TG Publication

August 2011

WE THINK GL BAL & ACT LOCAL Presented by: Think Global Team

THINK GLOBAL Initiative Project

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Table of Contents 3.............................................................................................Editorial 4..........Message from the Think Global Initiative Project Coordinator 5...................................................Capacity Building for Global Health 6.................................................Mobilizing Youth for NCD-Advocacy 8......Root Out, Reach Out: Medical Students in Action on Social Determinants of Health 10........................Tuberculosis: A Health Concern Around the World 11..................................................Health inequality inside a country 13..............................................................Climate Change and MDGs 14.......................................The Think Global Initiative Project Team!

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Editorial Dearest Friends of IFMSA, I am pleased to present to you the 1st publication for the Think Global Initiative Project at the 60th August Meeting in Copenhagen, Denmark. The publication is concentrated with a variety of Global Health-related articles shared by our global brothers and sisters from within IFMSA. Global Health issues are increasing in number every single day. Every day someone is affected by one of these global health issues and when you come to think about it there is something that we can do about it. We as young doctors and health practitioners have the power, a power that is of many, to change our world and build nations. Our love and passion for medicine can change our world and develop a world that fits a more perfect picture.

Rodney J. de Roche

Brothers and sisters of IFMSA, ‘we are the future now’ and we are definitely stronger in numbers. There is a great need for global advocacy and action at the local level. This publication is only a taste of the promise of what we can do create a brighter future for those that are yet to see it.

To conclude, I would like to congratulate not only the members of IFMSA’s Think Global Initiative Project Team but also everyone who participated in this venture-of producing a publication. I can confidently say that this is the start of something great; the bigger picture is yet to be seen.

Also a special thank you to the editors and authors in this publication, I do hope that you continue to make an impact in your worlds. Let’s continue to create the change that world so desperately needs.

Yours truly,

Rodney J. de Roche

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Message from the Think Global Initiative Project Coordinator Dear Readers, “Health is a shared responsibility”. This quote always reminds me of the fact that even today, after so many countries agreeing on Health for All approaches, we still have massive humanitarian catastrophes, which with

Usman A. Mushtaq TGIP Coordinator

simple interventions could save thousands of human lives. This knowledge has been neglected in the ba-

sic education and training of health workers around the world, especially physicians. The idea of health transcending national and geographical borders has been around for a quite long time, but medical institutions are taking a considerable amount of time in adjusting to the concept.

It has only been a few months since the Think Global Team was first announced, and so much has happened after that. The Think Global Initiative is IFMSA’s Global Health project with a broad area of work. Having affiliation with all of the IFMSA’s standing committees allows this project to have an incredible horizontal approach to

order to emphasize the linkages between different factors affecting the same diseases, and their underlying causes. Think Global has also partnered with different IFMSA projects and Officials, such as the SWG on Social Determinants of Health, Healthy Planet International, LO Public Health, SCOPH, Projects Director and LO WHO.

The dedication and the spirit in the team has allowed us to move quickly! With money in the bank (from the generous UNESCO grant), we have tried utmost to involve NMO’s in Think Global’s activities, and even more is yet to come!

With this first Think Global publication, we hope to collect thoughts and projects within IFMSA associated with Global Health. The media division has been working around the clock to make this publication a reality before the August Meeting in Copenhagen. The division’s efforts should really be applauded! We would also like to offer our sincere gratitude and appreciation to all those who have contributed to this publication. Hopefully, this publication will inspire you and others to conduct and build effective Global Health-related projects-both locally and globally! Please feel free to get in touch with us with your feedback or simply to know more about the work we do!

Have fun reading!

“Think Global, Act Local”

the issue of Global Health. A brilliant Think Global Team consisting of 13 dedicated members from 10 different countries has allowed us to concentrate on many different concepts simultaneously. Some of our main areas of focus have been on advocating for updated global health education in standard Medical Curricula, building up the youth movement towards the UN High-level summit on NCDs, Sustainable Health, working with the Global Health Education Consortium (GHEC) on it’s global health guidebook, and forging partnerships with the WHO’sGlobal Health Workforce Alliance. We have largely tried to integrate many of the aspects of the areas we work with in

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Capacity Building for Global Health Geneva Seminar on Health and Globalization (15-19 January, 2011) In IFMSA we should all be able to identify with the mission statement "Think Globally; Act Locally".

While most of us know

other IFMSA members benefit from similar exposure? We then realized that classes on "global health" or "the United Nations and Health" were never taught to us, we tried to find out what could we do as IFMSA alumni to widen the participation. We began thinking globally!

how to act locally and develop interventions or projects that advance the health and wellbeing of populations we belong to

We then met Dr. Inon Schenker, a former Staff Member

and care for, the question arises that if we are sure what when requested to "Think Globally"?

Jessica Tang & Maria Angela Mar3nez Gamero (APEMH-­‐Peru)

In May 2011 we had the good fortune to attend the 64th World Health Assembly (WHA) thanks to the Global Health

Council (GHC). This was an amazing opportunity for us to experience global health in action and also to try and answer the question stated above –are we sure as to how to “Think globally”?

Within the GHC delegation we met people from different countries. There were delegates at the WHA from 193 countries that attended this annual meeting in Geneva, Switzerland. Most delegates were Ministers of Health and their senior teams. " " However, there was one thing in particular that we enjoyed apart from the international learning and working experience with people of various backgrounds. During one of the working days, we met a Malaysian delegate who introduced us to a Peruvian couple whom were doctors.

This couple has been working in the WHO headquarters for many years and for them this was their 20th WHA! In the Plenary of the WHA heads of delegations we were discussing their views on current priorities in global health. Later, in the two sub-committees very essential topics where discussed (e.g. HIV/AIDS, WHO budget, MDGs, and International Health Regulations) it was such a great experience yet, we asked ourselves how could

of WHO, a leading specialist in HIV prevention and a global health consultant. He shared with us that for the last 5 years a Seminar on Global Health is held in Geneva every year. "Chemistry" was working for us and we were able to agree that holding the 2012 Geneva Seminar on ‘Health and Globalization’ specifically for IFMSA alumni.

This would help them to acquire the skills and knowledge they need to successfully engage in global health activities and careers. When sharing the news with SWIMSA alumni member, Dr. Cindy Bouvet from Switzerland, this initiative is now coordinated between two IFMSA countries; Peru (APEMH) and Switzerland (SWIMSA).

All these experiences inspired us in so many ways. Our experience in WHA was nothing short of amazing and it has given us a thorough understanding of the internal workings of an international organization such as WHO and a unique insight into the formation of international health policy. So now, that we think globally, we are acting locally – and are inviting anyone interested to participate in the 2012 Geneva Seminar to write to us (genevaseminar2012@gmail.com). Soon you could also find us on Facebook (Geneva Global Health Seminar).

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Mobilizing Youth for NCD-Advocacy How Youth Can be the Midas touch for Global Movement for the NCDs, and Existing Opportunities within IFMSA • Non-Communicable-Diseases (NCDs), which include diabetes, cardiovascular disease, cancer and chronic respiratory disease, cause 60% of all deaths globally (35 million) each year. The Moscow Ministerial Declaration revealed that this figure will jump to 75% by 2030.

• 4 out of 5 deaths occur in low- and middle-income countries.

• NCDs share the common risk factors of tobacco use, unhealthy diet and physical inactivity.

• NCDs only receive 0.9% of health official development assistance (ODA).

Nilofer Khan Habibul-­‐ lah (AMSA-­‐USA)

• NCDs are a major cause of poverty, a barrier to economic development, and a neglected global emergency.

Courtesy MDGs and NCDs Factseet: The NCD Alliance

With most of the attention of global health directed at vertical infectious disease-based programs, we now realize that the NCDs are increasing in numbers and we can no longer take a back-seat when it comes to rallying global support to combat this epidemic. On 13th May 2010, the United Nations, led by Caribbean Community (CARICOM) member states, voted unanimously for UN Resolution 64/265 to hold a United Nations High-Level Summit on Non-CommunicableDiseases in September 2011. This will only be the second time a health issue is brought at the global agenda on the UN High-Level Summit.

This article will mention how medical students can partake in IFMSA’s commitment to address NCDs. Yes, we are looking for someone like YOU!

Where do we start today?

Member States at the 63rd WHO World Health Assembly reviewed the progress achieved during the first two years in implementing the Action Plan for the Global Strategy on the Prevention and Control of Non-communicable Diseases. Some of the successful approaches included:

• implementing interventions aimed at monitoring NCDs and their contributing factors; • addressing risk factors and determinants supported by effective mechanisms of inter-sectorial action; and

• Improving health care for people with NCDs through health system strengthening.

However, one of the main concerns raised was the inadequate development in building sustainable institutional capacity to tackle NCDs in developing countries, which demands our immediate attention and efforts to progress

Current NCDs Movement within the IFMSA: How can YOU par3cipate?

At the recent 64th World Health Assembly, the IFMSA delegation proposed interventions during NCDdiscussions calling for affordable essential medicines,

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7 | Think Global Act Local increased youth involvement, and also that the social determinants of health aspect of the NCDs be addressed.

In line with the above IFMSA interventions during the 64th WHA, the current Think Global Initiative Project team is working on furthering the NCDs agenda within the IFMSA community by exploring potential collaborations on common advocacy ground, especially with the SWG on Health Inequities to incorporate the social determinants of health perspective on NCDs during SWG’s Week of Global Action on the Social Determinants of Health (WOA-SDH, 17th-23rd October) and other relevant groups such as the SWG on Women’s and Child Health.

Par3cipate in the proposed World Health Day on NCDs Awareness and Preven3on with Think Global and SCOPH! The aim of the this event, scheduled around the UN Summit on NCDs, is to mobilize youth to dispel awareness-such as healthy lifestyle practices pertinent to four shared risk factors: tobacco use, physical inactivity, unhealthy diets and the harmful use of alcohol, highlight NCDs issues and challenges within their local communities, re-emphasize on the growing threat of NCDs, and promote preventative measures to reduce NCDs numbers in the community. The theme is to focus on the fact that reducing NCDs numbers is within our reach-and largely a preventative public health issue which can be enforced with awareness and preventative methods on all levels; primary, secondary, tertiary and quaternary. Furthermore, we hope that this event will help fellow medical students realize the need and importance of having prevention and control of NCDs as part of standard medical curricula, and give birth to other sustainable youth-driven healthy lifestyle programs and efforts, which would be an ideal fulfillment of the long-term objective of this event. Stay tuned for more juicy details on the event and to participate! In the meantime, please feel free to contact Think Global Coordinator at thinkglobal@ifmsa.org

Join the newly-­‐created Small Working Group on NCDs! The aim of this SWG will be to work specifically on mounting youth involvement and response towards the UN High-level Summit on NCDs (Sept 19-21).Our work will begin soon after the General Assembly, continue until the UN Summit and/or extend beyond that if deemed needed.

Working objectives will revolve around: developing programming ideas for NMOs (both educational and advocacybased for the community) with concrete materials (advocacy guides, presentations, fact sheets, etc) for the tentative World Health Day on NCDs, which the Think Global Team is currently working on with the SCOPH Director, and building on IFMSA’s presence during the UN Summit on NCDs.

Final Thoughts We expect participants to be required to be available during, at least, the second half of August and until the UN Summit around which we'll also observe the proposed World Health Day on NCDs. More information on the SWG will be forthcoming. In the meantime, please write to our Liaison Officer on Public Health Issues if interested to participate or for queries at lph@ifmsa.org by Aug 6th!

The issue of NCDs is a pressing one. To reap sustainable and substantial development in reducing NCDs numbers, a multi-disciplinary approach, such as that of addressing the social determinants of health perspectives, and maternal and child health, is required. With a strong membership of 1.3 million medical students, the IFMSA can be a frontrunner and power house for generating youth response on this pressing issue, which will also result in innovative approaches to address NCDs. As a young physician-in-training, the onus is on you.

How will YOU contribute to combat NCDs, and help change the future of public health for the better?

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Root Out, Reach Out: Medical Students in Action on Social Determinants of Health Health inequities exist everywhere. World health statistics indicate huge disparities within and between countries in terms of access to health care services or health indicators such as maternal and child mortality. Life expectancy, for example, ranges from 82 years in Japan to 34 years in Sierra Leone. On the other hand, within countries for instance, a 20 year gap looms between life expectancies of the most and the least advantaged populations even in the United States – the wealthiest country in the world.

As a response to this global health challenge, the World Health Organization in 2008 released a report by the Commission on Social Determinants of Health, which summarized evidence from around the world showing how social circumstances such as income differences and employment conditions affect health and health care, particularly in worsening health disparities within and between nations. The report went on by saying that these disparities in health are “the result of a toxic combination of poor social policies and programs, unfair economic arrangements, and bad politics.”

The Commission recommended “improving daily living conditions” and “tackling the inequitable distribution of money, power, and resources” as solutions towards global health equity. The following year, the World Health Assembly passed a resolution calling Member States to

and to explore the role of medical students, particularly IFMSA, in addressing these shared global health challenges. For the past months, members of the SWG recalled existing efforts and envisioned new ones, with the hope of realizing the vision of the Policy Statement and

initiate global action on social determinants of health through measurement of health inequities, implementation of a “social determinants” approach in public health programs, adoption of a health-in-all-policies approach to government, and alignment of work on social determi-

the dream of “health for all” sooner rather than later.

nants with the renewal of primary health care.

ence on Social Determinants of Health this coming October 19-21, 2011 in Rio de Janeiro. This high-level meeting aims to bring Member States and other actors together to build political support and to make progress on national policies in addressing social determinants of

Fortunately, there is also an increasing awareness of the existence of gross inequities in health, as well as recognition of social determinants that worsen inequities, within

The SWG saw a huge opportunity this year. WHO and the Government of Brazil will be organizing the World Confer-

the IFMSA. Last March 2011, during the 60th March Meeting in Jakarta, Indonesia, the plenary passed a Policy Statement on Health Inequities and Social Determinants of Health.

This pioneering statement pledged to “launch a

health to reduce health inequities.

federation-wide movement or campaign that will champion health equity and will mobilize members to combat the social determinants leading to ill health” and to and to “participate in activities that aim to close the health gap and address the social determinants of health.”

matters. For this timely and urgent concern, however, the SWG proposed that IFMSA maximize the timing of the world conference to launch a global campaign for action on social determinants of health by designating the week of October 17-23, 2011 as IFMSA Week of Global Action

The Small Working Group on Health Inequities, which was organized last year by the Standing Committee on Public Health, accepted the challenge of leading the Federation in this massive effort to spread the awareness of social determinants, to understand the roots of health inequity,

on Social Determinants of Health.

For the past 60 years, IFMSA has been sending delegations to high-level conferences in an attempt to channel the voice of medical students worldwide on global health

During this week, while in Rio the world leaders are discussing global health policy and debating about action on social determinants, medical students from all over

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9 | Think Global Act Local the world will be doing real, tangible actions big or small, showing leaders the road to global health equity. Actions at the NMO level range from educational fora and round table discussions to street mobilizations and social media campaigns to community-based development projects that target vulnerable groups. NMOs are also encouraged to conduct analysis of social determinants in their respective countries, with the guide of analytical tools to be provided by the SWG. This global initiative will culminate in a strong IFMSA presence at the World Conference itself.

NMOs are greatly invited to participate in this global campaign. Efforts should begin with educating local NMO members on the issues of global health equity and social determinants of health, through interactive events as well as the educational materials that the SWG will provide. The Week of Global Action will be spearheaded by national Standing Committees on Public Health (SCOPH), but it is the SWG’s hope that global health equity and social determinants become the ultimate concern of all units of IFMSA at local, national, regional, and global levels.

The SWG envisions the Week of Global Action as a launching pad of more efforts for global health equity that cut across all Standing Committees, NMOs, and other units of the IFMSA. The Federation should lead in advocating for the incorporation of a “social determinants” view of health in the education of medical students and other health professionals. In addition, it should lead other global health actors in addressing the “global determinants of health” such as international trade policies and unsustainable environmental practices and call all stakeholders to work on health equity as a universal societal goal.

Renzo R. Guinto SWG on Health Inequi3es Coordinator

For six decades, IFMSA has witnessed global health problems emerge and unfold, and we have made some attempts to cure these defects. Now that we celebrate our 60th year, it is about time to act upon these lingering challenges through collective efforts, with unwavering commitment, and with an open, holistic, “social determinants” thinking. Disease-oriented interventions and health-centered programs should now give way to initiatives that cross the boundaries of medicine and embrace solutions from all sectors of society. The German pathologist Rudolf Virchow, who is regarded the Father of Social Medicine, once said: “If medicine is to fulfill her great task, then she must enter the political and social life. Do we not always find the diseases of the populace traceable to defects in society?”

Rooting out and reaching out are what medical students – and IFMSA as a whole can do, here and now.

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Tuberculosis: A Health Concern Around the World Tuberculosis represents one of the biggest health-related challenges in so many countries. It is predominantly present in underdeveloped nations and those most affected are the world’s poor. The health systems found in these countries, like mine, do not have the ability to diagnose TB and do not necessarily have access to medications and resources to treat the disease.

Luz del Pilar Revolledo LPO, IFMSA Perú

Every year, around the world, there are 8 million persons people get infected worldwide. who gets the infection, and

Every year on March 24th, NMOs around the world, have been working on I’ve experienced this as both an LPO and as a student concerned about this health problem in my country; and I know, without a doubt, that there’s a lot of hard work to do.

iIn Peru, my country, there’s is a new infection every 6 hours. 1.7 million persons die annually from tuberculosis, which

Especially in discovering other ways to provide an effective diagnosis, ways that’ll help the people to continue successfully with their treatment, to figure out the right methods of treatment which will not allow any more new cases of MDR-TB

means 4700 deaths a day.

In addition, treatment for tuberculosis lasts anywhere from 6 to 24 months and many people do not finish treatment, creating more drug resistant strains of the

Finally, in conclusion, in my opinion the most important of all is that we educate our people. Teach them methods of prevention and how to put an end to the discrimination against the patients who have acquired this dis-

disease. Multi Drug Resistant- TB clearly represents, clearly, the logical consequence of a mismanaged epidemic.

ease.

I know that this is a lot of hard work to do but we can certainly do it.

IFMSA allows us the opportunity of working in Global Health Issues. IFMSA has also enabled our understanding of the big problems of the health systems in each of our countries. By developing activities and campaigns of awareness about TB we can learn, as future doctors, how to prevent, treat, and defeat this illness that is part of our reality. This is our chance let us think about a better tomorrow, one in which every single country will be TB free: as a medical student and IFMSA member, that’s my dream.

Can you imagine that one in three humans is thought to be infected with M. tuberculosis? Is this going to stay this way? Are we going to let this situation?

Every year on March 24th, we remember the day when Dr Robert Koch shook the scientific community around the world by announcing that he had discovered the cause of tuberculosis, the TB bacillus- this happened in 1882. Koch's discovery opened the way towards diagnosing and curing TB.

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Health inequality inside a country What is it? Why is it there? What is meant by "Health Disparities"?

The Health Resources and Services Administration defines health disparities as "population-specific differences in the presence of disease, health outcomes, or access to health care."

The Institute of Medicine’s (IOM) 2002 report, defines disparities in health care as “differences in the quality of health care that are not due to access-related factors or clinical needs, preferences or appropriateness of intervention.”

In the United States, health disparities are well documented in minority populations.

When compared to whites, the minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes.

According to 1985 Health and Human Services’ “Report of the Secretary’s Task Force

Omar Safa RA of the VPE for the EMR

on Black and Minority Health,” health is said to be “influenced by the interaction of physiological, cultural, psychological, and societal factors that are poorly understood for the general population and even less so for minorities.” In short, it is challenging for social scientists to find ways to determine if, how, and to what extent each of these factors is related to health disparities experienced by minorities.

Health disparities are evident in the developing world, where the importance of equitable access to healthcare has been cited as crucial to achieving many of the Millennium Development Goals

What Causes Health dispari3es?

To better understand these causes we can simplify this by dividing them into 3 major categories:

• Health Before care: Disparities in health can arise from personal, socioeconomic, and environmental characteristics\variables that are external to the health care system and exist prior to the individual entering the system. Disparities in health status are known to correlate with income levels, adequacy and safety of housing, employment status, education level, lifestyle choices (e.g., tobacco use, alcohol use, diet, exercise), environmental conditions (e.g., air and water quality, pesticides, green space), and social conditions (e.g., crime rates, employment opportunities).

• Access to Health Care: Disparities in health can arise from personal, socioeconomic, and environmental characteristics that are exter-

1) Lack of Insurance Coverage: Health insurance coverage directly affects access to medical care, regardless of race. Without it, patients are more likely to postpone seeking medical care, more likely to go without needed medical care, and more likely to go without prescription medicines. Some of the disparity in coverage is related to differences in income level and type of employment. Low-income working adults face the highest risk of being uninsured because they work in lowwage jobs that do not offer insurance or cannot afford the high cost of private insurance.

2)Lack of a Regular Source of Care: Without access to a regular source of care, patients have more difficulties obtaining care, make fewer doctor visits, and have more difficulty accessing prescription drugs.Adults with a regular source of care have higher rates of receiving preventive services than those without, and children with a regular source of care have higher

nal to the health care system and exist prior to the individual entering the system. Disparities in health status are known to correlate with income levels, adequacy and safety of housing, education level, lifestyle choices (e.g., tobacco use, alcohol use, exercise), environmental condi-

rates of immunization than those without.

tions (e.g., air and water quality, green space), and social conditions (e.g., crime rates, employment opportunities).

to get care (e.g., schedule appointments quickly or during convenient hours), and excessive time spent in the

3) Structural Barriers: According to the “National Healthcare Disparities Report”, “Structural barriers—poor transportation, inability

Think Global Act Local |12 waiting room—affect a person’s ability and willingness to obtain…needed care”.

4) Scarcity of Providers: Access to medical care is further limited by the scarcity

by limited access to language interpreters. Less than half of the non-English speakers that said they needed an interpreter during a health care visit reported always or usually having one.

of primary care practitioners, medical specialists, and diagnostic facilities in inner cities and rural areas—communities with high concentrations of minority populations.

Thus, minority groups are more likely to report that they have little or no choice in where they obtain care.

2) Provider Discrimination: The IOM’s 2002 report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare,” suggests that unconscious or conscious discrimination on the part of providers accounts for a portion of the unequal, infe-

In addition, minorities have difficulty filling prescriptions in areas with inadequate pharmacy services.

5) Linguistic Barriers: Language differences can restrict access to medical care

rior treatment of minorities. Differences in treatment by race and ethnicity are particularly well-documented for cardiovascular disease, diabetes, kidney disease, HIV, and cancer. The IOM Report cites studies to support that, even after adjusting for socioeconomic status and health

for minorities who can’t understand the official language, for example, and according to a survey of non-Englishspeaking women in the United States, those who did not see a doctor for cervical cancer screening cited the inadequacy of the translated materials as a contributing

insurance coverage, minorities are less likely to receive antiretroviral therapy and protease inhibitors for HIV, to undergo cardiac catheterization and bypass surgery for cardiovascular disease, to receive hemodialysis for kidney failure, to be referred for a kidney transplant once on

factor.

dialysis, or to receive pain medication in the emergency room for a long bone fracture. According to the report, other studies investigating the appropriate level of care found that such disparities are not due to overuse of services.

6) Health Literacy: A recent survey revealed that between 20 and 25 percent of minorities in the United States believe that staying healthy is a matter of luck (versus 12 percent for whites), indicating that these groups may not be educated about the benefits of preventive care.

• Disparity Health Care Delivery: Once entry to the health care delivery system is gained, disparities can arise in the quality of care received. Studies show that diagnoses, treatments, and quality of care all vary according to insurance coverage and type, provider cultural competency, patient-provider communications, provider bias and discrimination, differential treatments based on population group, patient preferences and adherence to treatment plans, language barriers, diversity of the health care workforce, appropriateness of care, and effectiveness of care.

1) Patient-Provider Communication Problems: Communication between patients and physicians is critical to the delivery of appropriate and effective treatment and care. Regardless of patient race or ethnicity, miscommunication can lead to incorrect diagnosis, improper

Discriminatory tendencies on the part of providers are supported by a study that is based on actual clinical encounters. In that study, “doctors rated black patients as less intelligent, less educated, more likely to abuse drugs, more likely to fail to comply with medical advice, to lack social support, and less likely to participate in cardiac rehabilitation than white patients, even after patients’ income, education, and personality characteristics were taken into account”. In addition, there is evidence of unequal treatment on the part of providers when it comes to patient medical bills. In a study by the Allegheny County Health Department in Pennsylvania, African Americans were more likely to be asked about their ability to pay for treatment (independent of insurance status), less likely to receive payment allowances, and more likely to be referred to medical bill collection agencies than their white counterparts.

use of medications, and failure to receive follow-up services—all of which can adversely affect health or contribute to death. Among non-English-speaking populations in the United States (about 18 percent of the total population) the linguistic barrier is huge, and it is exacerbated

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Climate Change and MDGs “Climate Change is the biggest threat to Public Health in the 21st Century”- The Lancet To understand this powerful remark by one of the most renowned journals in the world, we need to look in depth of how something we used to think was affecting the biodiversity, also in fact impacts public health very severely.

Firstly, there is now a widespread agreement that the earth is warming, due to the emissions of greenhouse gases caused by human activity. It is also clear that current trends in energy use, development and population growth will lead to continuing and more severe change in global environmental system. The changing of the climate will inevitably affect the basic requirements for maintaining health and put basic determinants of health at risk.

The UN Development Program (UNDP) states that climate change threatens the

Faseeh Shahab President IFMSA Pakistan

achievements of MDGs especially MDG 7 (environmental sustainability), and if the environment is not sustained, the problems caused by it will affect the achievements of other targets, esp. health related MDGs. Following is a brief presentation on some of the aspects on how global environmental change affects human health and some cross linkage between MDG targets:

1. Changing paherns of disease and morta-­‐ lity Spread of vector born disease to new places is imminent due to global long-term change in weather patterns. It is not only restricted to the spreading of diseases but also to their patterns. A very clear

Usman A. Mushtaq TGIP Coordinator

example here is the pattern of dengue fever in Jakarta. Remaining as a big problem in the country,

dengue incidences were commonly reported in the rainy season between NovMay while recent data shows that dengue fever is now becoming more and more common throughout the year burdening the already overloaded health system.

Higher temperature also increases heat-related stress and also heatstroke incidences, directly affecting the elderly in urban populations and patients with respiratory and/or cardiovascular diseases.

2. Reduced air and water quality (ozone, carbon gases) Higher temperature in urban areas where the infrastructures of the buildings (with heater and tall height) trap warm air leads to the increment of production of pollutants such as ozone. This in turn raises the prevalence and burden of lower-respiratory tract infections and chronic obstructive pulmonary disease (COPD); affecting the vulnerable population the most.

Streams of hot water will also disrupt functioning ecosystems and lead to microbiological growth/increased presence of vectors.

3. Extreme weather events Globally, the numbers of reported weather-related natural disasters are mounting rapidly. Reports of natural catastrophes have risen three times since the 1960s. In 2007, 14 out of 15 “flash appeals” for emergency humanitarian assistance for floods, droughts and storms were five timesince the 1960s. In 2007, 14 out of 15 “flash appeals” for emergency humanitarian assistance for floods, droughts and storms were five times higher than in any previous years. The severity of the natural disasters is increasing as well. Even though it is difficult to say that the natural disasters have anthropological origin, it is observed that there is a clear link between raised emission and weather related natural disasters.

Pakistan in 2010 faced the worst floods in its history, affecting over 20 million people. The floods severely impacted the areas adjacent to the riverbanks from north

14 | Think Global Act Local to south of the country, an area spanning over 2000 km in length (!) Flash floods and landslides triggered by torrential rains overwhelmed the capacities of water reservoirs that resulted in submersion of cities and those who managed to survive were stranded on rooftops.

Thousands of hectares of cultivated land were destroyed, with the main highways cut off and communities left isolated due to washing away of roads and bridges. Leading to a disastrous setback for Pakistan to reach its MDG targets.

4. Food insecurity Droughts are becoming more severe in the most vulnerable places on earth and with combination of pattern changes of plants and livestock diseases, pest infestations, lessened forest productivity, changes in aquatic systems, and reduction of income from animal production and decreased crop yields lead to noticeable impacts on health. All of these things lead increment in malnutrition, especially affecting children under five in the low- and middle-income countries, low birth weight babies due to the nutritional problems from the mothers combined with sub-optimal breastfeeding make the babies prone to infectious diseases.

5. Water and sanita3on Climate change causes worsening access to water and sanitation due to extreme weather events leading to the damage on the infrastructure for drainage and pollution of the fresh water resources. Chemical/biological contaminants in water are the leading causes for diarrhea. It is estimated that 2.5 billion people are lack of proper sanitation. WHO estimates that the MDG target on sanitation will be missed by 1 billion by the end of 2015.

6. Climate refugees Researchers believe that 20 million people have lost their home and shelter due to climate-related events – this may increase to over 50 million within the next decade. Extreme predictions even suggest the chance of 150 million climate refugees by 2050. Internal refugees are the biggest problem in countries with dense population such as Bangladesh as the most striking example.

Climate change has direct implications for the efforts in achieving the MDGs. At the same time, as the UN Secretary-General has observed, the MDGs should also contribute to the capacities needed to tackle climate change by providing opportunities for broader improvements in economies, governance, institutions and intergenerational relations and responsibilities.

Conclusions Relationship between climate change and the MDGs involves both threats and opportunities, which work in both directions; one gives impact to another and vice versa in both positive and negative ways. For example, if the country has specific mitigation strategy for carbon emission, it will support MDG 7. Food and water insecurity, spread of water-, vector-, and air-borne diseases will impede the achievement of MDGs 4, 5 and 6. We need to figure out on how to best emphasize the fact that climate change is not only affecting the economy or the polar bears, but also affecting human health to a large extent.

15 | Think Global Act Local

The Think Global Initiative Project Team!

Usman A. Mushtaq TGIP Coordinator

Mayssa Rekhis ASSOCIAMED-­‐Tunisia

Charlohe Holm-­‐Hansen IMCC Denamrk

Salahuddin Robi IFMSA Bangladesh

Maria Aroca AECS Catalonia

Daniella Andia Milan IFMSA Bolivia

Nilofer Khan Habibullah AMSA USA

Hanna Schröder BVMD-­‐GErmany

Rodney de Roche IFMSA Greneda

Marco Bonsano SISM Italy

Angelo D’Ambrosio SISM Italy

Faseeh Shahab IFMSA Pakistan

Sebas3an Schmidt BVMD Germany

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