Ukrainian health care facilities
The COVID-19 pandemic greatly impacted Ukrainians and Ukrainian health care facilities and safety issues only escalated with Russia’s invasion of Ukraine on February 24, 2022.

Ukrainian Health Care Facilities Under Fire

Since Russia’s invasion, the World Health Organization (WHO) has confirmed 715 attacks on Ukrainian health care facilities, creating a shortage of proper medical care and supplies for Ukrainians. The Washington Post reported that Russian soldiers destroyed nearly all of the health infrastructure in the recaptured territories. This has left thousands of Ukrainians, mainly in seized villages, without necessary health care access.

Low Vaccination Rates, Disease Outbreaks and Health Concerns

At the beginning of the war, nearly 60% of Ukrainians were unvaccinated against COVID-19, with cases at a record peak. The Russian attacks have limited access to vaccinations, COVID-19 testing and treatment. In addition, crowded bomb shelters and border crossings have created the perfect conditions for extreme COVID-19 outbreaks. This would overextend the already limited capacities of Ukrainian health care facilities. Millions of Ukrainians that rely on regular doses of life-saving medication, such as insulin, are unable to access the medication necessary for survival. Hospital closures also put thousands of pregnant mothers in extreme danger. They end up in extenuating circumstances without access to health teams, checkups or delivery services.

Earlier in 2022, WHO estimated that 15% of these Ukrainian births would result in complications that would need skilled medical care: a feat difficult with limited medicine and oxygen access. Outbreaks of other diseases, such as Polio, HIV/AIDS and tuberculosis, pose great threats to Ukrainian lives during the war. The rampant misinformation regarding vaccines in Ukraine contributed to a low immunization rate, making Ukraine more susceptible to disease outbreaks.

Relief Organizations

Relief organizations have attempted to combat this issue by focusing their efforts on reinstating emergency medical care in seized areas, yet they face a number of challenges. Land mines and leftover military weaponry still threaten many recaptured areas. There is also an extreme shortage of health care workers, with many worried about entering dangerous areas. Finally, targeted attacks on Ukrainian energy sources have created mass blackouts throughout the country, leaving thousands of Ukrainians without heat or running water. This makes seeking health care and remaining healthy increasingly difficult.

Also, hospitals have canceled all nonessential procedures and patient records are unavailable due to internet outages. Blackouts also inhibit proper hygiene, as running water is often inaccessible. Infections run rampant due to poor hygiene, increasing the urgency for health care. Doctors must perform emergency surgeries in freezing temperatures while using headlamps as light sources due to frequent power outages.

Limited Resources

Limited resources make it increasingly difficult for relief organizations to provide aid. The Kyiv City Charity Foundation Food Bank is operating actively to provide food for Ukrainians, yet they have lacked proper food supplies since Ukrainian plants had to shut down production. This food bank, along with others in Ukraine, has received aid and supplies from foreign organizations such as Save the Children and the U.N. World Food Programme (WFP).

WFP recently received a $50 million donation from the United States, which has gone towards providing food for Ukrainians. It plans to assist more than 3 million people through these funds, with three operation locations established throughout Ukraine. WFP purchased most of the food in Ukraine to help their economy, but it has also created hubs in Poland to safely distribute food. It has been difficult for these organizations to anticipate needs throughout Ukraine as food insecurity and supply limitations change daily, but relief organizations have been able to help limit the extreme circumstances in Ukraine through aid.

Rebuilding Ukrainian Health Care Facilities

According to Deputy Minister of Health Oleksiy Yaremenko, damaged health infrastructure alone will cost at least $1 billion to fix, so rebuilding Ukrainian health care facilities is a lofty but necessary ambition. Along with foreign aid, internal organizations have helped Ukraine. Ukrainian civil society organizations have risen to the challenge, meeting the needs of hospitals throughout the country. The Alliance for Public Health (APH) provides limited service in most regions, including occupied areas.

To combat shortages, APH delivered 140 metric tons of medical supplies to Ukrainian hospitals between March 23 and April 6 alone. Its mobile clinics serve as transportation of humanitarian aid into conflict zones and evacuation vans. 100% LIFE, Ukraine’s largest organization for people with HIV, distributed an initial delivery of 18 million doses of antiretroviral medication, enough to cover a six-month supply for all people with HIV on first-line treatment.

The lack of health care provisions for Ukrainians has caused an increase in sickness and casualties. However, the presence of foreign aid and relief organizations has alleviated the damage. As the war continues, the lack of Ukrainian health care facilities and resources will likely become more harmful to the protection of Ukrainians and the rebuilding of society.

– Mariam Abaza
Photo: Flickr

Diarrheal Disease in South Asia
Diarrheal diseases such as cholera, rotavirus and E. coli cause intense episodes of diarrhea which depletes the body of water and electrolytes (sodium, chloride, potassium, etc.) and eventually can lead to death if not treated. Unsanitary water, poor waste management, coming into contact with fecal matter and a lack of access to health care often are causes of these diseases. While diarrheal diseases impact people all across the globe, one of the areas in which people suffer from them the most is South Asia.

4 Facts About Diarrheal Disease in South Asia

  1. A substantial number of worldwide diarrheal disease-related deaths happen in South Asia. According to 2016 reports, diarrheal diseases are the eighth highest cause of death globally among people of all ages. Even more, they are the fifth highest cause of death in children under 5. Diarrheal diseases also disproportionately affect South Asian countries such as India, Nepal, Pakistan, Bangladesh, Sri Lanka and Bhutan. About 90% of deaths related to diarrheal disease worldwide occur in South Asia and sub-Saharan Africa.
  2. Children in South Asia are much more likely to die from a diarrheal disease than anything else. A 2020 study that BMC Public Health conducted in India found that diarrheal diseases caused 50% of deaths in children aged 1 to 5, putting children at a higher risk when it comes to diarrheal diseases.
  3. Diarrheal diseases disproportionately affect areas in South Asia with poor access to health care, sanitation and clean water. Once again, a 2020 study that BMC Public Health conducted found that in India, factors such as improper stool disposal in the home, having a dirt floor, having a thatched roof and environmental issues all contributed to a person’s likelihood of contracting a diarrheal disease. Evidence showed that 46.5% of children in the study had no access to a toilet facility, and the children with toilets were 18% less likely to contract a diarrheal disease. Of the people in this study, 43% of the children lived in houses with dirt floors, and some also had thatched roofs. These people were 8% more likely to contract a diarrheal disease. These statistics show just how threatening diarrheal diseases are to people living in South Asia without basic human needs.
  4. Despite this grim data, the negative effect of diarrheal disease is lessening in South Asia. In response to this high amount of diarrheal disease-related deaths in South Asia, many groups, government and not, are making efforts to end this crisis. Between 1990 and 2010, diarrheal disease-related deaths decreased by 55%. One organization in particular, The Gates Foundation, focuses on the development and delivery of safe and affordable vaccines for many diarrheal diseases. This organization began working in South Asia in 2003, with the implementation of an HIV vaccine in India. Between 2003 and 2014, The Gates Foundation implemented more than 170 million vaccines in the region.

WHO and UNICEF Providing Help

In addition, the World Health Organization (WHO) and UNICEF released a comprehensive plan in 2013 that will help lower diarrheal deaths worldwide, especially in high-risk places such as South Asia. This plan outlines many goals such as reducing mortality from diarrhea in children less than 5 years of age to fewer than one per 1,000 live births and 90% access to appropriate pneumonia and diarrhea case management by 2025. With these goals, the plan also lists steps that will be taken and that are being taken to achieve them such as administering vaccines, initiation of breastfeeding amongst new mothers and providing uncontaminated drinking water to areas that do not have access.

In conclusion, diarrheal diseases are very deadly to citizens of South Asia, especially children under 5, and people without access to proper waste disposal, health care and clean water. While these illnesses are very prevalent, they are also very preventable, and given the aid of organizations such as the Gates Foundation and the World Health Organization, South Asia is already lowering the number of deaths diarrheal diseases cause.

– Evelyn Breitbach
Photo: Unsplash

Cholera Outbreaks in Lebanon
As of November 4, 2022, Lebanon has reported 18 deaths and more than 400 others infected with the notoriously contagious digestive disease, cholera. The World Health Organization (WHO) has classified the disease as a global threat to “public health.” Because the disease is so virulent, it has the ability to affect hundreds of people at once if spread through sewer and water systems within a community.

Current State of Lebanon

Since July 2021, the economic crisis in Lebanon seems to be one of the worst in the world since the 1800s. Banks are beginning to freeze withdrawals. As hospitals and pharmacies began to run out of medication and services to provide patients, the health of not only the people but also the economy began to take a dark turn. As of 2020, approximately 1.7 million refugees could be residing in Lebanon in extremely close-contact, low-budget camps. Furthermore, as of late 2019, “approximately three-quarters of Lebanon’s population” lived below the poverty line.

What is Cholera?

Cholera is a disease that spreads through the ingestion of food or water contaminated with the bacterium. The disease causes infected persons to experience a harsh acute diarrheal infection, eventually leading to severe dehydration. It can kill in hours if left untreated. The World Health Organization has reported that cholera transmission is “closely linked to inadequate access to clean water and sanitation facilities.” Commonly referred to as a “disease of poverty,” cholera outbreaks typically affect the world’s poorest people due to a lack of public sewage systems. As a result, human waste can mix with water that people use for drinking and cooking.

Cholera Outbreaks in Lebanon

After almost 30 years without a single case, cholera has re-appeared in Lebanon following a recent outbreak in Syria. Syria has recently reported more than 20,000 suspected cases and 75 deaths. There has been a high influx of Syrian refugees traveling to Lebanon. Consequently, the transition of the disease most likely occurred because of high population densities within the refugee camps. Reporter Daniel Stewart writes that the increase in cholera outbreaks is “mainly due to increased flooding, drought, conflict, migration and other factors affecting access to clean water.”

A Disease Linked to Poverty

In his research published in the National Library of Medicine, Arturo Talavera wrote that cholera outbreaks are key indicators of social development within a region. Cholera outbreaks remain a serious challenge in countries where people do not have assured access to safe drinking water and adequate sanitation. Talavera explained that cholera outbreaks affect low-income countries more than middle or high-income countries. Economic development is an important factor in determining how deadly an outbreak may be.

Solutions to the Cholera Outbreaks in Lebanon

Thankfully, France is delivering vaccines to Beirut. However, the World Health Organization warns that if not curved soon, the disease may begin to spread more rapidly. French Ambassador Anne Grillo explains that the recent cholera outbreaks in Lebanon are “a new and worrying illustration of the critical decline in public provision of access to water and sanitary services.”

The key to stopping cholera outbreaks is to provide communities with water security. Furthermore, vaccines can drastically curve the contraction of the disease. As more than 13,000 doses have already arrived in Lebanon with more to come, hopefully, Lebanon will be able to halt the spread of the disease with the help of foreign aid.

– Opal Vitharana 
Photo: Flickr

Aging Crisis in ChinaThe aging crisis in China will become a key concern for the country, as “the population aged over 70 years in China is projected to reach [more than] 300 million in 2060.” China is the fastest aging country in the world, but sources show that it struggles to maintain the necessary infrastructure and policies to accommodate its growing elderly population. The World Health Organization reports that an aging population requires different public health and socioeconomic support than a more evenly distributed population does. At the moment, China does not have a well-developed social security net for its elderly. However, studies estimate that the GDP amount spent on services such as pensions, medical care and welfare will need to nearly quadruple by 2050 to meet the needs of China’s population.

The One Child Policy

China’s large aging population is largely attributed to its low birth rate as a result of its one-child policy. The policy, which was in effect from about 1980 to 2015, significantly reduced birth rates. A primary effect of the policy is that the population no longer mirrors a standard age distribution or “population pyramid.” Instead, there are more people who are aged 50-54 than those who are aged 35-39.

Generally, scholars view a youthful population pyramid, where there are more people under age 25, as a better indicator of a nation’s health and longevity. China’s population, however, represents an aging nation, in which a key concern is that by 2050, the working-age population will be less than 60% of the total, leading to severe economic consequences. The aging crisis in China remains a key area of concern for the government, which is forming new policies to combat the issue.


Another issue is that many seniors, especially those who are lower income, reach the age of retirement without having enough savings built for retirement. If a person reaches retirement age without a healthy pension or adequate savings, they must either rely on others or, in the worst possible instances, succumb to conditions of poverty.

The same article cites a 2013 study done by Peking University reporting that “only 3% of respondents had a commercial pension and just 0.2% had a private pension.” An aging population can be a sign of increased access to health care and education, but because of China’s current and past enacted policies, a significant revamp of social policies is necessary to accommodate the aging population.

Urban Versus Rural Living

Moreover, limited access to education and rural living is linked to declining cognitive health. Though the World Health Organization reports that across China’s geographic regions, 75% of older people suffer from noncommunicable diseases as of May 2021, China’s poor and low-income populations struggle most with this issue as they have limited access to quality health care.

Research shows that there is significant regional and urban-rural disparity in China regarding economic, social and health issues. Poorer, rural communities have reduced access to care that would enable healthy aging. The COVID-19 pandemic in China has only exacerbated these challenges.

Moving Toward the Future

Once the Chinese government and Chinese academics began to see the long-term impacts of the one-child policy, many groups began prioritizing care for the elderly to begin to repair the aging crisis in China. A study done by Peng Nie and others found that from 2011 to 2015, statistics point to an improvement in healthy aging.

However, there are still significant geographical disparities that groups are seeking to address, such as the link between healthy aging and higher education or the link to higher socioeconomic class.

A positive sign is that China ended its one-child policy in 2015, expanding it to two children, and later, expanding it to three. This is a reassuring sign that China recognizes its aging health crisis, though implementation of policy to help Chinese citizens must be developed as well. Abandoning the one-child policy means that the age breakdown of the Chinese population may even out over the next few decades.

Additionally, the National Center for Gerontology (NCG), established in 2015 and located inside Beijing Hospital, focuses on preventative and control measures related to the aging crisis in China. This manifests in the form of research, training of medical professionals and the prioritization of health services for older people in remote areas.

The NCG published journals and established the National Plan for the Elderly Health Service System (2019–2022), which seeks to solidify a course of action for China. Among other goals, the NCG raises awareness for geriatric issues and encourages people to become involved in geriatric care.

– Lara Drinan
Photo: Flickr

Malaria VaccineIn October 2021, the World Health Organization (WHO) recommended a vaccine for the prevention of malaria. This malaria vaccine, called the RTS,S, is the first and only the WHO has recommended for malaria prevention.

Devastating Impact

Malaria has a devastating impact on countries where the disease is common. In 2020, there were 241 million malaria cases and 627,000 malaria deaths. In Africa, where 82% of malaria cases occur, 80% of malaria deaths consist of children under 5. In addition to the high death toll, malaria causes an estimated loss of $12 billion every year in lost productivity.

Over the past several decades, improved preventative measures including mosquito nets, antimalarial medications and efforts to reduce mosquito habitats have helped to contribute to a decline in the prevalence of malaria. Since 2015, however, progress in efforts to combat malaria has slowed, according to WHO. Some countries with especially high malaria transmission rates have even experienced an increase in malaria cases. After a slump in progress in recent years, though, the success of the RTS,S vaccine offers a ray of hope.

The Vaccine

Due to the complexity of the parasite that causes malaria, this vaccine took more than 30 years to develop. Research on the RTS,S vaccine began in the 1990s with the first clinical trial on it published in 1997. However, several more decades of trials would pass before researchers proved the vaccine to be safe and effective against malaria in children.

Trials completed in 2015, which followed a schedule of three or four vaccines for children between 5 and 17 months of age, found the RTS,S vaccine to reduce malaria-related hospitalization by 37% in the first four years of vaccination.

Over the course of three years, the pilot program, which included trials in Ghana, Kenya and Malawi vaccinated more than 900,000 children. The pilot program confirmed that the vaccine, while not perfect, reduces the frequency of severe malaria infection and demonstrated that large-scale vaccine distribution is feasible, according to WHO.

Based on the findings of the trials, the WHO expects that vaccinating one child could save the lives of 200 of them, according to its report. The WHO estimates that, if widespread vaccination is achieved, the RTS,S vaccine could save the lives of 40,000 to 80,000 children every year. Following the success of the pilot program, the WHO officially recommended the use of the vaccine for areas with high to moderate malaria transmission in October 2021.

In April 2022, the WHO reached the milestone of having 1 million children in Malawi, Kenya and Ghana who have received at least one dose of the vaccine.

A Historic Breakthrough

After several years of stagnation, this malaria vaccine represents what Dr. Mary Hamel, a medical epidemiologist who works on malaria prevention, called “a historic breakthrough.” In addition to being the first vaccine to provide protection against malaria, the RTS,S vaccine is the first vaccine for the parasitic disease, meaning the development of this vaccine represents not only a breakthrough in malaria research but a breakthrough in the world of vaccine development.

Though the vaccine’s efficacy is modest, its success is a major breakthrough in a decades-long fight against a disease that kills hundreds of thousands of people every year. As the first WHO-recommended malaria vaccine, this vaccine has the potential to save tens of thousands of lives every year and serve as a stepping stone toward future innovations in the realm of malaria prevention.

– Anna Inghram
Photo: Flickr

Maternal Mortality in Haiti
Because of its status of being the poorest country in the Western Hemisphere, Haiti’s maternal mortality rate is estimated to be about 521 out of 100,000 births. Many babies do not have mothers to feed them and caretakers have to watch babies slowly starve from malnutrition. Here is some information about maternal mortality in Haiti as well as what some are doing about it.

Haiti’s Lack of Maternal Health Care

Approximately 70% of women give birth at home in Haiti. For the women who do have access to a midwife or a trained doctor, the necessary medical equipment and a sterile environment are lacking.

The World Health Organization (WHO) estimates that there are as few as 23 trained health care workers for every 1,000 people. There is approximately one midwife for every 1,000 pregnant women.

Reasons for Maternal Mortality in Haiti

Mothers face a higher risk of complications during birth beyond a lack of maternal care. Oftentimes, maternal mortality can occur due to mothers not having the necessary baby delivery equipment, especially if the mother experiences labor complications.

Approximately 26% of the maternal mortality rate in Haiti has been related to hypertension during childbirth which results in death. Meanwhile, 23% of mothers die from postpartum hemorrhaging and another 10% of the maternal mortality rate is a result of infection and obstructions in labor in Haiti.

Result for the Babies

In Haiti, breastfeeding is one of the few ways to feed babies. The formula is extremely expensive and rare to obtain. After a mother dies, the babies have very few options. In 2019, 11-month-old Jezil died from malnourishment after her mother died. Jezil’s grandmother could not afford formula and fed Jezil with rice water. Jezil’s grandmother watched her granddaughter perish from an easily remedied situation if she had access to formula. Another option for families is to send babies to orphanages in hopes that the baby has better access to health care and education. Approximately 25,000 children live in orphanages that have at least one parent or a caretaker alive.

Solutions in the Case of Maternal Mortality

The Potter’s Family is a nonprofit organization based in Saint Louis du Nord in the Northwest region of Haiti. Tore Dobbie founded the nonprofit in November 2019. Over time, Tore has witnessed many babies die from malnutrition or go to orphanages because their families could not take care of them after their mothers died. In response, the founder began a formula program that aims to keep families together by providing aid to caretakers who have experienced maternal mortality.

In early 2019, David’s caretaker came to Tore in hopes of finding a solution to feed him. David was discovered in a pile of garbage before being taken to a church to see if anyone was willing to take care of him. A woman with a baby volunteered and soon realized she could not feed two babies. Tore provided the formula for David and he stayed with his new family.

Programs similar to the Potter’s Family give another option for families who have been through maternal mortality in Haiti. The programs help provide a means to feed babies while keeping the babies out of orphanages and growing up with their families.

Chris Karenbauer
Photo: Flickr

Hospitals Empower Women Amid ConflictAmid ongoing crises around the world, hospitals help women deliver babies and maintain good reproductive and sexual health. Supporting hospitals in conflict-ridden countries empowers women and can drastically reduce maternal mortality rates. In Afghanistan, maternal mortality rates have reduced by more than 50% in the past 20 years due to advancements in public health infrastructure. Hospitals empower women amid conflict by providing lifesaving support to new mothers and women of all ages.

Conflict-Ridden Areas

Hospitals and clinics in conflict zones save lives every day, in areas ranging from maternal care to helping the sick and wounded. When conflict strikes, though, medical care facilities experience difficulties procuring medicine, equipment and supplies. The hospitals and clinics may also struggle to maintain a steady supply of fuel and heating. Non-governmental organizations (NGOs) often help hospitals and clinics in conflict-ridden areas obtain supplies.

In 2021, the United Nations Population Fund (UNFPA) provided two hospitals in Afghanistan with emergency kits containing medicine and equipment to support the “reproductive, maternal and newborn health needs” of more than 300,000 people. In combination with NGO efforts, governmental investments in hospitals and other public health infrastructure are necessary to ensure adequate medical care in conflict zones, especially for women. Well-funded hospitals empower women amid conflict by safeguarding their reproductive health and ensuring safe deliveries.

Health Care for Women

Conflict zones make it difficult for women, children and newborns to access health care. For example, the war in Yemen has prevented many women and children with health emergencies from accessing medical facilities. Limited access to medical care for the Yemeni people has led to an increase in deaths, leaving pregnant women, newborns and children the most vulnerable.

Developing countries are unlikely to have enough fully functioning hospitals to support everyone’s medical needs, especially in times of conflict. Many patients in conflict zones must travel through dangerous sites to receive medical attention from a hospital. Such endeavors are particularly dangerous for pregnant women and women traveling with young children. High-functioning, accessible hospitals are highly beneficial to public health and safety in times of conflict, especially for women and newborns.

Improving Health Care in Conflict Zones

Improvements to health care in conflict zones may involve public and private coordination, addressing context-specific needs and developing sustainable responses to medical emergencies. Public and private coordination efforts may include governmental bodies, humanitarian organizations and other global public health actors including the World Health Organization.

When public and private actors collaborate, the efforts can provide optimized health care to those in need. Context-specific health care initiatives tailor medical care and responses to the most common or urgent needs of a community. Such initiatives involve speaking with local actors and communities to gauge their medical needs. States can improve health care sustainability in conflict zones by improving existing health systems, securing funding and prioritizing the treatment of chronic illnesses.

Robust medical systems are necessary to promote health, safety and peace in conflict-ridden areas. Access to health care is particularly important for pregnant women and newborns as these are highly vulnerable groups in conflict zones. Hospitals empower women amid conflict by providing access to maternal and reproductive health care, which saves lives and ensures safe pregnancies.

– Cleo Hudson
Photo: Flickr

WHO’s Blindness Prevention StrategyThe World Health Organization (WHO) has developed specific strategies to tackle blindness and related diseases through strategies including VISION 2020 and SAFE. Other countries may see progress in eye care support by implementing such strategies after the 74th World Health Assembly introduced a resolution to the improvement and accessibility of eye care services. Governments have adopted the resolution to make greater efforts to incorporate eye care in primary care. Methods from VISION 2020, SAFE and the recent PECI from WHO’s blindness prevention strategy may help bring the resolution to fruition.

Eye Disease: A Global Public Health Issue

WHO reported that at least 2.2 billion people suffer from visual impairment. Nearly half of these cases could have been prevented or have yet to undergo identification. A range of factors, including complications from disease, age, trauma and more can cause eye impairment. Some individuals do not receive timely treatment for preventative eye care, which can result in lifelong damage. Visual impairment can affect every aspect of a person’s life, ranging from career and school opportunities to independence and overall health.

For example, trachoma remains a public health issue in 44 countries. WHO says, using June 2021 data, that 136 million people reside in areas where trachoma is common. The individuals are also at risk of contracting trachoma-related blindness.

Visual impairment, such as blindness, leads to tremendous economic burdens and productivity loss. WHO estimates the cost of productivity losses from blindness and visual impairment at $2.9-5.3 billion per year. Some methods of treatment for visual impairments include surgery, corrective glasses and contacts as well as medication. The advancements in medicine allow more people to live without lifelong damage similar to blindness as such solutions are not as readily available for those living in rural areas or those of low income. VISION 2020 and SAFE are variations of the WHO’s blindness prevention strategy that aim to extend treatment for visual impairment and preventable blindness to regions where treatment is not readily available.

The Package of Eye Care Interventions (PECI)

According to the WHO, those living in developing countries or rural regions face inequities in the quality, rate and accessibility of eye care. Because of limited resources for eye care in low- and middle-income countries, estimates project that 50% of the global population will be living with vision impairment by 2050.

To support countries struggling with cases of vision impairment, some of which are preventable, WHO’s blindness prevention strategy has materialized in various solutions in the past two decades. One recent strategy from WHO is the Package of Eye Care Interventions (PECI) in 2020. This evidence-based approach, if implemented, allows countries to carefully determine where to prioritize budgets and integrate eye care interventions. The strategy will support work competency, fulfill medication and equipment needs and more. However, WHO’s blindness prevention strategy did not begin here.

VISION 2020 “Right to Sight” and SAFE

Before PECI, WHO developed the strategies VISION 2020 “Right to Sight” and SAFE. VISION 2020 began in the hopes of eliminating preventable blindness by the year 2020. Some of the goals of the strategy aimed to safeguard an estimated 100 million people, primarily in developing countries, from avoidable blindness. VISION 2020 also intended to save an estimated $102 billion in lost productivity from the time the strategy was implemented to 2020. This strategy, similar to PECI, focused on developing quality eye care facilities with trained eye care workers, implementing programs that help prevent major causes of blindness and promoting the integration of eye care in primary care.

Since then, WHO has recommended Surgery, Antibiotics, Facial cleanliness and Environmental improvement (SAFE) along with the previously mentioned strategies to prevent avoidable blindness. After the 74th World Health Assembly, more countries that have adopted the resolution may see progress in supporting their citizens with eye care and eliminating preventable eye diseases. By using WHO’s blindness prevention strategy, rates of preventable blindness may reduce.

– Michelanie Allcock
Photo: Flickr

Cold Harms Those in Poverty
It may be easy to guess that during the colder months, those in poverty have a much more difficult time surviving than in warmer times. All around the world, people are struggling to stay warm – many in poverty must decide whether it is more important to have “heat or eat.” One cannot underestimate the reality of how the cold harms those in poverty globally.

Why the Cold is So Difficult for Those in Poverty

For many, cold weather signifies the dreaded winter season. According to the World Health Organization (WHO), families who are poor are four to five times more likely to live in cold homes and more than 30% of houses that are lower-income cannot keep their houses warm globally. Especially during the pandemic, families who have lost jobs are struggling now more than ever to keep their households at a decent temperature. Fuel poverty was a term that first emerged after the 1973 oil crisis to mean a period marked by increased prices in fuel which disproportionately affects low-income families. In essence, it is the inability to afford heating for one’s house at a reasonable cost.

Fuel poverty becomes all the more alarming when one considers the ramifications of living in cold homes during the winter. It is unimaginably uncomfortable and the Institute of Health Equity also reports that cold homes lead to higher mortality and morbidity rates. Lancet Planetary Health found that five million people die a year simply from the inability to adjust to temperature changes. Colder temperatures have links to more deaths of those in poverty and the stress of not being able to afford fuel can come in the form of both physical and mental illnesses. Those in poverty sometimes cannot afford the extra expense of fuel and heating for their homes. If they do, the population must sacrifice other aspects of their spending, such as basic nutrition. Thus, it is clear that the cold harms those in poverty much more than the average-income family.

Examples of the Effects of the Cold in Lebanon

Several regions around the world are struggling because of cold, winter weather. Studies have not shown that colder nations are more subject to poverty. However, more people are struggling to pay fuel costs as a result of rising costs due to the pandemic and inflation. Thus, during times of economic peril, low-income families struggle immensely in the cold. Most recently, Storm Hiba has left Lebanese citizens and Syrian refugees in desperate circumstances.

Lebanon’s recent currency crisis has left many families in poverty, thus unable to afford the resources necessary to protect against the cold. Many are burning old clothes and plastic goods to keep warm, while others are simply relying on blankets. Since 90% of the Syrian refugees who live in Lebanon are in poverty, it is clear that the cold is disproportionately targeting them. Costs of wood are five times the minimum wage, while costs of diesel are 10 times what they were in 2019. Thus, those in poverty cannot afford to stay warm.

How Cold Harms Those in Poverty in Kazakhstan and Other Parts of Europe

Several other countries are victims of the cold weather’s effects on those in poverty. Kazakhstan, one of the coldest nations in the world, is deeply reliant on coal for heating. According to a study by Nazarbayez University, 28% of families in Kazakhstan have to spend more than 10% of their income simply on fuel for heating in the winter. This is a major problem for families who are in poverty, especially as energy prices rise.

According to the United Nations Office for the Coordination of Humanitarian Affairs, 6.9 million children have experienced displacement from their homes are at high risk for severe winter weather. The children come from numerous countries, such as Ukraine and Bosnia and Herzegovina. Already, they are trying to keep warm in plastic containers and deaths have occurred as well. Even wealthier nations experience severe cold weather plights due to fuel poverty. National Energy Action found that 9,700 people die in the U.K. from living in cold homes.

Save the Children and the Community Action on Fuel Poverty (CAFP)

Many organizations are trying to help victims of the cold. Save the Children is a U.K.-based organization that seeks to provide aid to children in poverty globally. The organization has continuously been searching for better accommodations for children in severe temperatures and has provided blankets, hygiene baskets and warm clothing to those in desperate need. The Community Action on Fuel Poverty (CAFP) is an organization that seeks to spread awareness of poverty through outreach to everyday people. It hosts workshops and sessions, training and energy-efficient campaigns to promote knowledge about the fuel poverty crisis in different communities in England specifically.

Learning about different benefits to lower the cost of fuel prices and information on legislation affecting fuel costs are what work the CAFP promotes. Also, people can call upon local and international governments to increase awareness of thermal discomfort, especially for poor families during the lockdown. Governments need to make long-term plans for sourcing heat for all families during the winter.

The European Union’s Plans to Address Fuel Poverty

The European Union has developed a program to address fuel poverty, recognizing the budget to prevent fuel poverty has decreased greatly. Its plan “Energy Efficiency in Household Buildings” offers incentives to citizens who meet income criteria to maintain energy-efficient heating and cooling. The “Better Energy Warmer Homes” plan provides energy efficiency measures to low-income households specifically. Similar programs should begin in nations with fuel poverty crises currently as there is a lack of similar government initiatives in countries ranging from Lebanon to Kazakhstan.

While the cold harms those in poverty, there are ways in which poor families can find relief and comfort. Calling on governments to do more and donating to organizations similar to Save the Children can greatly benefit those in the cold.

Rachel Reardon
Photo: Flickr

EpigeneticsEpigenetics is a recently developing branch of genetics that rose to prominence in the 21st century. Recent research has shown the biological effects of poverty through epigenetics. Epigenetics goes further than the genes a person inherits from their parents by showing how the individual’s genes react to their environment and other factors. One study that Molecular Psychiatry published concluded that children who grow up in families below the poverty line are “more prone to mental illness and alterations in DNA structure.” Since poverty brings numerous stressors such as poor nutrition and physical or psychological trauma, it can affect a child’s biological development, particularly in the brain. Epigenetics can help shape the future and bring to prominence that poverty can cause acute and chronic conditions.

What is Epigenetics?

The Centers for Disease Control and Prevention (CDC) defined epigenetics as “the study of how your behaviors and environment can cause changes that affect the way your genes work.” Epigenetics affects gene expression, specifically the process of protein creation. The environment and a person’s behaviors correlate with epigenetic changes; the connection becomes evident between a person’s genes, behaviors and environment.

There are three different mechanisms in epigenetics that can affect gene expressions, including DNA methylation, histone modification and non-coding RNA. DNA methylation turns the genes “off” and demethylation turns the genes “on.” More specifically, DNA methylation can directly inhibit the expression of genes. In this process, information from the gene becomes a functioning product such as proteins, which are essential molecules that help bodies function. Histone modification occurs with the adding or removal of chemical groups from histones. More specifically, it can also change if a gene is “on” or “off.” Finally, non-coding RNA is a biological function that helps control gene expression.

The Relationship Between Epigenetics and Poverty?

A 2019 article from Northwestern University explains that poverty can implement itself across genomes — “poverty leaves a mark on nearly 10% of the genes in the genome.” Previous research demonstrated that socioeconomic status is a significant determinant of human health and disease. For example, some factors such as lower educational attainment or lower-income increase the risk for heart disease, diabetes, different forms of cancers and other infectious diseases. Also, lower socioeconomic status is associated with other physiological processes that could “contribute to the development of diseases such as chronic inflammation, insulin resistance and cortisol dysregulation.”

In one recent study led by Dr. Adam R. Wende, researchers learned that end-stage heart failure patients had “cytosine-p-guanine, or CpG, methylation of the DNA in the heart.” This methylation was associated with race as the only variable between African Americans and Caucasians. In addition, researchers discovered through census tracking that African American patients lived in neighborhoods with higher racial diversity and poverty. This difference suggested to the researchers that “the underlying variable may be socioeconomic difference.”

Wende spoke about the impact of the study with UAB News. Wende stated that “we provide preliminary evidence that socioeconomic factors are likely associated with racial differences in cardiac DNA methylation among men with end-stage heart failure.”

Differences Between Children in Poverty and Higher Income Households

In another study published in 2016, scientists found that children who grew up in poverty had more DNA methylation than other children who came from higher household incomes. Researchers thought that this difference might have suppressed the impoverished children’s “production of serotonin transporter protein.” As a result, the kids in the impoverished households had less serotonin in the brain, which can lead to depression and other mental conditions.

Dan Notterman, a molecular biologist at Princeton University, found in his research that telomeres, the caps at the end of chromosomes, “[shorten] in children from impoverished families.” Research shows a link between telomere length, aging and poor general health, meaning that the shorter telomeres are, the worse a person’s health is and the faster the aging process is. In layman’s terms, poverty can cause children and adults alike to be more prone to mental and physical illnesses and hinder physiological processes at a genetic level.

Can Epigenetics Help Reverse Negative Health Outcomes?

Robert Philibert, a behavioral geneticist at the University of Iowa in Iowa City stated that “what this points out here is that if you really want to change neurodevelopment, alter the environment.” Epigenetics shows that the environment affects gene expression, and thus, the body’s biological functions.

Social determinants of health (SDH) are, as the World Health Organization (WHO) defines, “the conditions in which people are born, grow, work, live and age and the wider set of forces and systems shaping the conditions of daily life.” SDHs can influence health and gene expression through “income and social protection, education, food insecurity, social inclusion and nondiscrimination.” According to the WHO, SDH plays a significant role in 30-55% of health outcomes. Epigenetics shows people must address the systems that allow poverty to thrive in order to ensure people do not experience a disadvantage at the beginning of life.

Gaby Mendoza
Photo: Flickr