Pearls from the Lancet Global Health Network

Kids these days have it rough--the world is becoming too sheltered.
Round hole, square peg? The Ameri­can Academy of Pediatrics has recom­mended a redesign of the humble hot dog. The fast food results in the choking-related treatment of 15 000 youngsters in the USA every year. Experts say square-shaped hot dogs could save lives. But other foods, such as grapes, also pose a risk, according to the Academy. Sadly, their redesign might prove more difficult.

Canadian health care costs less than ours, but they have money to fund this type of research?
Medical drama Canadian researchers have revealed the shocking fact that medical dramas on television are not the best source of information about first aid, especially when it comes to seizures. The researchers spent many a gruelling hour watching episodes of House MD, ER, Grey’s Anatomy, and Private Practice, and found that 46% of depictions of seizure care involved inappropriate actions such as putting something into the patient’s mouth.

On a more serious note, will be interesting to see if this trend catches on in advanced economies.  Finland is quickly moving to my A-list as a result of its prominence in the BBC Wildlife Photography Competition, and now, I can claim that the trip has relevance to work!
Nurse prescribing Finnish nurses could soon be able to prescribe drugs for the specific medical conditions in which they have been trained, with authorisation from a supervising doctor. The bill, currently being con­sidered by the Finnish Parliament, is expected to improve the efficiency of services in health centres and to slow down the increasing demand for physicians.
Innovation and aggressively negotiation with donors pays off!  Can we apply to public health in the U.S.?
Pay for performance The World Bank has released the results of a study on the use of pay-for-performance (P4P) medicine in low-income countries. The study examined the effect of P4P on maternal and child health services such as facility-based childbirth and scheduled vaccination in Rwanda, and concluded that financial performance incentives are capable of improving both the quantity and quality of health services.  

In the Mississippi Delta, an Iranian health delivery model using community health works is being replicated.  Globalization at its best!   Maybe we can send sweet tea and pecan pie their way in exchange. . . .

Alternative holidays to adopt: Growlentine's Day

 Reposted from February 14, 2008.  It's still that good. The pictures are new--first one compliment of Aaron.

How do you feel about Valentine's Day? Do the looks of disgust and disdain on these animals' faces express your opinion?

You're not alone. There are a lot of V-day haters out there. And why not? It's a holiday that seems to be created to make some people spend

lots of money and other people to feel bad about themselves. It's pretentious and exclusionary. Anti-American, even!
So, I think it's time we take back February 14th from the lovers. Enough of the lovey-dovey, sickeningly sweet "You is my pookey bear" Hallmark cards. No more overpriced roses and sweeethearts with cool new messages like "text me! 143!". Honestly folks, we're better than that.
So here's my proposal. This February 14th marks the inauguration of a new age. This year, we celebrate GROWLENTINE'S DAY.

The rules are simple:
1. You must dress like a predator
2. You must growl at people (intensity of growling should be proportional to the strength of your feelings towards them--i.e. you growl loudest at those you love and hate, and more amiably at strangers and cute babies).

Beyond that, it's up to your discretion. There's no gendered expectations or norms, no need to find that special someone to spend the day with. Just an excuse to growl (which you know you secretly wish was more socially acceptable), dress up (Halloween in the spring. . .score!), and be silly. And hey, if you want to eat some chocolate and drink some wine with a saucy minx or a big, bad wolf, no one's saying that's against the rules. Bear in mind, you never know where a growl might lead you.

If it's for a good cause

Last week, my mom send me a list of the most influential cause marketing campaigns (by U.S. companies).

It was interesting to read as a global health person because the way in which I think about "influence" or "effectiveness", if you will, is obviously very different from how the author did.  For example, I tend to think about the administrative costs of raising money--the "feel good factor"to the donor is not at the forefront of my mind.  Cause marketing obviously relies on engaging consumers, which inherently means that resources that could have been passed along to the intended beneficiaries has to be put into the fundraising activities.  But, the question is: does that lead to greater levels of donations and/or other types of engagement that ultimately result in more resources for delivery on the ground?  A lot of people that run in a marathon as a charity runner wouldn't necessarily have picked up a checkbook to donate money to breast cancer research.  For programs that receive a lot of funding from the government, the broad-based support for the cause is an important part of sustaining political commitment.

Devil is in the details

(Note: this was also published at improvehealthcare.wordpress.com)

Harvard Medical School’s Department of Health Care Policy put an incredible event on this past Monday. The video and suggested reading are available on the website. The speakers were: David Cutler (Harvard), Allan Detsky (University of Toronto), David Goldhill (Media and Technology executive), and Daniel Kessler (Stanford).
Overall, I thought that the symposium was tremendous. Often speakers don’t want to disagree with either others ideas too much, or they disagree about minute details–at this event, there was no shortage of (very respectful) disagreement. I walked away feeling like I understand the nature and magnitude of the complexities of health care reform much better than when I entered and armed with some new language and frameworks with which to approach the issues. The longer I work in health delivery, the more I’m struck by the different sense of urgencies people feel: the speakers seemed intent of understanding the nature of the beast and saw it as a precursor to reforming health care. All except Cutler felt that the pending legislation was trivial or harmful, but failed to offer other actionable recommendations. I’m torn on this–I think history shows countless examples of how we’ve dug ourselves into a hole by not appreciating a problem fully. On the other hand, when the decision not to act may result in suffering and/or death, there does seem to be a moral imperative to get out of the ivory tower and get busy (recent post by Bill Easterly on the pointlessness of airport security makes me a little wary to assert this too confidently or with too much moral indignation).

doctors without borders

Human resources for health remains one of the most controversial areas of global health debate. Large numbers of medical practitioners, most notably doctors and nurses, trained in the developing world migrate to advanced economies, resulting in extremely inadequate levels of human resources in many parts of the world. Foreign medical professionals now make up an important percentage of our health care providers--my grandmother has commented that in her small town, none of the doctors at the hospital are U.S. born. By one estimate I found, 25% of health professionals in the U.S. hail from other countries.
As someone who spends most of the day thinking about the health problems facing developing countries, it can be a little jarring to open up the Boston Global or New York Times to learn that in fact, we in the United States are facing a "critical shortage" of doctors. These figures are a few years old, but the U.S. has roughly 1 doctor per 400 population. This of course varies regionally, but is the national average. Meanwhile, in India, where I traveled a few months ago, the ratio is closer to 1:1,700. I still can't even begin to wrap my head around Malawi, where there is one physician per 50,000 people. I have almost as many doctors in my office as they have in the entire country.

Final thoughts for 2010

I've spent the last few hours perusing global health and development websites. I wish that I had more time to do this on a regular basis.

A few comments and suggested readings from the web:

This is a blog that Bill Easterly just turned me onto: Good Intentions are not enough. I am all about people trying to start a dialog on how to improve aid and the mechanisms of how donor dollars reach the intended recipients. Great to find such a thoughtful author who is able to dedicate so much time to tackling these issues.
In particular, I wanted to highlight this series of posts:
I know a lot of students and recent graduates who are using the economic situation as an excuse to go abroad. While it's exciting that the climate may lead to a boom in interest in global health, it's important to seek responsible opportunities and think through what impact your travel and volunteering may have on organizations and their communities. Saundra does a great job of laying out some basics for the commitments you should be willing to make, the questions to think through, and common pitfalls. I'm learning a lot from this myself--I've wanted to go abroad for some time and have been wrestling with a lot of the issues that she mentions (most prominent in my internal dialog--what jobs exist that I can do better than a local? Where can I add value rather than be in the way?). These questions are not meant to be discouraging so much as a deep, honest look at what you're getting yourself into. It's okay to conclude that you're going for selfish reasons (to clear your mind, have fun before you're saddled with real-world commitments, etc.), but better to admit that up front and plan your trip accordingly.