As we near the end of June, which marks International Lesbian Gay Bisexual and Transgender (LGBT) Pride Month, we are joined by Michael Bare to discuss Diplomacy and LGBT public health. The TWiGHteam will talk barriers to LGBT Health globally, access to care and criminalization/violence against the LGBT community, how health professionals can advocate for change, and more.


On the recent RFRA legislation in the USA:

"The Abominable Crime" screening and discussion on Wednesday, July 15, is part of the Geopolitics of LGBT Rights Forum Series of the Johns Hopkins SAIS Center for Transatlantic Relations.

"The Abominable Crime" is a Pulitzer Center-supported, award-winning documentary by filmmaker Micah Fink that explores the culture of homophobia in Jamaica through the eyes of gay Jamaicans who are forced to choose between their homeland and their lives after their sexual orientations are exposed.

The film had its broadcast premiere on PBS World’s AfroPop series, and won the 2014 Trinidad and Tobago Film Festival's inaugural Amnesty International Human Rights Prize for a Caribbean film that best highlights a human rights issue. In its award announcement, the Festival described filmmaker Micah Fink’s documentary as a "touching, troubling reflection of the struggle gays and lesbians in Jamaica face to achieve their rights."

LGBTQ Health Conference: Bridging Research and Practice.

Saturday, October 31, 2015, 1 pm -7 pm

This year’s conference will more specifically focus on creating a dialogue between researchers and practitioners by integrating both research findings and clinical application into each panel or symposium. The LGBTQ Health Conference is an interdisciplinary translational research conference that aims to bring together scientists, public health professionals, social workers, psychologists, and counselors. We further aim to foster professional development and networking opportunities.

Researchers and practitioners at all levels, from students to established professionals, are welcome. Sessions will be designed for scholars conducting applied or translational research with LGBTQ populations and practitioners working with LGBTQ individuals and communities.

-       See more at:

33rd Annual ConferenceSeptember 24-26, 2015Portland, OR

world’s largest scientific gathering devoted to LGBT health issues and concerns.

GLMA’s Annual Conference educates practitioners and students—from across the health professions—about the unique health needs of LGBT individuals and families. The conference is a forum for discussion and exploration of how best to address these needs as well as the needs of LGBT health professionals and health profession students. GLMA’s Annual Conference also reports on research into the health needs of LGBT people.


**Be sure to watch the whole episode to hear stories from the field from both Dr. Eshaya-Chauvin and Dr. Greg Martin!**

Background: In conflicts, like those occurring in Sudan, Syria, Iraq, Yemen, Ukraine and beyond, war complicates the efforts of those not involved to get the health care they need. Speaking to this issue and representing the Health Care in Danger project was Dr Bruce Eshaya-Chauvin, Medical Advisor for the Health Care for the in Danger Project since November 2012, who has been many years in the field with the I.C.R.C as former head of Health Division of the ICRC and head of the Health Department of the International Federation of Red Cross and Red Crescent Societies.

The BIG issue: There are many major problems leading to lack of safe access to health-care including attacks against patients and health-care personnel (including kidnapping or murder), destruction of medical facilities and obstructions of health-care delivery.  A single act of violence that damages a hospital or kills health-care workers has a knock-on effect, depriving many patients of treatment they would otherwise have received from the facility or workers in question. It can also disrupt delivery of basic health-care services, such as mother and child care, treatment of chronic diseases) and vital public health programs such as vaccination campaigns.

So, what is Health Care in Danger: In 2011, the International Committee of the Red Cross (ICRC) launched its Health Care in Danger campaign, as global effort to mobilize support for health care providers in war zones and strengthen their capacity to provide lifesaving resources during civil conflicts. Respect for and protection of health care in armed conflicts and other emergencies is a huge problem that affects us all. 

How is HCiD currently working to resolve issues?  Instead of looking at incidents of violence in isolation, HCiD conducts a regular incident analysis in more than twenty countries where the ICRC is operational to look at problems “holistically”- consolidated in one place. You can check out the most recent of their comprehensive reports on violent incidents affecting the delivery of healthcare, covering 2012-2014, by heading hereHCiD collaborates with a huge number of organizations to to find solutions to violence that are tailored to the specific context.

*Events! Major international health-care organizations have agreed on a common code of ethics applicable in times of armed conflict and other emergencies. HCiD hosts "A Common Core on Ethics", on 30 June 2015!

*E-Learning!! The HCiD module introduces health-care personnel to the principles underpinning ethical considerations when working in conflict situations and other emergencies.

*More reading: A story on medical workers in conflict zones via NPRs Goats and Soda blog, the Human Rights Watch 2015 Report on Safeguarding Health in Conflict, and the GulfNews report on the state of Healthcare in Yemen. 
Also see the UNICEF blog on the Yemeni health system and the MSF press release on the bombing of hospitals in Syria, both from 18 June 2015.  Actually, just take a look at all MSF and ICRC press releases to get up to speed, including this one on ICRC opening a surgical hospital in Yemen despite all the fighting. 

*The Health Care in Danger youtube site is a wealth of information, covering different countries and the range of problems faced. Videos in EN and FR



RECAP - Jordan Jarvis of YP-CDN joined us again for this panel and brought a wealth of knowledge our way.  Definitely check out the show and post-show to hear her insights and perspective on NCDs and different aspects of the WHOs Global Action Plan (GAP) and 2014 status Report.  We focused on the implementation of the plan and talked Universal Health Care, Private sector involvement, poverty as a major obstacle, and barriers to prevention.  Here are some articles and publications that we found immensely helpful.  And for more on each of the nine individual areas the WHO wants to tackle, check out the actual report: Kris read the whole thing (you can too! or... just the first 5 pages OR check out the infographic... either way...) and says it is comprehensive, well organized, and easy to navigate!

Great articles from the UN, and report and statistic summaries from the Council on Foreign RelationsDevEx, and DevPolicy.  And we got some interesting info on progress in India, with a news story India is the first country to develop specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025.  

Add to all this: the WHO Europe just released a report about a new tool that helps countries reduce the marketing of foods with too much fat, sugar, and salt to children!


  • NCD’s, also known as chronic diseases, kill 38 million people each year, and almost three quarters of NCD related deaths occur in low- and middle-income countries.  
  • The death toll is projected to increase to 52 million by 2030. The report points out that if we do not take action in LMIC’s, the projected cumulative economic losses due to NCDs for the period from 2011-2025 is estimated at US $7 trillion.  This is a staggering number when you consider that the WHO estimates the cost of reducing the global NCD burden is US$ 11.2 billion a year: an annual investment of US $1-3 per capita.
  • In an effort to begin tackling the problem, the WHO published the first global NCD status report in 2010 and since then, we have made significant gains in regards to international cooperation and advocacy.
  • Then in 2013, the World Health Assembly approved the ‘NCD Global Action Plan’ (GAP) with the aims of reducing the number of premature deaths from NCDs by one quarter by 2025 (the “25 by 25 Plan”!). 
  • This 2014 status report aims to further define and support the implementation of all the targets by providing information and advice on how to scale up and implement programs, providing baseline and updated estimates of NCD mortality and risk factors, as well as case-studies.
  • It is very important to consider that action plans are more likely to be implemented if they are inclusive; developed in collaboration w/ full range of partners within and outside the state health sector. Ministries of Health need to work with Ministries of Education and the private sector (if we avoid conflict of interest!), to understand the impact of policies. (The Global Coordination Mechanism for NCDs helps sets the action plan and work toward targets, and you can read the discussion paper here!)

A strong NCD action plan is contingent on strong governance and leadership to coordinate and implement plans.  The leaders need to focus on prevention efforts the reduce risk of exposure to risk factors by providing supportive environments and promotion of health behavior, education, affordability. A strong plan also requires the strengthening of systems and a move toward Universal Health Care  to ensure people don’t fall into poverty due to health costs, while also working to improve efficiency of primary care  and increase domestic investment in health and health-financing mechanisms. Lastly the plan must help develop and standardize ways to measure progress an accountability, including the implementation of civil and disease registration, and mobilizing information and communication technologies to serve population health.

Episode 24: MEASLES

Here are a number of articles we found interesting but were unable to address in the show.  Many thanks to Brian Simpson at Global Health Now for always providing us with so many great resources!

Don't forget to head over to the JHU Measles Symposium event page where you can watch archived video of the meeting and get even more in depth information on the outbreak, controversy, and interesting insights into policy and prevention.

Measles Still Kills Thousands of Children Each YearGeorgia measles case a reminder disease is global issue, courtesy of the Seattle Times, and California warns against intentional measles exposures.  Want more on the global context? Read more on the German Measles outbreak from the Washington Post and CNN.

Be sure to look into The US and measles, from NPR, a Council on Foreign Relations interview with Laurie Garrett, and last up, HANS ROSLING talks Measles and vaccination rates.

Please check out more about the symposium and the Johns Hopkins Bloomberg School of Public Health!

TWiGH looks at Measles and more….

  • Measles is a highly contagious respiratory disease that causes rash, cough, runny nose, and high fever.
  • Complications of Measles can lead to Pneumonia, encephalitis, deafness, and death.  While the disease is especially dangerous to children and those with developed or weakened immune systems, a point well illustrated by information from the CDC citing that from 2001-2013, roughly 28% of children under age 5 who were infected with measles had to be treated for complications in a hospital.
  • Measles is an airborne disease caused by a paramyxovirus and can survive outside of the body on non-living objects and maintain transmissibility for up to 2 hours.
  • One person with measles can infect 90% of the people around him or her. Compared to other diseases in the news, Measles has the highest “R0” (R-Not) or reproductive rate - the number of people an infected individual infects.  The R0 for measles is 12-18,  4 for influenza and 2 for Ebola   
  • The Measles Vaccine - MMR: Introduced in 1963, the Measles vaccine has led to a remarkable drop in the incidence of measles. The vaccine is currently given as a combination in MMR which protects from Measles, Mumps and Rubella. Children are vaccinated with 2 doses - first between 12-15 months and second between 4 - 6 years. The MMR vaccine provides 97% protection against the disease.  
  • Vaccinations work on the concept of herd immunity which means in order for a disease to be eradicated, most of the population has to be vaccinated. As the vaccination percentage drops, the risk of an outbreak increases, which can be disastrous and lethal to immunocompromised populations or children too young to have been vaccinated yet.

In recent years, controversy about the safety of vaccines has arisen, based mostly on a 1998 study by Dr. Andrew Wakefield that was published in the Lancet claiming a link between autism and measles vaccine. Sadly, no one bothered checking the data or legitimacy of the study- the research was discovered to be fraudulent, the paper was retracted by the Lancet in 2010 and Wakefields' medical license was taken away


More Facts about Measles
- Studies show that Measles originated from the Rinderpest Virus which infects cattle and evolved to current day measles. It has no animal host and infects only humans making it an ideal candidate for vaccination efforts.
- The MMR vaccine is very important not just for protecting against Measles. Mumps and Rubella are the other M and R in MMR, and are also problematic diseases: many people don't realize complications can cause blindness, mumps could lead to sterilization, and whooping cough can be fatal.
- Measles was responsible for killing ⅓ of the native populations of Hawaii and Fiji when it was introduced there in the late 19th century.