The WHO Report on Global Women’s Health

November 23, 2009

The World Health Organization (WHO) recently released a comprehensive report entitled “Women and health: today’s evidence tomorrow’s agenda.” The report documents the difficulties that women worldwide face when seeking healthcare at all stages of life. Findings in the report indicate that though women live six to eight years longer than men, on average, they often lack essential healthcare throughout their lives.

According to Reuters, women seek medical services more often than their male counterparts, especially before, during, and after pregnancy. In addition, women in the United States pay approximately 48 percent more than men for healthcare services. The report discusses the fact that in many nations “sexual and reproductive health services tend to focus exclusively on married women,” therefore assistance during childbirth can be particularly difficult to access for “unmarried and marginalized women, teenagers and sex workers.” Further, the WHO report notes that 99 percent of the estimated 500,000 women who die during childbirth each year are in the developing world where there is an extreme shortage of medical supplies and trained healthcare providers.

The Boston Globe reports that 15 percent of deaths in adult women worldwide occur in maternity, and one in five deaths among women in this age group is linked to unsafe sex. The WHO report indicates unsafe sex, stemming from the dearth of information regarding safer sex strategies and contraception, has also contributed to the spread of HIV and other sexually transmitted infections. In sub-Saharan Africa, one in four women who wish to delay or stop bearing children do not use any family planning methods, according to the WHO. A National Public Radio (NPR) report indicates that HIV is the number one killer of women ages 15 to 49 worldwide. Further, in 2007, 15.5 of the 30.8 million global cases of HIV-positive adults were women. Reports indicate that the largest portion of these individuals live in Africa, where six percent of women of childbearing age have the disease. NPR reports that, per the CIA World Factbook, half of the women ages 25 to 29 in Swaziland are infected with HIV – a small nation with a total population of one million people, 26.1 percent of whom are HIV-positive.

Women in resource-limited regions are at a particular disadvantage, as these areas often lack access to screening and treatment resources for diseases like cervical cancer, the second most common type of cancer in among women. A study of the introduction of the HPV vaccine published in the New England Journal of Medicine in 2007 stated “Of 274,000 deaths due to cervical cancer each year, more than 80% occur in developing countries, and this proportion is expected to increase to 90% by 2020.” Complications related to pregnancy, including unsafe abortion procedures, are among the leading causes of death among girls aged 15 to 19 in developing nations. Though these issues are substantial concerns in middle- and high-income nations, the WHO report indicates that road traffic injuries are the leading cause of death in girls between the ages of 10 and 19 in these regions. Among women over the age of 60, chronic diseases account for almost half of the deaths worldwide, and cardiovascular disease – generally considered a “male disease” – is the primary cause of death for this age group.

Discussing the importance of the comparative women’s health report, Dr. Margaret Chan, director-general of the WHO, said “The obstacles that stand in the way of better health for women are not primarily technical or medical in nature. They are social and political…It’s time to make sure that women and girls get the care and support they need to enjoy a fundamental human right at every moment of their lives, that is, their right to health.” The overview statement for the report echoes this sentiment, explaining that “we will not see significant progress as long as women are regarded as second-class citizens in so many parts of the world…women are excluded from educational and employment opportunities…and have no freedom to spend money on health care, even if it means saving their own lives.”

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The Flu Vaccine

October 12, 2009

As new cases and concerns about seasonal flu and swine flu (H1N1) continue to spread worldwide, two vaccines have recently been made available. Both the nasal spray vaccine and injectable vaccine for seasonal flu have proven effective for specific portions of the population, however distribution is still slow. For the H1N1 (swine flu) virus, The Baltimore Sun reports, availability is still an issue and many areas have not yet received enough doses to meet the demand. While many in the developed world do not yet have access to the H1N1 vaccine, Dr. Bernadine Healy notes that the problem is even greater in the developing world. To help these nations fight the pandemic, the United States has agreed to donate 10 percent of its vaccination supply to the World Health Organization (WHO) – eight other nations will make similar donations.

Fantastic Image by Deborah Ervin

Inoculating individuals for both viruses is complicated by the time frame in which the vaccinations can occur. If one chooses nasal spray for both seasonal and swine flu, they must wait four weeks between doses, while if one is injected for one virus and uses nasal spray for the other, they can be administered together. Discovery Health reports that doctors recommend annual flu shots to lessen the chances of becoming ill. Individuals as young as six months can be inoculated, according to the Centers for Disease Control and Prevention (CDC) and side effects are reported to be minor. Because the virus used to make the seasonal flu vaccine is dead, it is not possible to contract flu from a flu shot, however one may expect a low-grade fever 8 to 24 hours following injection, a swollen or tender area around the injection site, a slight headache or chills within 24 hours.

The seasonal flu shot is an inactivated vaccine, and contains three influenza viruses – one A(H3N2) virus, one regular seasonal A(H1N1) virus (which differs from the 2009 H1N1 virus), and one B virus. The viruses used change annually based on international surveillance which track infection trends and scientists estimations about which strains will circulate during the year. In contrast to the flu shot, the nasal-spray flu vaccine contains a weakened but still living flu virus, sometimes called LAIV (live attenuated influenza vaccine). These nasal mists are approved for use in healthy individuals ages two to 49 who are not pregnant. In addition to nasal sprays, Discovery Health reports that researchers at Stanford University and the University of Alabama at Birmingham have been working with naked DNA in an effort to develop a vaccine that could be delivered via shampoo or dermal patch.

Three recent large-scale studies, including a study led by Dr. Arnold S. Monto of the University of Michigan, indicate that while the seasonal flu shot is more effective for adults and safe for women who are pregnant, the intranasal vaccine (nasal spray) is more effective at preventing flu in children. These studies showed 35 to 53 percent fewer cases of flu in children who were given the nasal spray vaccine than those who received injected vaccines. The Los Angeles Times reports that injectable vaccines prevent roughly 50 percent more seasonal flu in healthy adults than the nasal spray vaccines.

Due to the relative newness of the H1N1 vaccine, health authorities have implemented a number of tracking measures to ensure its safety. The Associated Press reports that Harvard Medical School scientists are working to link insurance databases covering 50 million people with vaccination registries to allow them to determine if people visit a doctor after being vaccination as well as the reason for the visit. Johns Hopkins University and the CDC are also working to ensure that any side effects are noted and addressed quickly. These efforts include emailing individuals who have been vaccinated recently to see how they are feeling (Johns Hopkins), and preparing take-home cards asking vaccine recipients to report any side effects to the nation’s Vaccine Adverse Event Reporting system (CDC). These measures are being undertaken as in the Internet-age, the Associated Press notes, one person updating their Facebook status to say that they got a flu shot and feel sick could cause a wave of similar reports.

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Associated Press on the Nasal Spray Flu VaccineThe New York Times on CDC Side Effect Tracking Measures

Air Travel and Disease

July 7, 2009

As the number of cases of influenza A(H1N1) (“swine flu”) continue to rise, researchers are seeking solutions to slow the spread of the virus. A recent report from CNN indicated that the World Health Organization (WHO) has recorded 29,669 cases and 145 deaths in 74 countries. The virus has been categorized as a phase 6 “moderate pandemic” by the WHO, meaning that most individuals who are infected will recover. However, amidst recent reports of mothers bringing their children to “swine flu parties” to expose them to the virus (a practice that the British Medical Association has spoken out against), an individual has presented with drug-resistant swine flu. Efforts to create effective vaccines are ongoing, as are alternative means of tracking and slowing the spread of the virus.

Air Travel and Disease

A group of Canadian researchers have analyzed the correlation of the spread of the disease (specifically focusing on influenza virus A (H1N1)) and air travel patterns. The project, known as BioDiaspora, tracks the movements of 2.2 billion airline passengers annually which can then be used to map the possible and probable spread of disease. As reported in the New England Journal of Medicine, the researchers gathered data from the International Air Transport Association (IATA) from the period between March and April 2008. Information about a total of 2.35 million passengers who flew from Mexico to 1,018 cities in 164 countries was mapped and compared to the spread of A(H1N1) to date. According to Dr. Kamran Khan, preliminary data indicated “If you had fewer than 1,400 arrivals from Mexico, you had only a 7 percent chance of getting an imported case.” In countries with more than 1,400 arrivals, the chance of infection in the area increased to 92 percent.

By tracking the spread of outbreaks of disease and comparing them with air travel patterns, researchers can predict which regions are at the highest risk of early infection. According to Dr. Michael Gardam, director of infectious disease prevention and control for the Ontario Agency for Health Protection and Promotion, disease-tracking tools may prove invaluable when dealing with outbreaks of infectious diseases, particularly those with short incubation periods. With this information, it will be possible to inform physicians in potential hotbeds of infection about how to identify a given disease, and ensure that vaccines are prepared and available in order to help stop the spread.

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WHO Information on PandemicsCNN Report on A(H1N1)New England Journal of Medicine on BioDiaspora

Health Among Aboriginal Populations

May 27, 2009

Rural areas often do not have the same quality of resources – especially health resources – available to urban areas. Among indigenous groups such as the Aboriginal and Torres Strait Islander populations of Australia, this is a particularly pressing problem. According to the Australian Government’s Australian Institute of Health and Welfare, as of 2001 an estimated 2.4 percent of Australia’s population identified as being of “Aboriginal origin,” “Torres Strait Islander origin,” or both.  Around 25 percent of the indigenous Australian population – compared to two percent of the non-indigenous population – lived in areas classified as “remote” or “very remote.” As in other nations, non-urban areas often are not surveyed regularly, so gaps in health and welfare information are not sufficiently monitored or addressed.
Aboriginal Woman with Child
The Australian Medical Association reports that representatives from the Indigenous Dentists’ Association have called for measures to improve oral health among indigenous groups such as the fluoridation of community water supplies. Per Medical News Today, the Dietitians Association of Australia indicates that due to the lower economic means of many people living in remote areas, high-quality nutritious food is not always available. Further, items such as sodas, sweets, and fried food are more available in rural areas and are lower-cost. Since one in every three Aboriginal people over the age of 15 worries about going without food, making healthy food options more available and affordable is a major concern to improving the overall health of the population.

Areas like the Northern Territory, where around 29 percent of the population are indigenous, also face a shortage of medical professionals to treat the conditions exacerbated by poor-quality food and lack of appropriate medical and dental care. Telemedicine programs such as iConsult provide opportunities to improve medical care in these areas and treat or lessen the severity of many conditions.

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CIA World Factbook – AustraliaAustralian Medical Association (Healthcare Providers)Medical News Today (Food and Nutrition)

Medical Social Networking

May 12, 2009

Social networking websites have become increasingly popular in recent years. Kerri Breen of the CBC News reports that YouTube has become the third most popular website in the world, Facebook now has over 200 million users, and Twitter has grown 2,565 percent in the past year. Through the new channels offered by these social networking websites and tools, users can discuss anything from cat toys to a bothersome rash on their arms.

Fighting a Cold Online
The ever-increasing popularity of these Web 2.0 sites offers new opportunities for their application to improve health and medical care. The New York Times reports that during the last week of April, “Swine Flu” was the most searched term on Yahoo, the Wikipedia page on “Swine influenza” received 1.3 million page views, and an estimated 125,000 tweets a day on Twitter mentioned the illness. Despite this increase in discussion about the virus, Alessio Signorini, a PhD candidate in Computer Science at the University of Iowa, told the NYT that this “noise” does not indicate actual trends in the spread of the virus. Dr. Philip Polgreen further explained that by tracking indicators within popular search terms, such as symptoms of a condition or virus, it is possible to better track its spread and plan more effectively for inoculations.

Growth in Internet use has also led to a rise in self-diagnosis and/or self-prescription. Through tools like Twitter or Facebook, individuals can simply state that they do not feel well, and are much more likely to do so than to visit a doctor. While this could potentially lead to their not getting necessary treatment, other forms of web use may help to ease discomfort, physical and/or psychological, caused by certain conditions. A number of websites have been introduced which allow patients with specific conditions (e.g., MS, diabetes, eczema) to form a community. ABC Health and Wellbeing reports that research indicates that patients with psoriasis indicated their perceived quality of life had improved following the use of these online support websites. Center for Connected Health and Boston’s Massachusetts General Hospital researchers have also found that these online networks provide a valuable base of information and support to patients, and that health outcomes can be further improved through physician involvement.

A number of social networking websites have also been developed to allow physicians, clinicians, researchers, and medical specialists to link to one another and discuss various areas of their practice. In addition to sites which allow doctors to create social connections, others, like iCons in Medicine, provide the opportunity for healthcare providers in remote or medically underserved areas to request assistance on difficult cases from physicians in 30 medical specialties. Through these teleconsultations and the social networking tools provided by programs like iCons in Medicine, doctors can collaborate on difficult cases and improve patient health at the point of care.

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CBC NewsNew York TimesABC Health and Wellbeing