20 Yasmine

Men, some populations that are not necessarily glamorous to work with, but.

00:46:25 Yasmine

Are among the most vulnerable and therefore the most vulnerable to diseases.

00:46:37 Announcer

We'll be back in a minute with more on this topic.

00:46:40 Announcer

You're listening to optimistic voices. Podcast with host Yasmine Bon and guest Heather Hall For more information on today's topic. Global health go to helpingchildrenworldwide.org Optimistic Voices Podcast season one.

00:47:00 Announcer

Episode 3

00:47:02 Announcer

Episodes this season include UMC campaign for a strong family for every child, short term, mission transformation, the HKW Teachers Learning, Collaborative impacting maternal infant mortality rates with champs, the Foundation for orphans.

00:47:21 Announcer

Embracing Transformation, University of Maine Honors College train the trainer attachment theory workshops for low resource environments and pre literate populations.

00:47:38 Yasmine

Another area that I'd like to highlight that's really important in global health, and that is a big topic right now, of course, is vaccine preventable diseases.

00:47:49 Yasmine

So there are over 25 diseases worldwide that can be prevented with vaccination and there are 15 diseases for which vaccines are currently being developed. They're in the pie.

00:48:00 Yasmine

Online and and you know, many of these I'm.

00:48:02 Yasmine

Sure, you'll know.

00:48:03 Yasmine

About because you've gotten them as a part of your routine immunizations, so you know measles, chicken pox, hepatitis, polio.

00:48:11 Yasmine

You know these are diseases that we don't see in the United States much anymore because of vaccination campaigns, but worldwide.

00:48:21 Yasmine

There are many people that are still dying of these diseases that have a solution.

00:48:27 Yasmine

Just just a simple vaccination and the World Health Organization estimates that vaccination saves about four to 5 million people every year.

00:48:38 Yasmine

So we'll talk a little bit about the global alliance.

00:48:42 Yasmine

For vaccines, they've vaccinated over 888 million children, and averted about 15 million deaths.

00:48:52 Yasmine

Through their work.

00:48:53 Yasmine

And and the the the Gabi as it's called the Global Alliance for vaccines and immunization.

00:48:59 Yasmine

A lot of.

00:48:59 Yasmine

The work that they do is in doing some.

00:49:03 Yasmine

Of the cost.

00:49:06 Yasmine

Efforts around vaccination, so vaccines are really expensive to develop and this organization was formed to share the cost that countries have to pay for vaccinations and so their efforts have really helped.

00:49:20 Yasmine

With some of these conditions, so of course you know cost is a big barrier to this, but vaccine hesitancy, fear of having vaccines is also a really huge barrier to these efforts, and we'll talk more about the the challenges of Community Trust and how that impacts health at a moment.

00:49:38 Yasmine

But I just wanted to highlight.

00:49:40 Yasmine

These vaccine preventable diseases as well.

00:49:43 Heather Hall

Yeah, and I think, uh, yeah, I mean that that that actually leads into the next kind of major global health topic which is emerging and re emerging diseases, you know?

00:49:55 Heather Hall

Because they're.

00:49:57 Heather Hall

'cause we've all seen with COVID, you know, there's you know, been a requirement for vaccination, especially for for travel and and and things like that may become more common as people are traveling more.

00:50:11 Heather Hall

So you know.

00:50:13 Heather Hall

There are diseases.

00:50:14 Heather Hall

That are often isolated to certain parts of the world, but we're now seeing them pop up.

00:50:18 Heather Hall

Unexpected areas.

00:50:21 Heather Hall

Or you know, less common areas and and a lot of that is largely due to the increase in travel to different parts of the world.

00:50:29 Heather Hall

You know, we don't really need a whole lot of explanation on this, because we've all seen this first hand.

00:50:35 Heather Hall

You know, with a few years ago, Ebola and then obviously the globally.

00:50:40 Heather Hall

Disruptive COVID-19 pandemic and then now monkeypox.

00:50:44 Heather Hall

So so yeah, so some of these emerging and reemerging reemerging diseases may become more of an issue again, as we're as we're moving forward and.

00:50:54 Heather Hall

Global health is.

00:50:55 Heather Hall

Is transforming because it's following the the transformation of societies and?

00:51:01 Heather Hall

And yeah so and that.

00:51:02 Heather Hall

That is definitely going to become.

00:51:04 Heather Hall

A larger area of focus in vaccines for preventable illnesses are definitely gonna play a role.

00:51:12 Heather Hall

And then just a little bit about noncommunicable diseases.

00:51:16 Heather Hall

Again, we often think about communicable diseases being a main focus in global health.

00:51:20 Heather Hall

And they are but also non communicable diseases are also becoming a more prominent focus in global health.

00:51:27 Heather Hall

And we touched.

00:51:28 Heather Hall

On this a little.

00:51:28 Heather Hall

Bit earlier now, more specifically non communicable diseases.

00:51:33 Heather Hall

Or actually, diseases that cannot be transmitted to other people such as heart disease, cancer, chronic respiratory diseases, and diabetes.

00:51:42 Heather Hall

The CDC actually states that deaths from non communicable diseases now actually exceed all communicable disease deaths combined.

00:51:51 Heather Hall

And this is the reason.

00:51:53 Heather Hall

Or actually the reason for this is changing social, economic and structural factors such as more people moving to cities and the spread of unhealthy lifestyles.

00:52:03 Heather Hall

Therefore, this will be an increasingly important focus of global health as more and more countries further develop and gain access, you know to unhealthy products, lifestyle, things like that.

00:52:15 Heather Hall

Again, this kind of touches on what you were talking about before his meeting with.

00:52:18 Heather Hall

Kind of that epidemiologic transition.

00:52:22 Heather Hall

So how how are diseases in certain areas changing and a lot of that has to do with lifestyle and the increase in non communicable diseases is a great example of.

00:52:33 Heather Hall

That one kind of real world example is that.

00:52:38 Heather Hall

When I was working as a nurse at a hospital in Kenya, you know I could.

00:52:43 Heather Hall

I could often tell which which patients were from more developed or wealthier parts of the country simply because of the reason that they were there.

00:52:51 Heather Hall

You know they tended to have especially diabetes, that tended to be an issue that they were coming in.

00:52:58 Heather Hall

Info or maybe even heart failure.

00:53:00 Heather Hall

Uh, we were having having some surgeries that were related to to being overweight, so so you know that really does.

00:53:09 Heather Hall

That really does play out as non communicable diseases are are on the rise and really does play out, especially in those countries that.

00:53:18 Heather Hall

You know, maybe don't have the infrastructure to support those because they haven't been used to to addressing those diseases.

00:53:25 Heather Hall

So and we'll talk a little bit more about that later.

00:53:29 Yasmine

Yeah, yeah, I appreciate that.

00:53:31 Yasmine

Bringing back the topic of of chronic disease infectious disease having that double burden in a particular country.

00:53:39 Yasmine

We talked a little bit about this before when we were talking about tuberculosis, but the the last topic I really want to highlight as a.

00:53:47 Yasmine

Big, you know?

00:53:49 Yasmine

Topic in global health.

00:53:50 Yasmine

Is antibiotic resistance.

00:53:52 Yasmine

We might even dedicate an entire episode to.

00:53:54 Yasmine

This in the future.

00:53:56 Yasmine

So as we were saying, you know.

00:53:57 Yasmine

Infections like tuberculosis, but also pneumonia, gonorrhea.

00:54:01 Yasmine

Yeah, these diseases.

00:54:03 Yasmine

Are becoming harder to treat because the antibiotics we use to treat them are becoming less effective and so a lot of this comes from irresponsible use of antibiotics.

00:54:15 Yasmine

So you know a doctor prescribing an antibiotic for a viral infection.

00:54:19 Yasmine

Or when people don't take their antibiotics.

00:54:21 Yasmine

As they are prescribed.

00:54:23 Yasmine

Or in the agricultural industry where antibiotics are used to promote growth in animals?

00:54:31 Yasmine

These things all exacerbate antibiotic resistance there in our ability to fight diseases is diminished, and it leads to longer hospital stays, higher medical cross, increased mortality, so we're increasingly getting closer to a world where we need a better solution to bacterial infections.

00:54:51 Yasmine

Besides antibiotics and we will need to be more vigilant about how we use antibiotics in the future as a result.

00:55:00 Yasmine

So you know, we boy, we've talked for a while now.

00:55:03 Yasmine

This is a not a complete list of all the big topics in global health, but rather a few of the really important ones that affect a lot of people.

00:55:11 Yasmine

And and when it comes to tackling these big issues, there's a number of challenges that clinics nonprofits.

00:55:20 Yasmine

Hospitals health systems are facing and you know, like all of these disease conditions, you'll see that many of these are are interconnected and you know have relations to one another and harkened back to what we're talking about with the sustainable Development goals, you know each of them is.

00:55:38 Yasmine

And has an influence on one another.

00:55:43 Yasmine

You know, for example, one of the.

00:55:44 Yasmine

The big challenges that I think about is.

00:55:48 Yasmine

You know Heather was saying before that chronic disease is becoming a big topic in global health, and as we discussed with the history of global health as a field, the emphasis really was on infectious diseases.

00:56:02 Yasmine

Malaria, smallpox, tuberculosis, diseases like that.

00:56:07 Yasmine

And really, people that work in global health tend to think more about those and not have as much emphasis on these chronic diseases, and so that really impacts how we're able to tackle these issues.

00:56:22 Yasmine

So, for example, in a lot of majority world countries.

00:56:26 Yasmine

Doctors have more training on infectious diseases.

00:56:30 Yasmine

They know more about malaria.

00:56:31 Yasmine

They know more about HIV and they have less training on diabetes management.

00:56:36 Yasmine

And you know how to prescribe medication for.

00:56:40 Yasmine

Or disease.

00:56:41 Yasmine

The endocrinology things these these deeper health topics because the focus is having to shift to include both with this double burden of disease.

00:56:54 Heather Hall

Yeah, that's that's a really great example of some of the challenges that are, you know, that are being faced in in global health and other.

00:57:03 Heather Hall

There another issue or challenge that I think is really important to discuss and I think is becoming more of a focus is, you know the distribution of services or access to healthcare.

00:57:17 Heather Hall

Or you know, or the affordability of healthcare specifically about you know the distribution of services or the supply chain.

00:57:26 Heather Hall

You know of medications as we talked about earlier.

00:57:29 Heather Hall

You know if you have HIV, yes, there are medications that can allow you to live a long and healthy life, but but it's an issue of access.

00:57:38 Heather Hall

Do you actually have access to those medications?

00:57:40 Heather Hall

'cause that's really going to.

00:57:41 Heather Hall

Affect the outcome.

00:57:43 Heather Hall

Also, you know again with the pandemic we we all were aware of the access to vaccines you know.

00:57:51 Heather Hall

Again, in some of your wealthier countries they were able to actually produce and make vaccines faster than other countries and and again that that really is something that can affect.

00:58:02 Heather Hall

Everybody, because especially with COVID.

00:58:05 Heather Hall

You know one population may be more well vaccinated against it, while another population might not be as well vaccinated and in that population.

00:58:16 Heather Hall

That's not as well vaccinated.

00:58:17 Heather Hall

There's going to be more potential for more variants of and mutations of COVID to develop, which then could potentially.

00:58:26 Heather Hall

You know, not be responsive to the vaccines, you know that are more heavily accepted or or available in this other population.

00:58:34 Heather Hall

So again, it's it's it's kind of we're all in this together and COVID was really a great example of how.

00:58:40 Heather Hall

Uhm, you know that access to health care services really is important to look at.

00:58:49 Heather Hall

On a global scale, not just.

00:58:50 Heather Hall

Uh country to country but but but it we you know again with with transportation and the connectedness of everybody.

00:58:57 Heather Hall

Nowadays one thing happening in one country can.

00:59:01 Heather Hall

Really affect the health and well-being of somebody in another country.

00:59:06 Heather Hall

And just a little bit more about affordability.

00:59:09 Heather Hall

Of of health care in 2000 and 2158% of adults worldwide. Agreed that many people in their country couldn't even afford good healthcare, so so that goes beyond.

00:59:21 Heather Hall

An issue of access that goes.

00:59:23 Heather Hall

You know you may have access to something, but you you can't.

00:59:25 Heather Hall

Actually afford it?

00:59:28 Heather Hall

You know?

00:59:29 Yasmine

So that's that's.

00:59:30 Heather Hall

A huge factor at play and really impacts how people utilize healthcare. I've even seen in just a couple examples I've seen in an African hospital where you know the patients weren't allowed to leave the hospital until they paid 70. At least 70% of their bill. And as you can imagine, that.

00:59:51 Heather Hall

That creates a really interesting situation, because, OK, if I.

00:59:55 Heather Hall

Can't leave the hospital to.

00:59:56 Heather Hall

Work, how am I going to pay my bill?

00:59:59 Heather Hall

You know, and this wasn't something that was done as a punishment or anything like that.

01:00:04 Heather Hall

It was more just a kind of.

01:00:05 Heather Hall

A reality of.

01:00:06 Heather Hall

Like OK, we we have to hold people accountable.

01:00:10 Heather Hall

To paying for the care that they're receiving.

01:00:11 Heather Hall

Otherwise you know the hospital is going to go under and then no one going to receive care, and so then you had to have family members try to find work to actually pay for these bills and those family members.

01:00:24 Heather Hall

You know the majority of them may have been children or or a wife, and they you know aren't maybe used to working.

01:00:30 Heather Hall

Or don't have the ability to work so it can be some really complicated situations that arise by not being able to pay for health care.

01:00:40 Heather Hall

And again, this is not.

01:00:41 Heather Hall

Something that's limited to other places around the world.

01:00:43 Heather Hall

This is not that US versus them.

01:00:45 Heather Hall

You know this is something that very much happens here in the United States and I think we all we all probably know that and have our own personal.

01:00:52 Heather Hall

Experiences or exposure to that.

01:00:55 Heather Hall

Uhm, but.

01:00:58 Heather Hall

But yeah, so that again does the affordability is really something important to to keep note of and and again the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths compared to other high income countries. You know EU.

01:01:16 Yasmine

Sorry, I'm going to have to.

01:01:17 Heather Hall

Restate that one.

01:01:19 Heather Hall

So again, you know affordability is not something that's limited to other places around the world.

01:01:24 Heather Hall

It's not an issue that's just in other places around the world. the US actually spends more than any other country in the world on health care that actually has the lowest life expectancy. The highest burden of chronic disease.

01:01:36 Heather Hall

The highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths compared to other high income countries.

01:01:43 Heather Hall

So again, it's not just an issue of, it's not just an issue in maybe a low resource country, but you know, affordability of health care is is an issue that really affects everyone.

01:01:56 Heather Hall

Another challenge that's often faced in global health is a lack of trained health care workers.

01:02:01 Heather Hall

So again, kind of touching back on that maternal maternal health topic.

01:02:07 Heather Hall

You know you're you're having women who are delivering in very remote areas, and oftentimes they don't have.

01:02:16 Heather Hall

Access to to health care they don't have access to a nurse and nurse midwife clinic.

01:02:21 Heather Hall

Things like that and oftentimes you'll.

01:02:26 Heather Hall

You know, some communities have tried to address this by.

01:02:29 Heather Hall

I mean having what they called traditional birth attendants or skilled birth attendance to try to provide at least a little bit more higher level of care in these communities to to help combat this challenge.

01:02:45 Yasmine

Yeah yeah, thank you, Heather.

01:02:48 Yasmine

The the lack of trained health care workers is a really big issue, and we'll talk in a minute about some of the strategies they use to.

01:02:55 Yasmine

Tackle that, but what we see in a lot of countries around the world is that they.

01:02:59 Yasmine

Have less than one.

01:03:00 Yasmine

Doctor per even 100,000 people, and so there's very little access to getting.

01:03:08 Yasmine

Skilled healthcare

01:03:10 Yasmine

Another big issue that we see is not just having access to healthcare, but having access to preventative services and screening and then on the foot on the other end of that, having access to advanced treatment of diseases so.

01:03:28 Yasmine

In Sierra Leone, for example, we are looking to begin.

01:03:33 Yasmine

A program on.

01:03:34 Yasmine

Breast cancer screening and cervical cancer screening in Sierra Leone.

01:03:40 Yasmine

But then the question with that is, you know once we screen for these.

01:03:43 Yasmine

Diseases once we have the ability.

01:03:45 Yasmine

To detect and and.

01:03:48 Yasmine

Take and detect and and know and diagnose these diseases.

01:03:52 Yasmine

Will a patient be able to have the ability to get treatment for them?

01:03:56 Yasmine

If a you know if you find out that you have a breast cancer diagnosis, well, how far away is the nearest Health Center that can provide you know?

01:04:04 Yasmine

Uh, mastectomy or chemotherapy radiation?

01:04:09 Yasmine

So the the benefit of having.

01:04:12 Yasmine

You know these what we call like early public health measures of prevention.

01:04:17 Yasmine

Things like that are only helpful if you can build it on the other side as well and have the the access to advanced.

01:04:24 Yasmine

Treatment of diseases.

01:04:26 Yasmine

And and that also really ties in well with the integration of health delivery, which is another really big issue we see in the global sphere.

01:04:34 Yasmine

So you know, having a a clinic.

01:04:36 Yasmine

That's nearby a patient.

01:04:39 Yasmine

You know, a person lives within a mile walk, perhaps of a.

01:04:43 Yasmine

Of a health.

01:04:44 Yasmine

Clinic and they have trained health care workers there.

01:04:47 Yasmine

Well that's great, but if this trained health care worker recognizes you know this person has a hernia.

01:04:53 Yasmine

This person has cancer.

01:04:56 Yasmine

They can diagnose this advanced disease, but how are they doing that?

01:05:00 Yasmine

Referral to this to a clinic that can do the treatment.

01:05:04 Yasmine

You know, are they able to have a contact with a hospital with a, you know, an advanced treatment center that can carry out this.

01:05:13 Yasmine

This helped delivery and the same thing with like we see in maternal and child health.

01:05:19 Yasmine

You know we can have a health clinic that does antenatal clinic visits, you know and and can take care of a patient before birth.

01:05:29 Yasmine

But then are they able to help the mother when she is in labor?

01:05:33 Yasmine

If she had, you know, a hemorrhage.

01:05:35 Yasmine

Would they be able to help her?

01:05:37 Yasmine

And if not, would they be able to refer her to a place and get her there in time to take care of her before you know she bleeds out?

01:05:45 Yasmine

So this integration of health delivery, which is.

01:05:48 Yasmine

Why you know in Sierra Leone?

01:05:50 Yasmine

Mercy Hospital has linkages with.

01:05:53 Yasmine

Clinics when we do outreach.

01:05:55 Yasmine

We particularly do it.

01:05:56 Yasmine

At areas that already.

01:05:57 Yasmine

Have a health clinic to improve this integration of health delivery.

01:06:05 Heather Hall

Yeah, integration of health delivery I think ties in well next to our the next challenge which.

01:06:13 Heather Hall

That cultural and language barriers you know to program.

01:06:17 Heather Hall

So if you have if you have.

01:06:19 Heather Hall

Resources in a community that are not major.

01:06:21 Heather Hall

Maybe culturally sensitive or have a more accessible to to those who maybe speak a different language than you know the the primary language of the country.

01:06:31 Heather Hall

You know, there can be a really significant.

01:06:33 Heather Hall

Impact on people's ability to to access health care and a couple. A couple example real life examples that I can.

01:06:40 Heather Hall

Kind of, you know, have to do with.

01:06:45 Heather Hall

You know when I've done some of the.

01:06:46 Heather Hall

The COVID work.

01:06:48 Heather Hall

You know and and people are making phone calls to to figure out what to do about COVID.

01:06:53 Heather Hall

You know either they've been exposed or they have COVID you know the importance of having an interpreter.

01:06:58 Heather Hall

Who can actually talk to them and you know and give them the appropriate information they need because there there are times, especially if you have languages that are are much less common in the in the country.

01:07:10 Heather Hall

You know they're not.

01:07:12 Heather Hall

That person might not be able to just go on a website and navigate the website to find the information they need, because the information might be in a totally different language.

01:07:20 Heather Hall

And so that I can really.

01:07:21 Heather Hall

Be a barrier to to.

01:07:23 Heather Hall

Care that people have one other example of this that I think of is when I worked with the refugee program in Ohio so we would have refugees that would come from all different countries and they would come to us at the Health Department to have their initial health screening.

01:07:38 Heather Hall

And then we would also set them up.

01:07:40 Heather Hall

With referral to a primary care clinic, but on numerous occasions we would have.

01:07:45 Heather Hall

We would have patients that would come back to the Health Department because they knew they could get help there specifically with an interpreter because there were other issues that they were having at some of the other places where they.

01:07:58 Heather Hall

Were trying to.

01:07:58 Heather Hall

Get care where they they, maybe didn't have.

01:08:01 Heather Hall

Uhm, you know adequate access to interpreters, or at least fast enough. Access to interpreters. And it really did create a barrier, and so a lot of times we would have have clients that would come back to the health department and we would have to just help them set-up appointments, not even getting care there at the health department, but getting care elsewhere.

01:08:22 Heather Hall

Yeah, so you can really go on and on about cultural language barriers.

01:08:26 Heather Hall

That's that's really a huge topic in and of itself and and you know, one of the one of the foundational things about is trust.

01:08:33 Heather Hall

You know, people have to be able to.

01:08:35 Heather Hall

Trust who they're getting care from.

01:08:39 Yasmine

Yeah, yeah, I'm I'm so glad you.

01:08:41 Yasmine

Brought that up, uhm?

01:08:43 Yasmine

Heather the the the cultural.

01:08:44 Yasmine

Issues and we'll talk about a little bit more about some strategies to tackle that, but trust in a community is a huge issue within the realm of global health, and in fact we work with the Christian connections for international health and they do a lot of work on how.

01:09:03 Yasmine

Faith and health are interconnect.

01:09:05 Yasmine

And one of the areas that they're looking into right now is the engagement of faith leaders in immunization.

01:09:12 Yasmine

So a lot of communities around the world are very religious.

01:09:15 Yasmine

They have a pastor, a preacher and Imam a rabbi, A leader whom they trust and believe in, and engaging faith leaders.

01:09:25 Yasmine

In a way.

01:09:26 Yasmine

Building that trust between a community and A and the health field is a huge area where they've been working engaging faith leaders and teaching about immunization, especially around COVID.

01:09:39 Yasmine

19 in you know health care utilization which we talked about earlier going to a clinic when you are sick.

01:09:46 Yasmine

Knowing some of the warning signs of things because trust is such a big barrier, and of course with trust you have the issue of fake news.

01:09:57 Yasmine

You know there's a lot of information and misinformation that's being spread.

01:10:00 Yasmine

Said about diseases, about how they're spread about, how to treat them and this, you know, it's something that we talk about a lot with COVID-19 and diseases like COVID-19. But even before COVID

01:10:16 Yasmine

We saw issues like this with other vaccinations.

01:10:19 Yasmine

It's a big reason for vaccine hesitancy, in fact.

01:10:23 Yasmine

I I spoke with a researcher from.

01:10:26 Yasmine

The from George Washington University and prior to COVID-19 he did a lot of research on why where vaccine misinformation comes from.

01:10:37 Yasmine

Where do people learn?

01:10:39 Yasmine

You know this information about vaccines you know?

01:10:41 Yasmine

They did this.

01:10:42 Yasmine

Condition or lead to that condition or not.

01:10:44 Yasmine

Healthy and.

01:10:45 Yasmine

He traced it back to terrorist groups.

01:10:47 Yasmine

Organizations like ISIS and Al Qaeda are spreading this information on their website, and then it gets filtered down, you know, through different other sites and eventually ends up somewhere on Facebook or Twitter and people will.

01:11:00 Yasmine

But and so bridging that gap of building trust and combating misinformation is a huge barrier to.

01:11:09 Yasmine

Global health worldwide

01:11:15 Heather Hall

Yeah, that you bringing up that story really reminds me of something that was kind of a light bulb moment for me in in public health is is learning the the difference between relief, rehabilitation and development and you know.

01:11:31 Heather Hall

So if you're having an issue.

01:11:33 Heather Hall

With like.

01:11:34 Heather Hall

Incorrect information being shared.

01:11:36 Heather Hall

You know it's going to be really important to know what type of intervention you're you're to know you know, know the situation to know the appropriate intervention to combat that issue, you know.

01:11:50 Heather Hall

So, for example, if you're having.

01:11:51 Heather Hall

An issue with.

01:11:53 Heather Hall

You know?

01:11:54 Heather Hall

Distrust and misinformation about vaccines, you know.

01:11:58 Heather Hall

But you see that these people need vaccines.

01:12:00 Heather Hall

You know the first step maybe isn't to just go in and try to administer vaccines.

01:12:04 Heather Hall

Maybe a first step is actually trying to address questions and you know actually have conversations with people better understand.

01:12:11 Heather Hall

And the hesitations, and the fears and concerns, which are totally justified.

01:12:16 Heather Hall

And you know, again, you have to figure out.

01:12:19 Heather Hall

OK, where are where are people?

01:12:21 Heather Hall

Where are communities in terms of of of what stage they're in?

01:12:27 Heather Hall

Are they in a state of relief meeting, relief efforts, rehabilitation?

01:12:31 Heather Hall

Efforts or development and I won't go into that too much here.

01:12:35 Heather Hall

'cause we'll probably touch on it in a little bit, but but yeah, that that's one thing that I found really, really helpful when looking at the challenges that a community is facing, but then also trying to figure out what interventions should be put in place.

01:12:51 Yasmine

Yeah, I I'd sound like a broken record.

01:12:53 Yasmine

Now I think the the difference between you know development you know is is this country in a or this community in the stage of development?

01:13:02 Yasmine

Do they need immediate relief?

01:13:04 Yasmine

You know humanitarian work after a disaster or rehabilitation is probably something we could do.

01:13:11 Yasmine

A whole other podcast episode on, but yes, depending on the context that a population is in will determine what interventions are used and apply.

01:13:21 Yasmine

And Heather, I wonder if we could talk a little bit about some of the interventions that we know have been proven to be effective in combating disease we've we've touched on a few of them.

01:13:32 Yasmine

You know, as we we talked about each of the diseases.

01:13:35 Yasmine

But you know, there's there's a few big topics in this that I think would be useful to.

01:13:42 Heather Hall

Yeah, sure so to.

01:13:44 Heather Hall

To build on the importance of understanding the stages of where a community is in terms of relief, rehabilitation or development.

01:13:51 Heather Hall

One thing that's really important in in assessing that is participation by the community.

01:13:58 Heather Hall

You know it's it's really vital to have that community input.

01:14:03 Heather Hall

You know these are other people community you know.

01:14:05 Heather Hall

Especially if you're maybe.

01:14:07 Heather Hall

Living in one country, traveling to another country and trying to to do some kind of work.

01:14:12 Heather Hall

It's really important that you come in with a, uh, learners mentality.

01:14:16 Heather Hall

You know you come in with humility and you come in to try to learn and learn from the people that are that are living there that are having the issues that are living those issues out day-to-day because they are the experts.

01:14:27 Heather Hall

In their community.

01:14:29 Heather Hall

They have invaluable insight and expertise into the many factors that make up and.

01:14:33 Heather Hall

Affect their community?

01:14:35 Heather Hall

And that's going to be information that you know you as the you know, outsider.

01:14:41 Heather Hall

You'll never be able to have and and.

01:14:44 Heather Hall

Therefore, their their insight is going to be.

01:14:48 Heather Hall

Uhm, you know can can really be beneficial and largely impactful in in what interventions are applied in how they're applied.

01:14:57 Heather Hall

So some of the most important interventions using global health again, which help us make progress toward those sustainment develop sustainable development goals, especially #3, which is good health and well-being.

01:15:08 Heather Hall

Some of those interventions are kind of.

01:15:12 Heather Hall

You can maybe even sum them up in 2 main categories.

01:15:15 Heather Hall

Prevention and education.

01:15:17 Heather Hall

Which can also be called health promotion and then also diagnosis and treatment.

01:15:22 Heather Hall

So to break down prevention and education a little bit interventions related to prevention are some of the most important because they can really prevent premature deaths and help stop or minimize the impact of diseases.

01:15:36 Heather Hall

Which, again, if not prevented, can affect many other.

01:15:40 Heather Hall

Areas of people, people.

01:15:41 Heather Hall

Lives kind of that domino effect.

01:15:43 Heather Hall

If you will, and as we said before, the Sustainable development goals are all interconnected and impact in one area can really affect the outcome in another.

01:15:53 Heather Hall

So for example, if you have a parent who has a child that is sick from a preventable disease, whether it's preventable through hand washing or vaccination, that parent may end up having to miss out on work or spend a lot of money to care for the child.

01:16:07 Heather Hall

And if your family is already impoverished or on the brink of poverty and illness, and one family member.

01:16:13 Heather Hall

Can cause major implications for the well-being of the entire family, which for many families is how they end up being stuck in a cycle of.

01:16:20 Heather Hall

Poverty, so again, if you can implement some of those preventative measures that help prevent families from going over that Brink, going into poverty or you know worsening the poverty, those interventions preventative interventions can be really impactful and really help move.

01:16:41 Heather Hall

Move people closer towards that.

01:16:42 Heather Hall

Goal of good health and well-being.

01:16:44 Heather Hall

Other types of prevention strategies you know, a lot of people probably already know our strategies, like screening.

01:16:50 Heather Hall

You know whether that's a mammogram?

01:16:52 Heather Hall

Cervical cancer screening.

01:16:54 Heather Hall

Obviously, vaccinations are are very well known and then also antenatal care is another type of preventative strategy.

01:17:02 Heather Hall

So I won't I won't.

01:17:04 Heather Hall

Dwell on that too much 'cause a lot of people are familiar with types of preventative strategies.

01:17:11 Heather Hall

I'm now moving on to education a little bit.

01:17:13 Heather Hall

Again, we all know how important education is.

01:17:16 Heather Hall

Education is something that can be shared freely and easily with one another and can empower people to take responsibility for their health in ways that only they can do.

01:17:25 Heather Hall

Which is probably one of my favorite things about education and why.

01:17:29 Heather Hall

I really enjoy education.

01:17:31 Heather Hall

Is that again it can empower people to to do something themselves.

01:17:35 Heather Hall

You know something that only they can do, that I can't do for them.

01:17:40 Heather Hall

Especially in some global contexts where access to mental medical treatment is limited.

01:17:44 Heather Hall

Education, especially when education is used.

01:17:49 Heather Hall

Through community engagement can.

01:17:52 Heather Hall

Really be a strong way to prevent diseases and promote health, and again can be very impactful in encouraging things like health seeking behaviors.

01:18:01 Heather Hall

One example from the field that I can think of was when I was again a part of that Community health and development program in Kenya, where one of the aspects of the school wash program was that schools had to have a hand washing station and then kids were taught how to wash their.

01:18:17 Heather Hall

Hands now if you know kids they often.

01:18:20 Heather Hall

Like to show off.

01:18:21 Heather Hall

New things they learn, and one of the thoughts was that you know kids would not only learn how to wash their hands, but then they would actually go home.

01:18:29 Heather Hall

And teach their families the same behavior and they would also end up being advocates for creating hand washing stations at their homes so they could wash their hands at home the same way they were at school, and so by engaging the kids and educating them in this health seeking behavior, washing hands, you know we have the opportunity to.

01:18:50 Heather Hall

Impact many more households and spread.

01:18:52 Heather Hall

You know this information much further in a way that otherwise would take much longer.

01:18:58 Heather Hall

It you know, if one community health worker had to do it all individually.

01:19:02 Heather Hall

And you know, Speaking of community health workers Yasmin, I know you were going to touch on that a little.

01:19:07 Heather Hall

Bit and so I thought.

01:19:09 Heather Hall

If you'd want to, maybe chat on community health workers a little bit before we talk about diagnosis and treatment.

01:19:15 Yasmine

Yeah, yeah, I'd love to.

01:19:17 Yasmine

I do want to circle back to what you're saying about hand washing stations historically.

01:19:23 Yasmine

In the field.

01:19:24 Yasmine

Of public health training children you know, educating children on good health practices.

01:19:29 Yasmine

Has been a major.

01:19:30 Yasmine

Strategy for getting people all across a country to engage in health seeking behavior.

01:19:36 Yasmine

We see this with seat belt campaigns.

01:19:39 Yasmine

Children were taught, you know, you're supposed to.

01:19:41 Yasmine

Wear your seat belt.

01:19:42 Yasmine

In your car and then you.

01:19:44 Yasmine

Know Mom picks them up.

01:19:45 Yasmine

In carpool and they say, you know, Mommy, why aren't you wearing your seat belt?

01:19:48 Yasmine

You're putting me in danger, and that would be it. Just it has major implications and is is a very effective strategy in the 1900s actually, you know, we see in the early 1900s.

01:20:01 Yasmine

Almost nobody is washing their hands.

01:20:03 Yasmine

Almost nobody is, you know, wearing shoes outside and you know, engaging in these safe hand washing practices, and we in the United States did hygiene campaigns in schools, some big names companies would go into schools.

01:20:21 Yasmine

And do these.

01:20:21 Yasmine

Plays about washing your hands and cleaning your food and washing your vegetables, and then children would take these interventions home.

01:20:30 Yasmine

And teach their.

01:20:31 Yasmine

Parents about it.

01:20:32 Yasmine

So that's just a really cool.

01:20:34 Yasmine

Way that public health has been operating over.

01:20:36 Yasmine

The last years.

01:20:37 Yasmine

But yeah, community health workers.

01:20:40 Yasmine

Community health workers are one of my favorite topics in public health and in global health especially, I watched Ted talk about it when I was a senior in college and that really awokened me.

01:20:55 Yasmine

This desire to work in public health because.

01:20:57 Yasmine

I thought that this was the coolest.

01:20:59 Yasmine

The coolest way to to start tackling health care worldwide.

01:21:04 Yasmine

So one of the main ways that Healthcare is advancing globally is through the use of.

01:21:08 Yasmine

Community health workers

01:21:09 Yasmine

The Ted talk that I'm talking about is called investing in healthcare workers strengthens communities, but the the essential topic of this is that a community health.

01:21:19 Yasmine

Worker is a layperson who is a trusted member.

01:21:23 Yasmine

Of their community.

01:21:24 Yasmine

This person is usually given training on disease recognition and treatment and then they are able to use that trusted relationship they have with the community to link between the people in that community and healthcare services so they can give treatment for basic conditions.

01:21:41 Yasmine

So you know, recognizing malaria, giving malaria medication.

01:21:44 Yasmine

But they also can refer people.

01:21:46 Yasmine

For treatment for serious disease conditions.

01:21:49 Yasmine

And and most of all, a lot of community health workers work in this area of education.

01:21:55 Yasmine

So educating communities on prevention on disease, recognition on building health, seeking behavior so you know, this, really.

01:22:04 Yasmine

This strategy is one that really helps with some of those issues we were talking about earlier, such as the integration of health delivery, bridging those cultural and language barriers to getting into a community because you select someone in a Community that has already has the trust of the of the people there.

01:22:26 Heather Hall

Yeah, I kind of wanted to touch touch again on.

01:22:32 Heather Hall

You know the cultural and language barriers.

01:22:35 Heather Hall

Like community OK sorry are you done then you want me to go ahead and move on.

01:22:40 Heather Hall

To diagnosis and treatment.

01:22:41 Heather Hall

OK sorry, OK yeah, so just to touch on really quickly about diagnosis and treatment.

01:22:48 Heather Hall

You know I don't want to spend a lot of time here.

01:22:50 Heather Hall

'cause I?

01:22:50 Heather Hall

Know we've covered so much.

01:22:51 Heather Hall

Already, you know, and diagnosis and treatment it is.

01:22:55 Heather Hall

Pretty self-explanatory, but again.

01:22:56 Heather Hall

And one thing to remember with global health is that diagnosis and treatment may look very different in one country compared to another, so they're mirror again, like we've kind of touched on before.

01:23:08 Heather Hall

There may be varying levels of ability between countries to diagnose and treat something, and you know the wealthier again the wealthier country does not.

01:23:16 Heather Hall

Always mean that they are better able to diagnose or treat something.

01:23:21 Heather Hall

You know one example that I always think of is malaria.

01:23:25 Heather Hall

You know malaria may be heavily present in one country, while it may not be an issue at all in another country.

01:23:32 Heather Hall

And you know, I've heard I've heard stories of of people, even some personal contacts, who you know they've been traveling overseas, came back.

01:23:40 Heather Hall

To the United States got.

01:23:42 Heather Hall

Sick you know?

01:23:43 Heather Hall

And it took their.

01:23:44 Yasmine

Their doctor, quite a.

01:23:45 Heather Hall

While to figure out what what they had.

01:23:47 Heather Hall

You know it wasn't.

01:23:48 Heather Hall

A first thought for the provider to.

01:23:51 Heather Hall

To test for malaria and then once they did test and found out.

01:23:55 Heather Hall

But it was, you know, they had to to reach out for a special consultation to even know how to treat it.

01:24:01 Heather Hall

And and you know, like Yazmin had talked about earlier, you know there's the total opposite end of that.

01:24:07 Heather Hall

You know the flip side.

01:24:08 Heather Hall

You know you're maybe looking at some other countries that are under resourced and they may have.

01:24:14 Heather Hall

They may struggle more with treating some of those chronic diseases such as diabetes, because again, maybe those health care.

01:24:21 Heather Hall

Providers haven't had to learn how to deal with that because that hasn't been as present in the population.

01:24:27 Heather Hall

But again, now as we're going through this, this change, you know, some of these providers are having to deal with it more and therefore are having to to try to figure out how do they actually address that.

01:24:39 Heather Hall

And you know, it's not necessarily even just a an issue.

01:24:42 Heather Hall

With with the.

01:24:43 Heather Hall

Health care provider.

01:24:44 Heather Hall

You know it's it's maybe even an issue of the patient dealing with their own.

01:24:48 Heather Hall

Health issue their own chronic disease you know such as diabetes.

01:24:51 Heather Hall

You know, if you're somebody who has diabetes and you need to be on insulin, you're going to need to have a refrigerator.

01:24:58 Heather Hall

Depending on you know how your treatment is going and so are you in a in a place where you have a refrigerator that you have access to where you can store your medication or you do.

01:25:07 Heather Hall

Or do you have access to more foods that.

01:25:11 Heather Hall

You know that aren't as starchy, or that will raise your blood sugar as much so.

01:25:16 Heather Hall

Yeah, so that that really comes into play with diagnosis and treatment.

01:25:20 Heather Hall

You know the the again the environment that you're living in, the healthcare infrastructure.

01:25:25 Heather Hall

All of those can really impact.

01:25:27 Heather Hall

Uhm, you know diagnosis and treatment again, not only.

01:25:31 Heather Hall

For the health care.

01:25:32 Heather Hall

Provider but again also for the patient.

01:25:34 Yasmine

Thank you Heather, for for bringing up.

01:25:36 Yasmine Vaughan

The the flip side of that.

01:25:38 Yasmine

And the the linkage between malaria in the United States and its linkage.

01:25:43 Yasmine

To other places and.

01:25:44 Yasmine

The ability to diagnose and treat being unequally distributed.

01:25:49 Yasmine

And you know to harken back we were talking about earlier about the interconnectedness.

01:25:53 Yasmine

Of the Sustainable development goals.

01:25:55 Yasmine

We see with climate change.

01:25:57 Yasmine

That this is a massive problem as we see in the United States, especially West Nile virus, West Nile virus being more common and more prevalent in places like Florida and the southern parts of the United States.

01:26:10 Yasmine

Because of the changing climate and having providers that have the ability to diagnose these conditions, even though.

01:26:18 Yasmine

They're sort of.

01:26:18 Yasmine

New so to speak to the area like we were saying before.

01:26:22 Yasmine

Health global health is.

01:26:24 Yasmine

We should have had a bet on how many times we are going to say interconnectedness, but these things are all connected and looking at global health from this global perspective is is really important.

01:26:35 Yasmine

I think you know to wrap.

01:26:36 Yasmine

Up as we've seen in today's episode, the health issues faced.

01:26:40 Yasmine

In one part.

01:26:40 Yasmine

Of the world, massive impacts on other parts of the.

01:26:43 Yasmine

World we've seen in the last few years.

01:26:45 Yasmine

An emerging disease in China.

01:26:47 Yasmine

Has the ability to impact everyone everywhere and we know that these issues in International Development like climate change, poverty, clean water are also connected to health and these are all impacted by social systems and by health systems.

01:27:02 Yasmine

You know it helping children worldwide.

01:27:03 Yasmine

We care about health issues.

01:27:04 Yasmine

All around the world.

01:27:06 Yasmine

And we seek.

01:27:07 Yasmine

Perceived good.

01:27:08 Yasmine

For everybody, so I hope you've enjoyed this overview.

01:27:11 Yasmine

If you were still there, listening with us of what is global health this, like I said before, this mile wide and inch deep overview of the topic and.

01:27:21 Yasmine

Heather, thank you.

01:27:21 Yasmine

So much for sharing your knowledge and your experience with us.

01:27:25 Yasmine

We hope to have you on the episode or on the podcast.

01:27:28 Yasmine

Do another episode again one day.

01:27:30 Heather Hall

Yeah great, thanks so much.

01:27:31 Heather Hall

I've had such a good time.

01:27:33 Heather Hall

I love talking about global health and public health and it's been a joy.

01:27:37 Heather Hall

Right, thank you, thank you.

01:27:39 Announcer

To learn how you can get involved in the work of helping children worldwide in global health, go to helpingchildrenworldwide.org global health.

01:28:05 Speaker 5

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