The Global Health Wanderer

While in-flight magazines are not always thought of as the highlight of the journey, I have grown to slightly look forward to the 15 minutes post take off where I am not yet allowed to turn on my laptop so instead I peruse the in-flight magazines. I always skip to the last few pages and examine the flight paths of the airline. Where can I go from New York? What if I stopped over in London? This is my little time to dream before the whirlwind of meetings, trainings, dinners, drinks, and repeat.

But this morning, a new infographic from Kaiser Family Foundation on US global health funding piqued a similar travel lust, oddly enough.Kaiser Info graphic How countries and communities try to ensure the health of their people is extremely different across the globe. How communities react to atrocities, war, famine, and acts of nature reflect inner creativity, culture and resilience.  Where would I first go on my tour of global health innovation?

1. After the 1994 genocide in Rwanda, for example, in which 1 million Hutus were murdered by their fellow country-men as the world stood by and watched in horror, no one expected 20 years later to see health equity as a top priority for the nation.  A mix of national and local level initiatives, including village-level funding and training of community health workers

2.  After attending a presentation at a national conference on health disparities by a member of the Brazil ministry of health, I added Brazil to my list. From what I understand, their public health system has gone through massive shifts and is now grounded in a participatory action framework, based on the pioneering work of Paulo Friere . This new system aims to put the decision-making in the hands of local jurisdictions, a very decentralized approach that is being used in developing countries around the globe.

3. While I have spent a great deal of time in Thailand, I must return as it continues to be a global health model, particularly in its HIV prevention. One of the most compelling graphs shows the projected (extremely high) rates of HIV infection, and also the actual rates (much lower) due to their proactive public health programs.  There was even an elected official called Mr. Condom – something that would most definitely cause ripples in the US congress. While radio PSAs were common in the 1990’s and early 2000s, it appears that some of the prevention messaging is shifting to highest risk groups – like the test Bangkok campaign.

What do these places have in common? What I want to see are the unique and innovative systems that people come up with all over the world. The passion that fuels these pilot programs that become large-scale programs is contagious.

For my fellow global health nerds out there, where do you want to go, work, experience?

Written By: Emily Klukas
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Post inspired by the daily prompt of: The Wanderer

State of the Science Round Up

State of teh Science Heading

April 22, 2014

We are starting a new Blog Series that will bring you state of the science and health equity findings, as well as community reactions to scientific breakthroughs.  Keep us posted of what you are reading and we will do the same!

HEARD Logo Gay Men Divided Over Use of HIV Prevention Drug

This article has gone viral across Facebook and pulls together arguments for and against using HIV treatment drugs to prevent transmission. The past few months the Commission has hosted several Town Halls where we are hearing version of this across the country. Know the debate and participate!

From the article: “It’s the Truvada conundrum: A drug hailed as a lifesaver for many people infected by HIV is at the heart of a rancorous debate among gay men, AIDS activists and health professionals over its potential for protecting uninfected men who engage in gay sex without using condoms…”

HEARD LogoCommunity-based HIV prevention can boost testing, help reduce new infections

We talk a lot around here about comprehensive prevention – meaning using a mix of different types of interventions to have a greater impact. This is a key strategy in CDC’s approach to HIV prevention and is well documented in public health field in areas such as preventing traffic fatalities (e.g. seatbelts, speed limit, driver’s license, child safety seats). This new article is provides support that comprehensive prevention (in this case community mobilization, mobile HIV counseling and testing, combined with post-test support services) leads to increased HIV testing, decreased risk behaviors, and a modest reduction in HIV infection.

From the article: “Communities in Africa and Thailand that worked together on HIV-prevention efforts saw not only a rise in HIV screening but a drop in new infections, according to a new study in the peer-reviewed journal The Lancet Global Health.”

HEARD Logo New Obamacare Patients Stock Up on Drugs, Except Birth Control
As today is the last day for open enrollment for the Health Exchanges (without penalty), what do we know at this point about who are the 7.5 million individuals hwo have indeed enrolled in the exchange? Well, based on this report by prescription provider Express Scripts, there are much higher rates of individuals in the exchanges who have accessed expensive specialty medications, such as those for HIV and multiple sclerosis, compared to those in employee covered plans.  What does this mean? Well, it could mean that people who are now getting coverage under the exchange are people who need life-saving treatment that could not get it before. Good news, right?

From the article: “The report from prescription provider Express Scripts shows many more new patients than usual filled prescriptions for drugs that fight the AIDS virus, for pain medications, for pricey specialty medications to treat chronic conditions such as multiple sclerosis or rheumatoid arthritis, for anti-seizure drugs and for antidepressants…”

HEARD Logo Multiple Disadvantaged Statuses and Health: The Role of Multiple Forms of Discrimination
Past research shows that discrimination indeed impacts a person’s health outcomes. But what is the case when someone has multiple stigmatized characteristics? This comes up a lot in our work, for instance being an immigrant, gay, and HIV+, our clients can experience discrimination on multiple levels. This relates to the first article in this post – the discrimination or judgment within the gay community around using HIV drugs to prevent transmission.  Read on to uncover recent research on how multiple levels of stigma and discrimination impact an individual’s physical and mental health.

From the abstract: The double disadvantage hypothesis predicts that adults who hold more than one disadvantaged status may experience worse health than their singly disadvantaged and privileged counterparts… The results suggest that multiply disadvantaged adults are more likely to experience major depression, poor physical health, and functional limitations than their singly disadvantaged and privileged counterparts. Further, multiple forms of discrimination partially mediate the relationship between multiple stigmatized statuses and health. Taken together, these findings suggest that multiply disadvantaged adults do face a “double disadvantage” in health, in part, because of their disproportionate exposure to discrimination.”

HEARD Logo NIH releases comprehensive new data outlining Hispanic/Latino health and habits
Are you writing a grant, report or newsletter and need some data to help paint a picture of health among Latinos? This report summarizes the study findings that assessed cardiovascular disease and risk factors for cardiovascular disease among 16,415 Hispanic/Latino adults. The finding show difference between Latino nationalities across various factors, including smoking, obesity, diabetes, health insurance, diet and exercise, to name a few.

Excerpt: “Although Hispanics represent 1 out of every 6 people in the U.S., our knowledge about Hispanic health has been limited,” said Larissa Avilés-Santa, M.D., M.P.H, a medical officer in the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, and project officer of the HCHS/SOL. “These detailed findings provide a foundation to address questions about the health of the U.S. Hispanic/Latino population and a critical understanding of risk factors that could lead to improved health in all communities.”… – from NIH Press Release

Written By: Emily Klukas
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Indonesia Blog 2

Surfing the Back-Roads of Indonesia: A world away brings equity home

I have to start this out with my conclusion: I am incredibly fortunate to have round the clock access to medical care.  As a public health worker, I have had plenty of lessons and experiences in the US on the importance of easy, culturally competent access to medical care for having a society that is overall healthy and happy.  But in my recent trip to rural Indonesia, these lessons became immensely real and extremely frightening.


Lombok is a rather small island quite close to the Eat, Pray, Love setting of Bali. Like it’s famous neighbor, it is blessed with rich mountains, warm waters and kind smiles. In the southern region, it attracts mainly surfers because of its near perfect barrels. According to our local friend, not 30 years ago villagers would travel solely by walking across the 70km island from village to village. Nowadays, motorbikes are the main form of transportation and the main roads are surfaced, allowing an insane dance between giant SUVs and tiny motorbikes, gliding through mountain roads. Through American eyes, it’s like a continuous game of chicken.


While some roads are now surfaced, many are still dirt roads (think mud and boulders) that require equal amounts of skill and assumption of one’s immortality.  As I have neither, I hired a local teen surfer (nick-named Hendrik, after Jimi Hendrix) to help get me to the waves. Having lived abroad some years back, I was used to hopping on the back of a bike and whizzing through the cities. The countryside? Not so much. As we sped away from the small village, my neck was already getting sore from whipping back and forth between the sapphire blue ocean and the emerald green mountains, and the occasional water buffalo.  At the same time, I became more aware that the road was getting worse and worse, the rain heavier and heavier.


Hendrik weaves through mud, between boulders and dodges SUVs like a pro. I breathe deeply and think of the waves at the end of this road. As we round a bend, the road opens into a flat stretch and I sigh for a moment of relief. Looking ahead hoping for more relief, we see the bike ahead of us waver, and then spin out, throwing a man to the road. Within moments, we are with him as he screams in pain holding his head. His head hit a rock and is bleeding on the road. He is German and not speaking English at the moment. Another German is with him and talks to him as I try to find someone with a cell phone to call for help. No one. More motorcyclists arrive as they are traversing the island. All of them stop, maybe 20 people, and no one has a cell phone. Finally, a woman in a mini-van comes across us and agrees to take him to the hospital. By this time he is not talking anymore. He is just silent. Staring at the sky. We move him into her van, she does a U turn and disappears around the bend.

I have no idea what happened to the man. Standing there in the rain, Hendrik and I got back on the motorbike and drove slowly to the next town. He asked if I was ok (“not really”). I asked if he was ok (“sure”). Almost every day since then I have thought about this. Thinking about how much closer to death we are in different settings. In the US, many of us can successfully avoid thinking about our own deaths until we are quite old. The fact is that this closeness to death has so much to do with things that aren’t usually tied to “health” like having a way to call for help and having an ambulance system.


This “infrastructural barrier”, while vivid in rural Indonesia, is no less troubling here in the US and its territories. Journalist and author T.R. Reid starts out his eye-opening book, “The Healing of America,” with a story of a woman living with lupus (a serious, but manageable condition) who died at 32 after not having timely access to medical care, due to lack of insurance to help pay for the high costs of the services she needed. Time Magazine ran a piece by Steven Brill about a year ago on the outrageous costs of healthcare that received huge attention and concern from across the country. In our staff’s work and time in Puerto Rico, we have witnessed countless barriers in getting needed health care, particularly for stigmatized groups like drug users.


Back to the conclusion I started with: I am incredibly fortunate to have round the clock access to medical care. I live in New York City. I have insurance, a phone, a citywide emergency system that I am familiar with, and doctors that speak my language. But this is not the case across the city and country.


This is the definition of inequity.

It is unjust that some have this access and others do not.

Written By: Emily Klukas
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Southern Blossoms on the Ground by Miriam Y. Vega

My obsession with understanding: The étouffée sounds yummy and glorious but the crab will kill me

My obsession with understanding: The étouffée sounds yummy and glorious but the crab will kill me


A few years back, I was with a work colleague conducting an organizational assessment in Florida. We sat with the executive director of said organization, going through the structured interview tool, while also trying to get a real, on the ground understanding of the organization’s work. We talked about the viability and fundraising strategies that community based organization need to take into account considering all the national policy changes. When she inquired as to what we were doing next, I mentioned we had several more organizations to meet with. She narrowed her eyes and scrunched her nose. She noted it was admirable that we were actually working and not hitting the beach. She then extended her arm, placed her hand on my mine and thanked me for the work I was doing. She noted that not many other vice presidents such as me would be so invested in other organizations on the ground.


I was taken aback by that immensely heartfelt gesture of appreciation. I wondered quietly “why wouldn’t I want to visit other organizations which do the same work that my team members do?”   I don’t believe we will reach an end to AIDS locked in an office with a pretty view. Part of my work obsession is enhancing my understanding though boots-on-the-ground research. I love to read articles and books. What I love even more is applying that knowledge. One could say I am obsessed with not holding tightly to an ivory tower perspective and then wondering why so-called evidenced based interventions are not working. Every time I think of such perspectives I hive as if I had just been exposed to a plate filled with crab. The étouffée sounds yummy and glorious but the crab will kill me. I continue to rack up the miles, ball up into seemingly smaller and smaller airplane seats, and listen up a storm. I go home wiser even if everything I previously swore I knew was thrown up in the air.


I was recently in Chapel Hill, North Carolina, an area embedded knee-deep in the “Research Triangle”; a grand land of universities, huge basketball rivalries, and even bigger research grants trying to marry (or at least date) community based funding. It’s an area that has seen growth of an emerging Latino population. I have been to this area on numerous occasions and oftentimes I had heard of this place called Carrboro, a liberal mecca trying to accommodate a growing day-laborer population. Besides just hearing about it for the hundredth time, I wanted to see it. Off we went by car (I do get motion sickness in busses) and did a neighborhood mapping. We didn’t stop to talk to the day-laborers out of respect for their privacy but I did note the glaring disparity between those standing there waiting for work and their surrounding areas, including the nice houses and performance bikes and shops that were all around. No text book can give this context. No tower can give you this bird’s eye view.


Thus, my obsession continues.


Post by Miriam Y. Vega, PhD


Inspired by the daily prompt of: Can’t get it out of my head


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