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Healthcare in Singapore
The healthcare system in Singapore is globally renowned for its compelling design, which satisfies both conservatives and liberals. The universal healthcare system provides economically efficient and high-quality medical care in both private and public facilities.

Objectives of Healthcare

According to the Affordable Healthcare passage from Singapore’s Ministry of Health, the five fundamental objectives of the healthcare system include:

  • To nurture a healthy nation by promoting good health;

  • To promote personal responsibility for one’s health and avoid over-reliance on state welfare and medical insurance;

  • To provide good and affordable basic medical services to all Singaporeans;

  • To rely on competition and market forces to improve service and raise efficiency; and

  • To intervene directly in the health care sector; when necessary, where the market fails to keep health care costs down.

To summarize, the government acknowledges the strengths and limitations of the public and private sectors in health. Overall, healthcare in Singapore has a multipayer financing structure, where a “single treatment episode might be covered by multiple schemes and payers, often overlapping.”

Specifics of Singapore’s Success

The system is known as the 3Ms, which consists of:

  • MediShield Life – a universal basic health care insurance that is mandatory for citizens and permanent residents and provides lifelong security against large hospital bills and specific costly outpatient treatments.

  • MediSave – a mandatory savings plan consumes between 7 and 9.5% of worker’s wages, helping cover out-of-pocket payments. These tax-exempt, interest-bearing accounts can be used to pay for family members’ health care expenses or routine care.

  • MediFund – the government’s safety net for Singaporeans who cannot cover their out-of-pocket costs, even with MediSave.

Healthcare in Singapore is ranked among the best healthcare systems in the world, according to the World Health Organization (ranked 6th in 2010) and Bloomberg’s list, “These Are the Economies With the Most (and Least) Efficient Health Care.”

However, several factors beyond its structure contribute to Singapore’s successful healthcare system. Singapore is a small island city-state with a population of 5.6 million. Singapore’s physicians per 1,000 people ratio is 2.294, compared to the U.S’s, 1.565. Additionally, rates of smoking, alcoholism and drug abuse are relatively low, as well as the obesity rate. The healthier population predisposes “the country to … lower health spending.”

Limitations of Healthcare in Singapore

Although healthcare in Singapore receives acclaim for its ability to fund its systems through private markets, there are several limitations to consider, especially concerning Singapore’s underserved population. The lack of hospital beds in the emergency section of public hospitals causes patients with basic insurance plans to have limited financial protection. Since the spending on healthcare in Singapore is one of the lowest in the world (SGD 9.8 million out of SGD 400 billion), subsidies for patients are substantially limited.

Additionally, Singapore prides itself on its multipayer financial system; however, patients pay more than 60% of healthcare costs out-of-pocket. Thus, as Rachel Ngu, a writer for Mims Today (healthcare news across Asia), explains, “patients will need to pay an initial amount based on a subsidized class, as well as co-pay the rest of the bill. Aside from that, they will have to pay 10% of the rest of the bill for Integrated Plans.” Therefore, patients with basic coverage are not able to afford urgent medical attention because of the financial strain of medical bills, notably those without add-on integrated plans for more expensive hospital procedures.

Healthcare in Singapore is effective because of the efforts of the government and the people. Singapore has created a functioning healthcare system that regulates the supply and prices of healthcare services. Also, the system seeks to provide its citizen with security in the face of large medical bills. Though healthcare in Singapore is replicable on some levels, the system tailors to the specific needs of the economy and the demands of the people.

Mia Mendez
Photo: Flickr

hunger in IndiaIndia has a constantly growing population of more than 1.3 billion. While its economy is booming, its unequal wealth distribution has created an issue for a large portion of the population. Over the past few decades, hunger in India has remained a prevalent issue for the population.

Undernourishment in India

Almost 195 million people (15% of the population) in India are undernourished. Undernourishment means that people are not able to supply their bodies with enough energy through their diet. In the 1990s, 190 million people in India were undernourished. That number remains the same today. Lack of proper diet leads to stunted growth for children; in India, 37.9% of children under the age of five experience stunted growth due to undernourishment.

Malnutrition in India

Malnutrition is one of the bigger implications of the overarching problems India has to deal with: a wide range of hunger, extreme cases of poverty, overpopulation and continually increasing population, a poor health system, and inaccurate national statistics due to the aforementioned overpopulation.

According to the 2018 Global Nutrition Report, India will not reach the minimum nutritional goals by 2025 set by the World Health Organization. With 46.6 million children stunted in growth, India “bears 23.8% of the global burden of malnutrition.” These goals include “reducing child overweight, wasting and stunting, diabetes among women and men, anemia in women of reproductive age and obesity among women and men, and increasing exclusive breastfeeding.”

Action Against Hunger

As a result of all these issues, there are organizations that are trying to help India in its pursuit to provide food to all. Action Against Hunger raises money through donations and uses these funds to provide sustainable food for impoverished areas of the world. For 40 years, they have been operating worldwide and have helped 21 million people in just the past year.

Action Against Hunger facilitates field testing and train small-scale farmers in sustainable practices. Additionally, the organization provides clean water to communities and helps populations in times of natural disasters or other conflicts.

Action Against Hunger launched its program in India in 2010. With a team of 144 workers, they helped over 75,000 people in just the last year. Much of their work has caught the attention of state governments. For example, they have partnered with the Indian state of Chhattisgarh to “offer technical support in the fight against malnutrition,” and plan to do so with other states as well. In Rajasthan, the organization executed the Community Management of Acute Malnutrition program. As a result, the Chief Minister of Uttarakhand recognized the organization for its advocacy efforts.

Moving Forward

While India may not reach the WHO goals in five years, progress continues to spread across the country. Each year, India is reducing the number of people who are malnourished. Organizations such as Action Against Hunger partnering up with local and state governments are the first step in helping pave the way for a hunger-free India.

– Shreya Chari 

Photo: Flickr

Life Expectancy in Timor-Leste
Timor-Leste, also known as East Timor, is a nation that occupies the eastern half of the island of Timor in Southeast Asia. With a population of 1.26 million people, Timor-Leste is one of the least populated countries in Asia. The Portuguese originally colonized the country in 1520. After declaring independence in 1975, Indonesia invaded the nation, which occupies the western half of the island. The Indonesian invasion brought violence, famine and disease to Timor-Leste, resulting in a large loss in population. After a majority of the Timorese population voted to become independent in 1999, Indonesia relinquished control and Timor-Leste moved under the supervision of the United Nations. The nation officially became independent in 2002, making it one of the newest nations in the world. These 10 facts about life expectancy in Timor-Leste outline the rapid improvement the country has made since Indonesian occupation and the issues it still needs to overcome.

10 Facts About Life Expectancy in Timor-Leste

  1. Life expectancy in Timor-Leste increased from 32.6 years in 1978 to 69.26 years in 2018, matching that of South Asia. The consistent improvement in life expectancy in the past decade is primarily due to the Ministry of Health’s public health interventions. Such interventions include the reconstruction of health facilities, expansion of community-based health programs and an increase in medical graduates in the workforce.
  2. Life expectancy in Timor-Leste increased despite a drop in GDP, which decreased from $6.67 billion in 2012 to $2.6 billion in 2018. However, Timor-Leste’s GDP rose by 2.8% from 2017 to 2018. Continued improvement in GDP and economic progress in the nation will only serve to increase life expectancy by providing more opportunities for employment, education and improved quality of life.
  3. Tuberculosis was the highest cause of death in 2014, causing 14.68% of deaths. In 2014, estimates determined that Timor-Leste had the highest prevalence of tuberculosis in Southeast Asia, and 46% of people with tuberculosis did not receive a diagnosis in 2017. Maluk Timor, an Australian and Timorese nonprofit committed to advancing primary health care, provides a service through which team members visit Timorese households to locate undiagnosed patients and raise awareness about the severity of tuberculosis in the community. The organization collaborates with the National TB Program and aims to eliminate suffering and deaths in Timor-Leste due to diseases that Australia, which is only one hour away, had already eliminated.
  4. Communicable diseases caused 60% of deaths in 2006 but decreased to causing 45.6% of deaths in 2016. While diseases such as tuberculosis and dengue fever remain a public health challenge, the incidence of malaria drastically declined from over 200,000 cases in 2006 to no cases in 2018 due to early diagnoses, quality surveillance, funding from The Global Fund to Fight AIDS, Tuberculosis and Malaria and support from the World Health Organization.
  5. The adult mortality rate decreased from 672.2 deaths per 1,000 people in 1977 to 168.9 deaths per 1,000 people in 2018. Additionally, the infant mortality rate decreased from 56.6 infant deaths per 1,000 live births in 2008 to 39.3 infant deaths per 1,000 live births in 2018. While public health interventions and disease prevention contributed to the decrease in the adult mortality rate, Timor-Leste needs to expand access to maternal health services in rural areas to continue to improve the infant mortality rate.
  6. Maternal mortality decreased from 796 deaths per 100,000 live births in 1998 to 142 deaths per 100,000 live births in 2017. The leading cause of the high maternal mortality rate is poor access to reproductive health services, as only 43% of women had access to prenatal care in 2006. While the Ministry of Health continues to expand access to maternal health care through mobile health clinics that reach over 400 rural villages, only 30% of Timorese women gave birth with a health attendant present in 2013. Even as access increases, challenges such as family planning services, immunization, treatment for pneumonia and vitamin A supplementation remain for mothers in rural communities.
  7. The violent crisis for independence in 1999 destroyed more than 80% of health facilities. Despite rehabilitation efforts to rebuild the health system, many facilities at the district level either have limited or no access to water. However, the number of physicians per 1,000 people improved from 0.1 in 2004 to 0.7 in 2017. The capacity of the health care system is also improving, as UNICEF supports the Ministry of Health in providing increased training for health care workers in maternal and newborn issues and in striving to improve evidence-based public health interventions.
  8. Timor-Leste has one of the highest malnutrition rates in the world. At least 50% of children suffered from malnutrition in 2013. Additionally, in 2018, 27% of the population experienced food deprivation. USAID activated both the Reinforce Basic Health Services Activity and Avansa Agrikultura Project from 2015-2020 to address the capacity of health workers to provide reproductive health care and the productivity of horticulture chains to stimulate economic growth in poor rural areas. Both projects aim to combat malnutrition by addressing prenatal health and encouraging a plant-based lifestyle that fuels the economy.
  9. Motherhood at young ages and education levels are key contributors to malnutrition, as 18% of women began bearing children by the age of 19 in 2017. Teenage girls are far more likely to experience malnourishment than older women in Timor-Leste, contributing to malnutrition in the child and therefore lowering life expectancy for both mother and child. As a result of malnutrition, 58% of children under 5 suffered from stunting in 2018. Additionally, findings determined that stunting levels depended on the wealth and education level of mothers. In fact, 63% of children whose mothers did not receive any formal education experienced stunting, while the number dropped to 53% in children whose mothers received a formal education.
  10. Education enrollment rates are increasing, as the net enrollment rate in secondary education increased from 40.5% in 2010 to 62.7% in 2018. Completion of secondary education links to higher life expectancy, especially in rural areas. Since 2010, Timor-Leste has increased spending on education. Additionally, local nonprofit Ba Futuru is working to train teachers to promote quality learning environments in high-need schools. After Ba Futuru worked with schools for nine months, students reported less physical punishment and an increase in innovative and engaging teaching methods in their classrooms. The organization serves over 10,000 students and provides scholarships for school supplies for hundreds of students. With more programs dedicated to increasing enrollment and the classroom environment, students are more likely to complete secondary education and increase both their quality of life and life expectancy.

These 10 facts about life expectancy in Timor-Leste indicate an optimistic trend. Although malnutrition, disease and adequate access to health care remain prevalent issues in Timor-Leste, the nation’s life expectancy has rapidly increased since Indonesian occupation and has steadily improved its education and health care systems since its founding in 2002. To continue to improve life expectancy, Timor-Leste should continue to focus its efforts on improving public health access and community awareness in poor rural areas, and particularly to emphasize maternal health services to reduce both maternal and infant mortality rates. Despite being one of the newest nations in the world, Timor-Leste shows promise and progress.

Melina Stavropoulos
Photo: Flickr

childhood obesity in poverty-stricken AfricaChildhood obesity is a major issue in middle-income countries. However, this issue is growing in low-income countries as well now. In Africa, micronutrient deficiency and wasting are among the biggest challenges associated with children’s health. However, with sugary foods and snacks becoming cheaper and more accessible, childhood obesity is becoming more of an issue in Africa. A 2000 survey revealed that 10% of low-income countries had a 10% rate of teenagers who were overweight. Just between 2014 to 2016, that number jumped from 40% to 75%. It is quite clear that this issue is quickly increasing.

The Problem of Childhood Obesity

According to the World Health Organization (WHO), childhood obesity in poverty-stricken Africa is one of the most pressing issues of this century. Without intervention, this issue will only continue to spread.  Along with it, long-term health problems associated with obesity, such as diabetes, will also increase. Furthermore, not only are obese people at risk of contracting preventable health conditions but they are also at risk of early death. According to WHO, obesity takes more than two million lives every year worldwide.

Despite the growing economy in Africa, millions still suffer from poverty. This poverty, coupled with the growth of obesity, has Africa simultaneously facing two major challenges. These two challenges have led to a significant increase in diseases throughout Africa. Since the 1980s, diabetes has grown by 129% in Africa. To combat the spread of diabetes and the consumption of high sugar beverages, South Africa has passed a bill that taxes such beverages.

Combating Childhood Obesity

A few organizations are taking steps to combat childhood obesity in poverty-stricken Africa. The World Health Organization places its focus on what types of foods to consume, the number of physical activities that are being completed and overall health. The organization believes that in order to avoid the increasing amount of childhood obesity that Africa is experiencing, there must be corrections to all three factors mentioned above.

WHO created the “Global Strategy on Diet, Physical Activity and Health” to reduce obesity and improve overall health. The strategy focuses on four major goals that will ultimately help combat childhood obesity, diseases and death. The four main goals are to reduce risk, increase awareness, develop policies and action plans and monitor science. Though created 16 years ago, this strategy will only begin to make an impact after several decades. In order for the strategy to succeed, all levels of life and business must assist in the effort.

Childhood obesity in poverty-stricken Africa continues to be an issue. Although a relatively new issue in developing countries, obesity is quickly increasing. Africa is now combatting both ends of the nutritional spectrum, with malnutrition and childhood obesity now prevalent throughout the continent. Despite increases in these issues, organizations such as WHO are working diligently to reduce childhood obesity in Africa.

– Jamal Patterson 
Photo: Pixabay

poverty relief reduces disease
The universal rise in global living standards has helped combat diseases, spurred on by international poverty relief efforts. In fact, one study found that reducing poverty was just as effective as medicine in reducing tuberculosis. Poor health drains an individual’s ability to provide for themselves and others, trapping and perpetuating a cycle of poverty. Better public health increases workforce productivity, educational attainment and societal stability. Here are 5 ways poverty relief reduces disease.

5 Ways Poverty Relief Reduces Disease

  1. Better Sanitation: According to the WHO, approximately 827,000 people die each year due to “inadequate water, sanitation, and hygiene.” Poor sanitation is linked to the spread of crippling and lethal diseases such as cholera and polio, which hamper a nation’s development. By investing in the sanitation of developing nations, the rate of disease decreases and the food supply improves. Furthermore, an all around healthier society emerges that can contribute more to the global economy. In fact, a 2012 WHO study found that “for every U.S. $1.00 invested in sanitation, there was a return of U.S. $5.50 in lower health costs, more productivity, and fewer premature deaths.”
  2. Improved Health Care Industries: A hallmark of any developed nation is the quality of its health care industry. A key part of reducing poverty and improving health, is investing in health care initiatives in developing countries. When the health care industry is lacking (or even non-existent), the population experiences high levels of disease, poverty and death. Many American companies have already invested millions into the medical sectors of developing nations, however. In September 2015, General Electric Healthcare created the Sustainable Healthcare Solutions, a business unit that donates millions in money and medical equipment to developing nations.
  3. More Informative Education: Knowledge is power when it comes to fighting disease. Educational institutions provide a nation with one of the best tools to fight diseases of all kinds. According to a WHO report, “education emphasizing health prevention and informed self-help is among the most effective ways of empowering the poor to take charge of their own lives.” Schools must teach about proper sanitation, how to spot warning signs and form healthy behaviors. School health programs are also an invaluable resource in times of pandemics and disease outbreaks, as they coordinate with governments. This cooperation has helped tackle diseases, including HIV/AIDS in Sub-Saharan Africa. Eritrea, for example, has one of the lowest rates of infection in the region (less than 1%), partially due to an increase in HIV/AIDS education measures.
  4. Enhanced Nutrition: Malnutrition and food insecurity weaken the immune systems of the impoverished and significantly lower one’s quality of life. Millions of children each year die from famine or end up crippled due to dietary deficiencies. By investing in and supporting agricultural sectors of developing nations, aid programs help in not only decreasing poverty, but also in cutting down on illness of all kinds. Likewise, international aid during conflicts and natural disasters is crucial to ensuring the continued health and productivity of a country. One nation combating such an issue is Tanzania. With the help of aid organizations like UNICEF, Tanzania has decreased malnutrition for children under five.
  5. More Effective Government Services: Arguably encompassing all the previous categories, governments with more money and resources can effectively help stop diseases. A healthy general population leads to more productivity, which increases tax revenue. Central governments can then invest that money back into health care and sanitation, creating a positive feedback loop. Governments also provide a centralized authority that can cooperate with organizations like the WHO. In the 21st century, communication and cooperation between world governments is key to halting pandemics and working on cures.

Impact on COVID-19

The COVID-19 pandemic is a prime example of how improved government resources provide poverty relief, which helps combat the virus in the developing world. For example, Kenya has less than 2,000 cases due to effective government actions in curbing the spread of the virus. The systems and governmental services built up over past decades sprang into action and coordinated with organizations like the WHO. The government has also implemented various economic measures to help mitigate the negative economic side-effects. Moving forward, it is essential that governments and humanitarian organizations continue to take into account the importance of poverty relief for disease reduction.

– Malcolm Schulz 
Photo: Flickr

tuberculosis in Eastern Europe
One of the oldest diseases, tuberculosis is still prevalent in hundreds of countries and nearly every continent. Although many countries have been able to reduce their number of cases through medical intervention and policies, Eastern Europe remains affected by the disease. Despite the rising cases of tuberculosis in Eastern Europe, European and other governments are coming up with new solutions to better treat individuals with TB and potentially eradicate the disease. Here are five facts about tuberculosis in Eastern Europe.

5 Facts About Tuberculosis in Eastern Europe

  1. Most of Europe’s tuberculosis cases are in Eastern Europe. According to the World Health Organization (WHO), Europe has the lowest incidence of tuberculosis in the world. However, the cases that do exist concentrate in Eastern Europe. The WHO found that 18 countries in Eastern Europe bear 85% of the tuberculosis burden for the continent. Over the past decade, cases of tuberculosis have halved throughout Europe. Despite this decrease, however, the number of cases in Eastern Europe is almost eight times higher than that of Central and Western Europe.
  2. Eastern Europe has the highest rates of drug-resistant tuberculosis. Multidrug-Resistant Tuberculosis (MDR tuberculosis) is currently the most prevalent form of TB in Eastern Europe. MDR tuberculosis occurs when the bacteria that causes tuberculosis becomes resistant to at least isoniazid and rifampin, the two most common drugs doctors use to treat tuberculosis patients. Typically, this resistance occurs when patients do not finish their antibiotics or when tuberculosis infects a person more than once. In all of Europe, 99% of MDR tuberculosis cases occur in Eastern Europe. As a result, scientists need to develop new antibiotics or treatments for patients in that region.
  3. Tuberculosis outbreaks are more common in poorer regions. In general, researchers tend to find tuberculosis in poorer and developing countries. Similarly, the levels of TB in Eastern Europe could connect to the overall poverty rates in the region. The poverty rates in Central and Western European countries such as the Czech Republic are as low as 10%. However, in Eastern European countries, such as Romania, the poverty rates are as high as 25%. In poorer countries, access to medical treatment and preventative care decreases. Thus, in Eastern Europe, a common struggle for individuals with tuberculosis is finding health care that is effective and affordable.
  4. Problems with tuberculosis are worsening due to COVID-19. The COVID-19 pandemic has led countries to implement social distancing and stay-at-home policies. As a result, the circumstances for individuals with tuberculosis in Eastern Europe may worsen. A recent modeling study looked at the rate of incidence of tuberculosis and the tuberculosis mortality rate during the lockdown. The study predicted that both the number of cases and the number of deaths will rise as people remain in close quarters. For example, imagine the lockdown in a high-risk country such as Ukraine lasting for 3 months with a 10 month recovery period. The rate of incidence would increase by 10.7% and the mortality rate would increase by 16%. One reason for this increase is the lack of medical care available during the pandemic. As more supplies and medical officials go towards fighting COVID-19, other diseases such as tuberculosis could go unchecked during the lockdown.
  5. Better diagnostic services are currently in progress. This year, in 2020, the European Lab Initiative (ELI) on tuberculosis, HIV and Viral Hepatitis, a regional center that has dedicated itself to the treatment of those three diseases, released its goals for 2020 and 2021. These goals, which include improved drug treatments and better tracking algorithms, hope to allow doctors in Eastern Europe to diagnose patients with tuberculosis faster. By diagnosing people earlier, the transmission of tuberculosis will slow, and those who test positive for tuberculosis will have a higher chance of recovery.

Although the rates of TB continue to drop in Western and Central Europe, wealth inequality and the COVID-19 pandemic are keeping the number of cases up in Eastern Europe. However, if progress on better diagnostic services continues, the occurrence of tuberculosis there will decrease.

– Sarah Licht 
Photo: Flickr

COVID-19 in Colombia
Officials have reported 16,295 cases of COVID-19 in Colombia and 592 deaths as of May 19, 2020. In an effort to contain the virus, the government has closed all international travel. It has also recently extended its nationwide stay-at-home order through May 25. Testing is available at the Colombian National Institute of Health facilities.

Most public locations remain closed. Individuals over the age of 70 will need to self-isolate until at least the end of May 2020. Municipal authorities allow one hour per day of exercise, at prescribed times, for individuals ages 18 to 60. Though the virus poses a nationwide public health threat, here are three particularly at-risk groups in Colombia.

COVID-19 in Colombia: 3 At-Risk Groups

  1. Indigenous Peoples: With historically limited access to food, shelter and health care, indigenous communities on the outskirts of cities and towns remain unprepared for the pandemic. A scarcity of clean water and hygiene products has left many without the means to maintain personal cleanliness and prevent infection. In addition, some of these semi-nomadic groups are now at risk of starvation. Due to quarantine restrictions, indigenous communities cannot move around to access their means of subsistence. They may be unable to grow their own food or survive by working temporary jobs. Organizations such as Amnesty International (AI) are working to raise awareness about this urgent issue and garner support from Colombian authorities. Along with the organization Human Rights Watch (HRW) and the Colombian Ministry of the Interior, AI petitioned the government to deliver food and supplies to at-risk indigenous groups. In response to these efforts, Colombian officials initiated a campaign to provide indigenous communities with food and supplies. The first round of deliveries went out in April 2020 but still left many without aid. AI and partner organizations will continue working with leaders of the campaign to reach more people in future deliveries.
  2. Refugees: Venezuelan refugees are another group at high risk due to the outbreak of COVID-19 in Colombia. The virus has compounded instability from low wages and rampant homelessness. Many have lost temporary jobs as economic concerns heighten nationwide. With fear and social unrest on the rise, refugees also face increased stigmatization. Some states, for example, are forcibly returning refugees in response to the virus. The U.N. Refugee Agency (UNHCR) and the International Migrant Organization (IOM) have instigated a call to action. Eduardo Stein, joint UNHCR-IOM Special Representative for refugees and migrants from Venezuela, explained in an April 2020 statement that “COVID-19 has brought many aspects of life to a standstill – but the humanitarian implications of this crisis have not ceased and our concerted action remains more necessary than ever.” U.N. representatives are seeking out innovative ways to protect Colombia’s migrant population and provide refugees with information, clean water and sanitation. Some organizations have also set up isolation and observation spaces for those who have tested positive. Others, including the World Health Organization (WHO), are distributing food and supplies to refugees and their host communities.
  3. Coffee Farmers: As COVID-19 continues to spread throughout South America and the world, Colombian coffee farmers are grappling with new economic uncertainties. Since extreme terrain limits the use of mechanized equipment, these farmers tend to rely on manual labor. In a typical year, some farms hire between 40% and 50% of their workforce from migrant populations. Now, however, travel restrictions have left many with a shortage of manpower. Large-scale farms are seeking out unemployed retail and hospitality workers from local areas, offering pay rates at a 10% to 20% increase. On smaller farms, family members can manage the crops. However, medium-sized operations, in desperate need of labor and unable to match the wages of larger competitors, are feeling a significant strain. Even the largest farms could struggle to meet their expected harvest in 2020. Public health officials have ordered strict distancing measures in the fields, which reduces picking capacity. Though disruptive in the short term, these efforts should help contain the spread of the virus and allow farmers to resume full operation as soon as possible.

COVID-19 in Colombia has undergone rapid growth, bringing economic and social challenges in its train. Now more than ever, it is incumbent upon world leaders to support vulnerable populations in Colombia and help the nation emerge from this world crisis.

– Katie Painter
Photo: Flickr

Microparticles That Could Alleviate Global Malnutrition
According to the World Health Organization (WHO), iron deficiency is the most common consequence of poor nutrition worldwide. Every year, 2 million children die globally from malnutrition. Efforts to refortify foods date back to the early 20th century, but the technology to stabilize those nutrients in different foods has progressed slowly. In a breakthrough method of encapsulating micronutrients, researchers at MIT have discovered a way to refortify common foods by using biocompatible polymers that have shown in efficacy trials to prevent degradation while being stored or cooked. The new method would allow for better nutrient delivery and absorption. If there were microparticles that could alleviate global malnutrition, such a development, if scaled up, could provide many developing countries with more nutritious food and prevent malnutrition-related diseases that primarily affect children and pregnant women.

Micronutrient Malnutrition

Malnutrition primarily affects those living in developing countries and the malnourished often represent 30 percent of their population. Malnutrition presents itself in a variety of ways, but most notably through anemia, cognitive impairments and blindness. Roughly 2 billion people live in low-resource areas where infectious diseases compound the effects of malnutrition. The lack of micronutrients is a quiet and prolonged killer and can cause premature death and loss of economic activity. There is also a direct correlation between those with the least education and most iron-deficient in these countries.

WHO has worked to tackle the causes of malnutrition using solutions such as promoting dietary diversification with enhanced iron absorption and supplementation, noting that solutions must meet the local population needs. Since many of these communities lack more than one vital micronutrient, efforts to supplement the diet can address multiple deficiencies, such as lack of folate, vitamins A and B12. Part of their plan includes programs that aim to eradicate infectious diseases that contribute to anemia, including schistosomiasis, hookworm, HIV, malaria and tuberculosis. Doing so would help end the cycle of poverty that many communities face due to disease and malnutrition.

Microparticles That Could Alleviate Global Malnutrition

The lead authors of the MIT study are Aaron Anselmo and Xian Xu, as well as graduate student Simone Buerkli from ETH Zurich. In the study, they claim to have developed a new way of refortifying foods using a biocompatible polymer microparticle. What is most notable about this new technology for supplementing foods is that the encapsulated micronutrients will not degrade during cooking or storage. Researchers selected the polymer BMC out of the 50 different polymers they tested, after trying them on laboratory rats and later on women. The same polymer is already classified in the United States as a dietary supplement safe for consumption. The next step for the researchers is to advance clinical trials in developing countries with local participants.

The researchers were able to encapsulate 11 different micronutrients using polymer BMC, such as vitamins A, C, B2, zinc, niacin, biotin and iron. They were able to successfully encapsulate combinations of up to four micronutrients at a time. Even after boiling encapsulated micronutrients for hours in a lab, they remained unharmed. Researchers also found that the new microparticles remained stable after experiencing exposure to oxidizing chemicals in fruits and vegetables as well as ultraviolet light. The polymers become soluble in acidic conditions (such as the stomach) and the micronutrients released. An initial trial did not yield a high absorption rate, so researchers boosted the iron sulfate from 3 to 18 percent and were successfully able to achieve high absorption rates, which was on par with typical iron sulfate. This trial added encapsulate iron to flour and used it to bake bread.

History and Limitations of Food Fortification

In its Guidelines on Food Fortification with Micronutrients in 2006, the Food and Agriculture Organization (FAO) of the WHO noted that the most common deficiencies were in iodine, vitamin A and iron, representing 0.8 million deaths annually. Developed nations typically do not experience these levels of malnutrition because they have access to a variety of foods that are rich in micronutrients, such as meat and dairy products. Underdeveloped countries consume mostly monocultures of cereals, tubers and roots. Prior to the 1980s, developed countries focused their efforts on protein-energy malnutrition. While protein-based foods did help to improve nutrition, it was the addition of iodine to foods in the 1990s that helped prevent degenerative characteristics such as brain damage and mental retardation in childhood.

To combat micronutrient malnutrition, WHO promotes greater access to a variety of quality foods for all affected groups. In addition to a more diverse diet, they strategize to create policies and programs with governments and organizations to educate the public on good nutrition, diversify food production and deliverability, implement measures to guarantee food safety and provide supplementation. Having the support of the food industry has been essential since the beginning of the 20th century to include these guidelines in their production of food. Salt iodization in the 1920s expanded from developed countries to nearly the entire world. However, a number of challenges have remained for the refortification of foods.

For example, early on in the fight against malnutrition, a lack of quality evaluation programs on the efficacy of food refortification left nutritionists wondering if the empirical improvements for certain populations were due to supplementation or a combination of socioeconomic facts and public health improvements. Analyzing the data with a comprehensive efficacy trial became the norm in an effort to better gauge the efficacy of their efforts. Other issues remain such as interactions of nutrients, the stability of polymers, correct levels of nutrients, physical properties of ingredients and how well customers receive the food. For instance, in large amounts, calcium inhibits iron absorption while vitamin C has the opposite effect in refortified foods.

Implications of the Study

The MIT study, funded by the Bill and Melinda Gates Foundation, modeled its research on the success of refortifying food with iodized salt from the past, incorporating micronutrients into a diet that would not require people to change their consumption habits. According to researchers, the next phase will be to replicate the study in a developing country with malnutrition to see if the microparticles can feasibly enter residents’ diets. They are seeking approval from the WHO Expert Committee on Food Additives. If successful, they will scale up manufacturing of the nutrient additive in the form of a powdered micronutrient.

The initiative could lead to a significant decline in global cases of nutrient deficiencies thereby reducing the effects of anaemia and other preventable diseases due to a poor immune system. By no means would it represent the first technological advance in refortifying foods and increasing access to nutrition, but the addition of microparticles that could alleviate global malnutrition may help many developing nations end a cycle of poverty that disease has perpetuated for generations, increasing their health and productivity in the process.

– Caleb Cummings
Photo: Flickr

Threats to Global Health
Mankind can often feel a state of invincibility. This might be due to ignorance or denial that one could become sick, but global health is constantly experiencing threats. Some of the biggest threats to global health include pollution, diseases and fragile locations. For people who live in developed and booming economies, this may mean nothing. However, those living in poverty are often in direct contact with the threats that can sometimes be fatal.

Air Pollution

Air pollution is one of the most widespread pollution problems and kills nearly 7 million people a year. According to the World Health Organization (WHO), nine out of 10 people breathe in contaminated air.

The most common forms of air pollution are smog and smoke. Smog can come from factories, industrial areas or vehicle emissions. The worst cases of smog often occur in major cities that have large populations. For example, several of the most highly polluted cities in China because of the population density and a large number of factories. Xingtai, named the most polluted city in the world, has a population of nearly 7 million.

Smoke is also a common air pollutant largely due to the large population of smokers. Inhalation of heavily polluted air can cause stroke, heart disease, chronic obstructive pulmonary disease, lung cancer and acute respiratory infections.

Diseases

Noncommunicable or noninfectious diseases are illnesses that do not transmit from one person to another, and in fact, people cannot transmit them at all. They include a wide number of disease but some of the most significant ones are stroke, cancer, diabetes and heart disease. The World Health Organization recognizes noncommunicable diseases as one of the biggest threats to global health. Air pollution can cause some forms of diseases, but environmental factors, lifestyle choices or genetics cause noncommunicable diseases.

According to WHO, noncommunicable diseases are the leading cause of death in the world as well as one of the biggest causes of poverty. In fact, 15 million people who have died from noninfectious diseases were living in poverty. This is often due to poor sanitation conditions as well as the inability to receive proper health care to treat said conditions.

Fragile Locations

Fragile locations are places that have poor sanitation, famine, drought or conflict (war or corruption). Living in fragile locations can lead to several complications especially due to poor health care. Often countries that have high unemployment and poverty rates are fragile locations. This is because the fragility of areas can put a risk on people’s health that may disable them or put them on the streets. Living in fragile locations can also increase the risk of developing noninfectious diseases.

Poverty

Nearly 36 percent of the world’s population lives in extreme poverty. When dealing with global health threats, a vast majority of those in need of care either cannot afford it or access it. People living in poverty frequently face the challenges of poor economic stability, poor or nonexistent health care and a weak education system. lack of education in developing countries can also lead to recklessness when caring for those with diseases, both noninfectious and infectious. According to the Office of Disease Prevention and Health Promotion, ODPHP, strategies that aim to increase the economic mobility of families may help to alleviate the negative effects of poverty.

Organizations’ Help on Global Health

The CDC closely monitors and researches global health threats and ways to prevent and respond to them. Whenever there is a serious global health threat, the CDC is on the front line to aid in recovery, however, aid is not always helpful. According to the CDC, 70 percent of the world’s countries report that they are not prepared to face an outbreak. However, the world can do its part to prevent air pollution by smoking less and relying more on economically friendly means of travel. Although people cannot alter genetics it is important to avoid factors that may cause noninfectious diseases. For those in fragile locations, organizations like the CDC and WHO are attempting to provide aid and support to those in need.

Threats to global health are everywhere. Some threats are inevitable but others are man-made. It is important to regulate and reduce people’s ecological footprints so global health can experience improvement as a whole.

Sarah Mobarak
Photo: Flickr

lessons from past pandemics
There are several lessons from past pandemics that apply to COVID-19 prevention today. With the rise of COVID-19, it is particularly important to look back at history to prevent similar detrimental results.

Spanish Flu and Social Distancing

One of the main lessons from past pandemics such as the Spanish Flu is that social distancing works. With cities around the world such as San Fransisco ordering social distancing, this lesson is as pertinent as ever. In 1918, Philadelphia threw a parade to support soldiers fighting in WWI that drew a crowd of 200,000 people. Just three days later, every bed in Philidalphia’s 31 hospitals comprised of people infected with the flu. Unfortunately, despite Philadelphia’s enforcement of social distancing after the infection rate rapidly increased, this response was too late.

St. Louis, on the other hand, was more proactive with enforcing city-wide social distancing regulations. Within just two days of detecting the first cases of the flu in St. Louis residents, the city enforced social distancing measures. This resulted in less than half of the flu’s death toll than in Philadelphia.

Social distancing is not just about staying away from others when ill but also about reducing the chances of becoming a carrier of the disease. Several people might have coronavirus and not even know it as only 19 percent of confirmed cases of COVID-19 become critical. Because of this, it is important to stick to social distancing regulations as much as possible.

HIV/AIDS and the Deadliness of Social Stigma

The ongoing HIV/AIDS pandemic faces a great amount of social stigma that has lead to insufficient government prevention methods. This stigma is due to discriminatory views that the virus infects those who are gay or drug addicts who use intravenous drugs.

Though governments are more responsive today, when the HIV/AIDS pandemic first arose, many including the U.S. were late to respond due to this stigma. This resulted in many protests and, eventually, the government became more responsive.

One of the main lessons from the HIV/AIDS pandemic that one can apply to the COVID-19 outbreak is the fatal impact of social stigma. There are several discriminatory sentiments toward the Asian community right now with the COVID-19 pandemic. This stigma has led to a rise in hate crimes. People of Asian descent are not the only community capable of suffering an infection from this virus, and discrimination towards them can be deadly just as the case with those that the HIV/AIDS pandemic affected.

Small Pox and Global Cooperation

The World Health Organization (WHO) ran a vaccination campaign to eradicate smallpox from 1966-1977. It jumped through many government hoops in order to run the campaign, which was eventually successful. The current coronavirus outbreak will require similar action. Following government orders and keeping up with guidelines and news from the CDC and WHO will greatly help with global cooperation to slow the spread of COVID-19.

A critical issue that requires immediate and rapid cooperation is the stocking up of medical masks and other medical supplies such as hand sanitizer in a frenzy. While buying these supplies might seem helpful at the moment, it is actually having consequential effects. Doctors have reported shortages of masks that could lead to a dire situation if buying habits like this continue. Additionally, reports state that masks for healthy people are ineffective as a means of prevention.

Another form of cooperation that will help prevent those that the virus affects is joining local activist coalitions in helping those vulnerable to COVID-19, such as unemployed or food insecure individuals. In Seattle, COVID-19 Mutual Aid is a coalition that is helping out in solidarity with those most vulnerable. One can obtain further information about its work by visiting its Instagram page.

Hope for the Future

Social distancing, destigmatization and global cooperation are key lessons from past pandemics that easily apply to COVID-19. Not only learning but applying these lessons to the current pandemic is key to beating this virus.

Emily Joy Oomen
Photo: Pixabay