Humanitarian Action Summit: Part II

It has been fascinating to see how this tight-knit group of humanitarian aid workers (about 200 in all) interact and to see what are the primary topics of interest. The humanitarian professionals participating in the Summit are field workers and managers, leaders of huge United Nations operations and field workers from small NGOs. 

Some of the main themes and issues that I took away from the meeting yesterday were:

1. The challenge of neutrality

For example, in many countries where conflict is taking place and humanitarian aid (HA) workers are needed there is a balance and a neutrality that must be maintained in order to allow the HA organization to stay there. This can sometimes mean collecting minimal data on the population, their experiences, etc. 

2. The politics of data use

By remaining neutral, publishing and releasing information to the global media that might taint the image of either governmental leaders or their allies might be reason to expel hard-working HA NGOs from the country. This can mean a choice between using data for advocacy purposes (e.g., to provide the world with information about rape and gender-based violence being used by national police and security forces) versus remaining silent and using that information solely to improve programmatic efforts on the ground.

3. Human resources gap

As in most health professions there is a large unmet need for HA health professionals ranging from surgeons to community health workers. As a result there was a large discussion of how to move tasks from higher to lower skilled health workers and what those implications would be for changing compensation patterns. For example, if nurses are given diagnostic or prescriptive privileges how might that increase their workload and require increased pay?

Overall, this Summit brings together a community with common goals and a diversity of perspectives. Their aim is to improve and protect the health and lives of populations that are victims of humanitarian emergencies and post-conflict situations. 

Reviewing changes since last year's Summit showed that progress in HA has clearly been made. However, as humanitarian emergencies increase in light of climate change and changing ecosocial conditions globally the HA responses will also need to evolve. For example, as land and water runs dry and populations are forced to leave their agriculturally-based labors for economic alternatives what impact might this have on conflict escalation? There is evidence that we are already seeing these impacts develop.

What questions or interests do you have in humanitarian assistance and aid? 

Humanitarian Action Summit: Part I

Yesterday, the Harvard Humanitarian Initiative kicked off the 3rd Humanitarian Action Summit in Cambridge, MA. The Summit brings together International NGOs and United Nations Organizations as well as others involved with humanitarian assistance, specifically related to humanitarian health.

Today the 7 working groups are conducting panel discussion. The three I attend will be

• Civilian Protection in Conflict
• Human Resources for Humanitarian Health
• Humanitarian Health Information Management

I am assisting the Information Management Working Group as a co-Rappatour. Working groups will be publishing their proceedings in the journal Prehospital and Disaster Medicine.

This is a great opportunity to get a big picture view of humanitarian assistance (HA) activities. What has struck me is that HA is more than just emergency relief in acute crises. These situations are incredibly complex and require a great deal of coordination and multiple skills.

Check back soon for more updates from the Summit!

School Nutrition Programs: Tied to Obesity?

The USDA (US Dept of Agriculture) has stated that there is insufficient evidence to suggest that the public nutrition programs (e.g. food stamps, public school lunches) they oversee are a cause of the obesity epidemic. I commend the USDA for working to improve the nutritional components of its public food programs (which, I believe is in response to evidence that the vast majority of its current food offerings are not very healthy and may in fact lead to excessive weight gain). For instance, the USDA is offering schools more choices such as whole grains, fresh fruits, and lean meats. However, these items are still significantly more expensive than the white, nutrition-less alternatives (white pasta, white bread, muffins, bagels, etc). Additionally, schools can only order a limited quanitiy of the whole-grain items. So when they run out -- they are out for the rest of the month.

There are currently programs in Masschussetts that are working with schools to help them understand the food menu options and train their staff to prepare new items well. For example, anyone who has cooked brown rice knows that it takes a little while longer than white -- and fresh vegetables cook differently than frozen.

Anecdotally, reports are promising that making public lunches nutritious by cutting back the high-sugar, high-salt, high-fat alternatives actually are well received by students. Studies that examine how much of the new nutritious meals are eaten compared to thrown in the trash only to be replaced with sugary soft drinks and soft-baked cookies are currently underway (yes...soft baked cookies were my snack of choice back in high school).

I'm excited to hear how things develop and hope the USDA continues to consider the evidence for providing nutrient-rich foods to low-income children and their families.

Salons to Stop Domestic Violence

Domestic abuse, also known as intimate partner violence or IPV, affects approximately 600,000 women in the United States each year (this number rises exponentially when you include emotional and psychological forms of abuse). Social norms promoting male "masculinity" and toughness are often stumbling blocks when it comes to correcting such behavior. Women are often hesitant to leave because they are afraid of what might happen (often with good reason), they believe he will change or that she deserved it, or they lack the skills, social support, or safety net to provided needed care and economic resources.

How can we in public health prevent such horrible abuses from taking place? There is an interesting phenomenon taking place around the country. NPR has talked about it and so has the New York Times. 

It is the use of hairstylists as advocates for women in abusive relationships.

In the Washington Heights neighborhood of New York City, and in other communities nationwide, government agencies are helping to train the trusted hairstylists at beauty salons. Given the stigma associated with experiencing IPV it can often be difficult to identify women in violent relationships. That is where this intervention really adds value. By training these women who hear stories of abuse to know what organizations and services are available to help victims they can become advocates on their behalf. They will no longer just be a shoulder to cry on, but rather a powerful community ally. 

More innovative programs like this are needed. Ones that capitalize on the social networks and bonds already established in communities. Now if only we had a rigorous evaluation of the program's effectiveness!

International Women's Month

Today I read Dina Habib Powell's commentary today on CNN.com about the changes that are being made in the US and around the world to educate and empower girls, and to promote female health. For example, the Obama administration has created the White House Council on Women and Girls, probably  similar to the Office for Women's Initiatives and Outreach that was established during Bill Clinton's time in office.  

Powell cited the recent creation of an "ambassador-at-large for women's issues" at the State Department, which will be filled by Malanne Verveer who worked as an assistant to (former first lady) Hillary Clinton and is chair and co-CEO of Vital Voices Global Partnership. A position that reflects the high priority of women in the administration; though some women's advocates do not think it goes far enough and that it should be a cabinet level position. 

Overall, this is something that women's health and human rights advocates are excited about. I hope that it allows our government policies to take an evidence-based approach towards women's reproductive health and to better consider the gender inequalities that women face around the world. 

What Wealth [Inequality] Means for Health

President Obama's recent budget proposal has been declared unanimously "ambitious." The health component of Obama's plan includes $634 billion dollars in spending over 10 years as a "down payment on health care reform." According to an article in the San Francisco Gate, approximately half of this amount would be generated by limiting charitable and mortgage interest deductions on taxpayers above the 28% income tax bracket and more would come from reducing Medicare payments to private insurers.

Given that I have little expertise in economic growth and government fiscal planning, I cannot comment to any great extent on the details of the budget plan nor its impact of the growing deficit and national debt, etc. However, I am excited to reflect on what it could mean for public health. 

An October 2008 report ranked the US just behind Mexico and Turkey for having highest income inequality of all OECD (Organization of Economic Cooperation and Development) countries.  In fact, many studies have found that countries with more equal distribution of wealth have -- at ALL levels of income -- better health outcomes. That means that not only does living in a more equal society confer health advantages to the poor and disadvantaged, but it also benefits the health of the wealthy. Notably, the health of the poor is improved to a much greater degree than the health of the wealthy (think of what $5000 could mean for someone making $20,000/year compared to someone making $200,000) through such redistribution. 

So how might this work?

1. Increased income may improve a person's ability to access needed resources (e.g. health insurance, transportation to health care, living in a toxin-free environment, buy healthier foods)
2. Increased income may improve a person's mental health and reduce stress (resulting in lower rates of chronic disease, such as hypertension and cardiovascular disease)
3. Redistribution of income may promote programs and services for the poor

In areas of great income inequality, housing segregation, stereotypes, and blame hamper the rich from investing greater resources towards disadvantaged populations. For example, why support a new 'free clinic' when you can build a state-of-the-art hospital with the latest health technologies? All too often highways, rivers, and walls separate the haves from the have nots -- and do not allow us to come together and learn from each other. 

How this might affect the middle class is something that I haven't been able to fully flesh out. I think that it is likely that they would benefit from these measures; though proposals that hurt entrepreneurial activities and small businesses could certainly serve as a disincentive for some who are trying to bridge that gap between the middle and upper class. Furthermore, it may need to be reassessed whether those making $250k should be labeled as "wealthy" to the same extent as those making much more. As an interesting Fox News (yes, Fox) article pointed out "HENRYs [high earners, not rich yet] carry significant mortgages, pay heavy property taxes, make charitable donations and sock money away for their children's college education." The slight increase in income tax coupled with the lack of deductions for mortgage payments and charitable giving may decrease the spending of people earning this much -- further deteriorating the economic situation. I just don't know.

My final assessment: this economic plan could be one of the single-most important factors that improve population health in the United States in the 21st century. While individuals may not see an overwhelming effect on their health, society as a whole could benefit greatly.

Health Care Reform Needed Now

By now you must have noticed that I am enamored with Nicholas Kristof. His latest column "Franklin Delano Obama" in the New York Times is fantastic. He examines three common arguments against health care reform proposals:

1. "We have the best health care in the world, and you want to create a socialized bureaucracy?"
2. "You want to wait months for a necessary operation, as in Canada?"
3. "You really want higher taxes to pay for this, stifling the economy and undermining our long-term competitiveness?"

The economic crisis highlights the fundamental problem of insurer-based system that requires (or nearly requires) employment. Each day people are losing their jobs and with it their health insurance.

Yet, health insurance alone is not going to solve America's poor health or its obesity epidemic. As Kristof explains, the health of Americans is embarrassingly low despite our technological advances and per-capita health care spending. Our health "care" system must move away from its treatment-focus and adopt policies and programs that invest heavily in prevention and is balanced throughout the prevention-treatment continuum.