Inflammation and stories on healthcare

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Health Care Systems Around the World

healthcare
The well-being of global citizens relies heavily on the health of their health care systems. However, the type of medical attention you will receive when you go to the doctor, or even the likelihood you will attempt to seek care, varies vastly depending on where you live. Indicators like average life expectancy, infant mortality and obesity prevalence highlight the success of the health care systems. With this wealth of information, we can assess why certain nations’ health care systems are in better condition than others.

1. France

France had the best health system in the world in 2000, according to the World Health Organization’s (WHO) most recent assessment of world’s health systems. So what makes France’s method so successful? First, statistics on doctors and life expectancy are often on France’s side. France has less doctors per capita than second place Italy at 3.07 per 1,000 people, but more annual doctor visits than most of the top 10. It also has 3.43 hospital beds per 1,000 people, which is rivaled only by Japan and Italy of those in the top 10. Life expectancy is 81.66 and infant mortality rate is 3.31 of every 1,000 live births.

It falls on the government to negotiate doctor and hospital fees in an effort to keep costs low. In addition, a national insurance program flips 70 percent of the bill for everyone. The other 30 percent is picked up by private insurance. This means that out of pocket spending on health care is only $307 per capita.

2. The United States

The United States has one of the biggest economies in the world, yet it ranks 36 this year on the success of its health care system. Perhaps this is because the United States, while a wealthy nation, has an infant mortality rate of 6.17 per 1,000 births and a life expectancy of 79.56, neither of which are something to cheer over compared to other industrial nations where the average is higher. In addition, obesity prevalence has reached 36.5 percent, about three times as high as France. This signals that while the United States has the capability to provide good health care, it is falling far behind its peers. That being said, the United States is often considered the leader in medical research and cancer treatment.

In this country, insurance is provided mostly by for-profit private insurance groups, with some exceptions. Those over 65 years old qualify for Medicare and the disabled or low-income population qualifies for Medicaid, which are sponsored by the federal government and paid for by taxes. The number of uninsured is dropping, and in 2014, only about 15.6 percent of the population goes without insurance. However, citizens still pay a whopping $987 per capita out of pocket for health care. Changes will occur over the next few years with the implementation of the Affordable Care Act, but it is still early to assess how recent patterns will change the ranking of the health care system.

3. Pakistan

Pakistan ranked 122 according to the WHO in 2000 and continues to struggle with health care and disease today. The average life expectancy is 67.05 in 2014, below that of Syria and Iran. In addition, infant mortality is a frightening 57.48 of every 1,000 births. Pakistan has only .6 hospital beds and .8 doctors per 1,000 people. All this indicates that the health care system in Pakistan is struggling, leaving its citizens in serious trouble.

There is much to learn from the health care systems of other nations, but changes can be made at different levels for different countries. For countries like the United States where some tweaking to the costs and the insurance sector would vastly increase the overall health of the citizens and the system, taking notes on France’s system would be beneficial. Changes would allow more people to get coverage for less money from the federal budget. But for places like Pakistan where the system is in shambles, a functioning health care system must be in place first. Overall, different nations stand in different positions, but health care systems across the world could use a restructuring.

– Caitlin Thompson 

Sources: CIA(1), CIA(2), Commonwealth Fund, Gallup Poll, NPR, The Patient Factor, PBS, WHO(1), WHO(2), World Bank(1), World Bank(2)
Photo: Telegraph

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Cancer Disproportionately Affects the Poor

cancer

A new report, published in part by the American Cancer Society, has revealed that certain types of cancers are strongly associated with living in poverty while others are associated with being wealthy.

The study included information from over 3 million cancer diagnoses, using poverty rates as the indicator of socioeconomic status (SES) in an effort to identify any links between the two factors. Each diagnosis was organized by type of cancer and by the poverty level of the area the patient lived in. Out of 46 cancer sites tested, 38 of them showed a significant relationship with poverty, whether that meant being more likely or less likely to have that type of cancer as a result of low SES. The cancers most strongly associated with high levels of poverty were found to be those of the larynx, cervix and Kaposi sarcoma, which affects connective tissues.

Conversely, wealthier patients are most significantly associated with melanoma and thyroid cancers. Why might certain cancers disproportionately affect the poor?

There are obvious ways in which poverty could impact health — the impoverished are more likely to lack access to health care and are less likely to have stable food security. However, there also appear to be impacts that are less noticeable and require more examination, as this study has revealed. The answer may lie in “behavioral risk factors” that occur more often in communities with high levels of poverty, such as “tobacco, alcohol and intravenous drug use, sexual transmission and poor diet.”

For the types of cancers that affect wealthier communities more often, the study finds these cancers are the ones most likely to be over-diagnosed. It seems that lacking access to adequate health care and certain behavioral factors together predispose those in poverty to have different kinds of cancers. What is most unfortunate is that the cancers associated with low levels of poverty, the study found, tend to be the most lethal.

A relationship does exist between SES and cancer, and this study is one of the first to use poverty levels to find this link. In one of the first studies ever done on the subject, published in the same journal as this newest report and using a different measure of SES, researchers said, “It is increasingly apparent that a substantial proportion of the disparities in cancer defined by race and ethnicity can be attributed to socioeconomic status.”

Unfortunately, this relationship is often hard to define and there are not extensive amounts of literature on the topic. However, interest in finding the links between cancer and poverty is growing, and the results of this report reaffirm the importance of taking SES into account. Hopefully more researchers will make similar efforts to examine the details of the relationship between poverty and health, including the unfortunate link between poverty and lethal types of cancer.

-Emily Jablonski 

Sources: Medscape, Wiley
Sources: OnlyMyHealth

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The History of HIV Research

hiv research
Since the first diagnosis back in 1981, the world’s approach to HIV and HIV research has changed drastically. Receiving a diagnosis of the disease that 33.4 million people are currently living with means something very different than what it did 33 years ago.

In 1981, when 26 homosexual men presented with unexplainable tumors and other strange symptoms, researchers and doctors worldwide were at a loss for what to do. As they later identified the disease as HIV, or human immunodeficiency virus, it dawned on them that they were dealing with a virus they were wholly unprepared to tackle.

In its early years, the life expectancy that came with an HIV diagnosis was heartbreakingly short and the answers for how to cure the virus were few and far between. According to Dr. Woodrow Myers, a public health official from Indiana, the life expectancy of someone who had HIV in 1987 was 18 months.

Actually diagnosing people who had HIV was an obstacle initially, seeing as it was a minimally understood virus, especially in areas of the world with a lack of information. Progress began when researchers developed a blood test that could be used to identify those who had contracted the virus, allowing researchers to start focusing on improving the lives of those with HIV.

As researchers gained more of a grasp on the virus, they developed the drug AZT, which was approved by the Food and Drug Administration in 1987 and was distributed to patients in the U.S. Unfortunately, AZT came with its own nasty cocktail of side effects, some of them life threatening, thus ruling it out as a viable solution.

Soon after, things improved when researchers developed a treatment that had multiple drugs in one pill and had some success in saving lives. These treatments were being administered up to 20 times a day, resulting in more unpleasant side effects; also not an ideal solution.

Fast-forward two decades and research has uncovered treatments that have made an HIV diagnosis less of a death sentence. Myers reports that the life expectancy with an HIV diagnosis is now 22 years, putting it along the lines of chronic diseases like diabetes and heart disease.

Though there is still no cure for HIV, the treatments are more manageable with a greater variety of options. Some treatments require only five pills a day and often have minor side effects, making managing the virus less intensive.

Justin Goforth, a 47-year-old who has been living with HIV for over 20 years, believes that in today’s world, an HIV diagnosis should not be restrictive in how you live your life, explaining “You can go to your doctor two, three times a year, get some tests done and make sure everything’s on track, and then just live the rest of your life as you would.”

This is not to say, however, that HIV should be less of a priority. Two million people died of HIV in 2008, with 2.7 million new diagnoses, and many more lives have been lost since then. Impoverished areas like Sub-Saharan Africa and Southeast Asia suffer greatly because they lack the education and resources to prevent and treat HIV, leading to often uncontrollable proliferation of the virus.

The progress shines through, however, as the number of people in poor countries receiving resources to treat people with HIV having increased 10-fold since 2002, and the standards of living have improved. As sexual education, treatment research and resource distribution improve, an HIV diagnosis becomes more and more manageable.

– Maggie Wagner

Sources: AIDS.gov, CNN, Oprah, The Herald News
Photo: Red Hot

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MERS Update: Is It Getting Worse?

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The number of MERS cases is increasing. The number has risen from 575 to 688 in the worst afflicted country, Saudi Arabia, and continues to show up in pockets in areas of the world less affected, including Algeria and the United States. As of June 4, WHO reported 681 laboratory-confirmed MERS cases and 204 deaths from the disease.

Professional health care experts assure that, at this point, the general public does not need to worry about the illness. If you have traveled to the Middle East, where the disease is rampant, you are much more likely to contract the disease, which is spread person-to-person. The symptoms are flu-like, including fever, cough, shortness of breath. Those thought to have contracted the virus are put in negative-pressure rooms and masked immediately in order to prevent further outbreak.

Recent findings have discovered the virus’ possible origins: camel milk. Drinking camel milk is a widespread tradition in the Middle East, and the Qatari government is urging everyone to boil the milk before consumption.

Hospital breaches have also contributed to MERS’ spread. Saudi Arabia in particular has been highly criticized for its lack of proper care in hospitals, which allowed the virus to further spread. The Saudi health ministry has put in more strict measures, and WHO has been “diligently” following up on reports of the disease.

Until then, the virus continues to increase in the Middle East. With a 30% mortality rate, the disease is spreading rapidly in other, more malnourished parts of the world. While there is still not a vaccine for the virus, the CDC has released prevention methods against contracting the disease, including washing your hands with soap and water often, covering your mouth and nose with a tissue when you cough and/or sneeze, avoiding touching your eyes, nose and mouth, and avoiding intimate contact with sick persons.

– Nick Magnanti

Sources: ECDC, Health Map, NY Daily News, Science Mag, Seacoast Online
Photo: Science News

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New MRSA Treatment on the Rise

mrsa treatment
Methicillin-resistant Staphylococcus aureus, better known as MRSA, is a staph bacterial infection that is resistant to most antibiotics, making it difficult to cure. The Food and Drug Administration has just approved a new MRSA treatment known as oritavancin.

MRSA is best known as the infection spread through hospitals, but is also commonly spread through communities, schools, prisons or other crowded areas. Since it is spread through skin-to-skin contact, the infection is spread in areas with crowding and sanitation deficiencies.

While developing countries may lack the medical records and diagnostic technology to confirm MRSA cases, the usual envirnoment in hospitals and crowded areas point to them as areas where MRSA can commonly spread. Surprisingly, the infection is also very common among hospitals in developing countries as well, making it a disease dangerous around the globe. While scientists are developing a way to treat people once infected, the simplest way of preventing it is simple sanitary solutions such as hand washing.

Once MRSA is in the body, it can cause infections of the valves of the heart or large abscesses. While many diseases need a cut or break in the skin to transfer, it has been recently discovered that MRSA just needs skin on skin. Although it is transferred easily and begins as a simple skin infection, in some cases it can lead to death.

The beauty of oritavancin as a MRSA treatment is that it is able to remain in the body for long periods of time, which eliminates the need to take antibiotics on a daily basis for up to a few weeks. This way, patients can lessen their time getting treated in the hospital and take away the risk of skipping antibiotic treatments.

In a study done to test the drug, researchers held a trial with 475 patients given one dose of oritavancin and 479 patients with one of the classic antibiotic vancomycin twice a day for 7-10 days. The results showed that the single dose of oritavancin worked just as well as the multiple doses of vancomycin.

The FDA has flagged the investigational drug as a “priority review,” meaning the regulatory agency must consider its application within six months. According to the Medicines Company website, the FDA’s action date for the drug is Aug. 6, 2014.

-Courtney Prentice

Sources: CNN, CBS News, NPR, Regional Health Forum
Photo: Sure Wash

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Sexual Assaults Due to the Lack of Toilets

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The lack of toilets is one of the main causes of rape in India.

In Lucknow, India on May 27, two teenage girls went out into the bamboo fields to relieve themselves since they did not have a toilet in their own house. This is common among many of the households in India. The two young girls were raped and killed, then hung from a mango tree in their village.

“More than 60 percent of the rapes in the state occur when the victims step out to relieve themselves because they do not have toilets at their homes,” the state’s top cop says.

According to UNICEF, almost 50 percent of people living in India relieve themselves outside in public due to the lack of toilets.

While the bigger issue due to the lack of toilets is women getting sexually assaulted, another issue to think about is lack of sanitation and the humiliation that women have to go through. The lack of toilets dehumanizes, degrades and makes women feel even more powerless despite all the other issues pertaining to poverty.

According to an article in The World Post, U.N. figures show that out of the 1.2 billion people, 665 million of them do not have a private place to go to the bathroom.

According to a study done by the World Bank in 2010, the lack of toilets in India costs more than $50 billion a year because of deaths and hygiene-related diseases.

Bindeshwar Pathak, founder of the Sulabh Sanitation and Social Reform Movement , an organization that makes low-cost toilets, decided to build toilets in 108 of the houses in the village where the two girls were from.

– Priscilla Rodarte

Sources: The Star, Huff Post
Photo: CNN

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Continuing the Cold Chain

According to sociologist Johan Galtung, structural violence occurs when there is a difference between actual reality versus potential reality. If the actual reality is unavoidable, then no violence is present. If the actual state of affairs is avoidable, then violence is present. Today, vaccines exist to prevent diseases such as measles, diphtheria, polio and tuberculosis, yet 2 million people from all over the world die annually from these conditions.

These deaths are not the result of a vaccine shortage, but rather are due to the inability to properly store the vaccines. In order to effectively prevent disease, vaccines need to be stored at very specific temperatures, controlled through refrigeration, from the time they are manufactured to the time of injection. This is typically described as the cold chain, and is difficult to maintain when traveling to more remote regions.

In an attempt to eradicate the structural violence, and in response to an outraged Sean Penn following the death of Oriel, a 15-year-old Haitian boy, by diphtheria, Harvey Rubin, an infectious disease doctor at the University of Pennsylvania, sought to address the problem. Rubin realized how prevalent cell phone towers were around the world and because in developing nations there are often blackouts, telephone companies often provide their own sources of power. After consulting engineer and mathematician Ali Jadbabaie, the two discovered that the power generated from these cell phone towers would be enough to power a refrigerator that could store vaccines. Moreover, the high frequency with which cell towers are distributed provides a chance to prevent the cold chain from breaking. Through delegating responsibilities to a larger team, spearheaded by undergraduate student Alice Conant, their efforts resulted in creating the nonprofit organization Energize the Chain.

Energize the Chain aims to form secure relationships with cell phone companies in order to increase the correlation between the number of cell towers in a given region and the successful preservation of the cold chain. They launched one of their first major projects in Zimbabwe in 2011. By pairing with cell phone company Econet Wireless, they were able to boost the number of viable vaccines that were distributed to 10 villages in Zimbabwe. Additionally, after partnering with the National Healthcare Trust of Zimbabwe, Energize the Chain was able to issue refrigerators that could stay cold for up to 10 days without power in order to maintain the precise temperature of the vaccines. There are currently 110 working sites in Zimbabwe and by December of this year Energize the Chain expects to install 100 more working sites.

By supplying these refrigerators to more rural regions of Zimbabwe, the partnership between Energize the Chain, Econet Wireless and the National Healthcare Trust of Zimbabwe provides greater accessibility to working vaccines. Moreover, the success in Zimbabwe provides the promise for expanding the program to other regions where high mortality rates are caused by an inability to receive necessary, lifesaving vaccinations.

– Jordyn Horowitz

Sources: Philly, Energize The Chain, Econet Wireless, JPR
Photo: All Africa

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WaterAid Shows Africa’s Growing Access to Water

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The nonprofit organization WaterAid released a new interactive map revealing that 14 nations in Africa are scheduled to have clean drinking water by the year 2030. This map was released as part of Africa Water Week, which took place from May 26 to May 31, to promote the idea that the accessibility of clean water in developing countries should have a central role in the U.N.’s post-2015 Sustainable Development Goals.

Since its establishment on July 21, 1981, WaterAid has worked to address the serious health, sanitation and hygiene issues that currently exist in a number of countries. This organization also realizes that education and a change in both policies and practices are needed so that an increase in hygiene and sanitation practices can help reduce global poverty. For more than 30 years, WaterAid has provided more than 19 million people with both clean and safe water in multiple countries, and it was even honored with a Top-Rated Nonprofit Award in 2013.

WaterAid hopes that the release of this map will encourage the U.N. to include global access to clean water, sanitation and hygiene by 2030 in their list of Sustainable Development Goals. This new set of goals is expected to expand on the Millennium Development Goals, which will reach their deadline Dec. 31, 2015. Before this deadline, the General Assembly is scheduled to confirm the Sustainable Development Goals in September. According to Water.org, water-related diseases are the cause of approximately 3.4 million deaths each year, confirming that this is a major global issue that needs to be addressed.

This map produced by WaterAid serves two very important purposes because it offers evidence that this is not only a worthy cause, but that it is also realistic and attainable. According to the map, 65.2 percent of people in Sub-Saharan Africa had access to water as of 2013, meaning that approximately 45 million people need to gain access to water per year to reach the 2030 goal. Although this is certainly a large amount of people, only 1.4 percent of the 2030 population needs to gain access to water every year in order to reach this goal.

– Meghan Orner

Sources: UN, WaterAid, WaterAid 2, Water
Photo: SAB Miller

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Call to Aid Syrian Refugees with Cancer

syrian refugees
The United Nation refugee agency’s top medical expert has recently published a warning of the dangers of overwhelmed health care systems in Jordan and Syria, which are flooded with Syrian refugees.

This client base of Syrian refugees does not arrive with marks of external violence or chemical warfare, but instead arrive fighting against a more internalized battlefield — cancer.

Paul Spiegel, the top medical expert of UNHCR, was quoted in the latest edition of The Lancet Oncology, the leading British medical journal, explaining how the overwhelming of the health care systems forces “UNHCR offices and partners to make agonizing decisions over who does and doesn’t receive care.” Siegel has documented hundreds of refugees in Jordan and Syria denied cancer treatment on account of limited funds.

So far there are more than one million documented Syrian refugees in Lebanon and 600,000 in Jordan. In the case of Lebanon, that number is expected to continue to increase, reaching 1.5 million by the end of 2014 (already equivalent to a third of Lebanon’s pre-Syria war population).

“We have to turn away cancer patients with poor prognoses because caring for them is too expensive. After losing everything at home, cancer patients face even greater suffering abroad – often at a huge emotional and financial cost to their families,” Siegel remarked.

For most cases, denial is based on poor prognosis, as a patient’s unlikely chance of recovery prompts committees to invest the limited money on more promising cases. In Jordan alone, between 2010 and 2012, the UNHCR’s Exceptional Care Committee was only able to approve 246 out of 511, or 48 percent, of the refugee applications for cancer treatment.

Amnesty International, in a newly released report, found that the inaccessibility of health care in Lebanon has prompted some refugees to return to Syria in order to receive the treatment they need.

“Hospital treatment and more specialized care for Syrian refugees in Lebanon is woefully insufficient, with the situation exacerbated by a massive shortage of international funding,” said Audrey Gaughran, Amnesty International’s Director of Global Thematic Issues.

While Amnesty acknowledges the strain on resources, including health care, caused by the wave of refugees entering Lebanon, the organization is calling on the government of Lebanon to adopt long-term strategies in order to properly address health care needs. Similarly, the organization called on the international community to step up and provide assistance to the Syrian refugees.

UNHCR outlined possible new approaches in a press release, stating solutions could include “mobile and online information campaigns focusing on preventive health and new financing models such as crowd-funding and potentially health insurance.”

No matter what solution is adopted by the asylum countries, the UNHCR’s biggest concern is avoiding inequality between host communities and refugees.

In the meantime, readers should not only support international organizations combatting this internalized war-zone amongst patients, but also support the 21st Century Global Health Technology Act. By calling one’s local legislators about this important bipartisan bill, the U.S. Agency for International Development (USAID) could have the authority to strengthen the development of health products that are affordable, culturally appropriate and easy to use in low-resource health systems.

— Blythe Riggan

Sources: Amnesty, Borgen, UNHCR 1, UNHCR 2
Photo: The Independent

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Will MERS Become a Worldwide Epidemic?

MERS
The U.S. has seen its third case of the MERS virus this past month. Despite showing no symptoms, an Illinois man was diagnosed with the virus on May 2, his infection proving unique: he is the first person to have contracted the virus in the U.S., which is already prevalent in the Middle East.

The Center for Disease Control and Prevention (CDC) has already begun to issue public warnings regarding the virus and its prevention methods. Yet while CDC response team leader, Dr. David Swerdlow, sees no immediate threat as the disease has had “no sustained transmission” in the U.S. like other viruses such as the flu, MERS is proving to spread rapidly overseas. According to Reuters, about 30 percent of those infected with the virus have died.

While we still know little regarding the origin of the MERS virus, it is characterized as a “severe, acute viral respiratory illness caused by MERS-CoV, a beta coronavirus,” meaning that, according to the CDC, most people will at some point in their life contract the virus. Spread person-by-person, the illness — for which there is still no vaccine  — is on the rise, and while it has not yet been characterized by the CDC as a global health emergency, the virus is continuing to result in an increasing number of fatalities.

While cases of the virus have emerged in nations of varying degrees of wealth, including Egypt, the Netherlands and Jordan, by far the worst-hit country has been its originator, Saudi Arabia. Deaths in Saudi Arabia as a result of the MERS virus have hit a whopping 163 as of May 17. Yet while the country — known for its vast oil wealth and a relatively strong GDP placement compared to other nations  — may not be the most prime example of impoverishment, a startling 20 percent of the nation’s population is still, almost secretly, living in poverty. Crippled by impoverished conditions, the world’s poor may be among those most at risk of contracting the severe virus.

While the future for the virus is still relatively unknown, appropriate actions by the CDC are being put into place in order to ensure proper combativeness in case of a pandemic. Forced now to wait and see the true effects of the virus characterized as a “deadlier, less transmissible cousin of the SARS virus,” the CDC ensures that they are prepared for whatever the outcome.

– Nick Magnanti

Sources: CNN, Al Jazeera, TIME 1, Washington Post, Public News Service, AL, Boston, TIME 2
Photo: ICCS