magazine
Issue 4 | November 2013
MEDSINMAGAZINE ISSUE 4 | NOVEMBER 2013
Contents 1. 2. 4. 6. 7. 8. 12. 13. 14. 15. 16. 17. 22. 23. 24. 25.
Welcome message from the National Director The Economic Determinants of Health How The Mining Industry Costs Lives Industry Transparency University Global Health Report Card Medsin’s Response to the Release of the UK Immigration Bill 2013 POST-2015: Our Vision: Our Voice What Matters Most for Global Health The Open Access Button page A vision for Global Health Education in the Future Training: helping Medsin to do more Updates from Activities What is the IFMSA? IFMSA’s 62 General Assembly August 2013 Chile Santiago South America NorWHO 2013
“A Healthy Profit” LEEDS NATIONAL CONFERENCE 2013 If you are fortunate enough to be receiving this magazine at the Leeds National Conference, then welcome! If this is your first exposure to Medsin, then expect a great weekend, and an even better social! We’ve done everything we can to make this weekend as good as it can possibly be, so please make yourself at home, and enjoy the experience! If, however, you didn’t get the chance to come to the conference, then don’t fret! The entire conference is being live streamed and will be available on YouTube afterwards, so keep your eyes peeled…
Leeds NC13 Conference Committee
Editor: Alice Clarke Graphic design: Chris Berry and Cameron Stocks Comms Director: Lucas Scherdel
MEDSINMAGAZINE ISSUE 4 | NOVEMBER 2013
Welcome, to this fourth edition of the Medsin Magazine! Whether you’re a seasoned Medsin veteran, or you’re new to the network, I hope that you enjoy the latest evolution in our flagship publication. As National Director, it’s my job to lead the network, and ensure that the National Committee are doing their best to support the development and coordination of our members. Medsin is an incredible catalyst for social change, giving thousands of students every year the tools, confidence and networks to amplify their effort and have a larger impact on health care through education, advocacy and community action. Over the last year we’ve had incredible success as a network; the coordinated themes of HIV and Migration made a significant contribution to global health. This year, we're focussing on the NHS and the Post-2015 agenda. The NHS Week of Action will run from the 25th Nov - 1st Dec, culminating in a zombie flash mob. To find out more about the week of action, and how to participate, check out medsin.org/nhswoa. The Post-2015 theme will examine the international processes deciding the future of the world after the Millennium Development Goals expire in 2015. The direction set out by
these changes will determine the world that we, as today’s youth, will live and work in for the rest of our lives, and yet we feel that youth have yet to be included in the discussion. In the new year, we'll be launching a big campaign on Post-2015, alongside a range of resources and educational materials so that we can better inform the public about what these changes might mean for them. We’re also proud to announce our redesigned weekly email newsletter. It is even more packed with opportunities, news and views from the network, and around the world of global health. Make sure you sign up at medsin.org. The next big events in our calendar are the National Campaign and Exchanges Training Day on the 7th of December, and the annual Global Health Conference, which will be hosted by Medsin Barts on the weekend of the 5th April. I look forward to seeing you all there! Medsin is always looking for ways to improve, so if you have any comments, questions or suggestions then let us know at medsin.org/feedback. I’m enormously proud to be leading such a highly motivated army of change-makers, and I hope that you take every opportunity to make the most of your time within Medsin.
Cam Stocks National Director
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The Economic Determinants of Health Richard Shelley “Mismanagement of the economy causes most of the social problems community activists spend their lives trying to rectify.” Unfortunately, this problem is rarely made the focus of much work in global health. For many, economists have succeeded in making the subject so dull that they have no desire to go anywhere near it. For others, the jargon thrown out by economics commentators makes it seem virtually impenetrable. And for those who understand many of the issues there is often a feeling that without an economics degree they are simply not in a position to argue for better alternatives. The aim of the Economic Determinants of Health Stream and National Working Group is to show that although many economic issues are complex, with a bit of work the core elements can be quickly understood, and are too important to ignore. The key to many of these issues is to think of them in terms of power. Who is the most powerful group and what do they want? Economics is often then the language used to justify these wants. This piece will focus on the core element that is money and how it affects healthcare provision. We are often told that there is not enough money. Not enough for the NHS, not enough for social services and not enough for green infrastructure projects. But what actually is
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money and where does it come from? The answer is trust. We can think of money as anything readily accepted for payment. We accept payment in the form of a ten pound note or bank transfer because of our previous successful experiences using ten pound notes or the numbers in our bank account to purchase things. This trust is further guaranteed by the fact that our taxes have to be paid in one of these forms. While new coins and notes are produced by the government they only make up 3% of the money in circulation. The other 97% is simply numbers in a computer created in exchange for a loan contract. A digital promise to pay is created in exchange for one in ink on a legally binding contract. In the words of Sir Mervyn King, former head of the Bank of England; “when banks extend loans to their customers, they create money by crediting their customers’ accounts.” The amount of new money created depends solely on banks’ willingness to lend and people's willingness to borrow. If we think about where the power lies, this is a great system for the banks. They collect interest on all the new money they create and yet are bailed out by the tax payer if they fail to meet the obligations of
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their digital promises. In the ten years prior to the economic crisis banks created one trillion pounds of new money, doubling the money in circulation to about two trillion pounds. The interest payments on this amount to about 100 billion pounds per year, or what it costs to run the NHS. At the same time this doubling of the money in circulation has pushed up prices (especially in housing), as there is much more money for a similar amount of desirable stuff. This in turn has made health service provision and infrastructure projects more expensive. More money is then needed to finance the same level of provision which, under our current system, has to come from borrowing. More borrowing means more money created as debt, again meaning more money in circulation chasing the supply of desirable stuff. However, this is not the only reason this system restricts provision. The financial crisis and resultant recession have been the trigger for numerous project cancellations and funding cuts. In the words of Lord Adair Turner, ex chairman of the Financial Services Authority, “the financial crisis of 2007/08 occurred because we failed to constrain the private financial system’s creation of private credit and money.” We continue to subsidise the banking sector at the expense of our well-being. However, it doesn’t have to be like this. Following the financial crisis the Government demonstrated that just like the private sector it can also create digital money. In a programme known as Quantitative Easing, the Bank of England created £375 billion (enough to fund the NHS for almost 4 years) and purchased government bonds
from the banks. The financial markets shot up and the banks and the wealthy did very well while the general public saw very little benefit. We don’t have to do it this way. With the creation of £10 billion, a fraction of the amount created for the banks we could fund a number of the important projects there is currently “no money for”. This would provide much needed jobs, increase tax revenue, reduce personal debt and through the projects funded increase our overall well being. The other major benefit of this “New Money for the Real Economy” proposal is in teaching people that money can and should be a public good. Details on this proposal can be found at PositiveMoney.org along with more information regarding the damaging consequences of our current money system including how it increases demand on our already overburdened Health and Welfare Services through driving inequality and poverty. Why spend your life trying to fix the water damaged floor when you could just fix the hole in the roof?
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How The Mining Industry Costs Lives Felix Jakens
“If TB and HIV is a snake wrapped around the continent, then the head is here in South Africa, and the fangs are in the mining industry.” Dr Aaron Motsoledi, Minister of Health, South Africa. When I was asked to write a piece for the Medsin magazine titled ‘how the mining industry costs lives’ I was slightly taken aback: I have 800 words to try and document a topic as vast as that? That can’t be done. Of all of the world’s industries, I would be as bold as to say none has exacted such a heavy loss of human life as mining. From Greek slaves being worked to death in Rome’s salt mines, to early coal mine shaft-failures in Wigan and Newport, to collapses in modern China as illegal mines strip rare minerals from the earth to provide parts for mobile phones, many lives have been lost as we seek to extract all manner of objects from the earth. So in an issue with so much death, drama and catastrophe, who spares a thought for the men who survive ‘life at the mine’ only to take home with them a death sentence? A cave-in at illegal mine in Zimbabwe causing 20 deaths will make headlines around the world; but gold mining activities being directly linked to 760,000 new cases of deadly tuberculosis and many thousands more of degenerative silicosis, each and every year? Forget it. That isn’t a story; and yet this tragedy is unfolding on a scale that we can barely begin to imagine.
South Africa already has the highest incidence of TB in the world, with an infection rate of around 1,000 per 100,000 population; while among gold miners the rate rises to approximately
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7,000 per 100,000 (the UK is around 14). That’s around one in three cases across the sub region and around 8% of the total burden; what’s more, data on this issue is sketchy at best, with many hundreds of thousands of men having worked in the mines who no longer identity as ‘former mine workers’ but who have suffered from extremely high exposure to silica dust and TB bacterium. This group has been described as ‘ticking time bombs’. But why are miners in the region so uniquely vulnerable?
Epidemiologists refer to a ‘perfect storm of disease’ in which physical, biological and social factors combine to create the highest rates of TB in the world. Exposure to silica dust, HIV infection, difficult working conditions and poverty come together to create the highest TB infection rates in the world. Around 90% of all the miners working in the South African gold mines migrate from rural areas or from neighbouring countries. High levels of poverty and unemployment mean a job in the mines is often the only work available. These men stay in cramped, single-sex hostel-style accommodation which leads to high risk of HIV infection; miners in Southern Africa have HIV infection rates of around 30%, which is very high. Being infected with HIV and the resulting weakening of the immune system makes a person 20-30 times more likely to develop TB. In the mines themselves, the cramped, hot working conditions are highly conducive to the spread of airborne TB bacteria. Miners are provided with protective masks but their size, and the heat of the mines, means they are often taken off, leaving miners exposed to silica dust and TB bacteria.
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Measures to prevent the spread of TB, such as air circulation and ventilation are extremely difficult to implement in the mines, which can be many kilometres deep with tunnels as narrow as two metres wide. A miner working without protective apparatus exposes himself to silica dust. Silica dust is found in gold mines and is easily inhaled. Once in the body the lungs cannot remove it and it can lead to a disease called silicosis, where lung function is impaired and has a variety of harmful effects. One of these is that silicosis damages the lungs and renders an individual around three times more likely to contract TB. Given the immense damage being done to miners and their communities, one would assume that this is a problem which has surface in the recent past; again you couldn’t be more wrong. In 1903 the Milner Commission Report into TB among miners stated “the extent to which TB among miners prevails at the present time is so great that preventative measures are a an urgent necessity”. So why has so little been done to stem this tide of misery? Again, in an issue so strewn with paradoxes, the interventions needed to tackle the issues of TB, HIV and silicosis are well know and cost effective. Prevention exposure to silica dust through introduction of dust dissemination technology, reducing single sex hostel style housing, ensuring on site diagnosis and treatment for workers and many others are well documented and proven to be effective. To frustrate the issue further, sector-wide application of these interventions would yield an overall positive financial gain to mining companies. A World Bank analysis of the issue estimated that an upfront spend of around $750 million would provide a benefit of $800 million by reducing loss of working hours, amount of training needing to be provided, healthcare costs etc. So despite this issue being clearly understood for over 100 years, with proven cost effective interventions, hundreds of thousands of miners still contract TB every year.
compliance to outright flouting of health and safety legislation. The Government of South Africa and surrounding countries can also do much more. In SA itself, the compensation system for ex-mineworkers is archaic beyond repair and desperately needs to be overhauled. Currently the fine levied against mines that breach health and safety legislation is too weak to be effective against multi-billion pound mining companies; the importance of mining to the South African economy clearly has an influence over the decisions of government. Unions also must have a case to answer. One accusation is that once these men leave the mines to return, sick, to their communities they are ‘out of sight out of mind’; no longer paying union dues and in some of the most remote, rural areas of the region. Donor governments can and should do more for these communities; using their leverage to increase pressure on all actors to do more to tackle these epidemics. Looking back, it isn’t hard to understand why so few people are aware of this issue. When a mine collapses it's clear who is at fault; the issue flashes into our minds and we can make clear judgements about blame and recourse. With an issue like TB the people who die are out of sight, in rural communities, away from the glare of the press. They die slowly, contracting silicotic TB years after they leave the mine. These men are poor, often abjectly so, with little capacity for recourse, and they have been dying in their thousands since the inception of mining. But that can’t be where we end, and RESULTS, along with Medsin and our partners around the world are working tirelessly to raise the awareness and create the political will to have a lasting and positive effect on the lives of miners, their families and their communities. To find out more join our stream or check www.results.org.uk
But why? Firstly, the mines themselves have a serious case to answer; from minor lacks in
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Industry transparency David Carroll The issue of withheld trial results has been around since before many of us were born and previous attempts to fix the problem have failed. However, this past year has seen a positive shift towards greater transparency. In January 2013, we saw the launch of the Alltrials Campaign. Alltrials is an initiative supported by 60,000 people, the great and good of healthcare, and over 200 patient groups that represent over 13 million patients. All signatories are calling on regulators worldwide to do everything they can to secure registration and publication of the results of clinical trials. The success of the Alltrials campaign has been countered by some unfortunate steps by the pharmaceutical industry to block the move to greater transparency. In Europe, the pharmaceutical industry is campaigning against these measures. Lobbyists are trying to prevent the insertion of a clause into the new clinical trials legislation in Europe that will require all results to be published within one year, and two pharmaceutical companies are moving to block attempts at greater transparency from the European Regulator. Over the past few years the European Medicines Agency has become a juggernaut of transparency. There was a brief window of transparency as the European Medicines Agency began to release documents submitted as part of marketing authorization applications, including clinical and non-clinical information, on request. It has also developed a transparency policy that it says will provide for greater clarity and openness in all areas of its operations — which could include pro-active release of data, rather than simply responding to requests. The agency ambition is to introduce its new policy from the start of 2014. However, plans to implement that policy have come under threat in recent months. The EMA was sued in February 2013 by the pharmaceutical company AbbVie about two separate requests for clinical study reports for
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adalimumab, a drug for rheumatoid arthritis, and InterMune, about a request for similar documents on pirfenidone, a drug for idiopathic pulmonary fibrosis. Despite a ruling by the European Ombudsman that clinical study reports do not contain commercially confidential information, both companies contended that the requested EMA documents contain commercially confidential information. This legal action is with full support of the European Pharmaceutical Industry Body. In April, the General Court of the European Union, in two interim decisions, ordered the EMA not to provide documents in response to the requests. The EMA had planned to provide the documents through their view that “clinical trial data should not be considered commercial confidential information.” A final hearing on the case may not be held until 2014. The EMA responded to the court order by declaring an intention to “continue with its policy to grant access to documents” but that “requests for access to documents similar to those contested by AbbVie and InterMune will be considered on a case-by-case basis.” In addition, the EMA confirmed that it would continue to develop a forthcoming policy on proactive publication of clinical trial data, pending the final decision of the court, and has since released a draft policy for public comment. Since the two pharmaceutical companies filed these legal actions, the EMA has received more than 30 statements of support from various stakeholders, including Medsin and PharmAware. The Court’s interim decision puts the European Medicines Agency into conflict with its upcoming transparency policy. The recent transparency from the EMA has been the only way that researchers could access otherwise withheld material.
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Their release was instrumental in spotting serious flaws in the evidence for Tamiflu. The Court’s decision at the request of AbbVie and InterMune puts it in conflict with the interests of patients. Glaxosmithkline joined the AllTrials campaign and promised to publish all the CSRs available as they “owe this to the patients who have taken part in their trials”. As the EMA remains committed to transparency and openness of information it has since applied to have the injunction lifted ,and its appeal was heard in Luxembourg this month, but an EMA spokesman said it is unclear when the court will deliver its ruling.
We’re on the brink of change. GSK has shown that it’s not beyond the reach of pharmaceutical companies to agree to that change. The EMA has tried to some extent to deliver that change. In delivering its ruling, the European Court has indicated that it is on the wrong side of history. The EMA now has to show that arguments in favour of secrecy no longer hold. Support the Alltrials petition by going to www.alltrials.net, add your voice and please, ask your colleagues and friends to add their voices and ask them to forward this to others when they have.
University Global Health Report Card This year, Medsin and UAEM will be collaborating on a project that will change the way people see the role of Universities in global health in the UK. The University Global Health Impact Report Card project is a grassroots research project that will rank universities by their contribution to global health. We encourage you to get involved in any way you’d like to! The evaluation of individual universities will require the help of volunteers from around the country. This is a unique way to get involved in a project that combines research with political action. Whatever your skills or background, we’d love to have you on the team. We are looking for researchers, who will collect and evaluate data, and committee members - keen and capable student volunteers interested in being part of the dedicated team that will run the project.
methodology to reveal which universities are progressive in the field of Global Health, and which are falling behind. If you want to join as a researcher or apply for a committee position, visit http://www.medsin.org/get-involved/latestopportunities/join-the-report-card-project If you are unsure of how you could be involved, or have any other questions, please feel free to email coordinators.reportcard@gmail.com at any time.
The Report Card will put pressure on universities to improve their contribution to Global Health, and allow the public to compare universities with a simple league table. The project will use a robust and transparent
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Medsin’s Response to the Release of the UK Immigration Bill 2013 Gemma Bowsher & Thomas Shanahan On 10th October 2013 the coalition government released an Immigration Bill, which includes proposals to charge migrants for access to NHS services. The proposed plans seek to limit the access of ‘visitors’ to health services in both primary and secondary care, by payment of a levy, or insisting on private health coverage. Even then services remain limited for those who can pay. As global health advocates and as a large group of future healthcare professionals, is this really the health system we want to work under? As a leading global health student network, Medsin-UK should be concerned that the Bill is not in line with the principles of the NHS, and is likely to lead to further health inequalities. Furthermore, there is a real public health concern that those in need of care will be refused access even if they are exempt from charges. Worryingly, the Bill also seems to be drawing on data that has been described by the authors as “estimates… presented as the best that can be made at present, recognising that they are based on incomplete data, sometimes of varying quality, and a large number of assumptions” (taken from The Guardian. 22 October 2013.)
and ‘promote equality through the services it provides.’ Such a Bill would deter those most in need of healthcare from accessing vital services, and encourage the institutionalization of inequality in healthcare provision. The NHS has a proud history of leading the way in universal access to health, yet we agree with the Refugee Council that these proposals would likely deter, actively exclude, or wrongly refuse the most marginalized groups from receiving vital health care services in this country.
“It would be a great shame if this legislation eroded the foundations of modern medical practice…”
Pregnant women, refugees, asylum seekers, victims of torture, victims of domestic abuse and people living with HIV are only some of the categories of vulnerable groups who would suffer as a result of this legislation. By refusing these people care it will be hard for health care professionals to say they are “making the care of their patient their first concern,” (General Medical Council, Duties of a Doctor) and that they are not allowing These plans are incongruent consideration of ethnic origin, with the stated aims of the NHS nationality and social standing to care for vulnerable groups to intervene between their duty
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and their patient . An immediate effect of this Bill is an increased public health risk. Restricting access would see the spread of diseases such as tuberculosis (TB) and HIV simply because some sufferers would not be able to afford to visit the doctor. The commonlycited example of one intensive care admission for a patient with HIV-related pneumonia costing as much as two years of anti-retrovirals is a good illustration of the false economies made by reducing access to preventive healthcare, and the wider health system costs of such a measure.
Women unable to receive antenatal care would experience a higher incidence of birth complications and require more risky and costly interventions. Missing these opportunities for disease prevention increases the costs associated with onwards transmission of disease, particularly those such as TB, which are highly communicable and particularly prevalent in certain migrant communities. Doctors’ groups are already objecting to these plans due to the lack of evidence that health tourism is a significant burden to the NHS, as well as concerns that the measures will deter migrants from seeking care and undermine the doctor-patient relationship.
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The Royal College of General Practitioners has rightfully expressed concern that GPs would have to take on the added burden of assessing immigration status, effectively acting as border guards in their surgeries. It would be a great shame if this legislation eroded the foundations of modern medical practice, which are based on confidentiality, compassion, and caring for the patient and the public as a whole
tax system. The levy contained in the Bill could deter well qualified professionals, such as doctors, nurses and other health professionals from working in the UK, which in turn could detract from the delivery of health care in this country. The common refrain that migrants are costing the NHS unaffordable sums of money is unjustifiable based on the existing data. Recently, during an interview on Radio 4, Theresa May refused to
“This is the start of further discussions and campaigns on the NHS…” A major fault of this Bill is the assumption that all overseas visitors are net beneficiaries of the system. Along with the British Medical Association (BMA) we believe that various categories of migrants, including those without indefinite leave to remain are in this country and contributing to the NHS by paying tax and making national insurance contributions. As a country we are reliant on the financial and human resources contributions of migrants working in the NHS, supporting our research institutions and paying in to our
quantify the problem when asked directly, however Department of Health figures show that £33 million was spent on ‘health tourism in 20112013, of which £21 million was recouped. As a result £12 million of funds were lost. This is only 0.01% of the £108.9 billion annual budget for the NHS (Department of Health Figures 2011-12). Any measures requiring the implementation of new charging systems will necessarily need funding, and as the BMA council chair Mark Porter states, ‘The NHS does
not have the infrastructure or resources to administrate a charging system that is not likely to produce enough revenue to cover the cost of setting up its own bureaucracy.’ We believe that government efforts should be focused on ensuring the recovery of the estimated £400-500 million a year in costs for treating patients from the EU and other countries with similar agreements, rather than adding new layers of bureaucracy and deterring those in need from seeking necessary health care. This is the start of further discussions and campaigns on the NHS over the next two terms. Next month you will have the opportunity as part of the NHS Week of Action to speak out and mobilize people to discuss what is happening to the NHS under the current government. Furthermore, early next year Medsin-UK and the Royal Society of Medicine will ask students and young people their opinion on the future of the NHS in the UK over the next 10-15 years. We hope you will get involved!
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POST-2015 Our Vision: Our Voice Nathan Cantley The Millennium Development Goals (MDGs) greatly transformed how we go about doing international development. These eight goals span global health topics, including reducing the number of people living under the poverty line, trying to increase numbers attending primary level education and reducing maternal and child mortality. They have also been the cause of both celebration and debate over their true efficacy. Now, the focus turns to what is going to happen, post2015. Some would like to see a world that mirrors the MDGs; full of targets and indicators surrounding a series of goals that focus on a different set of goals, done in a much more sustainable manner. Others (including myself) would prefer to see development take a form with greater accountability to our leaders and a better way to monitor and evaluate these goals with those whose lives are affected by the actions of this new agenda. For the last 12 months, and for the next 10, the international community is debating the post-2015 development agenda. Political figures like David Cameron have steered part of the
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process (not very well, some would argue) through the first half of 2013, and the debate now turns to the Open Working Group on Sustainable Development, and the crux of the debate. For us, as a major national student organisation in the UK, it is key that we discuss what will be important to us, through our own local and national discussions. Even more importantly, we must find a way to make this voice heard in sustained way. In the post-2015 era, with so many voices to be heard, we must find a way to make sure ours isn’t missed. Let's find our vision for the post-2015 world together and make sure we shout about it. Action cards and information packs will be disseminated through to branches and stakeholders over the next few months, detailing what you can do to stimulate post2015 discussion. If you can’t wait till then or would like more information on things you can read or to be involved in coordinating the theme, contact me at post2015@medsin.org.
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What Matters Most for Global Health Isobel Braithwaite Some of you will have heard of Healthy Planet already; many of you who are newer to Medsin won't have. If you're interested in the things that make the biggest difference to health around the world, and in the future of global health this century, it's a great Medsin activity to get involved in. Health isn't just about new drugs, access to medicines or even the number of health workers in a country, important though those things are. The simple things that really make a big difference between health and disease, the most fundamental things, are what Healthy Planet is about ecosystems that enable us to grow (and catch) sufficient, healthy food, clean air and water, adequate sanitation, and access to natural spaces where we live. Reducing climate instability is also a less obvious, but equally important, foundation for health. It has even been described by a Lancet commission as 'the greatest threat to global health of the
21st century'. That's a contentious claim, but we think the evidence is pretty strong. It's why we're sending a team to Warsaw for the next climate summit (COP19), from November 11th-22nd - to make sure that this message is heard and that health isn't forgotten in the negotiations. How exactly does the climate matter to people's lives? If you're a smallholder farmer in Zimbabwe, climate stability matters so that you can predict the rains and grow your crops to feed your family. If you're a child in a slum in Dhaka, climate stability matters so that your house isn't washed away by floods, leaving you vulnerable to hypothermia and diarrhoeal disease. If you're an old person living in Paris, climate stability matters because in a severe heat wave, when your family have left for August, you may not be able to protect yourself from the impact of the heat. And if you're a young person alive today, climate change matters because scientists think the world is going to be about 2 to 5 degrees warmer by the time you die: that's a massive increase when you know that the last ice age was 5 degrees colder. Even without considering the climate it often makes a huge amount of sense to adopt more sustainable policies anyway, for a range of other reasons, like energy security, healthcare cost savings.
to green space are often missed out, yet they're arguably some of the most important. We all rely on them for our survival, and health invariably suffers when we don't have them. Between them, these problems kill far more people every year than malaria, HIV/AIDS and TB combined - through a wide range of diseases associated with malnutrition, dirty water, poor sanitation and polluted air. What's more, climate change will exacerbate many of these problems, undermining much of our progress in development over the past few decades. We don't know exactly what climate change is going to mean for food production, our economic systems or in terms of social impact, for example as a driver of migration and conflict: that would need a crystal ball. But a fair summary is that it's not looking great. That's why we're calling for a fair and binding deal by 2015, which is already very late, and for far more adaptation funding on the table to protect the poorest.
Reducing these deaths and making use of the synergies that exist between environment and health requires better, more collaborative policy-making across multiple sectors. Globally, policies to help clean up our air and cut climate emissions, such as renewable energy, clean cook stoves and making active travel (walking and cycling) easier and safer, could save a high proportion of the 3.1 million air pollutionrelated deaths that occur When we learn about the around the world every year. determinants of health, things Shifting diets towards ones like food, water, air and access lower in saturated animal fat in
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wealthy countries with high levels of obesity and non-communicable diseases can have similarly widespread benefits. Apart from the urgent for an effective agreement to reduce emissions, rapidly, around the world, one of our key messages at COP19 is that it's the poorest people and those already living on the margins who are most vulnerable to the impacts of climate change. These are the people who have contributed least to creating the problem: Africa accounts for only 1% of the world's carbon footprint, yet it is where most climate change-related mortality occurs. The international community has a responsibility to help protect, and to empower them to protect themselves. That's a contentious claim, but we think the evidence is pretty strong. It's why we're sending a team to
Warsaw for the next climate sum. You can find out more in the Healthy Planet stream during the Medsin Leeds conference. We're also going to be calling on George Osborne to do much more to tackle climate change and air pollution simultaneously within the UK, because of the massive health impacts they both have, and it would be really great if you could join us in signing that just go to tinyurl.com/osborneletter. If you want to find out more about what we're up to in Warsaw, or about a conference that we're organising for next February, go to healthyplanetuk.org and/or follow @healthyplanetuk; if you want to email you can contact me at healthyplanet@medsin.org.
The Open Access Button David Carroll and Joseph McArthur Everyone reading this has hit a paywall at some point. Everyone has been denied access to academic research. Every time you hit a paywall is an isolated moment of frustration, which is unlikely to shake the ivory tower of academic publishing. The alternative to this system is open access, which makes research openly available for doctors, researchers, students and the public to read and re-use as they see fit. By putting these moments together using the Open Access Button, we will capture your individual moments of injustice and frustration and display them, on full view to the world. Only by making this problem impossible to ignore can we change the system. We started this project because we are frustrated by the current system and we want to change the publishing system we will inherit. The project was made possible by the invaluable support of developers, advocates and the open access community at large.
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Our team has worked extremely hard in the past few months to develop a prototype which we’re finally ready to show to the world. At launch, the button will be able to track and map every time a user hits a paywall, help them share their struggle and help them get access to the paper. Advocates can use the stories and data the button collects to push for change. Our data and code will all be available for others to use, improve on and do things we couldn’t have dreamed of. Everyone is affected by this problem and we need your help to make the problems of paywalls impossible to ignore. Together, we will make the invisible visible. Join us, this Monday 18th November at openaccessbutton.org.
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A Vision for Global Health Education in the Future Thomas Stephenson Global health education is a young discipline, and our understanding of what it is and who benefits from it is still improving. The first 13 years of the millennium have seen widening access to optional global health education for medical students. However, the much more important change has been the more gradual introduction of compulsory GHE into some UK and US curricula. My first vision for GHE is that medical schools should catch up in this regard. Comparative indicators, both of the intervention (the education) and the product (the student), will help to incentivise schools to do so. Where part of a larger curriculum, GHE should also be fully integrated (instead of sitting on the side like a serving of mushy peas). Thus far, however, attention within the discipline has fallen almost exclusively on medical education. Does the world really only need doctors to be educated in this way? To answer this question, let’s start with what we mean by ‘global health education’. Although details differ, largely the discipline agrees on aiming to instil two things: a systems-level approach to tackling future global health threats and a sense of global-citizenship, emphasising the global in the local. I foresee a much wider range of professions and individuals receiving GHE in the future, because the world in which this education is delivered is changing: an increasingly interdependent world is facing changing patterns of health threats; human resources for health remain inadequate in most parts of the world, and the composition of the healthcare workforce is changing away
from medical hegemony towards workers with more restricted skill-sets. These drivers will likely lead all healthcare professions to adopt GHE as a core component of their training, if only for reasons of self-preservation. On top of this, there is widening recognition that multidisciplinary approaches are necessary to alter the complex determinants of health globally. All professions with input into these determinants - architects, lawyers and business administrators to name a few - should receive GHE within their training in future. I foresee a greater amount of this training being optional than for the “classic” health professions. Above all, though, it should stop short of teaching how various professions can contribute to global health: this will preach a rigid response to health challenges and will inhibit innovation. Both key components of GHE also have the potential to provide a transformative experience within secondary education, and in progressive countries 16-17 year olds will soon be learning about the effect of ‘big pharma’ and climate change on health. And finally, in which parts of the world do I see GHE being provided in future? The short answer is everywhere, because the cocktail of background changes is taking place globally albeit with different mixes amongst nations. It is equally valid, and more necessary, for GHE to be provided outside the Western world. Thus, GHE will outgrow its nest (built for it, arguably, on neo-colonial foundations), and become a truly global component of education benefiting a much wider audience.
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Training: helping Medsin to do more Samson Williams I’m Sam and I’m the Medsin National Training Director. It’s my job to support your branches and activities so you have the skills you need to ‘Educate, Advocate and Act’!
Medsin training aims to equip you with skills and knowledge you need to work in your local branch or activity. Whether you need more confidence in presenting your campaign or activity ideas or want to know how to get the most out of your committee, training can work for you. Medsin training helps you to learn transferable skills such as leadership, communication and planning. These skills will not only support you in running your branches or activities more effectively and confidently, but are also useful for building your capacity for a future working within the NHS, global health NGOs or other organisations. In order to provide training throughout the Medsin network we have a large team of passionate and experienced trainers based in branches across the country. Medsin Trainers are dedicated to improving the network and have been put through their paces via our TNT training programme to learn how to pass on their skills and knowledge to YOU.
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“TNT was a whirlwind of fascinating and enriching training, as well as fun (and delicious) socials! We learnt a variety of techniques to enhance engagement and sharing of ideas, brainstorming, problem-solving, teamwork, and facilitation I came away from that one weekend with a wealth of knowledge that I am eager to share with my branch and network.” Stef, newly qualified Medsin Trainer
How can I get involved in training? Skills-based training sessions are regularly offered at national and regional events. They can also be organised at a local branches and activities. If you would like to arrange training for your branch or activity, you can contact me at: training@medsin.org or you can speak to your regional coordinator. The TNT programme runs twice a year, in Spring and Autumn. The next TNT programme will run in March/April, the application process for which will be advertised through the Medsin website and newsletter in the new year. If you have any questions about training or becoming a Medsin Trainer, please email training@medsin.org.
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Updates from Activities For more information, contact the individual organisations below, or email Nathan at activities@medsin.org
Crossing Borders Crossing Borders is a student organisation with the aim of reducing the barriers to healthcare faced by refugees, asylum seekers and undocumented migrants. We do this by educating the student population on the challenges that migrants face, advocating for change, and taking apart in local community refugee community groups. After the amazing Global Health Conference in Glasgow last March, Glasgow have set up a new branch of Crossing Borders - well done to Shona and the rest of the committee. They’ve been building on their relationships with migrant health organisations in Glasgow, have already run their first event, and are next planning to create a befriending scheme to try to improve the rates of attendance at GP appointments for migrants. Meanwhile, in Sheffield, we’ve run a posh cake sale; RefuTEA is an initiative from the Refugee Council to organise a tea party. Through these events we can encourage people to have a chat about migration over a piece of cake and a cup of tea. It was a great success on a rainy day in Sheffield, with lots of students stopping for a quick chat. The committee are also working hard to plan a cultural awareness curriculum, which can be taught in local secondary schools. We’ll let you know how the pilot has been getting on in the next Medsin Magazine.
The changes to healthcare entitlements for migrants have been plastered all over the news in the last few months. As Medsinners we are all aware of the harm that this will cause to many vulnerable people. If anyone is interested in doing any advocacy work in this area, or setting up a branch at your local university, please drop me an email at crossingborders@medsin.org and we’ll take it from there! Jamie Scuffell
HOMED Our strength is local action, with branches providing an astounding number of volunteers to projects working with homeless individuals. In doing so, they make a stand against the inequalities and injustices faced by those who are homeless, and we've been inspired to see this vision picked up at other universities with several new branches started in the last few months. Homed has been strengthened too, by better safeguarding practice and sharing of experiences and events between branches, many of us have been able to learn from professionals in homeless healthcare over the last year and gain a stronger foundation from which Homed can continue to grow. For more information email homeduk.committee@gmail.com Eleanor Swanson
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SKIP
Sexpression
SKIP envisage a world where all children are cared for and supported in accessing the basic rights of health, welfare and education within their communities. We strive to improve the lives of vulnerable and impoverished children by developing and maintaining sustainable, context specific community-based projects. By collaborating with external organisations across the globe we believe that it is possible to empower local communities to improve the well-being of their children.
Sexpression:UK is a network of youth educators and advocates who work towards tackling sexual health inequalities on both a local and national level. They do this through local small group teaching with young people in schools and community groups, maintaining a nonjudgmental environment and helping young people seek knowledge and skills they need to achieve the highest attainable level of sexual health. Sexpression also advocates on a national level for curriculum and policy change to improve access to education and services for young people and vulnerable groups. Over the last few weeks our branches have been recruiting new members to coincide with the new school year and our National Conference on the 9th/10th November focuses around diversifying sex education curriculum to include a wider appreciation of other social determinants of sexual health. If you are unsure if there is a branch of Sexpression at your university then please get in touch at branches@sexpression.org.uk and we'll point you in the right direction. Matt Tuck
Of course it is not just belief we want. SKIP is striving to monitor and evaluate our actions to help prove we are having a positive impact. We acknowledge the importance of training and educating our members not just to augment successful projects but to encourage students and future professionals to advocate the universal rights of the child and implement change. For more information visit www.skipkids.org.uk or email globalhealth@skipkids.org.uk Dave Burgess
Student StopAids Campaign It’s a new term for the SSAC and to spur us on to face the challenges that lie ahead let’s take a moment to reflect back on the huge success we have had with the UK’s Global Fund announcement. Just last month the UK Government revealed that it will be doubling its contribution to the Global Fund, committing £1 billion to the fight against HIV, TB and Malaria. Since it was established in 2002 the Fund has saved over
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9 million lives and put 5.3 million people on life-saving ARVs. With the UK’s contribution a further 750,000 people will get ARV access, 32 million will receive insecticide treated bed nets and TB treatment for over 1 million people. A life saved every 3 minutes! This achievement is in good part due to the dedication of the SSAC to keep the pressure high on the UK government to
maintain their commitment to the Fund, even when contributions waned as a result of the financial crisis. We protested at the AIDS conference in Vienna, we
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lobbied MPs, we got thousands of names on a petition and our persistence has paid off But, it’s not in the bag yet! The UK’s commitment rests on the promises of the other donating nations, particularly Japan, Germany, France and Australia also contributing funds! The UK will pledge 10% of the final amount so we need to ensure that other governments commit enough to reach the $15 billion total! Keep up-to-date with actions on this issue at student.stopaidscampaign.org Saoirse Fitzpatrick
Healthy Planet Some of you will have come across Healthy Planet before; many others won't. We're the ideal Medsin activity for those of you who don't want to see the global health and development goals of the last century slip backwards because of the health impacts of climate change, who think it's not right that nearly a billion people around the world still don't have enough to eat, or the fact that air pollution's consistently worse and green space harder to come by in poorer areas. We aim to inform people about the connections between environment and health, with a particular focus on climate change, and to advocate for policies that will protect and promote both.
specific action. This isn't just about climate change, nor about developing countries alone; in the UK alone, it's estimated that air pollution results in more excess premature deaths than obesity and alcohol combined - and most of that if pollution is due to fossil fuel use, either in power plants or in vehicles. What's more, it falls disproportionately on the poorest in society. With cities in countries like China and India rapidly reaching levels of pollution far above WHO guidelines, due to fossil fuel use, there aren't many issues that are both so global and so local to get involved in! How can you get involved? The first step is to get in touch! One easy way is that UCL Healthy Planet are organising a national conference in February of next year - their first big event ever! -which we hope you can come to, perhaps with a group from your Uni. Further information will be on www.healthyplanetuk.org when further details are confirmed. If you would like to get involved, email me at healthyplanet@medsin.org or on twitter at @izzybraithwaite. Isobel Braithwaite
We've got a fantastic team going out to Warsaw for COP19, the next climate summit (see 'healthyplanetuk' on Twitter or Facebook for updates) and alongside a Healthy Planet workshops stream we have a big stunt planned for the Medsin Leeds which will focus on health impacts of dirty energy sources like coal and tar sands, calling for our government to take
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PharmAware PharmAware is an organisation that seeks to promote ethical interactions between healthcare professionals and the pharmaceutical industry. Over the past year, we have run a successful campaign raising concerns about the flawed, “Guidance On Collaboration” document produced by the Ethical Standards in Health and Life Sciences Group. Working with our partners, this culminated in a BMJ publication in October 2013. They have also recently submitted evidence to the House of Commons Science and Technology Committee investigation into clinical trials. One of our members was part of two of the European Medicines Agency’s policy advisory groups. He was the only student representative in the groups that drew up the EMA's policy on publication and access of clinical trial data, which should come into force on the 1st January 2014. For more information visit www.pharmaware.co.uk or email pharmaware@gmail.com David Carroll
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Friends of Irise Friends of Irise is a growing network of university groups committed to educating the world about the importance of educating girls. We aim to educate people in the UK about the issues surrounding gender equality by teaching in local schools and putting on events within the university and local community. We also raise funds for Irise International, a charity supporting the education and empowerment of women and girls in East Africa as well as working to develop a replicable and sustainable solution to the lack of menstrual hygiene associated with school absenteeism. Since September FOI Sheffield have raised over £800 for Irise International; through their gig night My Big Fat Gypsy Folk Night and selling handmade Ugandan jewellery, and set up numerous teaching sessions in local schools. FOI UK are currently in the process of expanding – if you want to get involved please get in contact via friendsofirise@gmail.com. To find out more about FOI and gender equality issues in general come along to our stream ‘Gender equality – education, employment and the workplace’ at the Medsin National Conference. Caroline Plenty
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Minds for Health Minds for Health work to tackle inequality in global mental health. As part of their work they provide direct support to partner organisations in developing countries. Here, one of their volunteers Daisy Lewis talk about her time at Antara Psychiatric Treatment and Rehabilitation Centre whilst volunteering with Minds for Health: “My biggest project was the eight-week Music Therapy research programme that I conducted every Monday to Thursday morning from December onwards. Dr Rajalakshmi was keen to be a part of this, and her help and advice was invaluable. We were able to share the workload and bring a mix of three different cultures to the sessionsHindi, English and Bengali. The participants used the instruments provided by myselfincluding maracas, castanets, tambourines, bells, harmonicas and drums- and were asked to sing and play along to different songs and genres of music whilst I played guitar. I would start the sessions with a ‘familiar’ song, and we sang a variety of instrumental and action songs that the participants could play along to and copy, and concluded the
session with music listening; a selection of Bengali and Hindi classical music. The sessions were very fulfilling and challenging at times, but worth every second when the patients say things to you like “you have changed my life!” At first the participants seemed slightly apprehensive as they didn’t know what to expect, but by the end of the eight weeks, there were such drastic improvements in the patients, reinforced by the scores in the weekly questionnaires completed by the male and female group home leaders. The project was enjoyed by all and the patients were very sad to see them finish. I have since been encouraged by Dr Rajalakshmi to write and present an individual paper on my research for the World Music Therapy Conference in Delhi in March, and am in the process of preparing an abstract. I feel so lucky to have been able to spend four months working closely with everyone at Antara and I cannot wait to return!” Steph Hovey & Daisy Lewis
Kenyan Orphan Project KOP is a small charity making a big impact! KOP (Kenyan Orphan Project) works with university students from all over the UK to fundraise for projects in Kenya that provide children with access to school, health and nutrition. KOP students learn about global child health throughout the year: through KOP’s online course; training; and opportunities to attend various affiliates' events. Students then come to Kenya in the summer to see first-hand how poverty effects vulnerable children and how KOP is helping them thrive through health and education.
chance to see directly how poverty affects children’s opportunities to be healthy and learn inspires many students to become advocates for long-term change. We’re now all working hard to recruit for the Student Programme 2014. Enrolment is open between 1st November and 1st December 2013. Spaces are limited! If you’re interested in learning more, please visit our website and watch our brand new Student Programme video here: www.kopafrica.org/studentprogramme Martina Gant
This summer KOP hosted almost 150 students in Kenya who visited various projects supported by KOP. Students had the opportunity to meet the children they had been fundraising hard for in the UK. Having a
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KOP 2013: The Student Experience
Lucy Meredith, 21, KOP Student Programme Trip Leader 2013, Graduate in Music & Maths from Cardiff University The Kenyan Orphan Project (KOP) charity provides an incredible Student Programme for university students across the UK. As a KOP Trip Leader out in Kisumu in August for the 2013 Student Programme, the reality of the incredible work that KOP does in these poor regions of Western Kenya really hit me. I have been involved with KOP since October 2012 and the whole experience has been lifechanging. The Programme gives students the opportunity to fundraise towards sustainable projects supporting orphaned and vulnerable children living in poverty in Western Kenya, and also provides them with the valuable experience of actually visiting some of the projects their funds support. The main aim of the students’ visit to Kenya is to learn about global child health and inspire them to become advocates for change. KOP funds many truly inspirational projects but most poignant for me was Kochogo Integrated Child Development Centre, which was built and funded by KOP student groups in 2005. Set in a rural village an hour outside Kisumu, in an area of particularly high prevalence of HIV/AIDS, the centre feeds 180 children two nutritional meals a day. If it wasn’t for the centre, the children would go hungry and would either miss school or would be too malnourished to learn. KOP has also installed a bore hole to supply clean, fresh water to the facility and local community and has funded income generating activities. The centre is 100% funded by KOP so without KOP all those smiling faces would not have been there to greet us when they arrived at lunch time for their nutritious meal before we played games with them. The children seem so happy at the centre that it is easy to not realise the many challenges they face. As well as HIV/AIDS, many of them suffer from multiple other health risks, such as malaria, tuberculosis,
worms and several have been physically and sexually abused. While based at the centre I visited the homes of three families, where the children can't even afford KES 470 (less than £4) to go to school for a term as they have no parents to bring in any income. They live in mud huts with one or two grandparents who may be able to put a roof over their head but who are too elderly and sick to provide for them. Without KOP the reality is that some of these children would no longer be alive. KOP provides the nutrition and basic healthcare to sustain them as well as a safe environment for them to play, develop and learn. The charity cannot fund everything though. A mosquito net costs 40p! But these families cannot afford one. KOP is making a huge contribution to the lives of thousands of orphaned and vulnerable children and their communities. Kochogo is just one of the inspirational projects KOP supports. I also visited some other projects such as primary and secondary schools and the inspirational street children’s centre HOVIC (Hope for Victoria’s Children), but there are many more which I hope to visit when I go back next year while I am volunteering in my new job as a music teacher in Nairobi. KOP has really opened my eyes to the poverty and hardship that the rest of the world suffers from. KOP has inspired me to want to work for an NGO supporting sustainable projects in poor areas in Africa and has taught me how vitally important it is to tackle the three key areas of nutrition, health and education that the charity focuses on. Fundraising for KOP, and visiting the projects where our money has already made such a visible difference is a truly remarkable experience that I will remember for the rest of my life.
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Universities Allied for Essential Medicines At UAEM we believe that the status quo of access to medicines is unjust and untenable. We want to see a better world where people of all backgrounds have access to the treatments they need as they need them. We also believe we already have the power to make a change as students. Two key areas we focus on are: The Access Gap 10 million people die each year from diseases that can already be treated. Nearly 1/3 of the world’s population lack access to the essential medicines needed to treat these diseases. Although there are many barriers to access, one of the most important is a simple matter of cost. New medicines are prohibitively expensive, mainly due to patent protections. The patent system has been very successful in encouraging innovation in many different industries seeking profits from their newly developed products. By offering a protected monopoly of 20 years or more to the patentholder (in medicines, usually a pharmaceutical company) the price on the product can be set very high if it is in demand allowing costs of research and development (R&D) to be recouped and profits made. In pharmaceuticals, this link between the cost of R&D and the price of drugs makes new medications very expensive. The Research Gap The patent system drives innovation in drug development linked to the sales revenue of existing drugs. This skews the direction of pharmaceutical research towards diseases that disproportionately affect wealthy populations. This is not a fault of the pharmaceutical companies, it is simply a natural outcome of being a business with financial incentives - in this case the populations that can pay more for drugs suffer a different disease burden to poorer populations. This means diseases such as sleeping sickness, lymphatic filariasis, blinding trachoma and other ‘neglected diseases’ affecting millions of the world’s poorest people, do not constitute a sufficient market opportunity to attract commercial research and development.
In this environment, universities have a critical role to play. Many of our most important medicines were invented at universities; their accessibility around the world depends critically on how universities manage their intellectual property. As research institutions that exist to serve the public good, universities are natural leaders in the search for new treatments for neglected diseases.
Our Work Socially responsible licensing (SRL) Changing the policies and practices of publicly funded institutions, such as universities, calling on them to adopt socially responsible licensing policies we've developed to ensure their research products are accessible worldwide, and campaigning to redress the balance of neglected disease research. 6 UK universities now have SRL policies following UAEM campaigns. The Global Health Impact Report Card The report card is a UK version of the North American report card (see www.globalhealthgrades.org) that is essentially a league table grading the global health impact of a university’s education, research and access policies. The North American version has received significant press and university attention proving to be a powerful advocacy tool.
Working groups - we offer multiple working groups for UAEMers to get involved with focused projects throughout Europe, these projects include local advocacy tasks including submissions for parliamentary inquiries to work at the EU level. More information about UAEM UK can be found at www.uaem.org.uk, follow us on Twitter @UAEMUK, or contact the committee directly at uk@uaem.org Alan Abraham
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What is the IFMSA? Amelia Martin The International Federation of Medical Students' Association (IFMSA) is the world’s oldest and largest independent organisation representing associations of medical students internationally. It aims to empower its members to turn their visions and ideas about global health into a reality and it is where some of Medsin’s international work is achieved. The IFMSA was founded in 1951 as a result of the post-war wave of friendship among international students. It is made up of 100 national associations of medical students and separated into six different standing committees. A standing committee is simply a way to separate the work of the IFMSA into different groups and these are:
SCOME: The Standing Committee on Medical Education SCORP: The Standing Committee on Human Rights and Peace SCOPH: The Standing Committee on Public Health SCORA: The Standing Committee on Reproductive Health and AIDs SCOPE/SCORE: Organise the largest student exchange programs in the world Medsin offers bilateral professional exchanges at a number of universities. The idea is that medical students from across the world take issues they are working on in their countries- from campaigning on mental health to education on HIV in schools (amongst many others)and share their ideas and successes with other students from across the world. This is a two way process- as one also learns how to develop campaigns and strategies in a whole new way. A further exciting factthe IFMSA is affiliated to the United Nations AND the World Health Organisation and is the way to really get your voice heard in these inspirational organizations. Although you can get involved through joining the standing committee’s mailing list (please visit http://www.ifmsa.org/) one of the key places this global learning takes place is at the General Assemblies (GAs) held each year. These GAs usually involve six days of meetings with more than 700 representatives from 80 different countries! Medsin-UK usually take a delegation of 12 medical students to each conference who best represent the work being done by Medsinners across the network. Call outs for opportunities like these go out through our newsletter so make sure you are subscribed to keep up to date with deadlines to apply to these conferences (please see the
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www.medsin.org to sign up). The GAs for 2014 will be held in March in Tunisia, in April in Warsaw for the Europe Regional meeting (we really want Medsin to have a strong presence at this one so make sure that you look out for call outs in the newsletter). The final General Assembly of the year is held in Summer at the beginning of August in Taiwan. Just imagine sitting to dinner with a medical student from India on your left and another from the USA on your right discussing how to reduce inequity in health care! At the 62nd IFMSA General Assembly held in August 2013 in Chile Santiago a refreshed vision and mission was achieved for the IFMSA. If you think this is something that you could see yourself being part of in the future or simply want to learn more about the international work of Medsin and the IFMSA. Please email international@medsin.org
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IFMSA’s 62 General Assembly August 2013 Chile Santiago South America Anya Gopfert It was with cautious optimism that I boarded the plane in London on a beautiful summer morning, destination wintry Santiago in Chile. As the head of the UK delegation to the 62nd meeting of the IFMSA meeting, I was responsible for coordinating the small group of 4 students and ensuring the UK voice in all debates and discussions. Despite having extensive experience in these conferences, I always feel nervous and excited about the challenge of the full 10 days of Pre-General assembly and General Assembly debates. The plan being to leave with Medsin's aims achieved and to ensure delegates happy and in one piece, with people prepared to come home and take on new projects. The IFMSA is now home to organisations from 110 countries around the world and with 1.4 million members, the original structure is being outgrown and the need for change had been recognised. I attended sessions on reform. Meanwhile other delegates debated the future of the global health agenda, what will come after the millennium development goals and what we, as those of the future global health army, should be fighting for. The solidarity and the group mentality produced a feeling of the ability to make a change. You began to feel part of something bigger and plans, friendships and networks were born. After this Pre-General Assembly began the real craziness of the General Assembly. This involved six days of meetings with 700 representatives from ~ 80 countries, discussing all manner of global health topics including the future of student exchanges and the future of the federation. The energy, buzz and feeling of passion you feel at the IFMSA meetings cannot be matched. You really feel how bringing together many people with shared values and joint aspirations produces amazing things. Planned sessions filled up the day but the innovation and change
emerged from the debate and networking which continued long into the night. When I placed a vote, I endeavoured to represent Medsin as best as possible in the late night plenaries. As a native English speaker I often found myself also speaking up on behalf of others, to ensure justice and equity as far as possible. Debates varied from those on IFMSA bylaws to choosing policy statements ranging from medical education issues, to mental health and organ transplantation. The GA was also the time to vote in the new governing body. Cultures clashed and allegiances formed, but usually in the end, shared common goals allowed reconciliation and understanding. Five days of intensity. Five days of learning, exploring, thinking and being challenged. Five days to do so much in so little time. At times, one felt like a fish lost in the ocean, occasional comfort could be sought from a familiar face of fellow delegates. The next minute, you were back in the thick of it, passing of a resolution to work collectively on something- whether it was internally to improve the federation, or joint consensus to advocate and work on a specific topic. Above all the most special experience was the opportunity to meet people from other countries, just dots on the map until the GA, and hear languages you've never heard of all these experiences were endless. There is no doubt; this collection of people will make change in the world. They will be the leaders, the advocates, and the facilitators of the future. The change will be a journey, an expedition just like reforming the federation. There will be ups and downs, roadblocks, and walls to climb with moments of strength and moments of weakness. But, like we're united to better the federation, we’re united to better the world, and that is where we need to get to. And back in the UK? Well, I return to being just a medical student fighting my way through pathology exams and juggling placement schedules. On the side, I try to maintain perspective, keep the bigger picture in mind and ensure that there is a network of future leaders in the UK prepared to tackle these challenges. It's never easy to return to normality but at some point it's nice to have familiarity, routine, sleep and the chance to contemplate, reflect and plan the next endeavour.
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NorWHO 2013 Nathan Cantley Conferences that simulate real life processes, such as those of the World Health Organisation, have become all the rage in recent years. In August 2013, students from in and around Denmark organised the first Nordic WHO simulation, held in Copenhagen. The principle was simple; give delegates the task of representing a UN member state, an NGO, or a pharmaceutical or media employee [right word?]. Delegates would then act out how the World Health Assembly would come together to discuss a topic within Global Health, and come to a draft resolution, bringing together the approaches delegates thought important in tackling the issue. NorWHO brought together 60-70 [find en dash] delegates from around the world to discuss global issues in mental health care (including a couple of ‘outliers’, such as yours truly) [I don’t know what to do about this, it’s not clear what he means in the context, but I don’t want to coldly cut it]. Over the course of four days we heard a number of lectures, covering areas such as classification systems for mental health disorders, personal accounts of dealing with mental health illness, and ways the WHO could improve care. We also received training through workshops that delved into key parts of lobbying, such as communication, and how to gain a greater understanding of diplomacy, given by student leaders from across the world. As someone who has read a little about mental health in the past on a local basis I found this to be incredibly interesting and informative, and was intrigued to hear more from a global
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perspective. It also allowed us to learn hard skills and information outside that discussed in plenaries or our respective courses at home. Yet, undoubtedly what I found most interesting was the simulation of discussion, both in regional blocks and full-scale plenaries, about how the WHO Assembly could write a resolution that dealt with the multi-disciplinary and multi-faceted topic of global mental health. During the conference I acted as the UK WHO ambassador and found it quite difficult to make sure I ‘played my role’ throughout each discussion, rather than simply bringing my own personal opinions into my contributions to discussion. This was no truer when I felt the full force of two gentlemen who were representing the pharmaceutical company, Lundbeck. These two were easily the most persuasive throughout the conference as they mobilised key delegates representing countries such as Denmark, New Zealand, France, and the giant international funding body that is the USA, to create separate resolutions and propose clauses. These resolutions and clauses included phrases that would benefit pharmaceutical companies immensely if voted through. I tried to put through some clauses into the final resolution on topics such as mental health in the post-2015 agenda and research transparency in the publication of medical research done in the private and public sector. Yet, Lundbeck confronted me on several occasions, trying to ensure I did anything but that, and claiming through the BBC delegate that these clauses would “destroy all drug development and crush the industry's creativity.” These sensationalist claims did make me chuckle at times. I also loved how they brought money into it, helpfully reminding me on several times how much the pharmaceutical industry contributes to my country’s GDP.
MEDSINMAGAZINE ISSUE 4 | NOVEMBER 2013
Coalitions between Lundbeck’s ‘puppets’ formed, and the corruption of what some member states tried to put through into resolution made me wonder how much this happens in real life. This included one clause that tried to remove all competition between pharmaceutical companies, creating a free-forall and removing what they called ‘restrictive legislation’. They claimed that this legislation made new drugs too slow to be licences, and it was incredibly obvious that this proposition had been influenced by the Lundbeck delegates. I did find it good to see that my protestations on such ideas were heeded by other delegates, and most of Lundbeck’s paragraphs were either deleted or their attempts to delete my suggested paragraphs failed. On one such occasion the delegate representing MSF broke into a loud round of applause, as a significant paragraph on pharmaceutical regulation was ceremoniously deleted from the final resolution. Eventually, our final document included ideas such as a new ‘International Mental Health Fund’, developing research and development into mental health disorders and the interventions used to treat them, education programmes for the public and young people, and workforce initiatives to improve the wellbeing of employees. But how did we fare with our resolution compared to the actual WHO? Well, just this year at the actual World Health Assembly, the Mental Health Action Plan
for 2013-2020 was agreed by UN member states. You can read it here: apps.who.int/gb/ebwha/pdf_files/WHA66/A66 _R8-en.pdf. Many of the topics that we talked about during NorWHO can be found within it, including research, evidence bases, education, and use of multi-sector approaches. Yet it is encouraging to see that we came up with a couple of novel ideas in our resolution. The final resolution document that the NorWHO delegates agreed to at the final plenary has just been released, and can be found at www.tinyurl.com/norwho2013final. I hope the organisers plan another NorWHO for next year or the year after, as I can’t emphasise enough how interesting it was (albeit tiring by the end) to sit and have discussions about a topic as expansive as global mental health, and to see how factions of delegates found ways to represent nations’ views in a global forum. I have learnt a huge amount about how to come to a compromise on topics (which people who know me will realise is quite a step for my normally stubborn mentality) and how to work with other delegates to come to an agreed set of ideas. While I don’t see myself as a global diplomat of the future (at least not at the minute), this experience has definitely made me want to keep track with more detail on how the actual WHO comes to such agreements, and how we as students can make our mark in the future. So if you see a WHO simulation coming near you, jump at the chance to attend!
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