You have a Right to Mental Health


Image: King College London,  project Emerald (emerging mental health systems in low- and middle-income countries)

One of the key sessions  I attended at the second day of “The world in denial: Global mental health matters”( March 26-27, 2013, Royal Society of Medicine, London) highlighted the existing legal tools available to achieve international recognition of the Right to Health,  AND the problems of getting mental health included in this framework.  In particular how including it under disability has implications for access to treatment. This blog summarizes the session and puts information into context with current events, including the 66th World Health Assembly recommendations.

There was much I learnt that day, yet  of much I was already aware, as CABI’s Global Health
database has 20,000 records on mental health, 25% of them
focussed on developing countries. One of the eye-openers for me was an
understanding of the various legal tools dealing with international
recognition of the Right to Health
and the problems of getting mental health included in this framework;
how including it under disability has implications for access to

This is what I learnt, put simply, from talks given by Professor Norman Sartorius (President of World Psychiatric Association) and Gunilla Backman (Former health adviser SIDA & Editor, The right to health: theory and practice).


Basic Human rights: these are not defined or not universally accepted


There are 5 categories of  documents related to human rights

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Designers help people to see and medicine to hitch a ride with cola


This year’s “Designs
of the Year”
(an annual competition staged by Design Museum, London)
include two entries focussed on improving the health of people in developing

The first
is a pair of spectacles, whose lenses are filled with liquid silicon
via mini-syringes in the arms. All the wearer has to do is adjust a dial
to fill the lens (so changing its shape) until the world comes into
their refractive error corrected. Thus you don’t need an optometrist to work
out your prescription for you.                

Optometrists are in short supply in Africa &
India, so even if you can get hold of a pair of donated spectacle frames &
maybe the money to pay for the lenses ( =3 months wages in Africa), you mostly can’t
get someone to assess your prescription! Uncorrected refractive error and
cataract are the major causes of blindness in developing countries. There’s
only so much Unite for Sight and Vision20:20 can do in training &
field visits. 

These spectacles, whilst not high-fashion, will eliminate
the need for lens prescriptions and expert fitting, and would seem to be the
solution to getting 1 billion people to see properly for the first time.

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Low salt diets could allow iodine-deficiency diseases to re-emerge

Salt has been used for thousands of years to flavor
& preserve food BUT reliance on fast food, biscuits and tinned goods, with
their hidden salt content, has created for us a high salt diet and with it an
alarming rise in cardiovascular disease.

Reducing our salt intake, by working
with food industry and educating the public (World Salt Awareness Week), should
counter this disease epidemic.  BUT take this too far, and could an old
disease re-emerge? I speak of iodine deficiency in the diet, which can cause abortion,
stillbirth, goitres, mental retardation & birth defects: iodized salt
solved it.

WHO recommend universal salt
iodization for developing countries as a simple, safe and cost-effective
measure to address iodine deficiency, and many developed countries follow this

                                                                        Image: Amanda Mills, USDA. 

People afraid of salt so a disease re-emerges or is unaddressed?

If we ever needed
a reminder of the importance of iodized salt & public attitudes to health, you
only had to read “salt
rumors add to health crisis in pakistan
” (Washington Post).

A fuller discussion of these issues can be found in the March issue of Global Health Knowledge Basealong with the latest research on iodine
deficiency and salt iodisation.







Related articles

Eat less salt but make sure it contains iodine
Ethiopia en route to eliminating iodine deficiency disorder
Mild iodine deficiency in pregnancy in Europe and its consequences for cognitive and psychomotor development of children: A review
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Iodized Salt
The Significance of Iodine and 7 Foods Rich in Iodine
Stop Wasting Money On Expensive Sea Salt
It Had to Happen: CT'ers Go After Iodized Salt
Iodine deficiency and how it can impact pregnancy

Is artisanal salt healthier than commercial salt?

blogger, Henry Ko, health services researcher with SingHealth,
Singapore, provides a personal commentary on issues raised by Mark
's book  on salt: “Salted: A manifesto on the world’s most
mineral, with recipes

 As a
healthcare researcher with both professional and recreational interests in
food, nutrition, and cooking, I was drawn to a book I casually found whilst
scanning a bookstore shelf in the cooking section called “Salted: A manifesto
on the world’s most essential mineral, with recipes
”. The writer is ‘selmelier’, Mark Bitterman.  

Salted-Cover-Bitterman-from-author  Image: Mark Bitterman

For a book in
the cookbook section, I found it highly enlightening and detailed, almost like
a scientific textbook on salt. Make no mistake, this is not a regular cookbook.
It is a book with three sections that (1) highlights human’s history with salt,
especially the production of salt and culinary traditions of using salt, (2)
has a section on identifying all the many different types and features of
artisanal salts, and finally (3) a section with recipes for cooking and using
salt for food (e.g. seasoning, curing).

What I learnt
about the salt industry really opened my eyes. Some of the
points highlighted in the book and by skeptics of the salt industry in the
public, match – that there appears to be an agenda by big industry to sell iodised salt.

Editor's note:

You can read the full article  by Henry Ko in the March issue of Global Health Knowledge Base, along with the latest research on
iodine deficiency and salt iodisation.

Also relevant to the debate is "Salt, could it be implicated in autoimmunity?"(CABI's Nutrition and Food Sciences),
reporting on two animal studies in Nature two weeks ago.

Related articles 

Health-giving properties of artisanal salt
Eat less salt but make sure it contains iodine
Govt promotes use of iodised salt in far-west
Preserving Food: Traditional Method
Finding the Right Salt
Foods aimed at toddlers loaded with salt, study finds
It Had to Happen: CT'ers Go After Iodized Salt
Salty ain't healthy

Chocolate Made in South Africa for homesick Brits?


This blog is about the weirdness of global trade… and the
lengths (literally) we go for chocolate.

The wrapper on my Marks & Spencer (M&S) valentine chocolates read: “Made with our exclusive British Milk chocolate recipe, Made in
South Africa”.

Incredibly, it seemed that a firm in South Africa (SA) was targeting local people with a taste for British chocolate, and somehow M&S
sourced them for sale in the UK! 

Was this I wondered another example of fuel miles not being
built into food production costs (see “food miles”), like apples  from the Cape or Kenyan flowers at petrol stations?

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Nodding syndrome raises its head

In a previous blog, Mystery
disease outbreak in Ethiopia solved
, I mentioned in passing Nodding Syndrome (NS), a neglected
condition that is epidemiologically associated with onchocerciasis and affects children
5-15 years old. 

The syndrome causes epileptic seizures where the afflicted
suffer from involuntary head nodding, usually triggered by food or cold. They end
up severely disabled and, without treatment, finally die.   It is
devastating communities in northern Uganda, South Sudan, Tanzania and Cameroon.

As I reported at the time: “The USA’s Centre for Disease
Control is working to identify the cause: so far, the best guess is that it’s
linked to the parasite that causes river blindness combined with an autoimmune
reaction, and exposure to chemicals could predispose.”

I now hear that an international workshop was held on this
subject in Uganda, First
International Scientific Meeting on Nodding Syndrome (NS)
, with
the key objective to set a standardized case definition for suspect
and probable cases of NS.

I also hear that the journal African Health Sciences is to
devote an entire issue to the syndrome and is currently looking for authors to
contribute papers on NS/epilepsy. (Very necessary since there are literally just
a handful of research papers on the subject so far).

You can submit papers online to the journal at:
queries can be sent to: James K Tumwine, Editor in Chief African Health
Sciences: Email:;;

I acquired this information through my membership of HIFA2015 and would encourage readers to
join this excellent forum of health workers, publishers, librarians,
information technologists, researchers, social scientists, journalists,
policy-makers…(you name it we have it).  HIFA2015
is a campaign and knowledge network with more than 5000 members
representing 2000 organisations in 167 countries worldwide, with
the aim that “By 2015, every person
worldwide will have access to an informed healthcare provider”.

You might even wish to become a HIFA2015
Country Representative
: their
role is to engage new members
and champion HIFA2015 goals in their countries. We are currently looking for  country representatives in China, Central and
Eastern Europe, Central Asia, and Eastern Mediterranean Region. YOU can
register your interest when you join via the website.


Uganda: Nodding Syndrome
Symptoms Controlled, Hunt for Cure Continues

Investigation into
the Nodding syndrome in Witto Payam, Western Equatoria State, 2010.
Sudan] This url takes you to our Global
Health database

CDC Responds to Nodding
Disease in Uganda
  Youtube video

Mystery disease in Ethiopia solved: linked to weed toxin

Imagine this…

A mysterious disease terrorising your community, not infectious but spreading nonetheless, and killing your relatives and neighbours. All you want to do is pack your bags and flee. Worse, when your plight comes to the attention of the health authorities, they are stumped and its not going to be easy or quick to solve.

A recent example of this kind of illness is “nodding disease (South Sudan, Uganda, and Tanzania), which affects children 5-15 years old: they suffer epileptic seizures which causes their heads to nod, and they end up severely disabled and finally die. The USA’s Centre for Disease Control (CDC) is working to identify the cause: so far, the best guess is that it’s linked to the parasite that causes river blindness combined with an autoimmune reaction, and exposure to chemicals could predispose.

Other examples of non-communicable disease outbreaks

On Global Health, I found there are outbreaks going back to 1911 (epidemic dropsy) but more recent ones were in India,  Bangladesh, Nigeria, Brazil, China, Afghanistan and even the USA.

 What are the likely causes for these outbreaks? The body of research, as found on databases like Global Health, tells us that they could be contamination of food and water supply, exposure to chemicals or heavy metals in the environment, or even use of traditional medicine.

 Mystery liver disease in Ethiopia with a ‘happy’ ending

Can public health authorities in low-income countries solve & stop such outbreaks?   Yes. In 2005, in Ethiopia, a 4 year long outbreak of liver disease in Tseda Emba, a small village of the Tahtay Koraro district of Tigray, finally reached the attention of the Tigray Health Bureau (THB). Now, in 2012, the multidisciplinary and one-health approach they initiated has “solved” the mysterious illness, significantly reducing new cases. 

 The research work was the subject of an entire session at the recent World Congress Public Health (WCPH-2012) in Ethiopia, and is now published as 5 papers in the supplement to April 2012’s edition of Ethiopian Medical Journal (EMJ). [Abstracts to these papers will be available on Global Health]. It demonstrates the relevance of the one-health approach to public health in low-income countries and is a fascinating detective story….

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