The Independent and Health-Informed Tourist?

Mers-virus-3D-imageFULLBy Scinceside – Own work, CC BY-SA 3.0

An innocuous visit to Dubai
A young friend of my extended family was recently taken seriously ill and ended up in a London hospital following a short trip to Dubai to visit a partner working abroad for a few months. The symptoms of the infection, taken together with the location, and the fact that the trip involved taking a camel ride, led the hospital to suspect deadly MERS (Middle Eastern Respiratory Syndrome). Acting on that basis, the partner was tested in a local hospital in Dubai and sent home to wait-out the 14 day transmission window for this disease.

About MERS
Its caused by a coronavirus (MERS-CoV), and infection is linked to travel in the Middle East and close contact with camels, camel secretions and uncooked camel products. The fatality rate is 40%, but deaths are usually linked to underlying medical conditions which weaken the immune response. There is no vaccine: disease transmission is controlled by hygiene, by contact tracing of confirmed cases and the wearing of personal protective equipment by hospital staff (1). Since 2012, 27 countries (including UK) have reported 2266 cases, the majority in Saudi Arabia, with a serious imported outbreak in 2015 in South Korea.

Fortunately the friend turned out not to have MERS but it was a very difficult and traumatic 24 hours finding information to reassure relatives (40% fatality is a scary statistic) … and it set me thinking:

How much can you be expected to know as an independent traveller and what is the responsibility of your tour organiser to inform you? Continue reading

Universal health coverage: everyone, everywhere…what about cancer?

  World Health Day 2018

I’ve written about universal health coverage (UHC) before in the context of what’s covered under UHC in one country is not the same as another [Universal health coverage gains momentum in 2016] although there are agreed basics, the essential health services to deliver “health for all”.  The World Health Organization is focusing its efforts on supporting countries moving to UHC, and keeping the pressure on by running high profile events throughout 2018 on UHC beginning with  World Health Day, April 7th.

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Global health security, collaborating to stop epidemics

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Just three little words, “global health security”, but they represent such depths of meaning. A hundred years of modern scientific enquiry into infectious diseases such as yellow fever, malaria, and now zika. The wake up call of SARS and swine flu, where viruses with dramatic results leapt the species barrier. The galvanising effect of West Africa’s Ebola epidemic on the WHO, the international NGO and donor community and on governments. The concern over emerging and re-emerging infectious diseases, so many of them zoonotic in origin.

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Taking back control of opioid prescription drugs

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Addiction is, by its very nature, about loss of control. The more I’ve been in this job and the longer I’ve lived, the more substances seem to be added to the addictive list. 

In the past few weeks, my early morning news on the radio has featured addiction to alcohol, to food, to gambling, to smart phones, to illegal psychoactive substances, and, the inspiration for this blog, to opioid prescription painkillers. Sadly yet more deaths and lives destroyed. 

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Cancer, burnt toast and roast potatoes

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I should think the entire western world is now afraid to eat their roast potatoes.  This comes after the international media coverage  of the UK Food Standards Agency’s new campaign “"Go for Gold” , [@CABI_Health 23rd Jan ], which hopes to encourage us (UK) to reduce acrylamide in our diet by cooking starchy foods to a pale golden colour and no further.

Speaking as someone who spent nearly 20 years in labs handling acrylamide on a daily basis (for analysing proteins), I can’t say I am too worried about the acrylamide content of my Sunday lunch roast potatoes  and burning my toast.

But what about the general public? Should they be nervous…so what is behind the UK Food Standards Agency (FSA) campaign?

It’s their recently published Total diet study of inorganic contaminants, acrylamide & mycotoxins (TDS-2014), covering years 2014 and 2015 for the UK, and how the results fit with European Food Safety Agency (EFSA) recommendations.

A total diet study differs from other food surveys in that foods are firstly prepared and cooked for consumption. The aim of TDS-2014 was to estimate dietary exposure to contaminants for population age groups: it assessed 138 food categories, and for each category pooled food items collected from 24 UK towns.

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Universal health coverage gains momentum in 2016

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WHO definition: Universal Health Coverage (UHC) means everyone can access the quality health services they need without financial hardship.

This year it seems that organisations, governments and citizens everywhere are answering the call to UHC, whose annual awareness day is December 12th.

From this year forward, UHC is seen as central to improving health systems, improving economies, and ensuring global health security. The G7 group countries, the primary source of funding for Low and Middle-Income Countries (LMIC), met in Ise-Shima Japan 2016 and made UHC their umbrella concept. Through this, they seek to improve health systems and global health security.  Of the 17 SDGs agreed by the United Nations, just one is directly health-related but it is “achieving UHC”.

Judith Rodin, (President Rockefeller Foundation, has observed that “25 of the wealthiest nations all have some form of universal coverage, as do some middle-income countries including Brazil, Mexico and Thailand and lower-income nations, such as Ghana, the Philippines, Rwanda and Viet Nam, are working towards achieving UHC.”

Rather than talk about why we need UHC, I thought I’d talk  about what is actually proposed by middle-income and lower-income countries (LMIC) to fulfil UHC and what the NGOs, donors and global health community championing UHC would like it to encompass.

What is UHC?

UHC systems vary from country to country: there is no one size fits all.  It very much depends on the minimum health outcomes a government wants to achieve and how much of its GDP it is prepared to spend. The main variables being the level of care delivered, who delivers it, who receives it and how it is funded. 

UHC of itself does not mean universal access to health services nor care for all diseases. It’s about providing a basic level of health services (“Essential Packages of Health Services”) to as much of the population as possible.

The first UHC system was the UK’s National Health Service set up in 1948.

The USA has a non-universal system of health coverage.

What do LMIC see it as?

Over time,  as far as I can see, these basics for a cost-effective UHC have emerged:

  • government regulation, legislation and taxation
  • primary health care
  • vaccination programmes for children (for LMIC this is organised through GAVI, the Vaccine Alliance)
  • maternal healthcare (pregnancy)
  • health insurance to finance (public tax, private insurance or a mix of both)
  • financial protection: pooled funds to reduce out of pocket payments amongst the poorest and vulnerable  

Much of the information that now follows is derived from  the RSTMH 2016 Chadwick memorial lecture "Neglected Tropical Diseases in the Time of Blue Marble Health and the Anthropocene Epoch", given by  Professor Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine, Texas and President of the Sabin Vaccine Institute. 

 

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One Health: free online course from FutureLearn features CABI authors

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One Health is about connectedness: "the collaborative efforts of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals, plants and our environment”.

On One Health Day, November 3rd 2016, CABI's editors held a One Health (#OneHealth) Blogathon to focus attention, contributing a total of 6 blogs to Handpicked… and Carefully Sorted, each written from the viewpoint of a different sector.   Our Plantwise Blog contributed One Health: Plantwise’s ambition to improve the health of people, plants and animals.

We hope you found them informative but your learning need not be confined to our blogs!

Sign up to a free online One Health course from FutureLearn: starts November 7th 2016, runs for 6 weeks. Lecturers are the CABI authors Esther Schelling,  Jakob Zinsstag and Bassirou Bonfoh of Swiss Tropical & Public Health Institute.

Esther, Jakob  and Bassirou are all authors of chapters in CABI’s  book One Health: The Theory and Practice of Integrated Health Approaches [2015].  Indeed Esther and Jakob are also co-editors.

FutureLearn  courses are easy to follow and well-paced: you get one unit per week.  I speak from experience as because of my interest in evidence-based medicine, in October 2015, I took "Informed Health Consumer: Making Sense of Evidence". 

I hope you can make use of this One Health course.

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