For those who are still mourning the passing of the late, and great, Allan Rosenfield, it will probably not come as a surprise that – even posthumously – he is continuing to enrich our views of reproductive health policy. This week’s NEJM carries an editorial from him and his colleagues on reproductive health issues in the US. This editorial is timely given that in less than one week, the US will have the chance to elect a new President.

They rightly argue, that the miring of reproductive health issues into debates over religion and personal freedoms, has lead to situation wherein the US now lags far behind all other developed nations with regards to reproductive health indicators, and it may even be the case that the situation is deteriorating. They argue that there is a need to reframe reproductive health issues through the lens of a public health perspective – a perspective that dissociates blame and emphasizes structural factors – to adequately address reproductive issues in the next administration.

He will be missed…

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With just a few weeks to go before the national election in Ghana, the race is really heating up. The race between the incumbent NPP and the main challengers, the NDC, has become quite close in recent weeks and as such, both parties are coming with new election promises in hopes of securing a few extra votes.

During the last few elections, the NPP have made important health related promises to shore up support. The creation of a national health insurance scheme was actually one such promise. Ghana is perhaps the poorest country in the world to have successfully implemented a national health insurance scheme.

Earlier today Nana Addo Dankwa Akuffo-Addo, the flagbearer for the NPP, made a new health related campaign promise. He has promised free accommodation to all health workers in the Ghana Health Service. Free accommodation will represent a significant increase in the salaries of health workers and some have speculated that payment in form of housing may lead to more job lock than just increased salaries, which could significantly improve the distribution and retention of health workers in rural areas.

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Ascendance in Global Health

On October 28, 2008, in aid effectiveness, global health, HIV/AIDS, by Karen Grepin

Why do some diseases or health issues capture our attention more than others? Why, as I referenced in an earlier post, do you some diseases get so much more money than other or that could be justified based on their disease burden?

Earlier today I had the great pleasure to attend a talk by Jeremy Shiffman at the annual APHA meeting in San Diego. He argues that it can largely be explained by the rise of institutions to support these diseases as well as how these issues are framed. For example, he argues that HIV/AIDS has successfully been framed as a threat to security, development, and society the world over – an argument that resonates well with donors. In addition, institutions, such as the UNAIDS have been very successful at propagating the exceptionalism of HIV/AIDS argument over the years. He now plans to spend much of the next year analyzing a series of case studies in global health to test his theory.

To read more on Jeremy’s work, click here.

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A post-doctoral researcher at the Center for Global Development wrote about another way in which cell phones are transforming life for people in Africa, even in one of the poorest countries in Africa, Niger. She discusses some work that shows that the introduction of cell phones led to a reduction in grain price differences between markets. This shows that there are large barriers to acquiring more information and that information technologies, such as cell phones, are reducing the prices to obtaining some information.

In the health context, I have started to see more examples of work that is looking at how information technologies are transforming health service delivery. For example, using cell phones to improve adherence to HIV/AIDS treatments, and even a way for health workers to get their pay checks by cell phone. I can’t wait to see more.

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New global and public health programs

On October 27, 2008, in education, global health, public health, by Karen Grepin

I am currently attending the 136th annual American Public Health Association conference in San Diego, CA. One of the things I have been most surprised by is the proliferation of new programs in public health and or global public health.

Here are just some examples:

UCSF

George Mason

Claremont

Washington University in St. Louis

I could go on, and on…

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Sad news

On October 27, 2008, in Uncategorized, by Karen Grepin

I had written in an earlier post about research which suggested that the presence of a gun how in a community did not lead to increased rates of either suicide or homicide, at least in the short-run. This morning there was national coverage of an accident that occurred at a gun show not too far from where I live in Boston where a boy actually shot himself accidentally at one such show. So much for averages…

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There was in interesting editorial in the Ghanaian Chronicle this morning (yes, I read these things), which quotes a public health nurse from the Cape Coast Region in Ghana that argues that Traditional Birth Attendants are the cause of high levels of maternal mortality in the country. I speculate a bit, but the crux of her argument is that their presence gives false hope to expectant mothers, making them feel like they are in good hands, but in fact if anything were to go wrong, the TBA would be unable to help them. Because the TBA is available, then they don’t go to a clinic.

The argument made is a controversial one…the problem in trying to evaluate it is what is the counterfactual situation for most poor rural women? In the absence of a TBA, would they be better off? Would the Ghana Health Service be more likely to provide services to her area? Would she be more likely to seek out services? Do they really add no value? Hard to say.

For those interested in this question, I’ll throw out two articles. The first, which suffers from some very significant methodological issues, argues that training of TBAs is not helpful. The second, a randomized experiment in Pakistan (one of the few such experimental research designs), argues that training can have a big impact. Of course, this last study looks only at the effect conditional on having chosen to invest in TBAs. This is a great area for future research.

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Yesterday afternoon the Gates Foundation announced the successful applications to their new Grand Challenges “Explorations” program. Unlike the first Grand Challenges program, launched the few years back, rather than soliciting grant applications from big name, multi-center, research powerhouses, this time the program sought out ideas from just about anyone who had a good idea and was willing to discuss it on their 2 page application letter. But the big risk, big reward mentality that the Gates Foundation has been advocating remains.

Here are just one example of the successful applications:

Hiroyuki Matsuoka at Jichi Medical University in Japan thinks it may be possible to turn mosquitoes that normally transmit disease into “flying syringes,” so that when they bite humans they deliver vaccines.

By providing lots of smaller, $100,000 grants to researchers, the Foundation hopes to encourage more “out-of-the-box” research ideas. Basically stuff other foundations would be crazy to sponsor…at least at this stage in the game. Who would ever have thought that H. pylori could cause ulcers and that taking an anti-microbial could get rid of them? Just ask Barry Marshall, who literally drank a glass of the stuff to show that it did…and won a Nobel for his craziness.

Will it be successful? Who knows, but it certainly can’t hurt. It is not like the money would be better in the stock market these days….

To read more about the program, click here. Oh, and there is information there on the second round of the program as well.

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Fogarty International Fellowships

On October 22, 2008, in fellowships, global health, by Karen Grepin

I was recently made aware of a relatively new global health fellowship program intended for:

…medical residents and fellows, as well as scientists with PhDs engaged in health-related post-doctoral programs…

The fellowships are being offered from the Fogarty International Clinical Research Scholars Support and Research Center. The great thing about them is that they are very open to area of research, as well as to nationality. Non-US students, even those who did not go to school in the US, appear to be eligible.

Whenever I travel abroad, I always get questions from people I meet in these countries about scholarship and fellowship opportunities for further education. These look like they may be good options for a lot of people.

For more information, click here.

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Getting accurate, meaningful and internationally comparable measures of poverty is challenging in developing countries. Household surveys can use measures of income, consumption, and expenditures to try to estimate income although collecting data like this is very time consuming and does not always produce optimal results. Alternatively, many household surveys instead rely upon measures of asset ownership to proxy for wealth or poverty. While these are easier to collect, they still require tedious household surveys and the comparability across countries, or even within countries, can be problematic.

I saw an interesting paper this morning that uses remotely sensed measures of artificial night time lights as a proxy for poverty. Basically, your wealth with be correlated with your association with lights, either of your own, or in your community. Quite an interesting idea. The big advantages of this are that it uses existing data so does not require any additional data collection, is available continuously, and can be measured for the whole country, down to relatively small blocks. I am very curious to know how useful this measure will become, but for now think this is a really great idea…

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