Thursday, August 21, 2014

Selected Readings on Human Health, Disease, and the Environment

The following are responses and summaries of various readings related to Human Health, Disease, and the Environment. 
Under the Weather: Key Findings and Recommendations
            Many infectious diseases are influenced by weather and climate change as can be seen by the varying distribution of different diseases.  Temperature, precipitation, and humidity directly influence the behavior of diseases and their carriers.  Other factors including government health services, clean water and properly maintained sewage, population variations and travel, as well as land use can affect diseases.  Many models for studying the dynamics of disease have been developed, however they are not intended to be used as predictive or early warning systems.  It is not currently known for certain what impact global climate change could have on disease: while global warming could alter the range of current diseases, other factors such as improved housing, sanitation, and public health systems could offset any negative impacts from climate change.  New diseases may emerge from the increased rate of evolution in pathogens due to climate change, though this is highly uncertain.  It is an extremely slippery slope when attempting to extrapolate the data from one time and region to a larger scale; global climate change may have an effect on regional or seasonal climate patterns that is unforeseen.  The ever-increasing technological backing will only help to increase the accuracy and speed with which models and predictive systems can be developed. 

            The still being devised early warning systems will help to combine the surveillance and response of diseases with the prediction and prevention of diseases.  The use of disease early warning systems is dependent on the cost-benefit in certain areas of particular risk and should not be implemented in areas of low risk or insufficient means.  Disease early warning systems must be made up of more than just climate data, such as meteorological, epidemiological, and ecological data and should be initiated in a watch-warning type of system where watches are issued for vulnerable areas which are thereafter analyzed in a more scrupulous manner.  The system’s end users must be who the system is built with in mind, involving the local citizenry at every possible route and making sure that they are informed of necessary procedures and possible outcomes.
            Much more work must be conducted to link climate and disease.  The behavior and activity of diseases needs to be further analyzed in order to better know the potential risks of climate or ecological changes in the future.  The amount of epidemiological data needs to be greatly increased and put into a centralized location so that it may be easily accessed by many different people.  More effort needs to be put into the cooperation of different agencies and fields so that all may progress at a similar rate and in a similar fashion with like end goals.  Even should we be successful in achieving our goals, it is still very likely that disease will win in some instances due to the highly unpredictable nature of disease, and so our goal should be an overall improvement of people’s health and reduction of their vulnerability to disease.
Rx for Survival: Introduction
Recently we have begun to regress in our fight against disease and in the pursuit of human health.  Historically, with an era of globalization come new bouts with disease and disruption to society.  Diseases, just as goods do, travel at a much greater pace range today.  It is not possible to separate the transmission of goods and the transmission of disease.  In this particular globalization, one disease has grown out of control – AIDS – which is striking at the social structure and the economic makeup of many nations.  AIDS reinforced the idea the our surveillance of disease had grown poor for it had been around for at least fifty years and had been infecting humans for at least twenty before it was recognized by accident by pharmaceutical workers.  Drugs that kill bacteria and viruses are only temporary solutions because it is the nature of germs to continually evolve and adapt and multiple, therefore it is requisite that our fight against them will be always going on.  For today viruses and bacteria interact with one another more than ever before, inside the bodies of animals and people, and the more interaction they have the more likely it is that they will become a stronger and more versatile enemy.  Since the 1950s the conditions for this rapid germ expansion have been present.  Increased travel was seen after World War II and even more so at the end of the Cold War.  It is very similar to the time when people moved from tribes and villages to cities in ancient civilization and experienced great epidemics then.  The time of diseases to be able to initially infect people to the time it has infected millions has shrunk from decades to weeks.  Due to our poor surveillance, old diseases once thought vanquished have begun making a comeback.  Recent terrorism has created a stir at home to guard against possible biological attacks, but little to none of the money appropriated has gone towards the much more likely threat of natural infectious diseases.  The bird flu which currently persists on the Asian continent has two of the three abilities required to result in a world pandemic: the ability to infect humans and to kill them.  Though it has not yet been seen to move between people only between birds and people.  Increased surveillance throughout the world, incentives for countries that report problems, tests for early outbreaks, and the creation of drugs to be used at the onset of an outbreak are needed for the onset of a global pandemic.  The amount of lives saved from an outbreak will greatly outweigh the potential cost of preventing it.  Any increase in disease has far greater economic consequences than any terrorist could have.  With the collapse of the Soviet Union and the increased travel and contact between poorer and richer nations that followed outbreaks were almost certain to occur and increase in number.  Recent experience has proven that experts and professionally trained workers are not required to have an effect on disease.  The world is now much wealthier overall than decades ago and therefore it is completely within our grasp to take care of the world’s greatest health problems.  The wealthy must help the poor with these health issues.  Before the era of medicine people could expect to live anywhere from twenty-five to thirty-five years.  After thousands of generations of this situation, human life was changed within only about five.  This change was due to the medical changes which were enacted in the last 150 years: sanitation being the greatest of them all, combined with hygiene and vaccines enabled for the general health of the modern world to be greatly increased.  The great medical era of the post WWII times led to the belief that disease had been defeated which led to people resting on their laurels in complacency.  We forgot that disease, just like everything else, will adapt and evolve in order to multiple.  We now are in great position to bring together everything that we’ve learned in the past in order to make life better for the masses.  Should we falter the future does so look grim. 
A Pinch, A Fist, A Cup of Water
The best example of how money should be used to fund any aid project is that of the Bangladeshi fight against diarrheal related child deaths.  On November 13, 1970 a great cyclone hit on the coast of Bangladesh killed more than five hundred thousand people.  It was this event which caused oil executive Fazle Hasan Abed to abandon his place of luxury and return to his home country to help those in need.  The storm was forecasted, though the president of Pakistan, Yahya Khan, ignored it and would later pay for it through the revolt against him that it caused.  With the help of the Indian military eastern Pakistan was freed from their western oppressors.  Abed began working in the refugee camps helping build bamboo houses and supplying tools and medical aid to those in need.  Abed created what has become the world’s greatest NGO.  It all started with a budget of three hundred thousand dollars and six volunteers, the Bangladesh Rural Advancement Committee.  It now has more than one hundred forty six thousand workers.  Its mission is to provide health services, schooling, and financial services to the poor women of Bangladesh.  The project has helped to reduce the number of child deaths from 248 in every thousand to 69 in every thousand as of 2003.  This reduction in early child deaths has resulted in a proportional reduction in family size from seven to three.  The average life expectancy has increased from forty-four years to sixty-three years.  Originally funded only from donations, the BRAC now has a budget of over $235 million, with only twenty percent coming from donations.  Abed has built a nearly self-sufficient aid agency.  The primary function of the group in its early years was the teaching of Bangladeshi mothers to make a solution for those suffering from diarrheal illnesses which would replenish the system with nutrients and fluids: this project which lasted ten years saw the reduction in the death rates of babies with severe diarrhea from fifty percent to less than one percent.  The method that has been taught to the mothers of Bangladesh is now a part of the culture.  After the success of the solution teaching the next project was the immunization of the nation’s children.  In the 1980s only about two percent of Bengali children received immunizations and now over eighty percent receive them.  The solution project cost around $9.3 million from 1979 to 1990.  When in 1991 a great epidemic of cholera struck Central and South America, the usual death rate of one-third to one-half was avoid by the local people using the homemade method.  From this program we are taught that local programs such as these can be very effective on a large scale, though they require continual surveillance and adaptation, with those who carry them out believing in what they are doing. 
Forty-Nine Thousand Grandmothers
The people of Nepal suffer from a great deficiency of vitamin A in their diets.  The Nepali National Vitamin A Program has as its goal that it gets vitamin A drops to every child who needs them.  The administration of vitamin A is perhaps the simplest and cheapest way to save lives in human history.  Night blindness, which many have suffered throughout Nepal, is a sign of vitamin A deficiency.  Alfred Sommer did work in much of eastern Asia on the effects of vitamin A deficiency.  His work determined that nearly five hundred thousand people per year in just Indonesia, India, Bangladesh, and the Phillipines suffer from xerophtalmia, night blindness.  Many of the deaths were caused by diarrhea which was allowed entrance into the body through a lack of vitamin A.  His research showed that a lack of vitamin A could be allowed for infections and diseases to enter the body of children much more easily than into a healthy body.  The skin cells which help to keep out and ward off infectious diseases feed off of the nutrients of vitamin A, and therefore a lack of it allows for easy entrance into the body.  Sommer found that measles which depletes the body of vitamin A, while not the direct cause of illness or death, allows for other infections to enter and kill.  From Sommer’s work the world had become convinced that vitamin A supplements could help to solve many of the unnecessary child deaths throughout.  In Nepal volunteers were recruited in villages who would carry the much needed vitamin A drops and administer them to children twice a year.  The officials of the program made sure that the volunteers would get recognition for the work they performed.  The volunteers were made the most important and most highly regarded persons in every village.  The program has seen some 3.5 million children getting their vitamin supplements per year.  The death rate of infants has decreased from 133 per thousand in the 1980s to 64 deaths per thousand in 2002.  The volunteers now assist in other forms of health aid such as iron tablets and iodized salt instruction and oral rehydration treatments.  While this system has been useful up to this point, it is unclear how much more could be tacked on. 
One House at a Time
The greatest health project in human history is the world’s current campaign toward the elimination of polio.  Because polio does not show itself in every case of infection all those at risk must be immunized.  It is estimated that the countries of the world benefit from about $1.5 billion each year because they do not need to diagnose or treat smallpox, or lose the services of those afflicted with it since its eradication in the late 1970s.  Similar results could be seen with the eradication of polio.  The polio virus shuts destroys nerve cells, causing paralysis and potentially death.  Children who survive polio are marked as weak and strange for the rest of their lives.  Many places, such as North America and parts of Europe, freed themselves of polio only to have it reappear from poorer still infected nations.  The worst hit and hardest to treat places were found in India and Nigeria.  Muslims often rejected the vaccine which was thought to have been created and sent by the Americans who wanted nothing more than to harm them, make them sterile and such.  They had difficulty understanding why there were cures for polio being offered but they could not receive adequate health care from their local clinics.  The approach of the polio booths would not work for these people, for these people the vaccine would have to be brought to their doorstep; each one needing to be convinced personally.  With much marketing and governmental and local backing the vaccine drives were able to succeed, though only barely. 
Changing Minds
AIDS is a scourge on the Sub-Saharan African nations.  The area holds nearly sixty percent of HIV cases.  When Botswana declared its independence in 1966 it was seen as one of the three poorest nations on Earth.  Through the use of its great diamond reserves it has been able to build a stable democratic government, schools, roads, and clinics.  It held the highest growth rate in the world from 1966 to 1996 and saw an increase in the average life expectancy of more than twenty years over the same period.  By 2000 nearly forty percent of the Botswana population was infected with HIV.  With the revolution of AIDS treatment drugs in the mid 1990s an infected person could expect to add ten healthy years or more onto their lives.  The drug companies however decided to set the prices of these medicines at an exorbitantly high rate and they would pay for it with the approval of their customers.  In the late 90s the leading drug companies decided to combat this distrust with an initiative to rid Africa of its AIDS problem.  They chose Botswana for this experiment.  The AIDS problem in Botswana stems from their highly-mobile culture: often families spend much time apart and develop alternative sexual relationships.  Wives are taught to accept their husband’s misdeeds and affairs which have allowed for HIV to be transmitted at a much greater rate than elsewhere.  In Botswana more than twenty percent of the adult population is infected with some form of HIV.  The greatest issue that the project faced was the bureaucracy of the Botswani government.  Months would pass on an issue while it was fed from committee to committee and from ministry to ministry.  The most influential change that did get enacted was the mandatory HIV testing at hospital visits.  Once testing was made easier more and more people began coming in for testing and treatment.  The number of people affected by the project has increased from 3000 in 2003 to 43000 in 2005. 
Internet Research
An NGO is a non-governmental organization.  NGOs are organizations which are privately funded, though partial or total government funded is allowed only if the governmental representatives are refused admission to the operational executive.  There are around 40,000 NGOs operating internationally across borders.  Some of the first international NGOs are Rotary International and the Peace Corps.  Many international NGOs work closely with international or regional cooperatives such as the United Nations and the North Atlantic Treaty Organization.  NGOs can vary by sector and include business, civics, environmentalist, and humanitarian related goals.  Operational NGOs can be relief-oriented or development-oriented and are often divided between religious or secular, public or private, and scale – local, regional, or international - interests and funding.  Some NGOs work to promote causes or make aware governments and agencies of issues.  These NGOs are usually referred to as advocacy groups and generally merely choose to educate and inform rather than to act, though this is a requisite part of any change.  NGOs often find themselves influencing national and international policy-making, but generally as a goal are more involved in local action.  Some of the larger NGOs have budgets upwards of hundreds of millions of dollars.  The American Association of Retired Persons had an annual budget of over $500 million in 1999.  Many different types of organizations can fall under the NGO heading, such as non-profit organizations, not just for profit organizations, community foundations, civil societies, and charitable organizations.  There has been a great movement in recent years to attempt to distance the negative sounds of the “non” affiliation with positive words such as citizen sector organization, especially considering that many NGOs are actually funded by governments.

Readings above may have been drawn from the following sources:
Six Modern Plagues and How We are Causing Them, Mark Jerome Walters; Shearwater Books, 2003, ISBN 155963992X
Life Support, The Environment and Human Health, Michael McCally, editor, MIT Press, 2002, ISBN 0-262-63257-8
Rx for Survival,  Philip Hilts, Pengquin Books.  ISBN 0-7394-6974-6
Emerging Infectious Diseases,  Stuart A. Hill, Pearson Eductation Inc., publishing as Benjamin Cummings.  ISBN 0-8053-3955-8
Under the Weather:  Climate, Ecosystems and Infectious Disease, National Research Council, National Academy Press.  ISBN 0-309-07278-6

This article originally written December 2nd, 2008 for OU IPE 3913 - Human Health, Disease, and the Environment.

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