Part I- To Get Inspired, Build Empathy into Your Project Plan

~Written by Lauren Spigel, Monitoring and Evaluation Coordinator (Contact: lauren.spigel@vaxtrac.com; Twitter: @vaxtrac)

Also published on VaxTrac blog

Build Empathy First
In our first blog post about human centered design, we talked about building empathy for design thinking. But what does “empathy” really mean, and how does it translate into research methodology?

To have empathy is to understand another’s perspective. If your goal is to build empathy with the community you’re designing for, it’s important to budget time, space and resources to talk to a variety of project stakeholders about the challenge you’d like to solve before the project starts. While it’s difficult to convince donors to spend money on an extended R&D phase, giving communities a voice at the onset of your project can save your organization time and money by allowing stakeholders to voice their opinions and be active participants in the design process.

The methods we use to build empathy are reminiscent of the research methods found in academic settings. Human centered design is especially akin to the philosophy of community based participatory research (CBPR), which also recognizes that when given a voice, communities are best equipped to identify sustainable solutions to challenges they face. Like CBPR and more traditional qualitative research methods, human centered design relies on interviews, focus groups, observations, surveys, card sorts, among other interactive methods, such as role plays, immersion and community mapping to elicit feedback from stakeholders.

Let’s dive into the case example of how we are building empathy with health workers in Nepal to improve our user interface and workflow.

The Problem
The clinics we work with in Nepal are fundamentally different than the clinics we work with in Benin. In Benin, the clinics are urban and busy. There are vaccination sessions almost every day. Caregivers bring their children to the clinics for vaccinations.

By contrast, the clinics we work with in Nepal are rural. The population is dispersed. As a result, vaccinations only happen a few days a month. There may be one or two sessions that take place at the main clinic, but there are usually also a number of outreach sessions, in which the health workers walk several hours to sub-health posts within their catchment areas. Since the population is small, only a few children come to each session.

Building Empathy through Brainstorming and Workflow Cards
There are a number of methods we could use to get into the mindset of the health worker. The key is to remember that health workers are the experts. They understand their job better than anyone else. Our job is to listen, build empathy for what they experience in their jobs and translate that into our software design.

We are starting with the goal of understanding health workers’ workflows in different situations. In other words, what do health workers do to prepare for a vaccination session? What happens during a session? What happens after?

Our DC-based team started by brainstorming objects, people and actions involved in a vaccination session. We scoured the internet for images to represent everything that we came up with. We put together sample workflow cards and brought it to our project partners in Nepal.

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Draft Workflow Cards (Source: vaxtrac.com)

Seeing the sample workflow cards inspired our in-country partners Amakomaya to continue the brainstorm. They looked at our cards and told us what images worked and which images did not convey the right meaning. They grabbed a marker and started brainstorming their own list. We sketched images together.

We designed an interactive activity with health workers to use the workflow cards to get a better understanding of the different workflows they use during vaccination sessions. We are currently working to add Amakomaya’s feedback into an updated version of the workflow cards, which we will test out with a group of health workers early this year.
Using cards with simple images on them is a great way to get health workers talking about how they do their work. Cards are tangible objects that health workers can put in their hands and arrange in different ways. It gives the group a visual to refer to when someone has a question. It allows our team and health workers to identify gaps in the work flow as well as pain points.

We hope that by understanding current workflows and processes, we can understand the challenges that health workers face in their daily jobs and iterate our software so that it improves their workflow.

Check out our next post in our series about human centered design next week, where we’ll give examples of how we’ve been prototyping a monitoring and evaluation dashboard with our team in Benin.
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To learn more about incorporating design thinking into your projects, contact Lauren at lauren.spigel@vaxtrac.com or check out IDEO’s resources

Defeating Tuberculosis: A Possibility?

~Written by Sarah Khalid Khan (Contact: sk_scarab@yahoo.com)

Disease has always played a part in reforming community and geographical distribution of people through the ages. The bubonic plague, the Spanish flu, cholera and tuberculosis (TB), are some of the illnesses that have altered human history. Interestingly, TB has been glorified in literature more than others. The characters, Mimi in La boheme, Fantine in Les Miserables and Satine in Moulin Rouge all met with a similar fate at the hands of this disease.

According to the Global Tuberculosis Report 2015, the year 2015 is considered a turning point for TB as the global community progressed from Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs). TB mortality has decreased by 47% since 1990. Between 1990 and 2014, as a result of correct and timely diagnosis, 43 million lives were saved. We have made progress by moving from the “Stop TB Strategy” to the “End TB Strategy”. According to the latter, the targets for 2030 are to reduce the number of TB deaths by 90% and incidence by 80% (1).

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Source: TBAlert.org

These statistics give us hope for a world without TB. But, having worked in a tertiary hospital in a low middle-income country, I have my doubts. Although the statistics reported by the World Health Organization (WHO) are the best available at the moment, these are estimates with very wide confidence intervals and may not provide a precise idea of the current situation in low and low middle income countries (LIC and LMICs).

In the surgical ward where I worked, one-third of the abdominal procedures were for perforation due to abdominal TB. To my knowledge, patient records were maintained through an electronic health system on the hospital server. Hard copies of the records were kept in nurses’ offices or junior doctors; duty rooms. These were put in storage, usually available for 4 to 5 years. The conditions of the storage area were extremely shabby and damp, where paper records could hardly survive. Electronic records, however, were said to be available in perpetuity. No one knew if these records were ever shared with the WHO to help with estimates. Popular opinion was that if the world knew the actual incidence and prevalence of diseases like TB in countries like ours it would be an embarrassment. Regardless, it is essential to have as accurate as possible estimates to converge efforts towards a TB free world.

Despite the best intentions and apparently achievable goals, the situation remains grim. According to the WHO, TB still imposes a great burden on the world. In 2014, 9.6 million new cases of TB were diagnosed while 1.5 million people died as a result of TB (2). Despite the history of this disease, research for newer TB drugs has been limited (3). In 2012, a new drug for multidrug resistant TB was introduced after a drought of 50 years (4). In addition, though BCG vaccines are part of immunization programs in countries where the disease is endemic, the current vaccine was developed in 1921 and is not entirely effective (5). A systemic review and meta-analysis that included articles from 1950 to 2013 reported 19% efficacy against TB in vaccinated children compared to non-vaccinated children (6). Although current research is encouraging there are questions of affordability of newer drugs for low resource countries where TB is more prevalent. Furthermore, five percent of the global burden of TB is due to multidrug resistant strains (7). The research required for averting these cases poses additional problems of affordability, availability and accessibility in LICs and LMICs.

Children present another area of grave concern. It is estimated that 550,000 children are infected with TB each year. The condition is frequently overlooked in children, often due to delayed and inefficient diagnosis (8). Adoption of the latest recommended diagnostic tools by the WHO is a challenge in itself because accessibility, affordability and availability again come into play in LICs and LMICs. Since TB flourishes in poor living conditions, the current global refugee and migrant situation has increased concerns about TB exposure, infection and transmission (9).

It is time that LICs and LMICs focus on establishing the true burden of major diseases like TB, and work towards adopting recommended diagnostic tools and treatment for all forms of TB. Unless the state actors and international community work together, the policies and aid provided will continue to fall short and the target to end TB will remain out of reach.

References:

1. World Health Organization. Global Tuberculosis Report 2015. 2015.

2. World Health Organization. Research for Tuberculosis Elimination. 2014.

3. Frick M. 2014. Report on Tuberculosis Research Funding Trends, 2005-2013. [Internet]. Treatment Action Group. 2015. Available from: http://www.treatmentactiongroup.org/sites/tagone.drupalgardens.com/files/tbrd2012 final.pdf

4. Médecins Sans Frontières, International Union Against Tuberculosis and Lung Disease. DR-TB Drugs Under the Microscope. Sources and prices for drug-resistant tuberculosis medicines. 2nd edition. 2013.

5. World Health Organization. Tuberculosis vaccine development [Internet]. World Health Organization; 2015 [cited 2016 Mar 19]. Available from: http://www.who.int/immunization/research/development/tuberculosis/en/

6. A Roy et al. Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systemic review and meta-analysis.  BMJ 2014; 349:g4643

7. World Health Organization. Multidrug Resistant Tuberculosis (MDR-TB). 2015.

8. World Health Organization. Combating Tuberculosis in Children. 2015.

9. World Health Organization. Tuberculosis prevention and care for migrants. 2014.

How to Incorporate Design Thinking into your ICT4D Projects: A Blog Series

~Written by Lauren Spigel, Monitoring and Evaluation Coordinator (Contact: lauren.spigel@vaxtrac.com; Twitter: @vaxtrac)

Also published on the VaxTrac blog

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2015 was a year abuzz with talk about human centered design in the international development community. Words like “human centered” and “design thinking” may sound like international development buzzwords on par with “sustainability” and “capacity building” (thanks Devex), but behind the words are tangible methods you can use to elicit feedback from the people your project serves and use their insights to build better, smarter solutions.

If we break down the jargon, human centered design means to listen to the people that you are building a program for – before, during and after implementation. You listen to them because they are the experts. If you are designing an app for health workers to register patient data, you listen to health workers because they are experts on their workflow and needs. If you are designing an educational SMS system for youth, youth are experts in understanding what they want to know and how they want to discover that information. Simply put, human centered design is a series of methods implementers can use to engage with users throughout a project’s lifespan.

The human centered design process walks us through methods we can use during three key phases

1. Inspiration: defining the problem, the audience, understanding facilitators and barriers
2. Ideation: brainstorming ideas, testing out prototypes, finding the best solution
3. Implementation: choosing the best idea and implementing it, while still getting feedback and iterating

While human centered design is typically thought about in terms of technology projects, in recent years, the concept has been applied more broadly to solve complex global health challenges. In an interview with WIRED magazine, Melinda Gates, Co-Chair and Trustee of the Bill and Melinda Gates Foundation, described human centered design as “meeting people where they are and really taking their needs and feedback into account.” It sounds intuitive that we would want to understand the needs of the people we serve, but we often lack the tools and resources to do this well.

We are writing a three-part blog series to share our own experiences designing a mobile vaccine registry system for health workers. Our blog series will give case examples of the methods we used at various stages of the human design process. The first post will focus on how we are building empathy with health workers in Nepal to improve our user interface and workflow. The second post will look at how we’ve been prototyping a monitoring and evaluation dashboard with our team in Benin. Lastly, our final post will emphasize the importance of iterating after implementation by sharing our experience customizing our software, based on user feedback in Benin and Nepal.
We hope you will be able to use our experience to incorporate human centered design into your own projects.

To learn more about incorporating design thinking into your projects, contact Lauren at lauren.spigel@vaxtrac.com or check out IDEO’s resources

Let's Talk about Sex: Why the Zika Outbreak is Really about Reproductive Rights for Latin American Women

~Written by Sarah Borg (Contact: sarahannborg@gmail.com; Twitter: @sarahannborg) 

Also published on PLOS Blogs 

Health Ministries of Latin American countries have recommended that women avoid pregnancy until 2018 due to the presumed prenatal consequences of Zika virus. This is despite a lack of sexual education in schools, limited contraceptive access, and strict abortion laws. Women attempting to adhere to this health policy are faced with cultural, religious, financial and legal barriers.

There are a growing number of Zika virus cases, currently estimated at around 1.5 million, with the majority concentrated in Brazil. Over the past twelve months, cases of microcephaly (a rare condition in which babies are born with abnormally small heads and underdeveloped brains) in Brazil have risen from less than 200 to over 4,000. It is postulated that this is a complication of Zika virus.

The issue is further exacerbated by social inequality. The poorest of women in Brazil live in regions where mosquito-borne diseases like Zika are more prone. Often these women spend much of their time working outdoors, exposed to mosquito bites. They often cannot afford to pay for safe abortions, and have less access to prenatal care where diseases may be identified in utero. These women will be the ones who end up having to care for disabled children without the level of adequate education and knowledge required to look after them.

The Zika outbreak has highlighted a dire need for comprehensive sexual and reproductive health care for all Latin Americans. The United Nations high commissioner for human rights has called for Latin America to allow contraceptive and abortion access in response to Zika. Unfortunately, cultural and religious opposition impedes the choice to prevent a pregnancy that could result in an infant with microcephaly or other neurological disorders. The Christian culture of Latin American countries has left women in a precarious position. Many women, especially of lower socioeconomic status, do not have the means to avoid accidental pregnancy or exposure to Zika, and if unwanted pregnancies occur, there are few safe options available.

Rates of abortion, including unsafe abortion, are predicted to rise in Latin America. An unsafe abortion is a procedure to terminate an unwanted pregnancy by persons lacking the necessary skills and/or in an environment which lacks the minimal medical standards. Ninety-five percent ofabortions in Latin America are currently unsafe. Unsafe abortions account for 13% of maternal mortality and result in the death of 47,000 women per year worldwide.

Abortion laws in most Latin American countries are strict. Currently, knowledge that a child will suffer from microcephaly or serious neurological disorders is not grounds for a legal abortion in Brazil. However, abortions are still common. One in five Brazilian women under 40 have had at least one abortion. El Salvador, one of the countries affected by Zika virus, has some of the most severe abortion laws in the world. Abortion can result in a 40-year prison sentence regardless of whether if it is for a victim of rape, foetal anomaly, or the woman’s life is in danger. There have even been cases of women being charged with homicide for having miscarriages or stillbirths. Thus, women in El Salvador face another worry in addition to the potential consequence of miscarriage or stillbirth from Zika virus – prosecution for intentional abortion or homicide.

Conditions where demand for modern contraception and abortion are not met, like in current day Latin America, can lead to high rates of unsafe abortion. Tactics of advising abstinence have been long proven to be ineffective, and dangerous, and evidence shows us that making abortion illegal is not the solution either. If we want to prevent unsafe abortion, couples need to be provided with effective, comprehensive, accessible, appropriate and affordable family planning and sexual and reproductive health education. It has been demonstrated in various countries thatwhen modern contraceptive methods become available and their use increases, abortion rates decrease. If women who were not using contraception but wanted to delay pregnancy were provided with effective contraception, 30% of maternal deaths could be avoided worldwide.

In a step towards the right direction, Pope Francis recently indicated that while abortion is an “absolute evil”, “avoiding pregnancy is not an absolute evil,” and may be the “lesser evil” in certain circumstances like exposure to Zika virus, indicating a potential nod towards contraceptive use.

If Latin American governments do not address the issue soon, they will be faced with increasing rates of maternal mortality resulting from unsafe abortion and a generation of disabled infants cared for by parents who lack adequate financial and educational capacity to care for them.

Battling Cancer across Different Income Settings

~Written by Sarah Khalid Khan (Contact: sk_scarab@yahoo.com)

David Bowie, Alan Rickman and Rene Angelil, are a few of the well-known people that the world lost to cancer in the year 2015. My familiarity with cancer comes not just from losing my favourite celebrities to cancer, or dealing with patients in a tertiary care hospital in Lahore, but also from losing a few people very dear to me in my family. Every case of cancer is a battle for the person, their families, friends and doctors, as well as the healthcare system.

Cancer forms a major proportion of non-communicable diseases today. There were an estimated 14.1 million new diagnosed cases of cancer with an estimated 8.2 million deaths in 2012 (1). The most common sites of cancer have been recognized to be lung, colon, breast, liver, stomach and the cervix while the majority of cancer-related deaths are due to lung, stomach and esophageal cancer (2). Previously, cancer remained a low priority for low income (LICs) and low middle income countries (LMICs), as well as for donors (3). In 2008 72% of deaths due to cancer occurred in LICs and LMICs (4).  This may be a consequence of not only longer life spans and the majority of the world’s population being in the LIC and LMIC countries but also a lack of accessible and affordable treatment in these parts of the world.

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Estimated global numbers of new cases and deaths with proportaions by major world  regions, for all malignant cancers (excluding non-melanoma skin cancer) in both sexes combined, 2012. Source: The Cancer Atlas

While higher income countries have progressed from chemotherapy and radiotherapy to gene therapy, LMICs continue to focus on finding ways for uneducated or less educated to identify cancerous conditions in order to seek medical help before it is too late, for instance promoting breast self-examination. The increasing prevalence of cancer in LMICs exasperates the health sector with an already increasing burden of infectious diseases like tuberculosis, malaria and diarrhea. In these contexts cancer contributes to altering the epidemiology of these countries adding to the burden of non-communicable diseases which in turn worsens the double burden of disease. This creates considerable strain on the healthcare system due to increasing needs of diagnostic and treatment modalities besides the already unmet needs concerning infectious diseases.

There is an immense need for healthcare systems in resource poor settings to focus more on prevention rather than cure. Health professionals working in LMICs need to place greater emphasis on informing and educating people about warning signs of cancer as many resource poor settings have technology constraints and limited means of gaining health information. There are no quick fixes and circumstances are never as simple as they seem. Campaigns against smoking to prevent lung cancer have been addressed by discussions advocating for the rights of the poor who own tobacco farms as their only source of income (5). Modification of social behaviours for instance, requires extensive out-reach programmes by medical professionals but also bring into question the financial constraints of the country in order to pay for the services of these local healthcare workers.

In summary, LICs and LMICs have a longer way to go to provide sufficient healthcare for cancer patients. While high income countries are more likely to make medical advances for cancer treatment, resource poor countries can make strides through preventive measures like vaccination, behaviour modification and self-examination.

References :

1. Cancer. WHO Media Centre. World Health Organization; 2016 [cited 2016 Feb 14]. Available from: http://www.who.int/mediacentre/factsheets/fs297/en
2. World Cancer Report published by the International Agency for Cancer Research, WHO
3. Scaling up cancer diagnosis and treatment in developing countries: what can we learn from the HIV/AIDS epidemic? Can Treat International. Ann Oncol [Internet]. 2010;21(4):680–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20338877
4. Cancer in Developing Countries International Network for Cancer Treatment and Research. INCTR. 2016 [cited 2016 Feb 14]. Available from: http://www.inctr.org/about-inctr/cancer-in-developing-countries/
5. Tobacco Company Strategies to Undermine Tobacco Control Activities at the World Health Organization. Committee of Experts on Tobacco Industry Documents. World Health Organization. 2000.
   
6. International Women ’ s Day 2014 : women ’ s health equity is progress for all. Ginsburg O. 2014.

Uncovering the Realities of Human Trafficking

~Written by Sarah Weber (Contact: sarahkweber@gmail.com)

There is a hidden business of slavery that is tucked away from the untrained eye but alive and thriving today. The word "slavery" most likely conjures up images of African slaves in the United States (US) or Great Britain, a practice that was abolished in the nineteenth century. Although every country in the world now has laws banning slavery (the last being Mauritania in 2007), slavery still exists today in almost every country. Modern day slavery, also known as human trafficking, affects tens of millions of women, men and children around the world in the form of forced labor, domestic servitude, and sex trade [1]. In fact, there are more slaves now than at any other time in human history [1]. While the exact number of people trafficked globally is unknown, research efforts to better understand the magnitude of the issue have estimated that 21 to 36 million people are trafficked worldwide [1]. Human trafficking is the second largest criminal industry in the world after drug trafficking. Yet, the public is often not aware that it is such a significant global issue, affecting people not only in far away countries, but also in the countries, and possibly even the communities in which they reside.

What is human trafficking?

The terms “human trafficking,” “trafficking in persons,” and “modern day slavery” all refer to, "The act of recruiting, harboring, transporting, providing, or obtaining a person for compelled labor or commercial sex acts through the use of force, fraud, or coercion" [2]. A common definition was adopted by the United Nations (UN)'s Protocol to Prevent, Suppress and Punish Trafficking in Persons as:

"Trafficking in persons" shall mean the recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power, or of a position of vulnerability, or of the giving or receiving of payments or benefits, to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation or the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal of organs [3].

There are many different types of modern day slavery, including: debt bondage, contract slavery, sex trafficking, forced or servile marriage, domestic servitude, child labor and child soldiers.  According to Free the Slaves, a nonprofit focused on advocating against modern day slavery and liberating slaves, approximately 78% of slavery victims are in forced labor, 22% are in sex slavery, and 26% are children under age 18[1]. Learn more about the types of slavery and global statistics in this Free the Slaves factsheet here.

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Source: freetheslaves.net

A key component of human trafficking is the use of force, fraud or coercion to lure victims into positions of exploitation. Traffickers generally prey on people who appear vulnerable, including those who are experiencing psychological or emotional vulnerability, economic hardship, lack of a social safety net, natural disasters or political instability. Women and girls who have been victims of sexual, physical or emotional abuse, and runaway children are particularly at risk. Refugees and/or people living in areas of war or political instability are also at increased risk [2].

Human Trafficking and Health

In addition to human trafficking blatantly violating human rights, it results in devastating long-lasting health consequences for the victims. Since victims are often dependent on their traffickers for their livelihood, receive limited food and are often malnourished. This is especially problematic for the estimated 5.5 million children in slavery today [4]. Women in forced prostitution and child soldiers, are often given drugs by their traffickers to ensure compliance, thus drug addiction is sadly all too common. Women forced into the sex industry are at risk of sexually transmitted infections and unwanted pregnancy and often don't have the agency to negotiate safer sex practices. [7]. In addition to the physical health effects, victims of human trafficking suffer from impaired emotional and psychological health [7]. Traffickers control through fear, physical, emotional and sexual assault, and manipulation [8]. This has negative impacts on victims and often leaves them ashamed, psychologically traumatized, emotionally attached, and afraid to leave their trafficker [8].

Raising Awareness Globally

Although human trafficking still does not receive an adequate amount of global attention or recognition, efforts in the last decade have elevated awareness of the problem. In 2010 the UN General Assembly adopted the Global Plan of Action to Combat Trafficking in Persons and urged countries to take coordinated efforts to combat and eliminate human trafficking [3]. In 2013 the UN General Assembly adopted a resolution, designating July 30 as the World Day against Trafficking in Persons. The resolution was made to, “Raise awareness of the situation of victims of human trafficking and for the promotion and protection of their rights” [5]. In December 2014, the president of the US, Barack Obama, established January as National Slavery and Human Trafficking Prevention Month in the US and January 11th as Human Trafficking Awareness Day, in recognition that modern day slavery or human trafficking still exists in communities across the US and the globe [6].

It is important to remember that human trafficking happens across the globe. It isn't something that just happens across international borders and/or in low- or middle-income countries. The US has an estimated 60,000 victims of slavery and the United Kingdom (UK) has an estimated 13,000 [1]. While a majority of these victims come from overseas, an alarming number of people are trafficked domestically within both the US and the UK, with the Federal Bureau of Investigation estimating that 293,000 American youth are at risk for sex trafficking within the US each year [9]. Given the rise of social media and the Internet, traffickers now use the Internet as a primary mechanism for recruiting victims both internationally and domestically.

Stopping Demand

Efforts to educate the public are an important step in combating the issue. Human trafficking is an industry because there is demand. Traffickers are motivated by high profits, with an estimated $150 billion USD generated by traffickers each year [1]. Therefore, decreasing/stopping the demand is key to eliminating human trafficking. "Sex tourism"- travel planned for the specific purpose of sex, generally to a country where prostitution is legal - fuels the demand for human trafficking, as does large events which bring in crowds of people [10]. In fact, the US Super Bowl is one of the largest magnets for sex trafficking globally [10]. Efforts to hold accountable both the traffickers and those purchasing the services are needed to stop the demand. Global efforts such as the UN's Protocol to Prevent, Suppress and Punish Trafficking in Persons, tougher sentencing for traffickers and purchasers in many countries, and local efforts to raise awareness in communities are helping to combat the issue. However, vigilance and awareness from all people and continued united global efforts are needed to end human trafficking.

References:

1. Free the Slaves. http://www.freetheslaves.net/about-slavery/  

2. United States Trafficking in Humans report, July 2015. http://www.state.gov/documents/organization/243557.pdf 

3. United Nations Office of Drugs and Crime. https://www.unodc.org/unodc/en/human-trafficking/what-is-human-trafficking.html?ref=menuside

4. Anti-Slavery International. http://www.antislavery.org/english/slavery_today/child_slavery/default.aspx

5. United Nations World Day Against Human Trafficking in Persons. http://www.un.org/en/events/humantrafficking/

6. United States Department of Homeland Security. http://www.dhs.gov/blog/2015/01/20/national-slavery-and-human-trafficking-prevention-month

7. Center for Disease Control and Protection. http://wwwnc.cdc.gov/travel/page/sex-tourism

8. Polaris Project. https://polarisproject.org/victims-traffickers

9. Federal Bureau of Investigation, Law Enforcement Bulletin. https://leb.fbi.gov/2011/march/human-sex-trafficking

10. Federal Bureau of Investigation. https://www.fbi.gov/phoenix/press-releases/2015/super-bowl-sex-trafficking-operation 

Health Promotion: An Effective Approach to Achieve the Sustainable Development Goals

~Written by Karen Hicks, Senior Health Promotion Strategist & Lecturer, New Zealand (Contact: karen_ahicks@hotmail.com)

In September 2015 the United Nations adopted seventeen sustainable development goals (SDGs) (Figure 1) as part of the 2030 Agenda for Sustainable Development; which aims to end poverty, fight inequality, injustice, and tackle climate change. These SDGs are acknowledged as going beyond the previous Millennium Development Goals (MDGs) as they aim to address, ‘The root cause of poverty and a universal need for development that will work for all people’ (United Nations, 2015).

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Figure 1. Sustainable Development Goals. Source: http://wfto.com/sites/default/files/field/image/2015-07-21-SDGs.png

Each of the SDGs relate to health and wellbeing with aims, approaches and principles that are concomitant to the discipline of health promotion; a discipline that acknowledges the complexity of health and is based on the principles of human rights, equity and empowerment (Williams, 2011). Consequently, such principles imply that health promotion is an effective approach toward achieving the SDGs. This approach is supported by the global framework and described in “The Ottawa Charter for Health Promotion” (WHO, 1986) (Figure 2) which identifies five key action areas: building healthy public policy, creating supportive environments, strengthening community actions, developing personal skills and reorientating health services through advocacy, enabling mediation for effective practice.

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Figure 2. The Ottawa Charter for Health Promotion Logo. Source: http://www.who.int/healthpromotion/conferences/previous/en/hpr_logo.jpg 

An example of a collaborative initiative that illustrates health promotion as defined in the Ottawa Charter is the International Network of Health Promoting Hospitals & Health Services (HPH). The initiative works to reorient health care towards an active promotion of health for patients, staff, and communities. Further detail on the approach can be accessed on the HPH website.  

The principles and actions illustrated alongside the interdisciplinary approach of health promotion that empowers people and communities (Health Promotion Forum of New Zealand, 2014) and focuses on equity and the broader determinants of health (Davies, 2013) is acknowledged by the World Health Organisation, “Health promotion programmes based on principles of engagement and empowerment offer real benefits. These include: creating better conditions for health, improving health literacy, supporting independent living and making the healthier choice the easier choice” (WHO, 2013 p 16).  The value associated with the approach clarifies how health promotion can effectively contribute to achieving the seventeen SDGs where the SDGs can guide the delivery of effective health promotion to improve health, wellbeing and personal development throughout the global community.

References:

Clinical Health Promotion Centre. The International Network of Health Promoting Hospitals & Services.  http://www.hphnet.org/ Accessed 22/1/2016. Bispebjerg University Hospital Denmark.

Davies, J.K. 2013. Health Promotion: a Unique Discipline? Health Promotion Forum of New Zealand.

Health Promotion Forum of New Zealand. 2014. http://www.hauora.co.nz/defining-health-promotion.html#sthash.5sStc8VF.dpuf.

United Nations. 2015. http://www.un.org/sustainabledevelopment.

Williams, C. 2011. Health promotion, human rights and equity. Keeping up to date. Health Promotion Forum of New Zealand.

World Health Organisation. 1986. The Ottawa Charter for Health Promotion. WHO.

WHO (2013) Health 2020: a European policy framework and strategy for the 21st century Copenhagen, World Health Organisation.

The Environmental Cost that Living in this World Puts on Our Health

~Written by Sarah Khalid Khan (Contact: sk_scarab@yahoo.com)

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Source: Environmental Health, World Health Organization (WHO)

As revolting as it sounds, there are places in the world where the chances of consuming one’s neighbours’ faeces are quite high if one is not vigilant regarding sanitation and hygiene. That being the condition of many areas in low and lower-middle income countries does not mean that high and higher-middle income countries are exempt from any environmental conditions that are harmful to health.

But, what is environment health? The World Health Organization (WHO) defines the term as, “All the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours”. It, however, excludes genetics and the social and cultural environment.

In low-income settings, concerns for environmental health may arise in the context of sanitation and hygiene, as well as indoor and outdoor pollution. In high-income countries, many chronic diseases like diabetes and cardiovascular disease, are associated with sedentary lifestyles. While these might be attributed to behaviour, one must consider that such behaviours can arise from changes in the environment. Over 80% of communicable and non-communicable diseases can be attributed to environmental hazards.  Overall, conservative estimates indicate that about one quarter of the total global burden of disease is owing to this cause (WHO, 2011). Furthermore, the biggest killers of children under 5 years are all environmental-related diseases, including diarrhoea, respiratory infections, and malaria.

Other diseases of concern are helminthic infections, trachoma (a bacterial eye infection), Chagas disease, leishmaniosis, onchocerciasis, and dengue fever. All of which are associated with impoverished conditions and can be mitigated by improving sanitation, hygiene, and housing. Although conflicts and natural disasters might be catastrophic for any country, struggling economies tend to suffer more because disasters worsen the poor conditions which directly affect sanitation and hygiene practices, creating conducive conditions for various infectious diseases, and ultimately feeding into the vicious cycle of poverty.

Many interventions are underway to address these conditions, including Water, Sanitation and Hygiene (WASH) initiatives, Integrated Vector Management, Programme on Household Air Pollution, International Programme on Chemical Safety, Health and Environment Linkages Initiative, and Intersun Programme for the effects of UV radiation. The acknowledgement of the effects of the environment has grown. One of the Millennium Development Goals (MDGs) was, “To ensure environmental sustainability.” The Sustainable Development Goals (SDGs) are more extensive and thorough in placing focus on the environment. Goal 1 is to end poverty, goal 6 is to make provision of clean water and sanitation possible, and goal 13 is to stop climatic change resulting in floods and drought (United Nations, 2014).

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The Sustainable Development Goals. Source: United Nations System Staff College

It is encouraging to see steps being taken to control environmental hazards; however, the journey to measuring and eradicating such conditions still remains a challenge, which will hopefully be overcome through future endeavours.

References:

United Nations (2014). Sustainable Development Goals. doi:10.1017/CBO9781107415324.004

World Health Organization (2011). WHO Public Health & Environment Global Strategy Overview

Recent Therapeutic Advancements in Combating Dengue and Glioma

~Written by Kate Lee, MPH (Contact: kate@recombine.com)

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Sanofi-Pasteur's Dengvaxia has been approved for the prevention of the four subtypes of dengue in children over 9 years old and adults under 45 years old. Photo Credit: European Pharmaceutical Review

Infectious and chronic diseases are some of the top priorities in global health. Abundant funding, both from the government and private sector, is poured into therapeutics research to help decrease morbidity and mortality from both types of diseases. For example, recent news has highlighted two promising therapies with the potential to alleviate the global burden of two diseases: dengue fever, an infectious disease, and glioblastoma, a chronic disease.

After 20 years of research, Sanofi, a French pharmaceutical company, developed Dengvaxia, a vaccine to prevent dengue. Mexico is the first country to approve the vaccine for use in children over the age of nine and adults under the age of 45. A clinical trial last year found the vaccine to have an effectiveness of 60.8% against four strains of the virus[1]. Sanofi bypassed European and US regulations and sought regulatory approval for Dengvaxia in dengue-endemic countries. According to their press release, the vaccine, “will be priced at a fair, affordable, equitable, and sustainable price... and may be distributed for free in certain countries”[2].

Dengue is a febrile viral illness that is spread via the bite of an infected mosquito, and is endemic to tropical and sub-tropical climates. According to the World Health Organization (WHO), about 400 million people globally are infected with the dengue virus each year. Prevention has been limited to effective mosquito control and appropriate medical care[3]. These measures are often either ineffectively implemented, or there are limited, or no available medical resources in the community. Dengvaxia has the potential to reduce the burden of dengue, especially in developing countries that are particularly hard-hit with the disease. Future research could be directed towards making the vaccine more effective in children, as severe forms of dengue are the leading cause of illness and death in children in Asian and Latin American countries[3].

As one tropical virus is being prevented, another virus is being used to combat brain cancer. Researchers at Harvard and Yale have teamed up to use vesicular stomatitis virus (VSV) and Lassa virus, to search for and destroy cancer cells in mice[4]. Lassa is a febrile illness, usually transmitted by rodents, and is endemic to tropical and subtropical regions of the world[5]. VSV has been studied for many years and is generally effective in killing cancer cells; it becomes deadly to the patient when it reaches the brain[4,6]. Interestingly, including Lassa virus appears to make VSV safe for cancer therapy in the brain.

Researchers created a Lassa-VSV chimera, an organism that includes the genetic codes of two different organisms, to target glioma, one of the deadliest forms of brain cancer, which accounts for more than 80% of primary malignant brain tumors[7]. Glioblastoma is the most common form of glioma and is associated with poor survival, making this chimeric treatment a potential life saver for many patients. The next step in the treatment development process is primate research to evaluate safety. This is still a long way from the initiation of human trials, and eventual market, but promising nevertheless, for the millions of people globally who are affected by brain cancer.

Dengvaxia and the Lassa-VSV chimera represent recent advancements in therapeutics with potentially significant global impact for brain cancer and dengue respectively - diseases that affect populations in many nations.

References:

1.     Sanofi's Dengvaxia, World's First Dengue Vaccine, Approved For Use In Mexico. International Business Times. http://www.ibtimes.com/sanofis-dengvaxia-worlds-first-dengue-vaccine-approved-use-mexico-2219515. Published December 10, 2015. Accessed December 20, 2015.

2.     World’s First Dengue Vaccine Approved After 20 Years of Research. Bloomberg Business. http://www.bloomberg.com/news/articles/2015-12-09/world-s-first-dengue-vaccine-approved-after-20-years-of-research. Published December 9, 2015. Accessed December 20, 2015.

3.     Dengue and severe dengue. World Health Organization. http://www.who.int/mediacentre/factsheets/fs117/en/. Updated May 2015. Accessed December 20, 2015.

4.     Using a deadly virus to kill cancer: Scientists experiment with new treatment. The Washington Post. https://www.washingtonpost.com/national/health-science/using-a-deadly-virus-to-kill-cancer-scientists-experiment-with-new-treatment/2015/12/07/7d30bc5a-9785-11e5-8917-653b65c809eb_story.html. Published December 7, 2015. Accessed December 20, 2015.

5.     Lassa fever. World Health Organization. http://www.who.int/mediacentre/factsheets/fs179/en/. Updated March 13, 2015. Accessed December 20, 2015.

6.     Viral Therapy in Treating Patient with Liver Cancer. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01628640. Updated July 2015. Accessed December 20, 2015.

7.     Schwartzbaum J A, Fisher J L, Aldape K D, Wrensch M. Epidemiology and molecular pathology of glioma. Nature Clinical Practice Neurology (2006) 2, 494-503. doi:10.1038/ncpneuro0289