Global Health Sushi

Just imagine you could reach out to a worldwide network of 10,000 global health experts, all at the touch of a button.

Now you can.

The Global Public Health group on Linked-In just welcomed its 10,000^th member!

Started just over three years ago, the group now hosts a unique daily dialogue among thousands of people from all corners of the world - people working with different types of organizations or as independent consultants, and across multiple public health-related disciplines. The daily discussions have a main focus on programme implementation challenges and current public health news, as well as professional development and work opportunities.

“A lot of the time, members are simply sharing information and asking one another for advice,” said Vincent Wong, who started the group just over three years ago. “Back in 2008, Linked-In was a very tech-heavy site, not too much in the way of public health, and nothing at an international level. I was working as a consultant and thought it would be a fantastic platform for connecting public health professionals globally, particularly those seeking work.”

The Global Public Health group has indeed developed to fill that gap. With 10,000 members and 12 sub-groups covering specific topics such as maternal and reproductive health, social determinants, health finance and economics and much more, members are able to interact on broad themese as well as sharply focused work areas.

Contents are actively managed by volunteer managers in order to keep the focus on target, and to weed out use of the group for publicity. There are also linkages with other social media tools, such as a Twitter list of group members so information can be shared across platforms. As well as a convenient tool for sharing information, the group provides a space for peer support and interaction in an increasingly fragmented public health arena.

“As the membership grows and diversifies, we are seeing an increasing number of responses to questions and appeals for help,” said Tim France, Managing Director at Inis Communication and one of the group's volunteer managers. “As more organizations enter the global health arena, it is becoming obvious that having one place to network and support one another across our micro-specializations is vital.”

Global Public Health was recently changed to an open group, so daily discussions can be read by anyone, and is free of charge.

The 10,000^th member to join the group today was Winnie Ko from Genoa in Italy. A warm welcome to Winnie and to you if you are not already taking part.

To browse or join the discussion for free, click here.

The spin and commentary being created today around the recent trial results that show (although not for the first time) that antiretroviral treatment (ART) reduces HIV transmission is missing some pretty important considerations. I'll try to outline what I see as the main three here, but there are others too….

1. Half of the people living with HIV don't know it

Let's just be clear: there are 33 million people thought to be currently living with HIV in the world. Of those, only about half know their HIV status. The first big obstacle to realizing the potential of the 'new' research findings lies in the other 16 million people or so having an HIV test and sticking around for the results. After 30 years of the HIV response so far, we have reached 50% of PLHIV knowing their status. Increasing that number is going to be extremely challenging and the latest results will not change that.

2. Most people living with HIV don't need ART to stay well, because they already are

People who know they are living with HIV don't usually take ART until their immune system gets to a particular stage of decline, which is measured by the level of a specific type of white blood cell called CD4s. In early 2010, WHO issued a new recommendation that ART treatment should begin when CD4 counts get below 350. Normal CD4 levels are up to about 1000. People living with HIV mostly remain well until their immune systems enter this kind of decline, and so taking ART sooner (i.e. as soon as you know you are HIV-positive) likely has no therapeutic benefit for the individual taking it; they would be taking a drug, potentially for years, that has no direct benefit to them other than making them less infectious to others. That is going to be a hard thing to convince many people to do, especially when there are other options around for them to "with dignity and confidence, take additional steps to protect their loved ones from HIV," to quote Michel Sidibe, the head of UNAIDS today.

3. If all people living with HIV were to take ART, it would potentially divert drugs from those that need ART to stay well/alive

When WHO changed the CD4 threshold for starting ART to <350 (from <200), that threw projections of how much ART would be required out of kilter because more people living with HIV were suddenly 'eligible' for ART. Now imagine we effectively remove the threshold for starting ART: the number of people 'needing' ART would go from about 10 million to about 33 million, decreasing the current estimated ART coverage from about 50% of those who need it to about 16% (i.e. 5.2 m out of 33.3 m). Who would have priority access to the available drugs? Those who need them to prevent transmission, or those who need them to stay alive? We have been through a decade or so of unprecedented investment and attention to a health issue: expanding ART availability. Despite that, we have managed to reach only half of those people who need ART to stay alive. That proportion is only going to go down if you now introduce another 20 million people living with HIV into the global ART equation.

Besides these three considerations, other reasons for not spinning these research results as if they are a "serious game changer" (again quoting Sidibe's frothing) is that doing so could inadvertently decrease emphasis on safe sex approaches, driving other STDs and unwanted pregnancies. It also sends a message that using condoms or delaying sexual debut is somehow less than taking dignified and confident steps to protect loved ones. It may also generate a false sense of security that HIV is no longer a risk we need to worry about because there are drugs to take care of that. We also have no idea what widespread use of ART in this context would do to driving emergence of drug resistance.

So why all the excitement and focus on merely the potential positives of this new data? In my view it's because the HIV response desperately needs some good news right now. The current financial crisis and the responses of donors are highlighting the fragility of the amazing gains that have been made against HIV in the past decades. As Sarah Bosely (of The Guardian) said today, the results "will give a massive boost to organisations such as UNAIDS which are arguing, in a time of financial constraint, that there is an urgent need to get AIDS drugs to more people who need them."

In the science and health fields, responding in a biased and selective way to results such as these, and avoiding reference to any of the obvious realities that will hinder their implementation, will only damage organizations that should be cultivating the opposite reputation: one of balance, scientific objectivity and accountability.

Quick gains still possible, but only if urgent steps are taken

On the eve of a global ministerial conference on healthy lifestyles and noncommunicable diseases (NCD) in Moscow, the World Health Organization today launched the first WHO Global Status Report on NCDs, providing new information on the extent of heart and lung diseases, cancers, diabetes and other NCDs.

The report reveals that of all the 60 million deaths that occur throughout the world each year, almost two thirds are due to NCDs. And nearly 80% of NCD deaths are in low- and middle-income countries – busting the myth that NCDs are mainly diseases of the wealthy.

“The epidemic already extends far beyond the capacity of lower-income countries to cope,” says WHO Director-General Margaret Chan in the report. “In the absence of urgent action, the rising financial burden of these diseases will reach levels that are beyond the capacity of even the wealthiest countries in the world to manage,” she warns.

The new report argues that while the impact of NCDs has been rising in recent years, so has understanding of their control and prevention. To aid priority setting and encourage immediate action, the report also puts forward a series of highly cost-effective ‘best buys’, known to be effective, feasible and affordable in any setting.

Current evidence shows that NCDs are preventable, and that countries can reverse the advance of these diseases to achieve quick gains – assuming that appropriate and urgent actions are taken. The new report recommends that countries take action is seven main areas:

• A comprehensive approach: Evidence from successful NCD reduction programmes indicates that both prevention and treatment interventions are necessary. Reversing the NCD epidemic requires a comprehensive approach that targets populations as a whole and includes both prevention and treatment interventions.
• Surveillance and monitoring: Measuring key areas of the NCD epidemic is crucial to reversing it. Specific indicators must be adopted to track NCDs and used worldwide and surveillance systems must be integrated into national health information systems.
• Health systems: Strengthening of country health-care systems to address NCDs must be undertaken. Reforms and improvements in health-system performance must be designed to improve NCD control outcomes.
• Best buys: Some NCD control measures are so cost-effectiveness that they should be adopted and implemented immediately. According to the report, these include tobacco control, promoting physical activity and exercise, increasing alcohol taxes and related adverting bans, and population-wide salt reduction strategies.
• Sustainable development: The NCD epidemic has a substantial negative impact on human and social development. NCD prevention should therefore be included as a priority in national development initiatives and related investment decisions.
• Civil society and the private sector: Civil society groups are uniquely placed to mobilize political and public awareness and support for NCD prevention and control efforts. Businesses can also make a critical contribution to addressing NCD prevention challenges, through responsible marketing and product reformulation.
• Multisectoral action: Action to prevent and control NCDs requires support and collaboration from government, civil society and the private sector. Multiple sectors must be brought together for successful action against the NCD epidemic.

But the real question raised by the report is: How is it possible that the NCD epidemic grew silently and insidiously over the past 20 years or so, with alarm bells only being rung now? The answer most likely lies in the second point above: surveillance and monitoring. Health programmes have been so focused on measuring the explosion of disease-specific indicators, that few seemed to notice – or to care – that NCD impact was growing into what now appears to be the most significant health consideration in many low- and middle-income countries today.

Are we really busting myths about NCDs? Digging our heads out of the infectious diseases sand might be a more accurate description.

According to a short video just released by the Roll Back Malaria Partnership, a child dies every 45 seconds from malaria:

According to another video just released by the Global Fund against AIDS, TB and Malaria, a child dies every 30 seconds from malaria:

Two short videos, both released in the past few days (by Geneva-based organisations) for World Malaria Day. Both use this simple statistic as the opening statement in their videos.

I'm sure there is a prefectly good reason for the discrepancy, but to viewers this just looks shoddy that we can't get the simple, high-level health statistics to tally.