Intercultural and Global Health Issues Spring 2022 by ckohknox

Spring 2022 Intercultural and Global Health Issues

www.b360nc.com

Created by the students in PHRM 48500 Compiled by Cynthia P Koh-Knox Sharp, PharmD, RPh Purdue University College of Pharmacy

Topic (authors)

Intercultural and Global Health Issues Table of contents

Page

Alternative medicine Jan Lee, Alexandra Nguyen, Tiffany Nguyen, Brittany Drevalas, Maddy Radowski ................. 3 Biology and genetics

Miles Anderson, Bryce Colón, Nolan Isaacs, Thao Nguyen, Renee Wayner............................................ 9

Chronic diseases

Jason Chen, Brooke Grigsby, Krista Ico, Chris Nguyen, Ruolong Zhu ................................................... 13

Culture and tradition

Delivac Aboagye, Isabella Eichmann, Sota Shishikura, Hang Li, Justin Chong ...................................... 19

Environment

Jilian Banzon, Josh Grams, Shuhei Misawa, Nicklas Shewman, Cynthia Wan ...................................... 25

Health education

Andrew Montoya, Ben Craft, Dynasti Smith, Rose Wilfong, Stephanie Hessong................................. 31

Healthcare policies

Diana Dinh, Raegan Meyers, Ayush Kaw, Jordan Keuneke, Bryce Poindexter ..................................... 37

Natural disasters

Sravya Ambadipudi, Jenna Munshi, Drew Hoogerland, Alan Yuan ...................................................... 43

Nutrition

Lordez Asafo-Boakye, Lauren Davidson, Brittany James, Trang Nguyen, Conrad Sander.................... 48

Research and development

Jessica Du, Zachary Leung, Paxton Sample, Yuqi Wu, Aisha Adebisi .................................................... 56

Sanitation

Connor Emsley, Bridget Fitzgerald, Lingwei Lyu, Chloe Sullivan .......................................................... 61

Social determinants of health

Camille Goenawan, Mackenzie Miller, Alyssa Mulhall, Cliff Tsou, Justin Young .................................. 68

Socioeconomic status

Michael Franks, Gabriela Gmyrek, Nathan Mast, Tofilska ................................................................... 74

Unintentional and intentional injuries

Naomi Davis, Chinedu Ebube, Kade, Kake, Yunyi Pei ........................................................................... 79

Alternative Medicine FDA definition of the term "complementary and alternative medicine" (CAM) encompasses a wide array of health care practices, products, and therapies that are distinct from practices, products, and therapies used in "conventional" or "allopathic" medicine.

PHRM 485 ICGH: Spring 2022 Jan Lee, BSPS candidate Alexandra Nguyen, BSPS Student Tiffany Nguyen, BSPS/PharmD Student Brittany Drevalas, BSPS candidate Maddy Radowski, BSPS candidate 3

Background picture: https://www.goodtherapy.org/learn-about-therapy/types/complementary-alternative-medicine

Plant-Based Remedies and Therapies •

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Plant based remedies and therapies, also known as biologically based practices, are one of the four domains of complementary and alternative medicine, or CAM. CAM is defined by the FDA as: "the term includes, but is not limited to, botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, prebiotic and probiotics, whole diets, and 'functional foods.’” Overall, the therapy involves using substances from nature.

These therapies has been an intercultural issue because: •

They are often not associated with sufficient scientific evidence for both benefit and risk acceptable to certain cultures, especially in those where practices of conventional medicine is prominent

•

They have been gaining popularity due to increased access and availability especially through online media without sufficient information

Chelation Therapy •

•

A chemical reaction in which certain molecules bind to metal atoms, such as calcium, copper, iron, or lead, for treating conditions like lead poisoning

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Could lead to deficiency in important substances like calcium, copper and zinc

Main populations affected by this issue are: •

The generation of people with insufficient knowledge but easy access and exposure to media that encourages uses of such therapies

•

Those closely associated with certain immigrant populations that are more used to these types of therapies and are less familiar with conventional medicine

Diet Therapy •

This therapy utilizes different types of diet to treat or prevent a specific disease, such as cancer or cardiovascular disorders, as well as to promote general wellness and detoxify the body

•

Imbalance of necessary nutrients could lead to conditions like hypoglycemia

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Detox diets with fasting could be dangerous for people with chronic conditions like diabetes

•

Current regulation guidelines by FDA include: •

Depending on the CAM therapy or practice, a product used in a CAM therapy or practice may be subject to regulation as a biological product, cosmetic, drug, device, or food (including food additives and dietary supplements)

Professional/personal opinion: Although the risk these types of therapies pose is not negligible with the lack of scientific evidence to support its benefit nor to dismiss its risks, some are extensively accepted as parts of many cultures. Especially since this specific type of alternative medicine doesn't rely as much on usage of chemical substances, any beneficial or harmful effects caused by it could be easily prevented if patients were slowly and closely monitored. ~ J Lee Millstine D. Types of complementary and alternative medicine - special subjects. Merck Manuals Consumer Version. https://www.merckmanuals.com/home/special -subjects/integrative-complementary-and-alternative-medicine/types-ofcomplementary-and-alternative-medicine#v42283665. Published February 7, 2022. Accessed February 21, 2022.

Center for Biologics Evaluation and Research. Guidance on complementary and alternative medicine products. U.S. Food and Drug Administration. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/complementary-and-alternativemedicine-products-and-their-regulation-food-and-drug-administration#ii. Accessed March 28, 2022. 4

Background Information

Energy Therapies

•

The National Center for Complementary and Alternative Medicine (NCCAM) defines complementary and alternative medicine (CAM) as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.”

•

Energy therapies is a collective term that describes a variety of CAM treatments that use, modify, and/or manipulate energy fields.

•

The idea of energy therapies is to bring spiritual energy into a patient’s energy field or around the human body to promote balance and bring healing for mental/physical disorders.

Intercultural and/or Global Issue •

There are certain practices that originated in Eastern cultures, where others were developed in the West but have Eastern influences.

•

Reiki •

Originating from Japan, Reiki is the transmission of universal life energy and ki flows throughout the universe.

•

Practitioners hold their hands above points on the body and deliver energy to stimulate energy healing.

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Qi Gong • Qi is a life energy that travels throughout the body and is fundamental for human health and vitality. • Originating from China, the patient uses postures, exercises, and breathing techniques to enhance the body's qi for better balance and flow of energy.

•

Therapeutic Touch (TT) • Therapists and practitioners rearrange the energy field via an energy transfer from their hands to the patient. • Trademarked in Canada, therapeutic touch restores balance and harmony by removing disturbances and blockage in the energy field.

Who or What is Affected? •

Anyone who seeks out energy-based treatments; some common reasons for doing so include mood disorders, the body being out of balance, insomnia chronic pain, stress, fatigue, healing after surgery.

What Efforts/Solutions Have Been Made? What should/could be done? •

The FDA has drafted a guidance document, "Complementary and Alternative Medicine Products and their Regulation by the Food and Drug Administration," to help regulate products that can cause confusion as CAM practice increases in the U.S.

Professional/Personal Opinion •

For many years, energy therapies help focus on the care and health for the body, mind, and spirit and can reduce stress which can be linked to improving many health conditions. I personally believe that balancing the energy flow in the body can help relax and promote one's mind and body. - ANguyen

Ventola CL. Current issues regardingcomplementary a nd a lternative medicine (CAM) i n the United States: Part 2: Regulatory a nd safety concerns and proposed governmental policy changes with respect to dietary s upplements. National Li brary of Medi cine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957745/. Published September 2010. Accessed April 10, 2022. Energy therapies. The Gale Encycl opedia of Mental Health. https://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcriptsa nd-maps/energy-therapies. Published January 24, 2022. Acces sed March 28. 2022. Ros s CL. Energy medicine. In: Sakagami H, eds. Alternative Medicine. London, England:IntechOpen; 2012.

Body-Based Alternative Medicine Chiropractic Definition of Body-Based Alternative Medicine

- The idea that injuries or disease can be cured through physical manipulation of the body. Chiropractic Definition: alternative medicine centered on the treatment and prevention of mechanical disorders in the neuromusculoskeletal system Background: • Origins: In 1895, Daniel David Palmer manipulated a vertebra of a deaf janitor and allegedly restored the man's hearing. This event established the idea that manipulation of the spine can alleviate disorders. Chiropractic is also seen as the modern version of bone setting, an ancient practice of treating bone-related injuries. • Change Over the Years: The chiropractic community began to distance itself from Palmer's unscientific ideas and beliefs, and most chiropractors today are still anxious to several all ties to Palmer's ideologies. Palmer believed that all disease could be cured through manipulation of the spine, while most of the community leaned more toward conventional medicine applications, such as the treatment of neck and back pain.

Intercultural Issue: Modern chiropractic has loose origins and was based on several pseudoscientific ideas. Research suggests that chiropractic may possibly be beneficial for neck and back pain, but the idea that it can treat other disorders and diseases is completely unfounded.1 While most chiropractors treat strictly back and neck pain, some chiropractors will claim that their treatments can cure all kinds of illnesses or provide general well-being. This is especially a problem in countries without regulations for the practice. Regulations for the practice of chiropractic vary widely from country to country. Countries like America, Canada, and Australia have legally recognized chiropractic and universities offer formal degrees. This variation of regulations leaves room for more individuals who practice chiropractic to make unfounded claims about their practice. Solutions:

•

In 2005, the World Health Organization, in partnership with the World Federation of Chiropractic, published a set of guidelines on basic chiropractic training and safety. These guidelines provide the minimum educational standards and regulations for chiropractic practice. They have also been translated into several languages.

•

Regulatory bodies must outline what is and is not within the scope of chiropractic to dissuade those who would claim that their practice can cure any medical illness. In addition, further effort should be put into establishing further safety standards.

Professional/Personal Opinion: Chiropractic is possibly an effective treatment for temporarily relieving back and neck pain, however, it should not claim to cure or otherwise treat other illnesses or disorders. Regulatory bodies should have strict guidelines in place for chiropractic. - B. Drevalas References: 1. Ernst E. Chiropractic: A critical evaluation. Journal of Pain and Symptom Management. https://www.sciencedirect.com/science/article/pii/S088539240700783X. Published February 14, 2008. Accessed March 29, 2022. 2. Stochkendahl MJ, Rezai M, Torres P, et al. The Chiropractic Workforce: A global review - chiropractic & manual therapies. BioMed Central. https://chiromt.biomedcentral.com/articles/10.1186/s12998-019-0255-x. Published July 24, 2019. Accessed March 29, 2022.

3. WHO guidelines on basic training and safety in chiropractic. https://www.who.int/medicines/areas/traditional/ChiroGuidelines.pdf. Published 2005. Accessed March 29, 2022. 6

Mind-Body Based Therapies Background Mind-body based medicines fall under the category of complementary alternative medicine and uses the “power of thoughts and emotions to influence physical health”. Meditation, aromatherapy, and hypnosis are examples of mind-body based medicines that could be used by anyone.

Meditation had been a practice to help increase calmness and physical relaxation, which furthermore, improves psychological balance, coping with illness, and boosts health overall. Some key factors of meditation include being in a quiet place, getting into a comfortable posture, center focus of attention, and having an open attitude. Essential oils have a variety of uses and aromatherapy is the use of essential oils for therapeutics benefit. How essential oil can affect the mind is the scent molecules can travel from the olfactory nerves to the brain/amygdala which is considered as the emotional center of the brain. Some research shows no improvement in symptoms, but there are several clinical trials that help alleviate anxiety, depression, nausea, insomnia, and low appetite. Medical hypnosis can be used to improve health and wellness by helping patients relax, shift focus, and become more open to new suggestions/outcomes. An example of how a health care provider can help with pain is by getting the patient to focus on an object or breathing, and then, suggest how the patient is feeling more comfortable while they are focusing.

How are Mind-Body Based Therapies considered as a Global Issue?

These types of therapies could be professionally done or by oneself, which can vary in different responses to therapy. Clinical trials have been done but data is not consistent with how people respond to these therapies. This type of therapy could be considered as unreliable because results are different, however, this therapy could work wonders for some patients. Solutions Most of these therapies have very rare incidents of worsening symptoms or causing side effects. It is important that people have the knowledge and proper understanding of the therapy to use these therapies. It would be great if more research is done, so health care providers can have more knowledge to be able to provide CAM as an option for therapy. Professional Opinion These mind-body based therapies does not have strong data from clinical studies and minimal risks compared to other treatment options. I would consider these to be therapy options if other options are not available or not beneficial. As long at patient has a good understanding of the therapy and risks, I would recommend for the patient to try because the benefits could outweigh the risks. – T Nguyen

REFERENCES John Hopkins. Aromatherapy: Do essential oils really work? Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/aromatherapydo-essential-oils-really-work. Published 2022. Accessed March 28, 2022. NCCIH. Hypnosis for health. National Institutes of Health. https://newsinhealth.nih.gov/2019/07/hypnosishealth#:~:text=Medical%20hypnosis%20aims%20to%20improve,as%20an%20object%20or%20breathing. Published August 1, 2019. Accessed March 28, 2022. NCCIH. Meditation: In depth. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/meditation-in-depth. Published 2016. Accessed March 28, 2022. Ventola CL. Current issues regarding complementary and alternative medicine (CAM) in the United States: Part 1: The widespread use of Cam and the need for betterinformed health care professionals to provide patient counseling. P & T : a peer-reviewed journal for formulary management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935644/. Published August 2010. Accessed March 28, 2022. Pictures: https://www.vectorstock.com/royalty-free-vector/set-of-essential-oils-vector-20946357. https://www.istockphoto.com/illustrations/meditating

Why Are People Skeptical? Background Information Alternative medicine has been around for over 5,000 years and has shown significant improvement in people's quality of life, yet why are people still skeptical? Their skepticism is what is holding them back from attempting alternative medicine, which could potentially add remarkable benefit to their life. This is what makes alternative medicine an intercultural and global health issue. Despite all the benefits of different types of therapies, there are some notable drawbacks that are accompanied by possible solutions. Who Is Affected? People worldwide

Personal Opinion: I believe the pros outweigh the cons when it comes to alternative medicine and with the appropriate background research, starting an alternative medicine treatment can change someone's life. ~ M.Radowski

Problems with Potential Solutions Due to alternative medicine being a long-term treatment, it cannot be used in emergency medicine, but most people are discharged from an emergency room with a form of western medication. By focusing on educating medical professionals on the various alternative medicines, they can give appropriate referrals for alternative medicine to offer guidance to patients who are not comfortable taking prescription medication.

Alternative medicine is less expensive than Western medicine, so it would also be beneficial for patients who do not have health insurance. By getting referrals from educated medical professionals, this could provide a form of regulation for alternative medicine, since most of it is not FDA approved. A solution that would ease people's suspicion about alternative medicines is to push the FDA to either approve or deny the offered treatments. Although this sounds simple, it is a long process, so for now patients can read scientific articles and do proper research of the treatment they are Interested in before starting. This would overall reduce unforeseen side effects, which is another reason why some people have skepticism because they do not want the new alternative medicine they start taking to negatively interact with the prescribed medication they might be taking because this is always a possibility. Sources

Alternative medicine: Pros and cons. The Southeastern Spine Institute. April 14, 2021. Accessed February 21, 2022. https://southeasternspine.com/alternative-medicine-pros-and-cons/.

Tabish SA. Complementary and Alternative Healthcare: Is it Ev idence-based?. Int J Health Sci (Qassim ). 2008;2(1):V-IX.

SPRING 2022 GENETIC EDUCATION

PHRM485: GROUP 2

By Miles Anderson

Biological International Health Issues

Miles Anderson (Professional Student), Bryce Colón (BSPS Candidate), Nolan Isaacs (BSPS Candidate), Thao Nguyen (BSPS Candidate), Renee Wayner (Professional Student)

Source: https://grants.nih.gov/ngri.htm

SUMMARY OF TOPICS DISCUSSED International health issues related to advancements in biology and medicine are broad, ranging from issues with provider and patient education to international tourism to seek unregulated treatments. Presented here are five issues: genetic education, biosurveillance, issues related to longevity, stem cell tourism, and fetal testing methods to prevent diseases. The issues affect a wide range of people and raise a number of ethical considerations upon which each author will provide commentary.

Background: Genetic education is a means for individuals to obtain information about their potential risk of getting a genetic disorder or disease. Genetic education can also be used to better educate healthcare professionals. Genetics has provided great benefits to human health such as the identification and treatment of diseases linked to single-gene mutations. Genetics can also be utilized to enhance the health of humans by altering the genome. Genetic services include: Genetic counseling (i.e. obtaining, interpreting, and/or assessing genetic information and relaying this information back to the patient clearly and in the form of an action plan if one is necessary), a genetic test, and genetic education. Global issue: This is a global issue because it can affect poor people no matter the country or region. A certain region may have a lower or higher incidence of poorer people so there may or may not be less access to genetic education and services that are provided. Who/what is affected: Poor people in low income parts of the globe are impacted negatively by having less access to genetic education and services. What efforts/solutions have been made? (or should/could be done?): Make genetic programs a service paid for through the government or foreign government support, or make the services a free service offered by the healthcare system for those most in need. Opinion: Genetic education, information, and services should be available for the improvement or maintenance of an individual's health no matter someone's economic status or location in the world. Genetic education should also be applied to help healthcare providers all around the globe improve knowledge and improve confidence in making decisions. -M. Anderson 9

BIOSURVEILLANCE By Thao Nguyen

Background: So what is biosurveillance? It is the systematic process of detecting, reporting, and responding to pandemic potential pathogens before they become outbreaks. There are programs that have been implemented in the United States (BioWatch), Canada (National Enteric Surveillance Program, NESP), Germany, and other countries. Who/what is affected: Everyone is affected by the potential outcomes of these programs because of their goal of reducing the threat of infectious diseases by promoting global health security. The goal of these programs is to enable early detection of a threat and mounting of an integrated response. These programs are important because emerging and re-emerging infectious diseases are a major challenge for public health and economic security worldwide. What efforts/solutions have been made? (or should/could be done?): The way biosurveillance systems work is by gathering data from various sources like hospitals, pharmacies, and veterinarians and putting it into a database. Then that data is analyzed to see if there are any patterns or anomalies and those cases are flagged for potential outbreaks. From there, the system alerts public health officials and they can make the decision of what to do moving forward. During this time, all these different biosurveillance programs will be sharing their data and this promotes global health security. Opinion: These programs will be beneficial because they will give awareness to the infected countries and allow them to plan accordingly instead of in a rush. When the COVID-19 pandemic occurred, almost every nation was unprepared and which lead to mass panic, but that urged leaders to allocate resources to these programs. -T. Nguyen

Source: https://www.sciencedir ect.com/topics/medicineand-dentistry/ biosurveillance

LONGEVITY

By Nolan Isaacs Background: The study of longevity genes is a developing science that is translating to a very developing industry. The study of longevity is finding ways to increase the lifespan within individuals, whether this is through decreasing neurodegeneration, newer medicines, healthier lifestyles, or cleaner environments. Global issue: The current global issue with longevity is finding the technology to develop the biologics and then finding ways for the globe to sustain the effects of people being able to live longer. This is an issue because the common assumption is that most people would prefer to live longer, but finding ways to create these newer medicines while finding ways to not affect the economy and usage of resources is relatively impossible. Who/what is affected: The main thing getting affected by increasing lifespan and longevity would be the economy and the structure of the way things work. Increasing the lifespan of people means a larger population with resources that will be more used. Another huge thing getting affected is the future of medicine. Finding ways to enhance gene therapies to increase longevity opens up a whole other branch of medicine.

What efforts/solutions have been made? (or should/could be done?): The current efforts being made consist mainly of new research facilities across the globe at various universities and various companies. The first to make a breakthrough in developing such biologics would see great success with financial backing and certified awards. Other solutions to mask the effects that come with increasing the population would be to increase food production and increasing ways to create technology advancements with renewable resources instead of nonrenewable. Opinion: In my personal opinion, I believe longevity biologics and medicines should be increased in terms of funding and research. The benefits it could have across the globe with people being able to live longer and produce more could lead to a higher working economy and more successful living. I think the economy would adjust to the slow improvement of longevity just as it adjusts to other things that occur in the world. -N. Isaacs.

STEM CELL TOURISM By Bryce Colón

Background: Medical tourism is a phenomenon wherein people travel abroad to receive some sort of medical care that is unavailable or not affordable in their country of residence. Upwards of 1 million Americans make these medical journeys annually, but most involve cosmetic procedures and dentistry. Global issue: Stem cell tourism is a type of medical tourism that involves crossing international borders to receive stem cell treatment (see graphic on next page). It is attractive because it promises to treat desperate patients with chronic, debilitating conditions. Although some may travel to receive scientifically-backed and ethically investigative stem cell treatments (such as those in approved clinical trials), many patients travel to clinics that do not have the proper scientific backing or credentials to administer such treatments. Because much of the industry operates covertly and is not subject to regulatory scrutiny, it is difficult to estimate the number of patients traveling abroad for this type of medical procedure. It is also difficult to estimate the economic cost associated with this travel, although it is likely a multi-million dollar industry (7). Who/what is affected: The industry operates mainly through the Internet, with websites that advertise directly to the consumer. These websites are often shared in forums/groups for people with chronic diseases, but they rarely highlight the inherent risks that come alongside receiving a therapy not backed by mainstream science. Many of these websites use scientific nomenclature to attain the veneer of scientific legitimacy, but oftentimes they advertise therapies that they do not even perform. What efforts/solutions have been made?: Stem cell tourism is hard to address because regulatory laws only operate within nations. Many clinics have been accused of using cells not fit for intrathecal or intravenous injection. Or, if they harvest stem cells autologously, they may not properly treat and enrich the stem cells prior to injection.

Most of these clinics are located in the United States, but other countries with multiple stem cell clinics in operation include China, India, and Thailand. Stem cell tourism to countries like China is particularly difficult to control because China is not likely to abide by regulatory harmonization laws. Although the United States has updated regulatory laws that left loopholes (i.e. the minimal manipulation and homologous use clauses), low-to-middle income countries often lack the government apparatuses to enforce these kinds of laws. Although much of the literature suggests that healthcare professionals and nations have the obligation to protect patients by restricting their access to unproven stem cell therapies, others argue that patient choice is paramount. Indeed, some healthcare professionals argue that terminally and chronically ill patients should have the freedom to seek corrective medical care, regardless of the scientific veracity of the treatment. Some believe that stem cell counseling may be needed in order to guide patients through the dense and confusing information surrounding the stem cell boon, especially since many of the patients are emotional and hopeful about stem cells (8). These researchers believe that one way to prevent patients from being hurt by untested cell products is to provide better information that is accessible to laypeople, as well as train physicians on how to interact with patients should they consider seeking stem cell treatment. Opinion: The medical community and the international community have an obligation to protect patients, especially those who are medically fragile and vulnerable to outlandish "miracle cures"; nations should clamp down on unproven stem cell treatments. Choice is important, but only if the options are thoroughly vetted and scientifically sound. -B. Colón

HEREDITARY DISEASE PREVENTION & GENETIC TESTING ON FETUSES By Renee Wayner

Background: The anticipation of knowing characteristic about an unborn fetus is something many people look forward to. However, under some circumstances it is important to know this information for medical purposes. There are two common forms of genetic testing for fetuses: amniocentesis and chorionic villi (CVS). Amniocentesis is the process of extracting fluid from the amniotic sack. CVS extracts fluid from the blood in the placenta. Procedures such as amniocentesis and CVS detect serious conditions such as Rh factor that can negatively affect the woman and fetus. Global issue: Women’s access to reproductive and natal health is important worldwide. Across the globe, it is typically an expensive procedure or unknown as an option. In the US, the cost can range from $1000-7000 or more. It is not typically covered by insurance. The procedure can also concern mothers, as it is an injection into the stomach to extract the specimen. However, it is commonly unpainful due to anesthesia. Who/what is affected: Both women and fetuses are affected by these procedures. Women have the procedure before 14 weeks in the case abortion is considered. The chances of complications from these procedures are low (0.1-0.3% risk). What efforts/solutions have been made? (or should/could be done?): Further education within pregnancy care clinics is currently a growing process. What should be considered is making more affordable access to resources such as amniocentesis and CVS that could detect future health risks for both the fetus and the mother. Opinion: Education on options such as amniocentesis and CVS should be more common in women's health clinics. These measures can save the life of both the women and the fetus. The cost of treatment for detecting these lifealtering conditions is expensive. Knowing the results of these tests and women having knowledge of their impact can help multiple lives. -R. Wayner 11

Map showing the prevalence of unregulated stem cell clinics across the world. Source: .https://link.springer.com/article/10.1007/s13770-013-1116-7

References 1. Prenatal diagnosis: Amniocentesis and CVS. familydoctor.org. (2020, April 1). Retrieved February 22, 2022, from https://familydoctor.org/prenatal-diagnosis-amniocentesis-and-cvs/ 2. Chandrasekharan, S., Minear, M. A., Hung, A., & Allyse, M. (2014, April 9). Noninvasive prenatal testing goes global. Science translational medicine. Retrieved March 29, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112725/ 3. Pang, Tikki. “The Impact of Genomics on Global Health.” American Journal of Public Health, © American Journal of Public Health 2002, July 2002, www.ncbi.nlm.nih.gov/pmc/articles/PMC1447192/. 4. Abrew, Ashwini de, et al. “Challenges in Global Genomics Education.” Applied & Translational Genomics, Elsevier, 8 Nov. 2014, www.sciencedirect.com/science/article/pii/S2212066114000416. 5. Bartlow AW, Middlebrook EA, Romero AT, Fair JM. How Cooperative Engagement Programs Strengthen Sequencing Capabilities for Biosurveillance and Outbreak Response. Frontiers in Public Health. 2021;9. doi:10.3389/fpubh.2021.648424 6. What is Global Health Security? www.cdc.gov. Published October 12, 2021. Accessed March 16, 2022. https://www.cdc.gov/globalhealth/security/what.htm 7. Gharaibeh B, Anderson JE, Deasy BM. Combating the threat of stem cell tourism through patient education an: IEH. https://www.dovepress.com/combating-the-threat-of-stem-cell-tourism-through-patient-education-an-peer-reviewedfulltext-article-IEH. Published January 27, 2016. Accessed March 25, 2022. 8. Murray IR, Chahla J, Frank RM, et al. Rogue Stem Cell Clinics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002842/. Published February 2020. Accessed March 25, 2022.

SPRING 2022

Brooke Grigsby (BSPS student), Krista Ico (BSPS candidate), Jason Chen (BSPS candidate), Christopher Nguyen (BSPS candidate), Ruoling Zhu (BSPS candidate)

The Centers for Disease Control and Prevention (CDC) defines chronic diseases broadly as conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both. Chronic diseases have become a global health issue due to the lack of education to avoid these issues. Some come from living a lazy lifestyle and not taking care of ourselves. Some come from old age, genetics, or pathogens in the environment and cannot be avoided. Regardless of the source for these chronic diseases, they have not been taken as seriously as they are taken today. In this monograph, we will cover the following chronic diseases: pain management, STDs/HIV, Alzheimer’s, diabetes, and chronic depression

GLOBAL COSTS In the United States, 84% of health care costs are related to chronic disease In the United Kingdom, 78% of primary health care consultations are related to chronic conditions

QUICK FACTS Six in 10 adults in the United States have a chronic disease Chronic diseases are the leading cause of death and disability in the United States 13

HIV/AIDS Background HIV infection AIDS = late-stage HIV infection One of four incurable STDs first case reported in 1981 in U.S. Ryan White: • from Kokomo, Indiana • one of the frst children to have AIDS diagnosed on December 17th, 1984 at 13 years old after a blood transfusion

Brooke Grigsby, BSPS student

Who is affected The first reported case of AIDS was in 1981 in the United States when the CDC published that it was a disease affecting homosexual men. Since then, this has been disproven as the disease has affected millions internationally - regardless of sexual orientation, race, ethnicity, gender, age, environment, etc. However, there are alarming geographical trends that can be seen with the prevalence of the disease, and it is evident that there needs to be more done in underdeveloped countries to address the testing, diagnoses, and treatment of HIV/AIDS.

HIV/AIDS in underdeveloped countries: Since AIDS affects those who are immunocompromised, those with the greatest risk are people living in developing countries, because they are exposed to other infections and there is a lack of accessibility to health care services and information about AIDS. Since COVID, there has also been major disruptions in third world countries access to testing for the disease.

Solutions & Personal Opinion

AIDS became considered a public health crisis in 1986, and by 1994 was the leading cause of death for all United States citizens aged 25-44. However, a solution was not proposed until 1996 with the formation of UNAIDS and their 90-90-90 targets. These goals have not been met by the majority of the world, and the disruption from the COVID-19 pandemic threatens to derail the targets by another 10 years. There must be a solution to supply more HIV tests and information about AIDS to those underdeveloped nations, particularly in sub-saharan Africa, where in 2020, girls/women aged 1524 years old made up 25% of HIV infections globally. There is a significant need for a solution that increases access to self-testing in sub-saharan Africa and the rest of the world. In my opinion, the best solution would be to provide self-tests across the country, focusing on distribution in health care facilities. - BG

Progress:

Goals:

References:

https://www.jamaicaobserver.com/your-health-yourwealth/impact-of-hiv-prevention-response-inadequatemore-age-appropriate-sex-ed-and-reproductive-healthservices-to-target-youth_155697

https://www.beintheknow.org/understanding-hiv-epidemic/data

1. Jul 20 P, 2018. Global HIV/AIDS Timeline. KFF. Published July 20, 2018. Accessed April 12, 2022. https://www.kff.org/global-health-policy/timeline/global-hivaids-timeline/#1981 2. History.com Editors. History of AIDS. HISTORY. Published August 21, 2018. https://www.history.com/topics/1980s/history-of-aids 3. Kerr DL. HIV infection and AIDS in Africa and the Third World. The Journal of school health. 1989;59(8):369-370. doi:10.1111/j.1746-1561.1989.tb04749.x

Chris Nguyen Pain Management - Opioid Abuse BSPS candidate Pain management relation to opioid abuse Pain management is becoming an increasingly prevalent aspect of modern societies as certain populations begin to experience aging. The rise in chronic diseases necessitates the need for effective pain management treatments to enhance an individual's quality of life. Opioids are potent medications that are frequently used to treat pain that has seen increased usage correlating with the rise in chronic diseases and pain. This has led to the growing opioid crisis in the United States where opioid users are becoming addicted to their medications.

Pain management in undeveloped countries Wealthy countries enjoy an abundance of medications capable of treating various ailments, medications which are much harder to acquire in poorer countries. Pain management is common enough in the United States that it is actually causing issues in the form of the opioid crisis. Conversely, undeveloped countries desperately need medications to treat people with debilitating pain.

Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2013. Global comparison of morphine consumption.

Populations most susceptible to opioid abuse Pain management is a universal concept that every individual has to deal with during their lives, but it is most apparent in the elderly, which are more likely to have chronic diseases and require a means to handle their pain. For some, the pain can only be handled through the use of opioids. With their usage comes the risk of inadvertent abuse. American Medical Association, 2021. Reductions in opioid prescribing have not led to reductions in drug-related mortality.

Attempted solutions and issues Efforts to combat opioid abuse lie in improved anti-abuse drug formulations and better patient monitoring strategies. Drugs can be formulated to be unable to be dissolved and injected. Patients are monitored more closely via testing to determine they are strictly following their medication schedule. The issue is that while this stops the abuse of these medications, it also fast-tracks the shift towards black-market synthesized opioids which are far less safe and much more potent. Personal Opinion Unfortunately, our efforts to solve the opioid crisis have inadvertently resulted in an unprecedented growth in the production of illegal and more lethal unregulated opioids. Our efforts should concentrate more on improving patient access to treatment and recovery. - Christopher Nguyen References: 1. Rajbhandari-Thapa, J., Zhang, D., Padilla, H. and Chung, S., 2019. Opioid-Related Hospitalization and Its Association With Chronic Diseases: Findings From the National Inpatient Sample, 2011–2015. Preventing Chronic Disease, 16. 2. van Amsterdam, J., Pierce, M. and van den Brink, W., 2021. Is Europe Facing an Emerging Opioid Crisis Comparable to the U.S.?. Therapeutic Drug Monitoring, 43(1), pp.42-51. 3. Jayawardana, S., Forman, R., Johnston-Webber, C., Campbell, A., Berterame, S., de Joncheere, C., Aitken, M. and Mossialos, E., 2021. Global consumption of 15 prescription opioid analgesics between 2009-2019: a country-level observational study. eClinicalMedicine, 42, p.101198.

Alzheimer's Disease BACKGROUND Age-related, neurodegenerative Leads to 60–70% of cases of dementia.* Symptoms may include memory loss, problems with language, disorientation. Treatments can only relieve the conditions but will not stop or reverse its progression. *Dementia is the condition when the brain is damaged by injury or a disease.

Jason Chen, BSPS candidate

SIGNIFICANCE Starts slowly and progressively worsens, thus accessibility to longterm care and relief treatments must be ensured. Creates an enormous strain on the healthcare system, families, and the federal budget. Affects at least 50 million people worldwide.

Alzheimer's Disease has become a global health issue: As of 2020, approximately 50 million people worldwide are diagnosed with AD, with no treatment to reverse but to relieve. The number is expected to rise to 152 million by 2050. Additionally, the estimated total healthcare costs for the treatment of Alzheimer's disease in 2020 are estimated at $305 billion, with the cost expected to increase to more than $1 trillion as the population ages. Who is affected: Alzheimer's Disease is prevalent on the continent of Noth America, Western Europe, and Oceania among people in the age group of 75 and above. For instance, in the United States, the disease prevalence rate is 5.3% for those in the 60-74 age group; 13.8% for those in the 74-84 age group; and 34.6% for those who are 85 years and older. However, prevalence rates in some less developed regions around the globe are lower.

Deaths per million persons in 2012 due to dementias including Alzheimer's disease. Red indicates 376–1266 counts, lighter color indicates fewer counts in the representation of lower prevalence rates. https://commons.wikimedia.org/wiki/File:Alzheimer%27s_disease_and_other_de mentias_world_map-Deaths_per_million_persons-WHO2012.svg

What efforts have been made: By 2022, there is at least one Alzheimer's disease organization per major continent in the world. Patients and caregivers in North America and Europe are receiving extra support from multiple organizations that provide nonprofit advocacy and education on disease prevention, or conduct government-funded Alzheimer's research. In the hope to improve the Alzheimer’s Act (S. 880/H.R. 1873), the National Institutes of Health (NIH) secured an extra $300 million of funding at the end of 2020 to bring to a total of $3.1 billion in government investment every year, to allocate to different research institutes in the United States.

Personal opinion: Although the causes and risk factors of Alzheimer's Disease are not clear and the research for medical cures is still ongoing, I stay positive and believe that this disease will be conquered in the near future since massive attention is given to the patients, their families, and all caregivers, while the research is moving forward in a mindful manner with solid monetary support from governments across the globe. References:

1. Alzheimer's disease. Wikipedia. https://en.wikipedia.org/wiki/Alzheimer%27s_disease. Published March 27, 2022. Accessed March 29, 2022. 2. Federal Alzheimer's and dementia research funding reaches $3.1 billion annually. Alzheimer's Association. https://www.alz.org/news/2020/federalalzheimers-and-dementia-research-funding-r. Accessed March 29, 2022.

JC 16

Chronic Depression (Dysthmia)

Ruoling Zhu, BSPS candidate

Background Information Major Symptoms include periods of fatigue, irritability, and sadness lasting for two years or more Emphasizes mood and personal relations over physical symptoms compared to major depression More disabling than major depression in some cases Chronic Depression Starts to Get Global Attention Because: Dysthymia is about as common as major depression. Given its chronic nature, it is one of the disorders most often seen by psychotherapists. Globally, depressive disorders are ranked as the single largest contributor to non-fatal health loss, according to WHO. Over 300 million people are estimated to suffer from depression worldwide, equivalent to 4.4% of the world’s population. There is a range of severity within these overall estimates of prevalence, with at least one-third of symptomatic cases following a moderate-severe course. Although 70% recovered in an average of about four years, 50% had a recurrence with an average time of nearly six years. Who May encounter Chronic Depression? Dysthymia can affect children and adolescents. Data from NIMH shows that depressive disorders affect approximately 11.2% of 13 to 18-year-olds and that girls are more likely than boys to experience a depressive disorder. More than half of people with dysthymia eventually have an episode of major depression, and about half of patients treated for major depression are suffering from this double depression. Possible Treatments and Solutions Between Cultures One of the main differences seen across cultures is how anxiety and depression are expressed. Feelings are sometimes even better explained by religious or spiritual beliefs. Instead of seeking help from a mental health professional, this person will probably seek counsel from their spiritual guide. In other cases, doctors may use psychotherapy (talk therapy), medications such as antidepressants, or a combination of these therapies. Often, dysthymia can be treated by a primary care physician.

Prevalence of Depressive Disorders in 2015 Source: Global Burden of Disease Study 2015 (http://ghdx.healthdata.org/gbd-results-tool)

Cases of Depressive Disorders in 2015 Source: Global Burden of Disease Study 2015 (http://ghdx.healthdata.org/gbd-results-tool)

Personal Opinion Although depression is a pervasive mental disorder globally and affects us all, practical solutions for depression are available. Efficacious and cost-effective treatment can be used to improve the health and life expectancy of patients worldwide who are suffering from dysthymia. I think it is time to educate ourselves about chronic depression and support those who are currently suffering from this mental disorder. RZ Reference

1. Reddy MS. Depression - the global crisis. Indian J Psychol Med. 2012;34(3):201-203. doi:10.4103/0253-7176.106011 2. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.

Krista Ico, BSPS candidate

Diabetes

Diabetes is a chronic disease affecting millions worldwide. It is a disease that affects the way your body breaks down food into sugar to use as energy. Normally, the body breaks down the food into sugar (glucose) that gets released into the bloodstream. When blood sugar levels increase, the pancreas releases insulin that helps the body use the sugars as energy. With diabetes, this process has a fault either in the way the body produces insulin or reacts to insulin. There is no cure for diabetes, but drug developments have made this a livable condition. Diabetes can lead to a number of other complications including but not limited to: early death, lower quality of life, nerve damage, heart disease, stroke, kidney failure, and many more.

TYPE 1 10% of diabetic population Diagnosed early in life Characterized by no functioning insulinsecreting pancreatic beta cells of the pancreas; glucose intolerance Most common among non-Hispanic Caucasians, African Americans, and Hispanic Americans Cost and Treatment of diabetes: People with diagnosed diabetes have an average medical expenditures of $16,752 per year, of which about $9,601 is attributed to diabetes. The treatment for diabetes depends on which type the person has. For Type 1, the main treatment is to take insulin injections or use an insulin pump. It involves frequent blood sugar level checks and food awareness. For Type 2, treatment is dependent on how severe the case is. This can range from simple lifestyle changes to needing an insulin pump and other medications.

Efforts for a Cure: At the moment, there is no cure for either type of diabetes. Most current treatment options help patients manage the effects of diabetes and other health problems it can cause. For Type 1, cell therapy and bio-engineered mini and artificial organs are being researched and in clinical trials. For Type 2, drugs targeting insulin secretion, drugs targeting blood sugar levels, and fecal transplants are being researched and in clinical trials. References:

TYPE 2 Two types: non-obese (10%) and obese (80%) Diagnosed later in life Due to insulin resistance, tissues not responding as well to insulin as they normally do, or low insulin secretion Most common in China, India, and the United States due to their large populations

Cost breakdown of diabetes https://www.diabetes.org/about-us/statistics/cost-diabetes

Personal Opinion: The current efforts being made are giant steps in the great direction. Even if a cure is not found, scientists will find a way to make living conditions even better for patients with diabetes; however, I am confident that the people working on these projects will be able to come up with a solution for both types of diabetes in the years to come. - K. Ico

1. What Country Has the Most Type 1 Diabetics? MedicineNet. Accessed March 29, 2022. https://www.medicinenet.com/what_country_has_the_most_type_1_diabetics/article.htm 2. Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J. Epidemiology of Type 2 Diabetes – Global Burden of Disease and Forecasted Trends. J Epidemiol Glob Health. 2020;10(1):107-111. doi:10.2991/jegh.k.191028.001 18 3. American Diabetes Association. 7. Diabetes Technology: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43(Supplement_1):S77-S88. doi:10.2337/dc20-S007 4. Fernández CR. The Future of Diabetes Treatment: Is a Cure Possible? Labiotech.eu. Published November 15, 2021. Accessed April 11, 2022. https://www.labiotech.eu/in-depth/diabetestreatment-cure-review/

CULTURE AND TRADITION

Delivac Aboagye (PharmD student), Isabella Eichmann (BSPS candidate), Sota Shishikura (BSPS candidate), Hang Li (BSPS candidate), and Justin Chong (BSPS student) Spring 2022

Culture is the customs and arts of a certain group of people. Tradition is the transmission of customers or beliefs from generation to generation, or the fact of being passed on in this way. In this monograph, we will address issues of religion and spirituality, antivax, environment, preference, and health education and how these relate to culture and tradition.

RELIGION AND SPIRITUAL BELIEF BY: DELIVAC ABOAGYE

Background information:

https://nursinganswers.net/tags/religion/

According to the Merriam-Webster Dictionary, religion is a a personal set or institutionalized system of religious attitudes, beliefs, and practices whiles spirituality is sensitivity or attachment to religious values. Religion and spirituality affects the way people view or receive healthcare.

Intercultural/global issue: Religion and spirituality are both intercultural and global issues. This is because we are all brought up very differently. We as a generation take our spirituality and religion very seriously which tend to influence our behaviors and views. There are various religions in the world and even in the same religion, there might be different practices. This tends to bring up the issue of trying to provide health that caters to each individual based on their practices and beliefs. It is an issue because it becomes difficult to bridge religion and healthcare if as healthcare providers, we are not aware or not open.

Who or what is affected? Religion and spirituality affect everyone. In a healthcare setting, it affects how providers provide care and how patients receive the care. In a teaching setting, it affects how teachers present their views without undermining others' views and also how students view each other. Overall, it affects how we all view each other in terms of perspectives.

Efforts/Solutions There are various measures in place to help merge religion into our environment today. In research done in an Australian hospital, it was noted that patients wanted to be cared for based on their beliefs. This pushed the hospital to provide a chapel and priest services to patients and families that wanted them. Even though it was just one-sided, it was an effort to meet the patient at their point of need. Things that could be done in terms of healthcare are an integration of culture and religious competence in curriculum and training in both undergraduate and graduate medical education. Another solution is avoidance of assumptions. This provides the opportunity to ask questions to get to know someone. In terms of healthcare, it provides the opportunity for healthcare providers to know the best way to provide adequate care to their patients. In educational settings, it provides the opportunity to understand one’s perspective.

Professional Opinion Religion and spiritual belief play an important in our day-to-day life. It affects the way we view ourselves and others. And most importantly, as healthcare professionals, I do believe we must create an environment where patients can easily express themselves. This includes initiating programs that will cater to their spiritual and religious belief.D.Aboagye

References Gardner F, Tan H, Rumbold B. What Spirituality Means for Patients and Families in Health Care. J Relig Health. 2020;59(1):195-203. doi:10.1007/s10943-018-0716-x Dein S, Swinton J, Abbas SQ. Theodicy and end-of-life care. J Soc Work End Life Palliat Care. 2013;9(2-3):191-208. doi:10.1080/15524256.2013.794056 Torke AM, Fitchett G, Maiko S, et al. The Association of Surrogate Decision Makers' Religious and Spiritual Beliefs With End-of-Life Decisions. J Pain Symptom Manage. 2020;59(2):261-269. doi:10.1016/j.jpainsymman.2019.09.006 20

HEALTH EDUCATION BY: ISABELLA EICHMANN Canva Free Media

Background Information: H EAL TH EDU C AT IO N HA S A LW AY S B EE N AN IM PORTA NT SUBJ ECT WH EN TA LKING AB OUT DI FF ER EN T C UL TURE S A N D TRA DIT IO N S A RO U ND TH E WORLD. THE RE A RE MANY DIF FE RE NT A PPROACH ES A ND S TR ATEGI ES TO CO M MU NI CAT IN G HE A LTH CONCE PTS TO INDIV IDUA LS . THE AP PROACH ES TE ND T O B E D I FFE REN T DU E T O I NF L UE NC ES O F ONE ’ S CUL TURE AND TRADITIONS. A N INDIVIDU AL ’S M OR AL S AN D V IEW PO IN TS O N HEAL TH AR E F ORM E D WITH TH E HE L P OF THE C UL TURE ’S TRADITIO NS A ND VALU E S . B ECA U S E O F THI S , HE ALT H E DUCATION CAN B E DIF FICUL T TO TE ACH . HOWE VE R, A C O MMO N GRO U N D V IEW PO IN T IS T HAT H EA LTH PROF ES SIONAL S AND TE AC HE RS WANT TO M AK E S URE T HAT E VE RYO N E HAS A GOOD UNDE RSTANDING TO MAK E HE AL TH DE CISIONS F OR TH EM S EL VE S .

https://www.oregon.gov/ode/ educator-resources/standards/health/ pages/default.aspx

Intercultural/Global Issue: H E ALTH ED UC A T I ON I S AN I NT E R CULTURAL AN D GLOBAL I SSUE D UE TO MAN Y RE ASON S. A M AIN PR OB L E M I S C O MM UN I C A T I ON. T HE RE AR E MAN Y DIF FE RE N T CULT URE S ARO UND T HE WO R L D T HA T S PE A K DI FF E R E NT LAN GUAGE S, SO IT CAN BE D IFFI CULT T O GAUGE SO M E O NE ’ S U N DE R ST A ND I NG . W I T H T HI S, H EALT H E DUCATI ON IS TAUGH T D IFF ER E NT LY AR OU N D THE W OR L D DU E T O C U L T URAL DIF FE RE N CE S. SOME C ULT URE S M AY MAKE H E ALTH E D UC A T I ON M O R E O F A P R I O R I TY T HAN O TH E RS. SOM E CULTURE S MAY ALSO H AVE CE RT AI N B E L I E F S T HAT C A US E T H E M TO N OT UND E RGO CE RT AI N ME DI CAL PR OCE D UR E S. T H IS I S A G L O B A L I SSU E DU E T O H E ALT H PRO FE SSI ON ALS WAN TI NG TH E IR P ATI E NT T O RECE I V E C A R E T HA T W I L L PR OV I DE T HE M A HE ALT HI ER LIFE , B UT T HE P ATI E NT D OE S N OT W A NT TO FO LLOW TH ROUGH .

Who and What is Affected: E V E R Y O N E I S A F F E C T E D B Y H E A L T H ED U C A TI O N . S O M EO N E ’ S L E VE L O F U N D ER S TA N D I N G H E A L T H C O N C E P T S I S D E T E R M I N ED B Y H O W M U C H H EA L T H ED U C A T I O N T H E Y H A V E R E C E I V E D . T H E M E AN S O F R E C E I V I N G H EA L T H ED U C A T I O N C A N B E TH R O U G H H EA L TH P R O F E S S I O N A L S , T E A C H E R S , C U L TU R E, T R A D I TI O N S , B O O K S , O N L I N E S O U R CE S , M E D I A , A N D M O R E . B Y T H E S E M E A N S , AN YO N E A N D EV ER Y O N E H A S A C C ES S A N D EX P O S U R E T O S O M E K I N D O F H EA L TH E D U C A T I O N .

Efforts/Solutions: T H E R E H A V E B E E N M U L T I PL E E F F O R T S TO I M P R O V E H EA L TH E D U C A T I O N . T H E M E D I A H A S P L A Y E D A G R E A T R O L E I N I N C R E A S I N G TH E SP R EA D O F H EA L T H ED U C A T I O N . H EA L TH I S A L W A Y S C H AN G I N G , A N D A G R E A T W A Y TO C O M M U N I C A T E I T I S T H R O U GH T H E M E D I A . H E AL T H E DU C AT I O N I S R E P O R T ED O N T H E N E W S , P O ST ED O N O N L I N E P L A TF O R M S , P U B L I S H E D I N N E W S P A P E R S , M A G A Z I N ES A N D B O O K S , A N D M O R E. S O CI A L M E D I A A L S O H A S A N I M P AC T DU E T O H O W M A N Y U S E R S A R E O N VA R I O U S S O C I A L M ED I A P L A TF O R M S . F O R E X A M PL E , S O M E M O B I L E AP PL I C A T I O N S H A VE H EA L T H A D S O N TH E I R P L A TF O R M S T H A T A N Y O N E C A N S E E . AN O T H E R C O M M O N W A Y O F P R O M O TI N G H EA L TH E D U C A T I O N I S W H EN P H A R M A C I E S A N D D O C T O R S ’ O F F I CE S H A VE I N F O G R A P H I C S O N T H E W A L L S TH A T R A N G E FR O M P R O M O T I N G V AC C I N E S A N D D I S P L A Y I N G G EN ER A L H EA L T H I N F O R M A T I O N . L A ST L Y , AN E F F O R T T H A T H A S B E E N M A D E TO I N C R EA S E C O M M U N I C A T I O N I S TH E U S E O F T R A N S L AT O R S . A T R AN S L A T O R C A N B E U S ED W H E N S O M EO N E O F A D I F F ER EN T CU L TU R E A N D L A N G U A G E I S W A N T I N G T O R E C EI VE H E A L T H ED U C A TI O N A N D N E ED S SO M EO N E T O T R A N S L AT E I T F O R T H E M . TR A N S L A T O R S A R E VE R Y U S E F U L I N I N C R EA SI N G C O M M U N I C A T I O N E F F O R T S S O EV ER YO N E CA N H A V E A N U N D ER S TA N D I N G O F H EA L T H .

Professional Opinion: I B EL I E VE T H A T H E A LT H E DU C A T I ON I S V E RY IM P O RT A N T A N D A NY IS SU E S T H AT M AY O C C UR N E ED T O B E A DD R E SSE D IN A T IM E LY M A N N E R . E VE RY O N E’ S H E AL T H IS IMP O RT A NT A N D NE E DS T O B E A P RIO RIT Y S O I ND IV I DU A LS C A N LIV E A H E A LT H Y L IF E. T HE RE MA Y B E S O ME BA R RIE R S IN H E AL T H E DU C AT IO N , B UT W ITH H E A LT H A LW A Y S C H A N G IN G A N D A DV A N C IN G, IN DI VI DU AL S N E ED T O B E A W A RE O F T HE C HA N GE S A N D W H A T C A N B E DO NE F O R T HE M IF NE E DE D.

References:

I. Eichmann

C UL TU R E & HEA LT H L IT ER AC Y . C EN T ER S F O R D IS E A S E C O NT RO L A ND PRE V E NTI O N. HTT PS : / / WW W . C D C . G O V/ H EAL TH LIT ERA CY / C U LT U RE. H T M L . P U B L IS H ED D ECE M BE R 9 , 20 21 . A C C ES S ED M A R CH 2 8 , 2 0 2 2 . H OW CU L TU RE I N F LU EN C ES HE AL TH B EL I EF S . E UR OM E D IN F O . HT T P S : // W W W . EU R OM E D IN F O .E U / HOW- CU L TU RE -I N F LU EN C ES - HEA LT H- B E L IE F S . HT ML / . A CC E S S E D M A R CH 2 8 , 2 0 2 2 . STE L L E F SON M, PAI G E S R , C HA N EY B H, C H ANE Y J D . E V O L V IN G RO L E OF S O C IA L ME D IA IN HE A L TH PR OM OT IO N : U PD AT ED RES PON S IB IL IT I ES F OR H EA L T H ED UC A T I O N S P E C IA L IS T S . I N T J E N VI R ON R ES PU B LI C H EAL TH . 2 0 2 0 ;1 7 ( 4 ) : 1 15 3 . P U B L IS H ED 2 0 2 0 F E B 1 2. D OI : 1 0 . 3 3 9 0 / IJ E RP H 1 7 0 4 1 1 53 WH A T I S H EAL TH L IT ERA C Y ? C EN T E RS F O R D I S EA S E CON T R O L A N D P REV E N TI ON . HTTP S : // W WW . C D C . G OV /H EAL TH LI TE RA C Y /L E A R N/ I ND E X.H T M L . P U BL IS H E D F E B RU A RY 2 , 2 0 22. AC C ES S ED MA RC H 2 8 , 2 0 2 2 .

21 https://www.shapeamerica.org/advocacy/Reentry/K-12_School_Re-entry_Considerations.aspx

ANTIVAX BY:SOTA SHISHIKURA

Background Information: ED W AR D JE N N E R D I SC O VE RE D T H E F IR S T VA C CI N E I N 1 798 AF T E R C O WPO X PU S W AS I NO C UL AT E D T O A 1 3- YE AR- O L D B O Y AN D D EM O N S T R AT E D I M M U N IT Y T O S M ALL P OX . E VE R S I N C E T HE N , T HE RE HAS BE E N A C Y CL E O F I N C RE ASE D VACC IN ATI ON RA T E S , O P PO S I N G T HE VACCI N ATI ON , O U TBR E AK , AN D T HE N APP R E CI AT IO N O F T H E V AC CI N E . T H E R E WE RE A N U M B E R O F P R O T E S T S AN D O PP O S I T IO N WO R T H ME NT I O N IN G , B UT O N E T H AT IM PA C T E D S O CI E T Y M O ST WAS WH E N AN D R E W W A KE F I E L D M D R E L E AS E D A PAPE R "I LE AL LYM P HO I D - N O D U L AR H Y PE R P L AS I A , NO N SP E C IF I C CO L I T IS , AN D P E R VAS IV E D E VE LO PM E N T AL D IS O R D E R I N C HI L DR E N " I N A M E D I CAL JO U R N AL , T H E L ANC E T . W AK E F IE L D I N C O R R E CT L Y M AD E A C ON NE CT I O N B E T WE E N T HE M M R VA C CI NE AN D AU T I S M .

(https://www.thelancet.com/action/showPdf? pii=S0140-6736%2897%2911096-0

Intercultural/Global Issue: TH E RE ARE D IVE RGE N T CULT URAL P E RSP E CT IVES ON VACCIN ATIO NS WH ICH R E SULTE D FRO M IN D IVIDUAL R IGHT S AN D P UBLIC HE ALTH ST ANCE S TO WARD VACCI NAT ION , VARIOUS RE LIGIO US BE LIE F S, AND M ISTR US T O F VACCIN E S AMON G D IFFE R E NT CULTURAL COM MUNI TIE S

Who and What is Affected: HERD IM MUNITY IS DEF INED AS THE IN DI R E CT PR OT E C T IO N F R O M A N IN F EC T IOU S DI SE AS E T H A T RESULTED FROM A LARGE POPULATION BE C OM IN G IM M UN E E IT H ER T H R OU GH VA C CI N AT I ON O R IMMUNITY D EVELO PED THROUGH THE PR E VIO US I N FE C T IO N . IF V AC C IN E H E SI T AN C Y B E C OM E S M O R E PREVALENT, HERD IM MUNITY WOULD BE DI FF IC U L T T O A C H IEV E , POS IN G A R IS K T O T H OS E W H O A R E IMM UNO CO M PRO MISE D A N D C AN N O T R E CE IV E T H E VA C CI N E.

Possible Solution THERE H AVE BEE N S EVE RAL EFFOR TS TO IM PR O V E TH E V A C C IN E U PTAK E. SOME OF WH ICH I NCLUDES P RE SENT IN G VA C C I NA TI O N A S THE DEFAULT AP P R OACH , BUILDI NG A S T RO N G T RU S T , COMMUNICATING THE SIDE EFFECT S COR RE C TL Y, A ND A LS O EMPHASIZI NG TH E SAFETY OF T HE VACCINE . I T C O U LD A LS O B E HE L PFUL TO ANSWE R TH E QUE STI ONS ON IMMU NO LO GI C A S PE C TS O F VA CCIN ES AND P ROVI DE T HEM WITH LI STS OF RES O U R C ES T H AT A RE OPEN T O ACCE SS. WHI LE T HES E EFFORT S A RE E FF EC T I VE A T E NHAN CING T HE CONS UMER UNDER STANDI NG O N V AC C I N ES , I T IS AL SO IMPORT ANT T O BE TR ANSP AR ENT ABOUT T HE DE V EL O PM EN T PROCESS. FOR INST ANCE, THE NUMBER OF T E ST S C O M PLE T ED TO E NSUR E THE EFFICACY AND SAFE TY OF TH E V A C C IN E. TH I S WI LL A LL OW TH E P ATI ENTS T O UNDER STAND TH AT T HE RE W AS S U FFI C I EN T TES TS DUR ING T HE DEV ELOP MENT P R OCES S A ND HE NC E I T WI LL FURTHER CONV INCE TH E CONSUME RS ABOU T T HE S A FE TY O F TH E VA CCINE. OVE RALL, TH E MOS T EFFE CTIV E AP PR O A CH TO I MPR O V E THE V ACCINE UP TAKE IS BY MAKING T H E IN FO R MA TI O N TR ANSP AR ENT AS P OSSI BLE, AND INF O R M T H A T TH E SAFET Y/EFFICACY T EST WAS P ER FOR M ED C O RRE C T LY.

Professional Opinion: I BELIEVE THAT VACCINE UPTAKE NEEDS TO BE IMPROVED REGARDLESS OF THEIR CULTURE/TRADITION. TO DO SO, ADDITIONAL EFFORTS NEED TO BE PUT INTO COMMUNICATING TO THOSE WHO ARE HESITATING TO RECEIVE VACCINES DUE TO THEIR CULTURES/TRADITIONS REGARDING THE SAFETY AND THE BENEFIT OF THE VACCINE. IT IS ALSO IMPORTANT TO MENTION THE SAFETY/EFFICACY TESTS WERE PERFORMED TO MINIMIZE THE UNDESIRED EVENTS

~ S. Shishikura

References: Cultural perspectives on vaccination. History of Vaccines. https://www.historyofvaccines.org/content/articles/cultural-perspectives-vaccination. Accessed March 29, 2022. Donovan J. Vaccines stop diseases safely - why all the suspicion? Nature News. https://www.nature.com/articles/d41586-020-02192-w. Published July 22, 2020. Accessed March 29, 2022. Shen SC, Dubey V. Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parents. Canadian family physician Medecin de famille canadien. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515949/. Published March 2019. Accessed March 29, 2022. Wakefield A. RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)11096-0/fulltext. Published February 28, 1998. Accessed March 29, 2022.

PREFERENCE

BY: HANG LI

Background Information: In every culture, people usually has preference on some habits and health care approaches. Here, I will focus on two things in Chinese culture. I will state their own issues and what efforts have been done.

TABLE MANNER/HABBIT - FAMILY-STYLE SERVING

In China and some countries in Eastern Asia, people usually do not have a culture of separate serving. When a group of people is having a meal together, foods are usually served “Family Style”

TRADITIONAL CHINESE MEDICINE (TCM)

Traditional Chinese Medicine has a long history and covers a diverse range of practices that are usually regarded as a group in philosophical, geographical terms. It has long history and it is till popular in China.

SOME ADDITIONAL INFORMATION

：

What is Family-Style Serving Family-Style Serving is also known as shared dishes. Every person at the table picks food from common plates by using their own chopsticks. This habit has been applied for hundreds of years n China and many Eastern Asian countries.

TCM Includes

https://www.chilihousesf.com/blog/family-andfood-in-chinese-culture/

Intercultural/Global Issue: FAMILY-STYLE SERVING Many bacterial infections can be spread through saliva. H. Pylori. infection is one of them and it is serious. A Statistic study showed that around 44.2% of Chinese people have been infected by H. pylori. , and most of them did not realize that. The infection could cause peptic ulcers. More severe infections can cause gastritis and stomach cancer.

Acupuncture Tai Chi Herbal products Skin Cupping Moxibustion

https://www.ctnaturalhealth.com/traditionalchinese-medicine-ancient-medicine-modernbenefits/

Who is Affected: Thes e is sues will a f fe c t peo pl e in Eastern Asi a , mos tl y Chines e p eopl e.

TCM Many concepts have not been proven by conventional scientific investigation, and some concepts are hard to be verified by conventional scientific inquiry. This led to a concern that it is hard to make standards to monitor efficacy and safety. May disagree on treatments deemed appropriate for a person

Efforts and Opinions TABLE HABBIT There are many other bacterial infections that can spread through saliva. Thus, it is not hard to spread diseases through "Family-Style Dining". Many cities in China now encourage people to use "serving Chopsticks". It means people use serving chopsticks/public chopsticks to take food from communal plate to personal plate and then use another pair of chopsticks (personal) to eat. This would be a little bit complicated, but I believe that it could reduce the prevalence of H. pylori and other infections.

TCM

Even though TCM has many issues, we cannot simply say it is not good. it just has a different philosophy from modern western medicine. It is true that some of the concepts are ridiculous, but some of them work and we just have not identified the mechanism. Scientists are also working and trying to verify mechanisms by conventional scientific inquiry. A successful example is the Artemisinin for Malaria. Hospitals in China now are using TCM as a supplementary therapy. There is ongoing research that is focusing on the potential value of TCM used as supplementary medicine.

References: Fears R, Griffin GE, Larhammar D, Ter Meulen V, van der Meer JWM. Globalization of Traditional Chinese Medicine: what are the issues for ensuring evidence-based diagnosis and therapy?. J Intern Med. 2020;287(2):210-213. doi:10.1111/joim.12989 U.S. National Library of Medicine. (2021, May 5). H. pylori | helicobacter pylori infections. MedlinePlus. Retrieved January 24, 2022, from https://medlineplus.gov/helicobacterpyloriinfections.html Ren S, Cai P, Liu Y, et al. Prevalence of Helicobacter pylori infection in China: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2022;37(3):464-470. doi:10.1111/jgh.15751 Coghlan ML, Maker G, Crighton E, et al. Combined DNA, toxicological and heavy metal analyses provides an auditing toolkit to improve pharmacovigilance of traditional Chinese medicine (TCM). Sci Rep. 2015;5:17475. Published 2015 Dec 10. doi:10.1038/srep17475 Individual meals and serving chopsticks: Changing dining table habits. Cision PR Newswire. Mar 26, 2020. https://www.prnewswire.com/news-releases/individual-meals-and-serving-chopsticks-changing-dining-table23 habits-301030228.html

Surroundings

Background Information: Culture and tradition play a heavy role in the influence of many health beliefs. The surroundings, meaning your parents, community, and environment, can influence one’s beliefs in anything in general from a young age. Everyone’s upbringing is different which leads to varying beliefs.Where and how a person grows up has been a big part in affecting one’s beliefs in really anything. There have been many case studies that have been performed where children are observed to see if they pick up the same moral values as their parents as they grow up. There was also a study done by Maeliane Deyra that describes the influence of imagery on children’s perception on determinants of health and cancer.

Intercultural/Global Issue: There are over 190 different countries in the world that have varying cultures, perspectives, and traditions that influence one’s views on public health. From my personal experience, I am a Chinese American that grew up in the US and were raised by two immigrant parents. My personal views would differ quite immensely compared to those who grew up in Iceland or Somalia. We each grew up with different values taught by both our parents and our environment. There may be cases where there are similarities in the perspective but for the most part not everyone has the exact same values.

Who is Affected?: The main group of people that the influence of surrounding affects are young children and adolescents. When one is at this certain age their minds are most easily influenced which can lead to the highest sense of change in values. The brain develops the most around the time of birth to about the age of five and continues to develop until the age of 25. Constant reinforcement from values learned from family, community, and the environment can lead to the set values that the children will hold onto for the majority of their life.

Efforts Made/Professional Opinion: I believe that no matter what opinion or perspective that you have growing up as a child, you should never make haste judgments regarding someone else’s views. These views are their opinion and it is not fair to impose your own perspective on someone else even if you think their opinion is wrong. Respect others' background and learn about what influenced them in their life to reach their own viewpoint on global health or health issues in general. ~ H. Li

References Yuan, M., Lin, H., Wu, H., Yu, M., Tu, J. and Lü, Y., 2021. Community engagement in public health: a bibliometric mapping of global research. Archives of Public Health, [online] 79(1). Available at: <https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-021-00525-3> [Accessed 15 February 2022]. Deyra, M., Gay, C., Gerbaud, L., Berland, P. and Pizon, F., 2020. Global Health Determinants Perceived and Expressed by Children and Adolescents Between 6 and 17 Years: A Systematic Review of Qualitative Studies. Frontiers in Pediatrics, 8. Ariyo, O., Ozodiegwu, I. and Doctor, H., 2017. The influence of the social and cultural environment on maternal mortality in Nigeria: Evidence from the 2013 demographic and health survey. PLOS ONE, 12(12), p.e0190285. Institute of Medicine (US) Committee on Assuring the Health of the Public in the 21st Century. The Future of the Public's Health in the 21st Century. Washington (DC): National Academies Press (US); 2002. 4, The Community. Available from: https://www.ncbi.nlm.nih.gov/books/NBK221228/

IENVIl Iffi ([])NM IENlf People often say that we are given this beautiful Earth once, and when we destroy it, there is no second chance. As seen through phenomenons such as pollution, deforestation, and climate change, it does seem that humans have taken our home for granted. What most people often forget is that the destruction of the environment can directly impact their health. Air pollution could cause detrimental respiratory problems. Deforestation causes increased greenhouse gases in the air, which also affects breathing. Climate change leads to declined water sources. A lack of clean water or security of it leads to dehydration and resulting problems from this. Food deserts lead to malnutrition and limited ability to lead healthy lives. The more focus that is put on the environment can surprisingly directly one's health.

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Table of Contents

Pollution...................................... 2 Deforestation.............................. 3 Climate Change.......................... 4 Clean \Vater................................ 5 Food Deserts............................... 6 First row: GOODNET. 7 New Technologies That Create Clean Water for a Thirsty World. Accessed March 29, 2022. https://www.goodnet.org/articlesfi-new-technologies-that-create-clean water-for-thirsty-world

Second row (left to right): Britannica. Plastic Pollution. Accessed March 29, 2022. https://www.britannica.com/science/plastic-pollution; National Geographic Society. Deforestation. Accessed March 29, 2022. https://www.nationalgeographic.org/encyclopedia/deforestation/

Third row: Environmental Defense Fund. This is why fighting climate change is so urgent. Accessed March 29, 2022. https://www.edf.org/climate/why-fighting-climate-change-so-urgent Fourth row: The Ticker. Food deserts exacerbate socioeconomic disparities during the pandemic. Accessed March 29, 2022. https://theticker.org/3681 /opinions/food-deserts-exasperate socioeconomic-disparities-during-the-pandemic/

Monograph Created By:

Jilian Banzon (PharmD Student) Josh Grams (BSPS Student) Shuhei Misawa (BSPS Candidate) Nicklas Shewman (BSPS Student) Cynthia Wan (PharmD Student)

Spring 2022

• The three major types of pollution are air pollution, water pollution, and land pollution.

Pollution Josh Grams

• There is an island of floating garbage the size of Texas known as the Great Pacific Garbage Patch.

Pollution is the presence or introduction of substances into the environment that could produce potentially harmful or poisonous effects. These harmful and poisonous substances are known as pollutants.

Pollution is a global problem as all living things depend on clean resources of air and water to survive. When these critical resources become polluted, all forms of life are threatened. All over the world, regular people and governments are fighting against the ever increasing problem of pollution. From ways like increasing recycling all the way to even making laws that help combat pollution from factories and industrial plants. In my personal opinion, not enough is being done to help reduce the effects of pollution. There will come a time where the world finally realizes how important it is to keep the Earth clean, but I believe by the time that happens, it will be too late to do anything. We are still too slow to help and ignorant to the fact fact that our planet will eventually die if we don't change the ways we are doing things now. We need to come together as a species and clean up our oceans, our air and our lands in order for us to be able to show future generations the beauty that the world has to offer. ~ J Grams

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• Austria and Switzerland have the highest recycling rates. These nations recycle between 50 and 60 percent of their garbage. • The U.S. recycles about 30 percent of their garbage. Decompose Rates for Common Trash • Paper: 2-4 weeks • Orange peel: 6 months • Milk carton: 5 years • Plastic bag: 15 years • Tin can: 100 years • Plastic bottle: 450 years • Glass bottle: 500 years • Styrofoam: Never

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References

National Geographic Society. Pollution. National Geographic Society. https://www.nationalgeographic.org/encyclopedia/pollution/. Published October 9, 2012. Accessed March 29, 2022.

Pollution. Encyclopredia Britannica. https://www.britannica.com/science/pollution-environment. Accessed March 29, 2022.

Deforestation Jilian Banzon

What is deforestation? Deforestation or forest clearance is the removal of a forest or stand of trees from land that is then converted to non-forest use.

Nicole Bonaccorso. The Weather Channel. Before and After: Devastating Deforestation in Photos. Available at https://weather.com/science/news/devastating-deforestation-inborneo. Accessed March 29, 2022.

A deforested area near Novo Progresso in Brazil's northern state of Para. ANDRE PENNER/AP. Available at https://www.wired.com/2015/04/using-smart-satellites-to-monitor-deforestation-from-space/. Accessed March 29, 2022.

Why does deforestation matter? Deforestation is an important matter for discussion since it relates to all of us in a global perspective. Deforestation affects everyone in the world regardless of financial status or location.

Impact of Deforestation on natural medicine

Deforestation is negatively affecting our sources of natural medicines, of the 50,000 known medicinal plants, which are the basis of more than 50% of all medications, 20% are at risk of extinction at the local, national, regional or global level due to deforestation. This also is impacting developing countries because 80% of developing countries rely on traditional medicine for their basic health care and it is estimated that international trade of medicinal plants is a US $60 billion business.

Deforestation's association with vector borne and zoonotic disease

Chemistry Steps. Wilow trees, Salicin and Aspirin. Available at https://www.chemistrysteps.com/wilow-trees-salicin-and-aspirin/. Accessed March 29, 2022.

The increasing amounts of deforestation was shown to have a positive association between the number of vector-borne disease outbreaks and the decrease forest cover. There was also a positive association as well with zoonotic disease outbreaks.

Deforestation's relation to climate change

Figure 2. (A) Association between the change in forest cover and the number of outbreaks of zoonotic diseases from 1990 to 2016. (B) Association between the change in forest cover and the number of outbreaks of vector-borne diseases from 1990 to 2016. (C) Association between the change in palm oil areas and the number of outbreaks of zoonotic diseases from 1990 to 2016. (D) Association between the change in palm oil areas and the number of outbreaks of vector-borne diseases from 1990 to 2016. Fitted smooth regressions (in blue) with confidence intervals (in light blue) are shown (data from GIDEON and FAOSTAT). Available at https://www.frontiersin.org/articles/10.3389/fvets.2021.661063/full. Accessed March 29, 2022.

Deforestation is related to climate change because trees capture greenhouse gases and prevent them from accumulating in the atmosphere and warming our planet. When we cut trees and they fall, they release into the atmosphere all the carbon they’ve been storing. What the deforesters do with the felled trees, either leaving them to rot on the forest floor or burning them, creates further emissions. Deforestation causes about 10% of worldwide emissions.

Solutions for Deforestation

There are many strategies to help fight deforestation, These include: Reduce your consumption of single-use products. Demand that the forest-derived products you purchase are made from 100% post-consumer recycled content materials and when products are made from virgin forest Demand that the sourcing is done in an environmentally and socially responsible manner. Educate your friends, family, and community about how our everyday actions can impact forests around the world. Avoid false solutions like biofuels, biomass, or carbon offsets that rely on wishful thinking, yet in practice release more greenhouse gas emissions. There is also organizations that have donations to help with the efforts to stop deforestation as well such as the Greenpeace organization.

Environmental activists’ campaign against deforestation. Available at https://www.dreamstime.com/environmental-activists-campaign-against deforestation-vector-illustration-saving-forests-trees-eco-conceptenvironmental-image161463193. Accessed March 29, 2022.

Personal Opinion In my personal opinion, I believe deforestation is an ongoing concern today and still needs to be focused on. Our environment around us depends on our efforts to keep them alive and cared for and without the forest around us it can cause many problems as mentioned beforehand. ~ J. Banzon

References 1. The World Bank. Deforestation, a headache for natural medicine. Available at https://www.worldbank.org/en/news/feature/2015/01/13/la-deforestacion-un-dolor-de-cabeza-para-la-medicinanatural#:~:text=Around%20the%20world%2C%20thousands%20of,used%20daily%20to%20make%20medicines .&text=Of%20the%2050%2C000%20known%20medicinal,global%20level%20due%20to%20deforestation. Accessed February 15, 2022. 2. Morand S, Lajaunie C. Outbreaks of vector-borne and zoonotic diseases are associated with changes in forest cover and oil palm expansion at global scale. Frontiers in Veterinary Science. 2021;8. doi:10.3389/fvets.2021.661063. 3. Rainforest Alliance. What is the Relationship Between Deforestation And Climate Change? Available at https://www.rainforest-alliance.org/insights/what-is-the-relationship-between-deforestation-and-climatechange/. Accessed February 15, 2022. 4. Greenpeace. Solutions to Deforestation. Available at https://www.greenpeace.org/usa/forests/solutions-todeforestation/. Accessed March 29, 2022. 27

Getty Images; 2018. https://www.hindustantimes.com/op inion/diabetes-and-heartdisease-should-be-top-health-priorities/storytwpgRq 1 UhJkZmoCtz93gSL.html. Accessed March 29, 2022.

c ll'nioi,i"ti"' C'hi'rig e One World Sign. European Public Health Alliance; 2020. https://epha.org/unlocking-

Nicklas Shewman Climate change is the rapid change of the world's climate due to human influence (1 ). Climate change can cause extreme changes in weather events around the globe. It can cause extreme hot and cold temperatures as well as draughts and floods(1 ). The effects of the sudden and extreme weather changes lead to health issues. Instantly apparent health issues are increased respiratory and cardiovascular disease, injuries, and premature deaths (2). However, the unpredictable weather also leads to issues with food and water-borne illnesses. An area experiencing a drought will not be able to produce food as easily as once before. This will cause a food desert and famine within the area. Increased rainfall and flooding can also contribute to food deserts because the crops may not be able to handle the large amounts of water(2). Flooding can also lead to higher water-borne diseases since the disease carrying agents can be spread person to person more easily with the water making the agents more mobile(4).

Charlesstockis. The Hungry Female Holding an Empty Bowl on White Background. Getty Images; 2016. https://www.istockphoto.com/photo/the-hungry-female holding-an-empty-bowl-on-white-background gm620716694-108302187. Accessed March 29, 2022.

Lanes Group pie; 2018. https://www.lanesfordrains.eo.uk/commercial/new s/drought-right-time-prepare-floods-saysdr ainage-specialist/. Accessed March 29, 2022. 1.

Climate Change Indicators: Weather and Climate. EPA https://www.epa.gov/climate indicators/weather-climate. Published May 12, 2021. Accessed February 14, 2022 2. Climate effects on health. Centers for Disease Control and Prevention. https://www.cdc.gov/climateandhealth/effects/ default.htm#:-:text=The%20health%20effects %20of%20these,and%20threats%20to%20me ntal%20health. Published March 2, 2021. Accessed February 14, 2022..

Ways to increase access to clean water

Albinia, Alice. “A Water Crisis Looms for 270 Million People as South Asia's Glaciers Shrink.” Magazine, National Geographic, 3 May 2021, https://www.nationalgeographic.com/magazine/article/water-crisis-looms-for-270-million-people-south-asia-perpetual-planet-feature.

ACCESS TO CLEAN WATER

The worldwide water shortage crisis by Shuhei Misawa

Access to clean water is a basic human right unmet by millions of people across the globe. Over 884 million people do not have access to improved water source and 785 million people do not have access to safe drinking water(1). This worldwide issue primarily affects developing and underdeveloped countries, and those who are affected frequently lack the resources to address the problem. This is because the access to clean water and poverty are inextricably linked(2). Those who rely on agriculture for food and money cannot plant crops unless they have access to clean water. Another way poverty is linked to the access to clean water is through the education system. Around282 million people spend more than 30 minutes going to water sources, owing to the fact that many individuals make several visits(2). In many developing countries, women and girls are responsible for gathering water and spend 200 million hours every day doing it(2). This drastically lowers the number of children in school, particularly females(2). Diseases from contaminated water & poor sanitation

Cholera

Diarrhea

Typhoid fever

There are 3 million cholera infections and 95,000 cholera fatalities worldwide.

Diarrhea affects 7 billion children under the age of five annually, with 446,000 children dying as a result.

Typhoid fever affects 11 million people each year, with an estimated 129,000 fatalities.

References 1. Global WASH Fast Facts | Global Water, Sanitation and Hygiene | Healthy Water | CDC. Accessed April 10, 2022. https://www.cdc.gov/healthywater/global/wash_statistics.html 2. Water.org - Water Charity For Safe Water & Sanitation. Accessed April 10, 2022. https://water.org/

Promoting rainwater harvesting in communities, schools, and healthcare facilities that is appropriately maintained (2) Supporting activities to enhance the quality of drinking water and decrease the spread of waterborne diseases, such as domestic water purification and safe storage (2). Develop and implement water safety plans(1) WASH in health-care facilities should be improved and implemented in many developing countries(1) Education on the importance of clean water(2) “Water-Efficient Technology Opportunity: Rainwater Harvesting Systems.” Energy.gov, https://www.energy.gov/eer e/femp/water-efficienttechnology-opportunityrainwater-harvestingsystems.

Personal Opinion Lack of access to clean water is undeniably linked to global warming and climate change, but many of the issues arise from our collective actions. I feel that we do not care enough about our environment and that we continue to pollute and mismanage our water supplies. We take our access to clean water for granted, and unless we realize the full consequences, we may be forced to face a worldwide water crisis. - S. Misawa 29

FOOD DESERTS Cynthia Wan

What are food deserts?

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DoSOmething.org. 11 Facts About Food Desens. Accessed March 29, 2022. ==·dosomethtng.orgtus,faas/11-faasdeserts#. -.cexc�Aboul1fl2023.5�20m1tl1on%20p eople9ti2CMtve,l01&20m1 e5'b20from%20al!lt.20Su11111111111 permarke1. �

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2022. hnps://spoonuniversity.com/1 esfy1e/food-d • obes1ty-ra1:es. o According to The Annie E. Casey Foundation, f od deserts are defined as "geographic areas • where residents have few to no convenient options for securing affordable and healthy f oods -- especially fresh fruits and vegetables." Essentially, they are areas that do not allow people eECaseyFoufldai,on.ExploringAmer�a·sFoodDeserts. easy access to nutritional foods, especially fresh groceries. TheAnr. Accessed 29 March 2022. hnps://www.aecf.org/blog/expla1ng-amer.:::as-food-deserts

-23.5 million people in the U.S. live in food deserts -2.3 million people live in low-income, rural areas that are > 10 miles away from a supermarket • there is a $400 million investment from the U.S. government going towards this cause

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1annon Lucy oss ett. uar ian. th deserts' everywhere, it's no wonder so many Brits are obese. Accessed March 29, 2022 tpsllwww.theguard1an.com/commeru15fr oct/12r�s-brns-obese-fresh ovemme,--

Food Empowerment Pro1ect. Food Deserts. Accessed March 29. 2022. https://food1spower.org/access heal1hlfood-deserts/

Kim D.Lee C. seo D Food deserts " Korea> A GIS analysos of food consumpuon panems at sub-disma IM!I ,n 5eoul us,ng the KNHANES 2008· 2012dat.l.NulfResProct 2016.10:S doo:104162/nr 2016.10.5.530

Wagner J, Hinton L, McCordic C, et al. Do UrbanFood DesertsExist in the Global South? An Analysis of Na1robt and Me11.lco City Susta/nobiflty. 2018, 11:1. do110.3390

World Map Bank. World Map & co..m,es Map ,n Blank/Pnntable/Phys�a11Po1,1Cal/Ubeled/Geograph,cal. Accessed March 29. 2022 hltpsJ/Worldmapblank.com/Wll<ld-map-cl,paN AuSlrclhan Spac.al Analyucs. Access (0 quah(Y food 1n Brisbane's suburbs Accessed March 29. 2022 h1tpsJlslorymaps.¥cg,s.com1S1oroes1s197f 42c5b5d4c998496e3d9Sfabd21a

From the Writer:

Bauersby J, Crush J. Africa's Urban Food Deserts Urban Forum 2014, 25:143·1S1. doi:10.1007/s12132· 014-9225-5

Let's take a look at New York City's Green Carts program ... In order to become a Green Carts vendor, only a license is required. The food will be provided by the city, so there 1s no investment 1n the business. There is a waitlist to become a vendor and the only costs are those associated with obtaining the different permits/licenses. This helps to encourage New Yorkers to eat healthier foods that are also easily accesible. LJ Dawson. PolitJCO. How Mike Bloomberg Got New York to Eat Its Vegg,es. Accessed March 29. 2022 https://www.pol1tteo.com/news/magazine/2020/01/23/bloomberg-mayor-new-york-city-vegetables heal1h-food-policy-100092

When researching food deserts, I kept trying to think what feasible solutions could be. In the end, it seemed to be a paradoxical problem. If more supermarkets were built in low-income areas, eventually it would encourage people to live in the city. It could be closer to their jobs, and although it would be in a "poorer" neighborhood, wealthier people would have a lower cost of living. Eventually it would become gentrification, but with supermarkets. A program in New York City called Green Carts inspired me to come up with my personal solution. I am not sure how feasible it is, but at least it is a start, right? Instead of providing even more vendors with jobs, larger cities could think about offering a program to inmates where they grow fresh vegetables and fruits in a garden as community service, and in return, serve these to the community free of charge. This teaches the inmates how to contribute to their community and provides what is lacking to those that need it. Hopefully this can be the start of a new idea to continue to combat food deserts. 30

Health Education ICGH 485 - Spring 2022

Andrew Montoya (BSPS Candidate) Ben Craft (PharmD Student) Dynasti Smith (BSPS Student) Rose Wilfong (BSPS Candidate) Stephanie Hessong (BSPS Student)

Background Health education pertains to the issue of how the general public perceives and understands their healthcare. When thinking of issues pertaining to health education, availability of health education is a main issue that affects a population’s education. Along with this, health literacy and media can also influence a population’s education. This also includes how it can be influenced by the training of professional programs and standardization of the profession to provide patients with a familiar experience. Finally, health education can also be influenced by how it is standardized in public schools and how it can be biased.

Availability of Health Education By: Stephanie Hessong

Background Information

Health and quality of life rely on more than a functioning health care system. People must have access to general health education to understand aspects of a healthy lifestyle. They must be aware of ways to reduce factors that contribute to health problems in order to recognize and take action to prevent health issues such as chronic disease, poor mental health, and sexually transmitted diseases.

Public and Private Schools School based health education provides adolescents with functional health knowledge needed to maintain healthy behaviors throughout their lives. This education is offered in K12 schools in the United States and the extent of education can vary for topics such as sexual education.

Community Programs Community based healthcare education programs are designed to reach people outside of traditional health care settings to inform them about topics that encourage health and wellness. These programs are often offered at worksites, community health centers, and in health care facilities.

Online Resources

Source: Where Has All the Sexual Education Gone? STANDUP! https://www.standuprasash.com/blog/where-has-all-the-sexual-education-gone

Source: The Role of Health Education Teachers & Students in the Community - Video & Lesson Transcript | Study.com. Study.com. Published 2021. https://study.com/academy/lesson/the-roleof-health-education-teachers-students-in-the-community.html‌

Health education topics can be accessed online from credible websites such as the Center for Disease and Control. Some medical centers offer virtual healthcare appointments as a convenient option for patients who are far away or do not need physical examination. Source: Telehealth Visits Skyrocket for Older Adults, but Concerns and Barriers Remain. University of Michigan. https://labblog.uofmhealth.org/rounds/telehealth-visits-skyrocket-forolder-adults-but-concerns-and-barriers-remain‌

Professional Opinion

What is the Issue?

Who is Affected?

The lack of health education is a global issue that leads to lower life expectancy, decreased quality of life, and an increase in health issues such as chronic disease

Lack of health education can affect people from all demographics. Those who are affected the most often fall into the categories of low income, the elderly, and people living in developing countries with a poor healthcare system.

Potential Solution

A potential solution is to offer virtual appointments at satellite locations in low income areas that lack health centers. In a study conducted by Ronald Dixon, results showed that patients that did not need physical examination were about as satisfied with the virtual appointment. Results also showed that virtual appointments have reduced costs for both the patient and provider.

The availability of health education can be improved by making virtual appointments and community health programs more prevalent in low income areas. It's helpful that many options are available but they need to be made available in all locations -S. Hessong

Resources Dixon RF, Stahl JE. Virtual Visits in a General Medicine Practice: A Pilot Study. Telemedicine and e-Health. 2008;14(6):525-530. doi:10.1089/tmj.2007.0101 https://www.liebertpub.com/doi/abs/10.1089/tmj.2007.0101 Centers for Disease Control and Prevention. Health education in schools | CDC. www.cdc.gov. Published April 21, 2021. https://www.cdc.gov/healthyyouth/healtheducation/index.htm Educational and Community-Based Programs | Healthy People 2020. Healthypeople.gov. Published 2014. https://www.healthypeople.gov/2020/topicsobjectives/topic/educational-and-community-based-programs

Health Literacy By: Rose Wilfong

Background Information Health literacy is defined as a patient's ability to obtain and understand health information and services to make appropriate health decisions. Low health literacy is associated with poor health outcomes, medication errors, trouble managing chronic diseases, missing preventive services, and other deleterious effects. Roughly 9/10 adults struggle with health literacy, and people with high health literacy skills can have lower health literacy skills in some situations. Strong health literacy skills allow an individual to look after their health and make informed medical decisions.

Health Literacy and Health Education Health education is directed towards developing, improving, and promoting health literacy and health education interventions are critical for improving health literacy.

Affected Groups Globally affects individuals with dissimilar: Education level Age Culture and language

Current Solutions and Interventions Increase availability of relevant instructional modules and health education. Staff organizations with individuals experienced with quality improvement to continuously update organizational health literacy framework. Provide information for patients in their primary language. Use simple language and define technical terms. Discuss cultural differences in medicine and make appropriate suggestions. Increase and support adult health education.

Future Steps

Professional Opinion There are good techniques in use that measure health literacy. I would like to see further efforts in creating multiple plans of action for different groups divided by their health literacy measure. I would also like to see further improvement of health education tools to continuously improve health literacy. - R. Wilfong

Resources

Source: Readability and Plain Language and Health Literacy - Oh My! Communicate Health. https://communicatehealth.com/wehearthealthliteracy/readability-and-plain-language-andhealth-literacy-oh-my/

Source: Health Literacy Services. UHIPJG. https://uhipnj.org/health-literacy-services/

Predict potential barriers individuals face in receiving treatment. Implement changes to organizational frameworks and improve accessibility and ease of use for patients. Create instructional modules available for patients to improve their health education and health literacy.

1. An Introduction to Health Literacy. National Library of Medicine. https://nnlm.gov/guides/intro-health-literacy. Published December 17, 2021. Accessed April 11, 2022. 2. Meggetto E. Factors influencing implementation of Organizational Health Literacy: A realist review. Journal of Health Organization and Management. https://www.emerald.com/insight/content/doi/10.1108/JHOM-06-2019-0167/full/html?. Published March 18, 2020. Accessed March 28, 2022. 3. National Action Plan to Improve Health Literacy. Office of Disease Prevention and Health Promotion. https://health.gov/our-work/national-healthinitiatives/health-literacy/national-action-plan-improve-health-literacy. Published August 24, 2021. Accessed April 11, 2022. 4. Noblin AM. The impact of health literacy on a patient's decision to adopt a personal health record. Perspectives in health information management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510648/. Published September 2012. Accessed March 28, 2022. 5. Rīga Stradiņš University. Health Literacy as a challenge for Health Education. SHS Web of Conferences. https://doi.org/10.1051/shsconf/20184002004. Published January 31, 2018. Accessed March 28, 2022. 6. What is health literacy? Centers for Disease Control and Prevention. https://www.cdc.gov/healthliteracy/learn/index.html. Published February 2, 2022. Accessed March 28, 2022. 33

Media

By Andrew Montoya

Background Information

Media has a major area where people obtain information on various topics. A variety of sources are classified as media like social media, internet, news outlets, etc. These platforms have some advantages and disadvantages on health education. According to a study, 74% of all U.S. adults use the Internet, and 61% have looked for health or medical information.

Positives of Media

Source: How to boost the online reputation of your healthcare practice. ScienceSoft footer icon. https://www.scnsoft.com/blog/howto-boost-the-online-reputation-of-your-healthcare-practice

Negatives of Media

Social Media Misinformation Various platforms are used by the general public or by Spread of false information or professional to spread information on health or certain diseases. information not backed by studies on all media outlets. Fake profiles of health Internet professionals are used to spread this. Research articles and studies can posted and found easily by the public. Websites are used to spread information and raise Limited Access awareness on specific disease like HIV.gov. It is also used to Across the globe, people are limited on spread general Information of illness and protection against the type of media outlets they can use them like CDC.gov. like social media apps or the internet. This limits the kind of information they receive. Source: Top benefits of social media in the healthcare industry: Infiniti Research. Business Wire. https://www.businesswire.com/news/home/20180705005245/en/Top-Benefits-of-Social-Media-in-theHealthcare-Industry-Infiniti-Research

Who is Affected by Media

Media affects everyone around the globe. Those with access are susceptible to misinformation on health topics and may not know how to find a creditable source. Those without or with limited access to media are not able to obtain useful health information based on their health or just general information.

Solutions

Limiting/diminishing the spread of misinformation Providing information on how people can fact check information that is spread through media Improving accessibility of media around the world

Professional Opinion

Media is one of the best ways to improve somebody's health education. Nowadays, the newer generations obtain fresh information from media and other sources. That is why I believe that we should improve the quality of information that is spread with creditable sources; this will help decrease misinformation. Then we should help improve access to media so that everyone will be able to find information that they are searching for. - A. Montoya Resources 1. Centers for Disease Control and Prevention. (2015, November 6). Products - data briefs - number 66 - July 2011. Centers for Disease Control and Prevention. Retrieved March 28, 2022, from https://www.cdc.gov/nchs/products/databriefs/db66.htm 2. Ventola CL. Social media and health care professionals: benefits, risks, and best practices. P T. 2014;39(7):491-520. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103576/ Accessed February 17, 2022.

Standardization of Pharmacy Practice What is “Standardization of Practice?”

The standardization of practice concerns the development of a common patient care process for a certain profession to establish consistency, specificity, and intentionality when interacting with patients. This relates to health education because standardization begins with educating healthcare students and will eventually impact how patients receive care in general. When thinking about who is affected by this issue, it mainly pertains to those who practice pharmacy, but it also concerns the patient as it dictates how patients interact with pharmacists.

Professional Opinion

What is the issue?

In the field of pharmacy, most agree standardization would be beneficial to the profession. However, some believe that this is not enough as it does not separate pharmacy from any other profession. With this in mind, many colleges of pharmacy have implemented standardization practices into the curriculum, but it has been done in varying ways across the US and other countries.

In my opinion, Colleges of Pharmacy should work towards standardizing the implementation of the PPCP into the curriculum rather than multiple different approaches. As well, it would be beneficial to implement IESA into Joint Commission of Pharmacy the PPCP to differentiate pharmacists Practitioners. Pharmacists' Patient from other professions. Care Process. https://jcpp.net/wp- B. Craft, PharmD Student content/uploads/2016/03/PatientC areProcess-with-supportingorganizations.pdf. Published 2014. Accessed February 17, 2022

What’s Being Done?

The Joint Commission of Pharmacy Practitioners created the “Pharmacist’s Patient Care Process” (PPCP) in 2014 to establish a standard of care in pharmacy. This process was then mandated to be taught in Colleges of Pharmacy in the US, but how it was taught was not standardized. In a commentary about the PPCP, Minnesota professors argued the lack of standardization is detrimental to the profession. The authors suggested rooting the PPCP around the pharmacist’s assessment of indication, efficacy, safety, and adherence (IESA), which helps separate pharmacy from other professions. Along with this call for further standardization, other organizations, like the Patient-Centered Primary Care Collaborative, are creating guidelines for healthcare teams to standardize care further.

Resources 1. Sorensen TD, Hager KD, Schlichte A, Janke K. A dentist, pilot, and pastry chef walk into a bar…why teaching PPCP is not enough. Am J Pharm Educ. 2020;84(4):7704. doi:10.5688/ajpe7704 2. Patient-Centered Primary Care Collaborative. The patient-centered medical home: integrating comprehensive medication management to optimize patient outcomes. 2nd ed. Washington, DC: Patient-Centered Primary Care Collaborative; 2012. 3. Joint Commission of Pharmacy Practitioners. Pharmacists' Patient Care Process. https://jcpp.net/wpcontent/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf. Published 2014. Accessed February 17, 2022 35

Sex Education and Bias By: Dynasti Smith

Background/How This Relates to Health Education Sex education and bias are important components in health education. Sex education is one of the first things we learn in our health education courses in school. Multiple studies show that sex education reduces rates of unprotected sexual activities and risky sexual behavior, teen pregnancy, and sexually transmitted diseases. Implicit bias in health care is caused by conscious attitudes that play a negative role in patient care. Race, sex, religion, ethnicity, and economic status are examples of variables that can lead to a inaccurate assessment of a patient’s condition.

An Intercultural or Global Issue Sex education and bias is a global and intercultural issue. Sex education should be taught in every education system. However, different cultures across the globe do not discuss and/or find sexed appropriate for health education. Bias is a part of everyday life. Some bias is unconscious and some is conscious. Implicit bias is a form of conscious bias that is common in healthcare.

What is the Issue and Who is Affected? Studies show that sex education targeted at adolescences who are not sexually active is the most effective. However, in certain cultures children are exposed to sex-ed after being sexually active. Bias in the work place is common amongst minorities in health care. Addressing bias and being aware of where it comes from is the first step. Adolescences and all people from different backgrounds and walks of life experience bias and sex-ed issues.

Source: Community catalyst looks inward and outward in observance of Minority Health Month. Community Catalyst. (n.d.). Retrieved March 30, 2022, from https://www.communitycatalyst.org/blog/community-catalyst-looks-inward-and-outward-inobservance-of-minority-health-month#.YkPVrC1h01I

Solutions and Personal Opinion Diversity and inclusion events Being aware of unconscious/ conscious bias Open dialogue and debunking bias Open access to contraceptives Sex-ed in middle school Addressing the mental side of sexual activity

Source: Rekhter, M. (n.d.). Let's talk about sex. . . education: With New Sexual Education Laws in Indiana, CHS students, staff debate state of sex ed at our school. HiLite. Retrieved April 11, 2022, from https://hilite.org/60112/recent-updates/lets-talk-about-sex-education-with-newsexual-education-laws-in-indiana-chs-students-staff-debate-state-of-sex-ed-at-our-school/

My personal opinion is we grow from uncomfortable situations. Sex and bias need to be discussed so we can grow from it. Also, open communication is the first step to health education. -D. Smith

Sources 1. Van Ryn, M. (2016). Avoiding unintended bias: Strategies for providing more equitable health care. Minnesota medicine. Retrieved March 29, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476527/ 2. Parenthood, P. (n.d.). State of Sex Education in USA: Health education in schools. Planned Parenthood. Retrieved March 29, 2022, from 36 https://www.plannedparenthood.org/learn/for-educators/whats-state-sex-education-us

HEALTHCARE POLICY: A GLOBAL HEALTH ISSUE Spring 2022

Diana Dinh, BSPS candidate

Raegan Meyers, PharmD student

Jordan Keuneke, BSPS candidate

Ayush Kaw, PharmD student

Bryce Poindexter, BSPS candidate

Background Healthcare policies are the laws, regulations, and practices that are implemented to protect the well-being of the people. They affect not only individual patients, but also play a role in the function of larger institutions. Here, we examine healthcare policies that arise in the areas of harm reduction, public vs private healthcare, paid leave, alternative medicine, and FDA regulations. Our research has yielded insight into the limitations of harm reduction services in global pandemics and rural communities, the safety concerns with the FDA fast track program and the policies implemented to address them, as well as, looking at the laws around all types of paid leave in the United States and how we compare to the rest of the world in terms of the amount of time and support given, as well as the advantages and disadvantages of both private and public healthcare.

Harm Reduction Diana Dinh (BSPS candidate)

Harm reduction is an approach used around the world that acknowledges that some people are not ready to or not capable of stopping their substance use. It focuses on limiting the harm associated with substance abuse. 1 HARM REDUCTION SERVICES Syringe access programs & supervised injection sites 1 Distribution of sterile injection equipment Safe disposal of needles and syringes Reduce the risk of contracting HIV, hepatitis C, and other blood-borne infections Access or referral to medical, mental 2 social health, legal, and services Community naloxone distribution 1 Effective in decreasing deaths due to overdose Training programs for recognizing overdose symptoms Opioid treatment programs 2 Dispensation and administration of medicationassisted treatment (MAT) medications Substance abuse counseling Individual and group therapy PROFESSIONAL OPINION While the implementation of harm reduction services is immensely beneficial to their recipients, there is a clear need for increased funding to improve the accessibility of these programs to rural, lower-income, and/or underrepresented populations. -D. Dinh

GLOBAL PERSPECTIVE & COVID-19 3 There is a significant funding gap for harm reduction programs in middle and low-income countries In areas where opioid agonist treatment is available, access is still limited for certain populations (women, transgender, homeless) The COVID-19 pandemic has affected harm reduction services worldwide Thailand: Limited access to opioid agonist therapy and HIV-related services due to travel restrictions and quarantine regulations Bulgaria: Reallocation of resources and funding to COVIDrelated programs diverted support from harm reduction programs Dominican Republic: Shutting down a needle-service program due to physical distancing restrictions Harm reduction services have begun to adapt by offering mail-delivery of harm reduction equipment and offering virtual consultations 4

LIMITATIONS IN RURAL SETTINGS Patients who could benefit from harm reduction programs may have to travel long distances to access them in an area that lacks sufficient public transportation Programs designed to help substance abusers in rural areas may have a limited range of services compared to their urban counterparts 82% of rural residents lack access to detoxification services, which are necessary in limiting effects due to substance abuse Rural health providers report a concern about the lack of resources to dedicate to patients with opioid use disorder on top of meeting the demands for non-substance abusers There are currently efforts to integrate or co-locate harm reduction services with primary health services in rural areas

1. Harm Reduction. Recoveryanswers.org. https://www.recoveryanswers.org/resource/drug-and-alcohol-harm-reduction/. Published 2022. Accessed March 29, 2022. 2. Frequently Asked Questions | CMS. Cms.gov. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Opioid-Treatment-Program/OTP-FAQs#_Toc58928060. Published 2022. Accessed March 29, 2022. 3. The Global State Of Harm Reduction 2020. 7th ed. London: Harm Reduction International; 2020. 4. Substance Use and Misuse in Rural Areas Overview - Rural Health Information Hub. Ruralhealthinfo.org. https://www.ruralhealthinfo.org/topics/substance-use. Published 2022. Accessed March 29, 2022.

A Global Comparison: Public versus Private Healthcare Jordan Keuneke (BSPS candidate)

What is Public Healthcare? 2 Public healthcare (also known as Universal healthcare) is designed to meet the cost of healthcare needs and is typically funded by the government. This can be health insurance or a publicly funded hospital system or both. Public healthcare is variable by nation. Some countries' insurance may pay for some or all of a patient's medical expenses. Additionally, publicly funded insurance may have restrictions on where the insured can receive treatment.

Countries with Free and Universal healthcare Countries with universal but not free healthcare Countries with free but not universal healthcare Countries with neither free nor universal healthcare 1 Unknown 2019

2 Each form of healthcare offers its What is Private Healthcare? Private healthcare is healthcare that is paid advantages and disadvantages. A couple of out of the pockets of the individual. Insurance the advantages of public healthcare include the coverage of medical care for all citizens, is purchased from a private healthcare insurance provider. Many countries offer both boosting economic productivity, and taking public healthcare and private healthcare for the burden off of businesses who pay for most or part of employees' private healthcare those who prefer it and can afford it. insurance. Disadvantages include lowered Public Healthcare doctors' earnings, rationing of medical Pros: services, and increase in doctor shortage. Private healthcare offers its own set of - Equal access to healthcare advantages and disadvantages. Advantages - Covers basic human right include quicker access to services, increased Cons: privacy, and shorter wait time. Disadvantages - Extended wait times include the expense of purchasing, inequality - Increased taxes that occurs due to only those who can pay - Lack of innovation being able to afford it, and paying for part of Private Healthcare the service not covered by insurance.

Pros: - Choose your own doctor - Improved facilities Cons: - Expensive - Creates inequality

Professional Opinion I believe that the best option for most countries is to offer both forms of healthcare. Including a public healthcare policy would allow for all citizens to be covered while those who can afford it, can still purchase private healthcare insurance. - J. Keuneke

References: 1. List of countries with Universal Health Care. Wikipedia. https://en.wikipedia.org/wiki/List_of_countries_with_universal_health_care. Published March 23, 2022. Accessed March 28, 2022. 2. Health Insurance Glossary. Census.gov. https://www.census.gov/topics/health/health-insurance/about/glossary.html. Published November 21, 2021. Accessed March 28, 2022.

Alternative and Complementary Medicine Raegan Meyers (PharmD/ BSPS student)

What is It? 1 be Complementary Medicine: medical therapies that fall beyond the scope of scientific medicine but may used in treatment of disease and illness. 3 Alternative Medicine: medical therapies that are NOT regarded as orthodox by the medical profession GLOBAL CONTROVERSEY Some forms of alternative medicine are1 not considered orthodox as far as western medicinal practice (USA). But many countries practice them regularly and it has shown to work for them.

Complementary medicine like acupuncture does not demonstrate any scientific evidence supporting it but it has dated back to 100 BC in China An example of Alternative medicine is Ayurveda. Is a natural system of medicine, originated in India more than 3,000 years ago. The term Ayurveda is derived from the Sanskrit words ayur (life) and veda (science or knowledge). This form of medicine is still practiced. In the United states it is considered a pseudoscientific. 1

Overall, this topic impacts all people globally. Relating it back to health care system policy, we practice western medicine in the United States and many people here believe we are doing it the "right way". Many of these methods do not have studies done in the United States that show consistent results of direct benefits which leads to them not being recommended by medical professionals.

Pictured above are the Top 20 countries by life expactancy

PROFESSIONAL OPINION I feel like complementary and alternative medicine have proven themselves worthy of being recommended by health care professionals. Mainly because it has been around for centuries in different cultures and religions and not every country practices western medicine and have made it thus far. The United States does not have the largest percentage of older adults.

Real Life Examples

Acupuncture

Chiropractic

- R. Meyers Ayurveda. Johns Hopkins Medicine. (n.d.). Retrieved April 11, 2022, from https://www.hopkinsmedicine.org/health/wellness-andprevention/ayurveda#:~:text=Ayurveda%2C%20a%20natural%20system%20of,translates%20t o%20knowledge%20of%20life. Chiropractor. ExploreHealthCareers.org. (n.d.). Retrieved April 11, 2022, from https://explorehealthcareers.org/field/chiropracticmedicine/#:~:text=Chiropractic%20medicine%20focuses%20on%20the,particularly%20to%20t he%20spinal%20column.

Stylianou, T. C. and N. (2018, May 14). Nine facts about how long we live. BBC News. Retrieved April 11, 2022, from https://www.bbc.com/news/health-43726436

witch doctor, a healer, a benevolent worker

Types of complementary and alternative medicine. Johns Hopkins Medicine. (n.d.). Retrieved April 11, 2022, from https://www.hopkinsmedicine.org/health/wellness-andprevention/types-of-complementary-and-alternative-medicine

Paid Leave

Ayush Kaw (PharmD student)

Paid Leave in the US vs the World Paid family and medical leave typically provides a set number of weeks or months to be used for a worker’s own serious, longer-term health condition, to care for a family member with a serious health condition, or to care for or bond with a new 1 child, and for reasons related to a family’s member’s military service. On average, it provides six to twelve weeks of fully or partially paid leave per year, without the need for accrual. Paid family and medical leave may be insured and is often funded by contributions from the employer and/or the worker. With it depending entirely on an employers given amount here in the U.S while the global average hovers around at least a month of guaranteed paid leave.

Maternity and Paternity Leave Around the World The U.S. is one of six countries without national paid maternity leave. With legislature in the works to provide up to four weeks of federal mandated leave. When looking at other countries, there is evidence of what people need and what’s feasible. 12 weeks is a modest amount, and anything less is grossly inadequate. The rest of the world, including low-income countries, have found a way to do this, with global averages around 29 weeks for new mothers and 16 weeks for new fathers

The U.S. is one of six countries without any national paid leave Professional opinion: The United States is one of the richest countries in the world — and yet one of only a few countries not to offer some form of paid family leave for new parents. Paid family and medical leave and sick leave can help workers meet their personal and family health care needs, while also fulfilling work responsibilities. Access to paid leave is a particularly salient 4 concern for women, who comprise nearly half of the nation’s workforce and who are often the primary caretaker for children and aging parents. Yet, many U.S. workers do not have access to paid leave time and it’s something that needs to change so we can take better care of our work force. - A. Kaw

Sick Leave Paid sick leave can be used to recover from a short-term injury or illness such as a cold. It is often provided on an accrual basis up to a set number of hours or days per year. On average private sector workers are given seven days 1. https://www.washingtonpost.com/world/2021/11/11/global-paid-parental-leave-us/ 2. Francis E, Cheung H, Berger M. How does the U.S. compare to other countries on Paid Parental Leave? Americans get 0 weeks. Estonians get more than 80. The Washington Post. https://www.washingtonpost.com/world/2021/11/11/global-paid-parental-leave-us/. Published November 11, 2021. Accessed February 17, 2022. 3. https://www.nytimes.com/2021/10/25/upshot/paid-leave-democrats.html

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Natural Disasters ICGH 485 - Spring 2022

Natural disasters have a large impact on societies, in particular the healthcare systems within these societies. Our goal for this monograph is to explore the effects of natural disasters on healthcare systems, with a specific focus on the following subtopics: hurricanes, humanitarian aid, first responders, poor sanitation, spread of disease, and lack of access to proper care.

Sravya Ambadipudi (BSPS candidate) Jenna Munshi (BSPS candidate) Drew Hoogerland (BSPS candidate) Alan Yuan (BSPS candidate) 43

First Responders Jenna Munshi, BSPS candidate

Background

Global Health Issue

The consequences of a natural disaster encompass the entire affected community. The first response to the disaster is often a group of individuals trained to help people, mitigate the results of the disaster, and manage the chaos. These individuals are cleverly titled “First Responders.” Whether it’s fire, hurricanes, floods, earthquakes, or a pandemic, society relies on first responders to protect it from danger.

Countries with a more decentralized Emergency Medical Service (EMS) might have all of the necessary resources to respond to a disaster but lack the organization to properly utilize these resources. Fragmentation – whether it is in the supply chain, delivery, or transport – can prevent a country from achieving an efficient response in the face of disaster. India is an example of a country with a fragmented EMS system. It has no centralized group like the United States’ 911. Rather, it has a variety of different systems, both public and private, that manage emergency services. This fragmentation results in lack of standardized care and protocols, as well as uneven distribution of funding and resources. Decentralization to this effect can indicate that certain regions of the country will be more prepared than others which could potentially lead to overcrowding in the more prepared and wellfunded areas.

People Affected All people are affected by natural disasters, however those in countries with a decentralized EMS system are the most likely to experience negative consequences.

Current Solutions

Current solutions center around centralization of EMS systems. While this is easier said than done, countries can take small steps in the direction of centralization by consolidating resources, mandating training and protocols.

Opinion

I believe first responders are an integral part of natural disaster response. However, their effectiveness can vary depending on the resources and organization of the afflicted country. In the case of decentralized EMS systems, first responders seem less effective overall in helping the population because they have a harder time facilitating rescues. In an organized, centralized EMS system, it’s easier to show effectiveness and allows first responders to act quickly to save a larger amount of people. ~ J Munshi

References: Balikuddembe JK, Fu B, Reinhardt JD. Health care challenges after disasters in lesser developed countries. Oxford Research Encyclopedias. 2019; 10(1093): 9780199389407.013.337. Morgan O, Tidball-Binz M, van Alphen D. Management of dead bodies after disasters: a field manual for first responders. 2009: 03-48. 44

Spread of Disease How do Natural Disasters affect the spread of disease? Natural Disasters such as hurricanes and earthquakes tend to change the way communities live in a short term and drastic method. One such drastic effect of natural disasters is the increase in the spread of disease. This can range from a direct increase in diseases through direct contamination or through other indirect measures. One main method of coping with most natural disasters is to ensure people’s safety through setting up camps where they can move to until the natural disaster in question. These overcrowded camps, although helpful, tend to create a space that is inducive to the spread of diseases. Because natural disasters tend to destroy many communities’ main water supply, most water gets contaminated with fecal material and toxic chemicals leading to an increase in diseases such as cholera whilst forcing there to be a scarce supply of it.

Sravya Ambadipudi (BSPS candidate)

Why is it a Global Issue? Natural Disasters, although different throughout the world, tend to create a similar reaction in communities to maximize survival and minimize casualties. Because most communities tend to utilize the same methods of recovery such as camps which cause disease through a similar method.

Who does this affect? People living in an area which is prone to natural disasters are most affected by this topic because they are most likely to be required to move to camps in order to stay away from the path of the natural disaster. Examples of these places would be Florida where hurricanes or more prominent so an evacuation is necessary for the people living by the coast. Figure shows the average projection of diseases after a natural disaster has occurred in an area. Izumikawa, Koichi. (2018). Infection control after and during natural disaster. Acute Medicine & Surgery. 6. 10.1002/ams2.367.

Efforts that Have been made As most of the spread of disease occurs through camps with the limitations of food and water. Due to this many researchers have considered that an increase in water per person per day along with the management of solid wasted would be able to prevent water contamination and help prevent many vector-borne diseases. They have also determined that along with providing water for everyone, there needs to be an effective and efficient method to disinfect drinking water: chlorine, which is widely available. Another major suggestion made has been vaccination against some of these diseases. One example would be the measles vaccination being done as soon as people start coming to camps being one of the most cost-effective public health interventions in disaster settings. There have been vaccination campaigns for other diseases such as cholera, hepatitis, and tetanus.

What do I think? I believe that the spread of disease through natural disasters is a major problem that is affected by anyone that lives in a natural disaster-prone area which makes it an everlasting problem. There are small changes that have been implemented such as vaccination and access to water that have been able to help with the spread; however, there are still many other factors such as overcrowded camps that increase the spread of disease throughout the camp.

Faye References: Kouadio IK, Aljunid S, Kamigaki T, Hammad K & Oshitani H. (2012) Infectious diseases following natural disasters: prevention and control measures, Expert Review of Antiinfective Therapy, 10:1, 95-104, DOI: 10.1586/eri.11.155 MORROW-JONES, H.A. and MORROW-JONES, C.R. (1991), Mobility Due to Natural Disaster: Theoretical Considerations and Preliminary Analyses. Disasters, 15: 126-132. https://doi.org/10.1111/j.1467-7717.1991.tb00441.x

Figure shows the prevalence of natural disasters throuhout the world between the years of 1995-2015. Weather-related disasters are increasing. The Economist. https://www.economist.com/graphic-detail/2017/08/29/weather-relateddisasters-are-increasing. Accessed April 11, 2022. 45

Contaminated Water & Poo I Sanitatio Spring 2022

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NUTRITION Spring 2022

INTERCULTURAL GLOBAL HEALTH ISSUES

CONRAD SANDER, BSPS student LORDEZ ASAFO-BOAKYE, BSPS student BRITTANY JAMES, BSPS candidate TRANG NGUYEN, BSPS candidate LAUREN DAVIDSON, BSPS candidate

INTERCULTURAL GLOBAL HEALTH & NUTRITION OBESITY Insights on the prevalence of obesity and possible solutions.

Brittany James, BSPS candidate

LUNCH DIABETES Find out different ways to diabetes crisis and Perspective on the incoming revamp your plate. a projection of how it will affect everyday life.

Lauren Davidson, BSPS candidate

MALNUTRITION Reasons for malnutrition and solutions to mitigate the problem.

Trang Nguyen, BSPS candidate

HYPERTENSION Education on hypertension, its nutritional causes, and potential treatment,

Lordez Asafo-Boakye, BSPS student

DISEASE MANAGEMENT Management of chronic diseases caused by insufficient/over-sufficient nutrition.

Conrad Sander, BSPS student

NUTRITION Nutrition is the assimilation by living organisms of food materials that enable them to grow, maintain themselves, and reproduce. Nutrition is related to many aspects of global health issues. Every country suffers from the problems with nutrition. In this publication, we will discuss the different forms of conditions and diseases caused by malnutrition and the management of them. Some of the topics we will be discussing are obesity rates, malnutrition, disease management, hypertension, and diabetes. Globally, all of these topics pose a significant risk to human health. As students in the pharmaceutical science program at Purdue University, we are interested in how these threats impact us globally, and how we can create healthier generations.

PURDUE UNIVERSITY PHRM485 Spring 2022 49

OBESITY BY BRITTANY JAMES

Background

Since 1975, obesity rates have nearly tripled. In 2016, over 1.9 billion adults were overweight and of those, 650 million were obese. Obesity rates are consistently increasing despite it being preventable. In the U.S., 70.9% of men and 61.9% of women are overweight or obese compared to 38% of men and 36.9% of women worldwide.

Global Implications

Prevalence of Adult Obesity: Asia vs the USA Compared to the United States, Asian countries have significantly lower rates of obesity. The highest rates of obesity in Asia are in Thailand and the lowest rates are in India. It is possible that low obesity rates in India are due to cultural traditions of food and/or religion. Prevalences of obesity are rising in Asia due to globalization and urbanization.

30.2%

6.8%

2.2%

USA

Thailand

India

USA: Fast Food and Obesity Rates It is no secret that U.S. obesity rates are rising due to the number of fast-food chains. Not only are these fast-food chains so dominant in society, but they also serve many chemicals that are banned in some other countries because of the implications they have on our health. One example of this is astaxanthin, which is a food dye that gives farm-raised salmon its coral color. It can be hazardous to our health and is banned in Australia and New Zealand, but still approved as safe to use in the U.S.

Socioeconomic Status and Obesity According to a study done by Lindsay McLaren, evidence from different countries including Europe, the U.S., Australia, and Canada, higher socioeconomic groups tended to have healthier diets and less obesity rates. This conclusion is also true for individuals that live in poverty within the U.S.

Ritchie H, Roser M. Obesity. Our World in Data. https://ourworldindata.org/obesity. Published August 11, 2017. Accessed April 11, 2022.

By definition, "obesity" is a condition involving excessive bodily fat. The standard BMI for a healthy adult male and female is between 18.5 and 24.9. Overweight is a BMI between 25 and 29.9. Obesity is a BMI over 30. Despite the controversy behind the metric used for considering patients as overweight or obese, it is still a reference used in medical practices today.

Solutions Consume less processed foods. Engage in exercise every day. Eat more fruits and vegetables. Eat more fiber. Get 7-8+ hours of sleep per day. Focus on reducing stress levels. Consume low-glycemic foods. Contact your doctor to check for hormonal imbalances.

Professional Opinion There are so many factors that may cause obesity. I believe that society is becoming much more stressed with work that our health is not prioritized anymore. Better education on how our daily choices (lack of exercise, excess consumption of processed foods, etc.) have tremendous impacts on our health must be done. Brittany James, BSPS candidate, Spring 2022 Purdue University Fun fact: Some countries in Africa and other regions in the world consider overweight and/or obese individuals as wealthy.

Currently, there are over 400 million people with diabetes worldwide and over 1.9 million deaths per year from diabetes. By 2045 projections show that 700 million people will have diabetes worldwide. And by 2060 they predict that over ⅕ of the U.S population will have diabetes. The majority of those new patients start in childhood. This global health crisis projects a future that affects three main parts of everyday life. ADVERSE EFFECTS: Chronic diseases such as diabetes come with a bevy of side effects that appear and intensify with time. The longer you have diabetes the more likely you are to get adverse effects such as peripheral diabetic neuropathy, cardiovascular disease, or strokes. In the future, as more children get diabetes these effects will increase in prevalence. HEALTH CARE SYSTEM Due to the young patient population, and increasing prevalence of debilitating side effects more patients will be hospitalized for longer. An increased hospitalized population creates a new burden that will increase wait time and prices for medications and therapies.

DIABETES BY LAUREN DAVIDSON BSPS student

JOBS, MONEY, AND THE ECONOMY Finally, individuals' ability to work and provide for themselves will be affected by the increase in diabetes patients. For example out of the 50% that live with painful diabetic neuropathy an estimated 35-43% have their employment status affected, missing upwards of 5.5 days per month due to chronic neuropathy caused by diabetes. SOLUTIONS/Personal Opinion Overall, future diabetes populations will affect all aspects of life worldwide. To combat diabetes obesity, malnutrition, and lifestyle choices, which are further discussed in other articles within this journal, need to be a topic of early education for adults to children. Awareness along with good nutrition options are the key to halting this crisis. - L. Davidson

DIABETES: a chronic disease that affects how your body turns food into energy. Type 1 diabetes is caused by the immune system attacking cells that create insulin. While type 2 diabetes is caused by insulin resistance that is created by an unhealthy diet or obesity. 51

MALNUTRITION BY TRANG NGUYEN

Malnutrition has been a concerned problem around the world with only a few countries can meet the nutrition targets. Accroding to the World Health Organization, malnutrition can be classified into two categories (1) undernutrition (stunning, wasting, underweight) and (2) overweight, obeisty, and diet-related noncommunicable diseases. The most common cause of undernutrition and inadequate vitamins or minerals is the lack of access to food and/or nutritious food due to poverty and geographical constraints. This is especially true in regions such as West and Central Africa and Asia where the prevalence of malnutrition is very high. The consequences are tremendous, including delayed growth, impaired brain function, and even death, without timely intervention. Culture, religion, and social media are other indirect factors resulting in inadequate food intake. In some countries, especially in Asia, there is a strict standard to be considered as a good-looking person with the physical appearance of a slim body and pale white skin. People are obssessed with these standards, believing it to be more admirable and is likely to obtain more opportunities and promotions in life.

Source: 2021 Global Nutrition Report Social media also spreads the image of slim celebrities with a low nutrition diet for the purpose of losing weight in a short period of time. Some even stop eating and drink water for a few days or just have one meal a day to lose weight at a faster speed. As malnutrition becomes a major public health problem in developing countries, many governments and non-profit organizations are donating nutritious food and technology to help people access food more easily. There are also some solutions to address and promote nutritional information in public such as schools' lunch programs and community campaigns. Social media should be used more efficiently to inform people about nutrition and maintain healthy diets. Overall, malnutrition is the inadequate intake of food and it is one's responsibility to make nutritious and healthy food choices. In addition, it is crucial to appreciate and minimize food waste due to food disparity based on geography and economy.

~ T. Nguyen

HYPERTENSION BY LORDEZ ASAFO-BOAKYE

Hypertension, according to the World Health Organization (WHO), is defined as blood pressure levels over 140/90 mmHg. Over a billion adults across the globe struggle with high blood pressure. The condition may be caused by underlying, uncontrollable factors such as old age, family history or preexisting health conditions such as diabetes. Other causes can include a lack of exercise, obesity and high alcohol and caffeine consumption. However, hypertension has causes that relate to poor nutrition.

Potential Complications & Treatment

Nutritional Causes of Hypertension Poor nutritional habits are a major contribution to elevated blood pressure levels. Dietary practices such as high salt intake, eating foods rich in fats (especially unsaturated), and the lack of vegetables and fruits in the diet are all reasons one may develop hypertension.

Numerous complications arise from hypertension, some of which include arrhythmias, myocardial infarctions, and heart failure. Treating and monitoring hypertension is crucial to preventing more concerning health conditions. Hypertension can be prevented or even improved by making simple lifestyle changes such as frequent monitoring, balanced diets, and exercising more. There are also many drugs on the market to treat the condition and prevent any further complications.

Regional disparities A study done by BMC Public Health, suggests that higher prevalence rates of hypertension in the Who Africa region could be due to a major lack of awareness, especially in the elderly. And due to this, people with hypertension may not know how to monitor, treat, or simply know what is causing their condition, or the fact that they even have it. The study concluded that with educating the population and providing treatment, people with hypertension were able to control and properly manage their condition.

Across the Globe Statistics from WHO show that about 1.3B adults around the world have high blood pressure. The WHO region with the highest prevalence of hypertension is the Africa region. The Americas on the other hand, had the lowest prevalence of hypertension within the population at a rate of 18%. The disparity seen in these prevalence rates could be due to differences that may be seen in quality of nutrition and the varying socioeconomic levels.

Opinions In my opinion, hypertension can be easily prevented or even managed with simple lifetsyle changes. Long-term therapies to reduce blood pressure may be costly for some and so making simple lifestyle changes such as reduced sodium diets and exercising regularly could be highly beneficial . 53 LAsafo-Boakye.

DISEASE MANAGEMENT BY CONRAD SANDER

Chronic diseases and complications that stem from from insufficient or oversufficient caloric intake can have major effects on the body's ability to operate and function. Proper nutrition is essential for children's development. If not properly treated, children that are suffering from oversufficiency and undersufficiency of nutrition are at a high risk of developing serious chronic conditions. Learning the ways to manage and prevent these diseases are crucial to living with them.

Oversufficiency Management Diseases and complications associated with excessive nutrition intake include; Obesity Heart Disease and Stroke Type 2 Diabetes Certain Types of Cancers Obesity is the most prevalent of these diseases in the United States. Management of this disease is crucial to prevent further complications through health eating plans, regular physical activity, changing of dietary habits, and (if necessary) weight-loss medicines/surgery. Heart disease and strokes are serious diseases that are common in individuals with poor nutrition habits. To prevent this; monitor blood pressure, manage high cholesterol and triglyceride levels with fish pills and limit alcohol and cigarette use. Type 2 diabetes is another serious disease that can be managed by consuming foods rich in fiber and healthy carbs to keep blood glucose levels steady and monitoring and recording these levels. Certain cancers like colon and uterine can result of an unhealthy diet. Cancers should be managed by treatment using surgery, chemotherapy or radiation therapy. Dietary changes are a challenge for everyone. A study conducted in a rural Peruvian village has shown the difficulty of dietary changes due to cultural and environmental factors.4 These variables must be accounted for when promoting healthy diets.

HIGHEST PERCENTAGE OF CHILDREN UNDER 5 IN THE INDIAN STATE OF UTTAR PRADESH THAT SUFFER FROM MALNUTRITION BY DISTRICT District

Stunted

Underweight

Wasted

Bahraich

52.1%

38%

14.3%

Shravasti

50.9%

40.8%

20.3%

Balrampur

41.1%

37.2%

24.9%

All India

35.5%

32.1%

19.3%

Statistics courtesy of National Family Health Survery of India 2019-2021 http://rchiips.org/nfhs/factsheet_NFHS-5.shtml

Undersufficiency Management Diseases and complications caused by insufficient nutrition that develop from a young age have long-term effects on growth, immunity and psychology.

Marasmus and Kwashiorkor Marasmus and Kwashiorkor are conditions that are mostly found in children and are caused by lack of access to food resulting in severe undernutrition. Marasmus is caused by longterm expenditure of more energy than a person is taking in and results in sever weight loss, dehydration, and diarrhea. Marasmus can be managed by; Rehydration and Nutrition Rehabilitation Gradually Increasing Nutrient Up-Take Kwashiorkor is caused by a protein deficiency and causes stunted growth and swelling of the appendages and stomach. Kwashiorkor can be managed by a treatment plan that starts with an increase of carbohydrates, sugars and fats until the person is stabilized then supplied with proteins.

Professional Opinion If you or someone you know if suffering from a nutrition disorder, please contact your doctor or dietician. These treatments vary and are diet and lifestyle focused. C. Sander 54

SOURCES 1. Obesity. World Health Organization. https://www.who.int/health-topics/obesity#tab=tab_1. Accessed March 29, 2022. 2. Ramachandran A, Chamukuttan S, Shetty SA, Arun N, Susairaj P. Obesity in Asia - is it different from rest of the world. Diabetes/Metabolism Research and Reviews. 2012;28:47-51. doi:10.1002/dmrr.2353 3. Haider S, Thayakaran R, Subramanian A, et al. Disease burden of diabetes, diabetic retinopathy and their future projections in the UK: Cross-sectional analyses of a primary care database. BMJ Open. https://bmjopen.bmj.com/content/11/7/e050058.abstract.Published July 1, 2021. Accessed February 21, 2022. 4. Perez-Leon S, Pesantes MA, Aya Pastrana N, Raman S, Miranda J, Suggs LS. Food perceptions and dietary changes for chronic condition management in rural Peru: Insights for Health Promotion. Nutrients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267004/. Published October 23, 2018. Accessed March 29, 2022. 5. Malnutrition. World Health Organization. https://www.who.int/news-room/factsheets/detail/malnutrition. Accessed March 29, 2022. 6. 2021 Global Nutrition Report. globalnutritionreport.org. Accessed April 10, 2022. https://globalnutritionreport.org/reports/2021-global-nutrition-report/ 7. Nutrition. Encyclopædia Britannica. https://www.britannica.com/science/nutrition. Accessed March 29, 2022. 8. Maddock J. The relationship between obesity and the prevalence of fast-food restaurants: Statelevel analysis. American Journal of Health Promotion. 2004;19(2):137-143. doi:10.4278/0890-117119.2.137 9. McLaren L. Socioeconomic status and obesity. OUP Academic. https://academic.oup.com/epirev/article/29/1/29/433380?login=true. Published May 2, 2007. Accessed March 29, 2022 10. Hypertension. World Health Organization. https://www.who.int/healthtopics/hypertension#tab=tab_1. Accessed March 29, 2022. 11. Hypertension. World Health Organization. https://www.who.int/news-room/factsheets/detail/hypertension. Accessed March 29, 2022. 12. Okello S, Muhihi A, Mohamed SF, et al. Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: A cross-sectional study of seven communities in East and West Africa (sevencewa) - BMC public health. BioMed Central. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09829-5. Published November 13, 2020. Accessed March 29, 2022. 13. Kismul, H., Van den Broeck, J., & Lunde, T. M. (2014, April 15). Diet and Kwashiorkor: A prospective study from rural DR Congo. PeerJ. Retrieved April 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994641/

Research & Development / Technology Jessica Du (BSPS candidate), Zachary Leung (BSPS candidate), Paxton Sample (BSPS candidate), Yuqi Wu (PharmD Student), Aisha Adebisi (BSPS Student) Spring 2022 Background: There are several aspects within research and development that contribute to its growing worldwide issue. This monograph will speciﬁcally focus on the following subtopics: economics, lack of human resources, low success rate, communication, and lack of competition.

Picture?

Economics of Research and Development

US Prices (cont.) The following chart demonstrates the average

amount of money spent, per capita, on pharmaceutical products annually across the top 10 spending nations.

Paxton Sample

Global Economics According to Drug Watch, the United States is the

highest spending nation in drug discovery costs. The ﬁgure below shows the annual spending costs, normalized to the US, that the top seven nations put into the pharmaceutical industry. Furthermore, this trend continues when comparing the average prices people spend on pharmaceuticals in each country. In eight of the top pharmaceutical development countries, there is at least a 50% discount on average drug prices.

Human Economics Importing medication into the USA is illegal. However, given the dramatic difference in drug prices between the US and its neighbors, purchasing medication across the border is seen as some people's only hope. According to the Kaiser Family Foundation, nearly 20 million US citizens import their pharmaceutical products. 8% of Americans are willing to break the law, in many cases out of necessity, to get their medication. A common example revolves around the price of insulin. Buying insulin in the States can cost upward of $3,000 a month. Across the northern border, purchasing the same amount of insulin would come out to around $150. That is 5% of the cost. 5% for something that, for many, is a lifeline.

Comparisons

US Prices An article in JAMA estimates that the average cost of pharmaceutical research in the US is around $1.3 billion. The median value, however, is only around $900 million, indicating a strongly negative skew in the trend. This indicates that a majority of drug research costs somewhere in the billions of dollars range. Likely due to the high price of getting a drug to market combined with the low amount of competition in the pharmaceutical industry, the average American spends over $1000 a year on their medications. This is quite a bit compared to nations like Australia (a 49 on the scale compared to the US) who spend only $400 annually.

Though the US is obviously spending more money on the pharmaceutical industry, there is no “black and white” approach to making drug prices go down. Potential solutions may lie in the comparison between the US and Germany, who spend similar amounts of money on discovery, but whose citizens pay only a fraction of what US citizens do. Major differences include capped copays and a much more involved central government in the actions of hospitals. -PSample

Resources

Terry, M. (2020, March 4). The median drug development cost is $985 million, according to New Study. BioSpace. Retrieved April 11, 2022, from https://www.biospace.com/article/median-cost-of-bringing-anew-drug-to-market-985-million/ Olivier J. Wouters, P. D. (2020, March 3). Research and development costs of bringing a new medicine to market. JAMA. Retrieved April 11, 2022, from https://jamanetwork.com/journals/jama/article-abstract/27623 11#:~:text=Based%20on%20data%20for%2063,estimated% 20to%20be%20%241336%20million.

Lack of Human Resources Zachary Leung (BSPS candidate)

Background + Affected groups: Pharmaceutical and medical research and development requires not only funding but also skilled and well-educated human resources. More developed and wealthier countries have more human resources, enabling them to better conduct research. The factors behind this global disparity in skilled human resources are two-fold: the limited capacity and number of institutions for higher education, as well as the ﬂight of human capital to more developed nations.

Human Capital Flight

In developing nations, healthcare and research spending is heavily linked to GDP. Hence, as developing nations grow, so should their healthcare and research spending, which should result in an increase of trained professionals. Instead, the opposite is seen, with the number of trained professionals in developing countries often decreasing instead. This is because of human capital ﬂight. Human capital ﬂight, commonly known as ‘brain drain’, is an economic phenomenon where individuals who receive advanced training in their home country often emigrate to another country.

Disparity in Training Capacity Above is a map of countries that often experience brain drain.2 Some, like Cuba and India, train more professionals than they can employ. Human capital flight is a benefit for them, allowing them to trade unneeded human capital for a steady stream of financial capital from their expatriates.

Above is a graphical representation of how the world’s top training institutions are distributed. Parts of South America, Central Asia, MENA, and most of sub-Saharan Africa have a relative dearth of high-ranking universities.1 This results in a deﬁcit of highly trained professionals, a major contributing factor in their relative lack of research capability and output. While still capable of training a limited number of professionals, they do not possess the training facilities to develop human capital on a scale that allows them to be competitive, and thus, globally relevant. Potential solutions: None. Medical and research investments are tied to GDP. Hence, the only way to increase training capacity with current funding levels would be by reducing training quality. Sources: 1.

2. 3.

Al-Shamsi M. Addressing the physicians' shortage in developing countries by accelerating and reforming the medical education: Is it possible?. J Adv Med Educ Prof. 2017;5(4):210-219. Udonwa NE. Human capital ﬂight challenges within an equitable health system. Niger J Med. 2007;16(4):307-311. doi:10.4314/njm.v16i4.37327 Castro-Palaganas E, Spitzer DL, Kabamalan MM, et al. An examination of the causes, consequences, and policy responses to the migration of highly trained health personnel from the Philippines: the high cost of living/leaving-a mixed method study. Hum Resour Health. 2017;15(1):25. Published 2017 Mar 31. doi:10.1186/s12960-017-0198-z

Likewise, wealthy countries like the USA, Canada, and the UK are a common destination for trained professionals. This phenomenon is termed brain gain. These developed countries have a high demand for trained professionals, and suffer from a chronic skilled human capital deficit. Human capital flight is a benefit for these nations, as it allows them to obtain skilled human resources without having to invest in the training of additional professionals. However, for developing countries that already have a deficit of trained professionals, human capital flight is purely detrimental. These countries have limited training capabilities, so the lost of their scarce professionals harm them greatly. Training of new professionals is an expensive and lengthy investment, and the frequent emigration of their freshly trained talent means they see little return on this. This further disincentivizes further investments in education, resulting in even fewer trained professionals.3 Potential solution: None. Since developing nations do not possess the economic strength to offer their professionals better terms than developed countries, short of unethically restricting the movements of their trained professionals, they have no way to stop their lost of human capital.

Professional Opinion: There is no ethical and plausible way to change the human resource disparity between countries other than increasing national economic strength. Hence, such countries will need to endure their lack of human resources for the foreseeable future. -Zachary Leung

Low Success Rate Yuqi Wu (PharmD Student)

Grant success rates in different countries and discipline: ●

●

● ●

UK: success rates for grants are between 22% (medical) to 38% (physical). US: success rates in 2015 of 19%, which includes small grants for early career younger researchers, which inflate success rates. Germany: success rates around 35% for all disciplines. China: The 2015 data shows success rates of more than 20%-30%.

Main reasons for development termination for Pharmaceutical R&D: ● Of drugs that were not approved, 56.7 were not approved due to lack of efficacy, 17.2% due to lack of safety, and 21.5% for commercial reasons. ● Commercial reasons were significantly more likely to be the cause of failure for small and medium sized enterprises Who should care about this problem? Everyone works in scientific research-related industries.

Professional suggestions: a. Conduct pre-investigation on main funding trends. b. Enhance knowledge sharing globally. c. Increase the use of computer simulations to improve the efficacy of all phases of drug development. ~ Y. Wu References: 1. Ch7: success rates. The science monster. http://thesciencemonster.com/book/chapter-11-funding-science/ch7-suc cess-rates/. Accessed April 11, 2022. 2. R&amp;D time and success rate. Knowledge Portal. https://www.knowledgeportalia.org/r-d-time-success. Accessed April 11, 2022. 3. Drug approvals - from invention to market...12 years! MedicineNet. https://www.medicinenet.com/script/main/art.asp?articlekey=9877. Accessed April 11, 2022.

●

In 2019, the pharmaceutical industry spent $83 billion dollars on R&D. Adjusted for inflation, that amount is about ten times what the industry spent per year in the 1980s. It takes an average of 12 years for an experimental drug to travel from the laboratory to market. Only five in 5,000 drugs that enter preclinical testing progress to human testing. One of these five drugs that are tested in people is approved. The chance for a new drug to actually make it to market is thus only 1 in 5,000. 59

Communication Aisha Adebisi, BSPS student

Ways pharmaceutical companies can collaborate with others

Background Information

Drug discovery and development process is challenging and timeconsuming, that can take between 10-15 years and costs hundreds of millions of dollars. The best way for the development of novel therapeutics is the collaboration of various industries such as academia, industry, and government, which will enable scientists with better research tools enables them to move toward breakthroughs faster. The Value of Collaboration ❏

❏

Academia:collaboration provides financial backing from pharma which allows them to do impactful work Industry:collaboration allows pharma companies to fill gaps in their portfolio at lower cost and risk Global: Collaboration, allows industry to fill in the gap for the absence of drugs to treat diseases that are predominantly found in low- and middle-income countries[1]

Source:https://www.sanofi.com/en/science-and-innovation/stories/the-v alue-of-industry-academic-collaboration

Potential Solutions ❏

❏

Mutual understanding in collaborative agreements is often an issue, hiring leaders from the academic sector into industry and vice versa can help tackle this issue Establishing trust should lead to a greater sharing of data, which can be facilitated by new digital-access tools Flexibility and a willingness to change practices to adapt to what is required is also key in these collaborations and will lead to greater returns for partners[2]

Professional Opinion There needs to be continued collaboration between various industries to have more efficient and less costly drug pipelines and develop new treatments with high unmet medical need. ~A Adebisi References:

https://www.meijo-u.ac.jp/english/research/collaboration. html

[1]Pedrique B, Strub-Wourgaft N, Some C, et al. The drug and vaccine landscape for neglected diseases (2000-11): a systematic assessment. Lancet Glob Health. 2013;1:e371–79. •• Provides concrete data to show the bias against developing new treatments for neglected diseases See Congressional Budget Oﬃce, Prices for and Spending on Specialty Drugs in Medicare Part D and Medicaid(March 2019), www.cbo.gov/publication/54964. [2] WHO (2020), ACT-Accelerator: Status Report & Plan, September 2020 – December 2021, World Health Organization, Geneva, https://www.who.int/publications/i/item/act-accelerator-status-report-plan.

Lack of Competition Jessica Du

Competition is what drives companies against one another to work towards their individual goals and innovations. Without it, companies are not as compelled to attack certain developments. Big pharma companies throughout the world act as monopolies, are overpowering, and do not allow smaller companies to accomplish innovations. This lack of competition leads to big pharma controlling almost all aspects of the pharmaceutical industry. A predominant example being high prices of medications.

Drug companies use their power and set their own prices and increase them at any particular point on lower-cost, generic drugs. These companies take total advantage of government regulations and operations to block competition and keep prices from falling. Methods to prevent competition: - Patent protection: gaining a patent by remarketing an already existing drug (a patent-extending maneuver). - Pay-for-delay agreements: large companies will pay off a generic competitor, pushing them to let go of a patent and take their cheaper product off the market.

Next Steps: - The FDA created a policy to make reviewing applications for generic drugs quicker, especially for drugs that have limited competition. - Ongoing challenges against pay-for-delay agreements and methods companies use to delay the production of generic drugs. Professional Opinion: More policies need to be made to allow more competition and prevent big pharma companies from further overpowering the industry. 〜J Du References: 1.

Miller, E. (n.d.). Big Pharma's block on competition a bad prescription for U.S. drug prices. Drugwatch.com. Retrieved April 11, 2022, from https://www.drugwatch.com/featured/big-pharmas-competitionblock/ 61

SANITATION

Group 9:

Connor Emsley, BSPS Student Bridget Fitzgerald, PharmD Student Lingwei Lyu, BSPS Student Chloe Sullivan, BSPS Student

Background Information

Our topic is the issue of sanitation. We will be explaining what sanitation is, why it is important, and why lack of sanitation can be a major global health issue. Our issue will be divided into four subtopics: history of sanitation, sanitation laws/standards, compliance to sanitation, and cleanliness perceptions. We will be comparing sanitation in four different countries from around the world (United States, Brazil, India, Switzerland) to explore cultural differences regarding sanitation.

Current State of Sanitation Bridget Fitzgerald

WHAT IS THE HISTORY OF SANITATION AND WHO DOES IT AFFECT?

Sanitation is a human right recognized by the United Nations. Poor sanitation is highly associated with diseases that are transmitted through the fecal-oral route. Currently, there are 4.2 billion people using sanitation services that leave human waste untreated and there are 673 million people having no toilets and practicing open defecation.

United states

The Joint Monitoring Program (JMP) collects and reports national-scale data on water and sanitation across countries. The JMP uses the American Housing Survey (AHS) to estimate national water and sanitation access. This data excludes people experiencing homelessness, so national statistics overestimate access to water and sanitation in the US. Additionally, adequate sanitation facilities are lacking for approximately 38,000 American Indian and Alaska Native homes (or 9.5%). Of these homes, approximately 7,100 (or 1.8%) lack access to a safe water supply and/or waste disposal facilities, compared to less than 1% of homes for the U.S. general population. Despite most Americans having access to sanitation, there are still high incidences of diseases that are transmitted fecal-orally.

Brazil

Currently, there are more than 1.2 million people without access to safe water. According to a 2018 survey by the National Sanitation Information System, only 83% of Brazilians have water distribution services while about 50% enjoy sewage collection and treatment services. Between 2010-2014, a total of 13,929 hospitalizations occurred due to diseases associated with poor sanitation in the metropolitan region of Porto Alegre. 93.7% of these cases were related to fecaloral transmission. Hospital fatality rate was 2.2%, with fecal-oral transmission diseases were the main causes of death.

India

In 2019, approximately 450 million people had no access to toilets. The risk of spreading diarrheal and waterborne diseases is increased by the lack of regular handwashing and microbial contamination of water in their homes and communities. The situation has led to nearly 100,000 diarrheal deaths of children under five years in India.

National Outbreak Reporting System (NORS). https://wwwn.cdc.gov/norsdashboard/. Published February 4, 2022. Accessed March 27, 2022.

Switzerland

Switzerland has a well-developed network of waste management facilities. Virtually every region possesses the infrastructure required in order to dispose of its own wastes. There are over 2,500 water suppliers in Switzerland, most of which are municipally organized.

Odagiri M, Schriewer A, Daniels ME, et al. Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage. Water Research. https://doi.org/10.1016/j.watres.2016.05.015. Published May 4, 2016. Accessed March 27, 2022.

Professional/Personal Opinions

There needs to be a greater emphasis placed on the importance of sanitation in America, and in other countries across the world. The prevalence of preventable diseases can be decreased if access to clean water, toilets, and sanitation were more readily available. - BFitzgerald 63

Sanitation Laws & Standards Chloe Sullivan

Legality of Sanitation

Sanitation refers to public health conditions involving clean drinking water and human waste disposal. Depending on the country, organizations responsible for sanitation may also provide services such as trash pickup, street cleanup and maintenance, water resource management, and more. Laws regarding sanitation are put into practice because without a legally enforceable set of standards for public cleanliness, contamination of drinking water or improper disposal of human waste could easily occur without detection and result in detrimental health consequences for the general public.

United states There is no central organization responsible for sanitation in the United States; it is up to local city governments to provide these services to citizens. However, the Safe Water Drinking Act allows strict standards regarding the concentration of several different contaminants in drinking water in the United States to be defined and legally enforced by the EPA, a national organization.

India

WHOM DOES IT AFFECT

Poor sanitation is highly associated with diseases that are transmitted through the fecal-oral route. Currently, there are 4.2 billion people using sanitation services that leave human waste untreated and there are 673 million people having no toilets and practicing open defecation.

Switzerland

The Federal Office of Public Health (FOPH) is responsible for management of clean drinking water in Switzerland. Similar to the other countries listed, the FOPH sets strict standards regarding the legally allowed amount of contaminants present in drinking water that render it safe to drink. In its Agricultural Policy 2022, the Swiss government discussed methods to treat water that does not meet the standards, but the public has complained that the measures taken are not enough, and stricter action needs to be taken to maintain safe, clean drinking water throughout the country.

Brazil

The Bureau of Indian Standards (BIS) is responsible for ensuring water quality in India. Like the EPA in America, the BIS lists acceptable limits of contaminants present in drinking water, and if water does not meet these standards, action is taken to fix the problem. However, the BIS lists much less requirements than the EPA, and even with less criteria to meet, Mumbai is the only city where all tap water meets these requirements.

The ANA (National Water Agency) is responsible for all basic public sanitation in Brazil. In 2020, a new law was introduced that redefined the basic framework of sanitation in Brazil. The central aim of this law was to ensure that 99% of households in Brazil have access to clean, safe drinking water and 90% of households have access to working sewage by 2033. This law allows public drinking water to be completely standardized and regulated by the government.

Professional/Personal Opinions Sanitation laws involving quality standards for drinking water and waste disposal are extremely necessary for maintaining health of the general public, since water-borne contaminants and organisms in biowaste can lead to easily spreadable deadly diseases. However, although these laws are technically in effect, in many countries, they are not being followed, and health problems result. Governments should put more effort and resources into enforcement of water 64 and waste laws to ensure public health. - CSullivan

Sanitation Compliance Connor Emsley

WHAT IS Sanitation Compliance? Sanitation compliance is how a society carries out regulations and recommendations regarding sanitation. A government or organization can put rules and guidelines in place, this is only impactful if they are followed accordingly. Many aspects can play into a society’s sanitation compliance, including education, cultural practices, availability of resources, and more. In most cases, multiple aspects will influence how a population views and practices sanitation on a daily basis, which therefore impacts their overall health.

WHO IS IMPACTED? Although compliance to sanitation is of global importance, countries with limited access to sanitation resources are at most risk for harm. According to the CDC, 2.3 billion people lacked basic hygiene services to wash their hands with soap and water in 2020. Although hand washing may not initially sound like a global health issue, the CDC estimates that regular hand washing could reduce deaths from diarrheal disease by 50% and prevent over 1 million deaths a year. Although this is easy to do in the United States, this is not true across the globe. For example, only 61% schools in Brazil and 54% of schools in India have access to basic hygiene per Unicef. On top of a lack of availability, hygiene awareness remains low in many of these places as well. According to a 2016 study among residents in Southern, rural India, only 33.7% of those sampled were aware that sanitary latrines help protect against disease transmission while 41% were aware that using soap while washing hands helped protect against disease. Without proper awareness, people

CURRENT EFFORTS As of 2010, access to safe, clean drinking water and sanitation are recognized as human rights by the UN General Assembly. Today, WHO leads the global effort to improve sanitation practices and education. Unicef has also been a major player, advocating for and spreading awareness of the importance of water, sanitation, and hygiene (WASH). Unicef maintains operations in over 100 countries to expand clean water use, reliable sanitation, and basic hygiene practices. Aside from direct action, Unicef also runs media campaigns and provides direct funding to schools. With education and basic sanitation resources, huge steps can be made to increase sanitation compliance throughout the world.

Professional/Personal Opinions Sanitation is an extremely important part in any society, regardless of a country's wealth. Of course sanitation has increased importance when acting as a defense against deadly diarrheal diseases in locations with limited access to healthcare, but the COVID pandemic has highlighted the importance of sanitation in all settings. In the US, although access to sanitation remains high, an informal poll surveying 24,000 adults showed that only 58% always wash their hands with soap after using the bathroom. Although there are many problems with sanitation globally, it is important to practice what we preach and stay clean at home. - C. Emsley

Cleanliness Perception Lingwei Lyu

WHAT IS CLEANLINESS PERCEPTION? Cleanliness perception refers to how people view cleaning, disinfecting, and proper hygiene. This gives an assessment of how important sanitation is to people with diverse cultures, do they view sanitation as a critical factor? The global scale for cleanliness is the EPI (Environmental Performance Index) which provides a data-driven summary of the state of sustainability around the world.

Whom does it affect? Cleanliness perceptions of different countries will be assessed. These are public perceptions, anyone who lives in that particular country will both have an effect and also be influenced by it.

United states - EPI: 69.3 For self and home hygiene, 92% of Americans say maintaining good hygiene is a top priority. For public hygiene, cleanliness serves as a determinant of service experience, and it interferes with the customer's satisfaction with a place (hotels, malls, etc). Hotel guests rank bathroom and toilet cleanliness as the most important factor; the exterior and interior of the restaurant, along with eating utensils are the top factors to consider when dining out. Hospital cleanliness is an important factor in public perceptions. Patients' and visitors' assessments are based on a mixture of tangible and less tangible factors relating to the physical environment, behavior of staff and other people, and organizational structures. In 2008, 18% of people had concerns about the cleanliness of hospitals.

https://worldpopulationreview.com/country-rankings/cleanest-countries-in-the-world

Brazil - EPI: 51.2

Switzerland - EPI: 81.5

Cleanliness plays an important role for Brazilians, the time spent on cleaning and personal hygiene is correspondingly high. However, currently, there are more than 1.2 million people in Brazil who lack access to safe water, and 20 million without access to improved sanitation. This results in high rates of infant death mortality and hospitalizations of adults and children. There are several issues proposed by the public perception: Inadequate knowledge of the water supply. Poor channels of communication between the community, the water and sanitation service, and the local public health authority.

In 2022, Switzerland ranked as the 3rd cleanest country in the world. Switzerland scored exponentially high for both drinking water quality and sanitation, it also reached a perfect score on Species Protection Index. Unlike other countries, Switzerland puts more effort into the investment in sanitation rather than lower production of waste. This decision did produce a positive impact on the environment, but it also brings negative aspects according to public perceptions. 85% of people were complaining about littering, packages and cigarettes were found on the ground. The size of the trash bin is too small, and tourism just brought more burden to littering, according to the public survey.

India - EPI: 27.6

Professional/Personal Opinions

India is a multi-religion country, most cleanliness and modesty are limited exclusively to religious activities and cooking. Sanitation and cleanliness were not the top considerations in India. People keep their homes clean, but the public areas such as roads and parks tend not to be their concerns. Street foods and open markets create concerns for food quality as well. Unsafe drinking water, poor access to adequate sanitation facilities, and inadequate handwashing are major causes of global childhood disease and death The Clean India Mission (aka Swachh Bharat Abhiyan) was started by the Indian government on October 2nd, 2014. The objectives of SBA include elimination of open defecation, eradication of manual scavenging, modern and scientific municipal solid waste management, and bringing positive behavioral changes regarding healthy sanitation practices.

We can compare the public perceptions of the four countries and analyze that countries with high EPI tend to have more regulation and education on cleanliness and people have more access to sanitation; for countries with low EPI, access to clean water and no awareness of public hygiene are the most important issues. In my personal opinion, the community and the local public health authorities should work together to educate people about the importance of cleanliness and provide sanitation resources to the local public. Especially in rural areas, people tend to have less awareness of hygiene. In addition, a governmental mission similar to SBA in India is also a great way to improve the living environment. Again, different countries have different cultures and environmental conditions, one solution may not fit all. We need to find the most suitable one. -LLyu

References 1. Brazil's water crisis - water in Brazil 2021. Water.org. https://water.org/our-impact/where-we-work/brazil/. Accessed March 27, 2022. 2. Capone D, Cumming O, Nichols D, Brown J. Publication loaded Water and Sanitation in Urban America, 2017–2019. American Journal of Public Health. https://doi.org/10.2105/AJPH.2020.305833. Published September 9, 2020. Accessed March 27, 2022. 3. Mergermarket. Brazil's new sanitation bill to draw domestic and foreign private investment. Forbes. https://www.forbes.com/sites/mergermarket/2020/07/14/brazils-new-sanitation-bill-to-draw-domestic-and-foreign-privateinvestment/?sh=9ed04c74ef01. Published July 14, 2020. Accessed March 27, 2022. 4. National Outbreak Reporting System (NORS). https://wwwn.cdc.gov/norsdashboard/. Published February 4, 2022. Accessed March 27, 2022. 5. Odagiri M, Schriewer A, Daniels ME, et al. Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage. Water Research. https://doi.org/10.1016/j.watres.2016.05.015. Published May 4, 2016. Accessed April 7, 2022. 6. Safe water and waste disposal facilities: Fact sheets. Indian Health Service. https://www.ihs.gov/newsroom/factsheets/safewater/. Published May 2021. Accessed March 27, 2022. 7. Santiago Siqueira M, dos Santos Rosa R, Bordin R, de Cássia Nugem R. Hospitalizations due to diseases associated with poor sanitation in the Public Health Care Network of the metropolitan region of Porto Alegre, Rio Grande do sul state, Brazil, 20102014. Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil. https://pubmed.ncbi.nlm.nih.gov/29211143/. Published March 6, 2017. Accessed March 27, 2022. 8. Waste management - United Nations. Waste Management. https://sustainabledevelopment.un.org/content/documents/dsd/dsd_aofw_ni/ni_pdfs/NationalReports/switzerland/waste.pdf . Accessed March 27, 2022. 9. WATER QUALITY. WATER FOR WATER (WfW). https://wfw.ch/wasserwissen/wasserqualitaet-schweiz#/. Accessed March 27, 2022. 10. Water, sanitation and hygiene. Strengthening sustainable WASH programming. https://www.unicef.org/india/what-wedo/water-sanitation-hygiene. Accessed March 27, 2022. 11. National Primary Drinking Water Regulations. EPA. https://www.epa.gov/ground-water-and-drinking-water/national-primarydrinking-water-regulations. Published January 26, 2022. Accessed March 29, 2022. 12. Yoshikawa LF, de Carli Rosellini C. Brazil's Basic Sanitation Regulatory Framework. International Bar Association. https://www.ibanet.org/article/90EB44B0-5346-4E00-993F-2DE6543708D7. Accessed March 29, 2022. 13. Bureau of Indian Standards. Central Ground Water Board (CGWB). Central Ground Water Board, Ministry of Water Resources, RD &GR Government of India. http://cgwb.gov.in/wqstandards.html. Published 2015. Accessed March 29, 2022. 14. FOEN, FOPH. Reporting for Switzerland under the Protocol on Water and Health. UNECE. https://unece.org/DAM/env/water/Protocol_reports/reports_pdf_web/Switzerland_summary_report_en.pdf. Accessed March 30, 2022. 15. Handwashing data to inform the COVID-19 response. UNICEF DATA. https://data.unicef.org/resources/handwashing-data-covid19- response/. Published August 3, 2021. Accessed March 29, 2022. 16. Hygiene fast facts. Centers for Disease Control and Prevention. https://www.cdc.gov/healthywater/hygiene/fast_facts.html. Published November 30, 2021. Accessed March 29, 2022. 17. Reinhart RJ. How often do people wash their hands during a pandemic? Gallup.com. https://news.gallup.com/poll/348725/often-people- wash-hands-during-pandemic.aspx. Published November 20, 2021. Accessed March 29, 2022. 18. Sanitation. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/sanitation. Accessed March 29, 2022. Veerapu N, Subramaniyan P, Praveenkumar BA, Arun G. Promotion of sanitation and hygiene in a rural area of South India: A community-based study. J Family Med Prim Care. 2016;5(3):587-592. doi:10.4103/2249-4863.197305 19. Vos, M., Galetzka, M., Mobach, M., van Hagen, M. and Pruyn, A., 2019. Measuring perceived cleanliness in service environments: Scale development and validation. International Journal of Hospitality Management, 83, pp.11-18. 20. Whatley, V., Jackson, L. and Taylor, J., 2012. Improving public perceptions around cleanliness and health care associated infection in hospitals (service improvement). Journal of Infection Prevention, 13(6), pp.192-199. 21. Srivastava, R., Pradhan, D., Sharma, L., Singh, O., Gupta, S. and Mukherjee, S., 2020. The perception of Swachh Bharat Abhiyaan and attitude towards cleanliness among dental students of Kanpur city: A cross-sectional study. Journal of Family Medicine and Primary Care, 9(4), p.1904.

SPRING 2022

SOCIAL DETERMINANTS OF HEALTH BACKGROUND INFORMATION

Social determinants of health can be defined as the conditions in the environments where people are born, live, learn, and work that affect a wide range of health, functioning, and quality-of-life outcomes and risks. These can be broken into the five following domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. CAMILLE GOENAWAN, BSPS CANDIDATE MACKENZIE MILLER, BSPS CANDIDATE ALYSSA MULHALL, BSPS CANDIDATE CLIFF TSOU, BSPS CANDIDATE JUSTIN YOUNG, PHARMD STUDENT 68

ECONOMIC STABILITY CAMILLE GOENAWAN

BACKGROUND

Economic stability is one of the main social determinants of health as lower stability tends to correlate with poorer health. People with steadier incomes are less likely to live in poverty, so they are more likely to be able to afford basic necessities and therefore are more likely to live healthier lives. Poverty is not only a national issue, but a global issue that, according to the US Department of Health and Human Services, has yet to see much change.

SOCIOECONOMIC STATUS

One factor that contributes to economic stability is socioeconomic status. The factors that contribute to socioeconomic status are family income, parents’ education levels, and parents’ occupational prestige. Lower socioeconomic status tends to correlate with poorer health as these people are less likely to be able to afford necessities, such as healthcare and nutritious foods. Chetty R, Stepner M, Abraham S. Association between income and life expectancy in the United States. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2513561. Published April 26, 2016. Accessed March 26, 2022.

FOOD SECURITY

As mentioned before, areas suffering from chronic poverty have higher rates of malnutrition; people who are not as economically stable don’t tend to have access to nutritious foods. According to a study done in 2020, inadequate food intake and poor dietary quality were directly or indirectly responsible for physical health problems in 2015.

SOLUTIONS

There are many factors that contribute to or are affected by economic stability that correlate with health such as socioeconomic status, nutrition and food security, and education availability. In order to properly address this issue, various employment programs, career counseling services, and child care centers were made available for people to be able to find stable jobs and careers to support themselves and their families.

Artiga S, Hinton E. Beyond health care: The role of Social Determinants in promoting health and health equity. KFF. https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-healthcare-the-role-of-social-determinants-in-promoting-health-and-health-equity/. Published July 9, 2019. Accessed February 17, 2022. Siddiqui F, Salam RA, Lassi ZS, Das JK. The intertwined relationship between malnutrition and poverty. Frontiers. https://www.frontiersin.org/articles/10.3389/fpubh.2020.00453/full. Published January 1, 1AD. Accessed February 17, 2022.

OPINION

In my personal opinion, economic stability is a complex topic that affects a lot of different aspects of health that can be overlooked. When perfect, healthy lifestyles are depicted on social media, we can often forget how unattainable that lifestyle is to most. However, everyone should have a fair chance at good health, and a big aspect of someone’s lifestyle is their income and economic stability. -C Goenawan

EDUCATION ACCESS & QUALITY

ALYSSA MULHALL

BACKGROUND Education is a domain of social determinants of health because it has been shown that people with higher levels of education are more likely to live longer and healthier. The impact education has on a person’s health is one that some people don’t usually think about but is an important component we need to consider. Education helps people to be better informed about how to take care of their health as well as placing them in better financial circumstances to be able to access quality health care.

POSSIBLE SOLUTIONS There are links between children receiving a good education from a young age and the impact that has on their health. Multiple studies show how early education and early childhood programs in school can help foster physical and mental development and health. Without these health resources and teacher support, children have poorer health with tendencies to participate in unhealthy behaviors at a younger age, showing that educational opportunities earlier in life have lasting effects on health throughout adulthood. The completion of high school can also serve as a health indicator. There are links between dropping out of high school and poor health, with those who do not graduate high school reporting to have at least one chronic health condition or even premature death. School programs need to be implemented to help engage and encourage students to stay in school and graduate. Higher education plays a big role in a person’s health because having a college education is associated with greater health benefits. With increasing levels of college education, people are less likely to die from illnesses like cancer and cardiovascular disease, with them reporting better health compared to high school graduates. Education also prepares people to be able to analyze information and manage complex problems, with the critical skills needed to navigate today’s complicated healthcare system. Limited health literacy and limited general literacy can prevent people from learning about health, using medications properly, and taking advantage of preventative services. Someone with poor literacy may have difficulty evaluating and applying explanations from their doctors about how to manage their condition. With language, limited English proficiency also creates similar barriers as limited literacy does with people not being able to communicate with or understand what their doctors are telling them. Health care providers and organizations need to develop and use methods that will help diverse populations understand and make good decisions about their health.

PERSONAL OPINION Education plays a huge role and impact on a person’s health, with helping to provide them with resources and knowledge needed in order to have a healthier lifestyle. They are also able to have a better understanding of the different aspects that can play a role in their health and how to manage and utilize those aspects to improve their health. -A Mulhall

Education as a Social Determinant of Health. Social Determinants of Health: Education is Crucial. https://publichealth.tulane.edu/blog/social-determinant-of-healtheducation-is-crucial/. Published January 27, 2021. Education Access and Quality. Education Access and Quality - Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/educationaccess-and-quality. 70

HEALTH CARE ACCESS & QUALITY BACKGROUND INFORMATION

CLIFF TSOU

Healthcare access and quality is the third domain in the social determinants of health. There are differences in the coverage of healthcare depending on the location, this can determine whether an individual can be eligible to receive healthcare, and what preventative measures the healthcare plans are capable of providing. This location difference can also account for the difference in education and knowledge of healthcare plans available to them. Healthcare coverage is a global issue, especially in areas of poverty, and especially when universal healthcare is not available in the region. A clear example of the difference in healthcare coverage can be seen by the difference in healthcare policies in different countries. Simply put the major difference in the current healthcare system in developed/developing areas are determined by whether or not the healthcare policies established are universal. Universal Healthcare classic examples include Taiwan, and Germany where health insurance comes in the form of a social insurance plan that is affordable by all citizens. Brazil as of 2021 is the only nation where anyone under Brazilian jurisdiction can receive free healthcare. Currently, the United States is one of the major developed countries without universal coverage, 91.4% coverage by 2020, according to the Census. However this is not to say universal healthcare is superior in any way as it does have its backlashes. This is where the quality of the healthcare comes into play, though coverage might be important in providing more individuals with healthcare, if policies do not cover certain criteria it is still rendered useless in improving life expectancy. A 2018 study titled, “Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries,” showed there are still significant deaths due to preventable causes despite universal coverage.

SOLUTION There is currently a plausible solution on the way that could potentially be a one-in-all solution to all the healthcare systems in the world and that is the establishment of Universal Health Coverage (UHC). This healthcare system is meant to be the “grand convergence” in global healthcare. The establishment of this system would then lead to universal reduction in deaths of healthcare preventable causes. However, currently, the establishment of this system is halted by the prevalence of COVID-19, and other regional matters such as finances in different countries and how quickly countries can prioritize and strengthen their health delivery systems.[2] It is also predicted that by 2035, a general framework of such an establishment could be achieved.

PERSONAL OPINION In my opinion I think Healthcare Access and Quality is definitely one of the most important aspects when it comes to social determinants of health, as it shows on a much greater scope, how deaths can be avoided. I also think the potential establishment of a universal health coverage system could be greatly beneficial especially in countries with lower income with poor healthcare qualities. -C.Tsou

[1] Kruk ME, Gage AD, Joseph NT, Danaei G, GarcíaSaisó S, Salomon JA. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries [published correction appears in Lancet. 2018 Sep 20;:]. Lancet. 2018;392(10160):2203-2212. doi:10.1016/S0140-6736(18)31668-4 [2] Mao W, Ogbuoji O, Watkins D, et al. Achieving global mortality reduction targets and universal health coverage: The impact of COVID-19. PLOS Medicine. 2021;18(6):e1003675. doi:10.1371/journal.pmed.1003675

NEIGHBORHOOD & BUILT ENVIRONMENT JUSTIN YOUNG

BACKGROUND Environmental health, transportation barriers, and location are social determinants of health. In regard to location, poor housing conditions are associated with a wide range of health conditions, including respiratory infections, asthma, lead poisoning, injuries, and mental health. Sanitation is a critical component of health. The Alma Ata declaration stated that primary health care is the key to attaining health for all. The Declaration of Alma Ata in 1978 emphasized the importance of primary health care and included “an adequate supply of safe water and basic sanitation” as one of its eight key elements.

GLOBAL ISSUE Poor sanitation is linked to transmission of diseases such as cholera, diarrhea, dysentery, hepatitis A, typhoid and polio and exacerbates stunting. The diseases associated with poor sanitation are particularly correlated with poverty and infancy and alone account for about 10% of the global burden of disease.

WHO IS AFFECTED? Inhabitants of low-income urban regions were on average closer to general acute care, educational institutions, and mental hospitals than residents of high-income urban areas. In suburban and rural locations, however, the difference in median distances between teaching, children, and mental institutions was significant (ranging from 15.6 to 30.7 miles). A CDC report from 2015 also supports the date that there is an inequality in access to health care based on the environment. “Rural counties had higher infant, neonatal, and post neonatal mortality rates than large urban counties.” These health deserts cause inequalities in access to health care.

SOLUTION Safe housing contributes to the federal government’s efforts to prevent and end homelessness programs like Housing and Urban Development-VA Supportive Housing (HUD-VASH) which helps veterans .The solution to improve sanitation in developing countries involves education of effective handwashing interventions and promoting long-term behavior changes. One solution for this disparity is through Telehealth. It makes it possible for rural patients to see specialists in a timely manner while staying in the comfort of their home or local facility.

PERSONAL OPINION Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013;38(5):976-993. doi:10.1007/s10900-013-9681-1 Ely DM, Hoyert DL. Differences Between Rural and Urban Areas in Mortality Rates for the Leading Causes of Infant Death: United States, 2013-2015. NCHS Data Brief. 2018;(300):1-8.

In my opinion, adequate sanitation, together with good hygiene and safe water, are fundamental to good health. I believe that education is the most effective way to improve sanitation. - J. Young 72

SOCIAL & COMMUNITY CONTEXT BACKGROUND INFORMATION The last domain involved in the social determinants of health is the social and community context in a person’s life. Social and community context can be defined as the relationships and interactions people share within their communities. These relationships can have a major impact on a person’s well-being and health. There are negative and positive relationships in everyone’s life within their community. Sometimes the negative relationships in a person’s life cannot be controlled. Some examples of these negative relationships that cannot be controlled include growing up in unsafe neighborhoods and absent parents because of drug use, abandonment, or prison. Other examples of negative relationships include discrimination and bullying. This can occur in a local area like at a park or community center or these can even occur in a space such as a school or church or workspace.

PERSONAL OPINION The relationships a person builds within their community are important aspects for their health. Negative and positive relationships have a lasting impact on a person for their life. In my opinion, it is important to understand the different types of relationships and the ways to build more positive relationships in the community and help those stuck in negative relationships. ~ M Miller

MACKENZIE MILLER

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Social supports and community context air cares. American Institutes for Research. https://www.air.org/centers/air-cares/social-supports-andcommunity-context. Accessed April 7, 2022.

POSSIBLE SOLUTIONS

Many people who lack positive relationships in their community struggle with their health, mentally, physically and emotionally. Growing up with only negative relationships can start a vicious cycle for generations to come of only negative relationships. One way to help convert negative relationships into positive relationships in a community is having interventions. If a person is moving in the wrong direction down a bad path, stepping in to stop their actions before they become worse can benefit that person and the people around them in life. Other ways to promote positive personal relationships in a community include encouragement at work and in school, promotions at work, and making homes and schools a healthy environment for all. By implementing anti bullying programs at school and teaching antidiscrimation policies at school and at work, it makes these environments a safer and more supportive space. Support from loved ones also promotes positive relationships. This support may vary from person to person on how they give and receive it. Making the community a positive space also promotes positive relationships. This happens by fulfilling civic responsibilities such as volunteering in the community and voting for representatives for the area. Artiga S, Hinton E. Beyond health care: The role of Social Determinants in promoting health and health equity. KFF. https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promotinghealth-and-health-equity/. Published July 9, 2019. Accessed February 17, 2022. Social Determinants of Health. Social Determinants of Health - Healthy People 2030. https://health.gov/healthypeople/objectives-anddata/social-determinants-health. Accessed February 17, 2022.

SPRING 2022 PHRM 485 - INTERCULTURAL AND GLOB AL HEALTH ISSUES

SOCIOECONOMIC STATUS AND ITS EFFECT ON HEALTHCARE Background Information Socioeconomic status encompasses a huge proportion of the current issues in global health, especially within the United States. Differences in socioeconomic status result in some of the most prominent barriers to high-quality healthcare around the world. Additionally, nutrition and access to food is impacted largely by the socioeconomic status of individuals and communities. The psychological aspect is notable as well, and includes cultural and traditional differences. These cultural issues can create friction in a westernized healthcare system and can result in less positive healthcare interventions. Poverty leads to increased anxiety and creates a plethora of other issues that higher-class individuals do not have to worry about. This increased worry is related to more mental health problems among impoverished communities, highlighting another significant barrier to wellness directly impacted by socioeconomic status. As we have outlined, socioeconomic status covers a huge range of health problems that must be addressed and that we will try to explore further within the context of the United States.

Gabriella Gmyrek (BSPS candidate) Sarah Tofilska (BSPS candidate) Michael Franks (BSPS student) Nathan Mast (BSPS candidate)

Access To Healthcare By: Nathan Mast

Healthcare access varies in populations due to: Spatial factors ---> Uneven distributions of healthcare providers and consumers Nonspatial factors ---> Socioeconomic and demographic characteristics

Background Everyone is affected by their ability to access healthcare resources. Examples are focused on populations strongly impacted by spatial or nonspatial factors

China's Healthcare Reform China’s healthcare reform launched in 2009 was pointed at improving rural healthcare resources. Absolute inequalities of health resources increased instead. Researchers concluded that improvements needed to include stronger incentives for the health professionals working in remote and poor counties, targeting the precise poor areas to allocate health subsidies for improving working conditions, and sustaining and extending the benefit scope in poor counties

How do you Define "Access to Healthcare"? The Socioeconomic status of individuals and communities can play a role in healthcare access inequities. Access to health care is defined as the “timely use of personal health services to achieve the best possible health outcomes.”

Sociodemographic variables can be grouped into three categories: 1. Socioeconomic disadvantages 2. Sociocultural barriers 3. High healthcare needs

Identifying Areas of Need A US analysis integrates spatial and nonspatial factors into one framework, and identifies the areas and population groups for Health Professional Shortage Areas (HPSA) designation. This analysis system enables reforms to be extremely specific and targeted to the areas with the highest needs.

Professional Opinion? Areas can be intelligently identified and necessary resources ranked by taking advantage of a sophisticated analysis method. Using this information, healthcare systems can be systematically improved and incentivized to help reduce health inequities. ~ N. Mast https://www.sciencedirect.com/science/article/pii/S1353829204000085 https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-health https://www.tandfonline.com/doi/full/10.1080/00045608.2012.657146 https://www.mdpi.com/1660-4601/16/1/49/htm 75

Background Info

Diet and Nutrition

Diet and Nutrition have significant ties to socioeconomic status, especially within Michael Franks the United States. Different cultures Quality of Food Intake by Race and Income across the country have different dietary preferences and tolerances and different Since 1994, the quality of food intake across all races and incomes has increased overall. However, there are still major discrepancies between classes and races of people have access different races as well as different incomes. to different types of food and exercise. Different factors are used as benchmarks Compared to Black and Mexican American populations, the white population has experienced the greatest increase in (about 7%). for diet and nutrition as they relate to Regarding income, there has been an increase in the disparity of food socioeconomic classes. These factors qualities between high-income families and low-income families (3% disparity include: Food quality, maternal nutrition, between 1989-1991 and 9% disparity between 2011-2014). access to food or lack of access (food Lower income families are more likely to consume energy-dense foods such deserts), and access to exercise. as carbs and fats compared to nutrient-dense foods. ”

Diet Quality and its Effect on Maternity

https://www.forbes.com/sites/sorensoni mpact/2021/01/07/ozs-could-be-theplace-based-solution-we-need-totackle-usda-food-deserts/

Food Deserts

Maternal complications have been linked to poor diet quality. Poor quality nutrition can create problems preconception, during pregnancy, and during postnatal periods. These complications include gestational diabetes, hypertension, and postpartum depression. In-utero malnutrition can be defined as either inadequate nutrients or excess of nutrients. In-utero malnutrition can lead to complications for the child that include fetal growth restriction, low/high birth weight, obesity, as well as increased risk of chronic disease in the child.

Food deserts are a lack of spatial accessibility to Exercise adequate nutrition. This phenomena is Exercise and fitness has historically been found to be lower in exacerbated by deprived economic and lower-income communities and higher in high-income sociocultural conditions. Although the number of low-access food areas has decreased to 5.6% communities. However, this has recently been disputed as new since 2010, an increase in low-income areas studies suggest that past research has failed to fully encompass the different types of exercise that are accessible. since then, 5%, has made the net percent of In 56-study combined cross-analysis, it was found that out of population in low-income/low-access areas has the four categories of physical activity (transportation, increased to 5.96%. occupational, housing, and leisure time physical activity), only Professional Opinion? leisure time physical activity showed a directly proportional There is an abundant need for access to correlation to socioeconomic status. higher quality foods, especially for low- and middle- income families as well as black and Efforts Education is one of the most powerful forms of change for non-white hispanic populations Research standards for low-income and marginalized communities are outdated and should be updated to reflect more unbiased -F. Michael observations

communities. Already, activists are educating lower income and racially marginalized communities about how important nutrition is to out own health. Many groups are forming programs built around 76 the dietary customs of different cultural groups as well.

Patetta, M.A., Pedraza, L.S. & Popkin, B.M. Improvements in the nutritional quality of US young adults based on food sources and socioeconomic status between 1989–1991 and 2011–2014. Nutr J 18, 32 (2019). https://doi.org/10.1186/s12937-019-0460-4 eierlein, A. L., Ghassabian, A., Kahn, L. G., Afanasyeva, Y., Mehta-Lee, S. S., Brubaker, S. G., & Trasande, L. (2021). Dietary Quality and Sociodemographic and Health Behavior Characteristics Among Pregnant Women Participating in the New York University Children's Health and Environment Study. Frontiers in nutrition, 8, 639425. https://doi.org/10.3389/fnut.2021.639425 Aubuchon-Endsley NL, Kennedy TS, Gilchrist M, Thomas DG, Grant S. Relationships among Socioeconomic Status, Dietary Intake, and Stress in Breastfeeding Women. J Acad Nutr Diet. 2015 Jun;115(6):939-46.e1. doi: 10.1016/j.jand.2014.12.017. Epub 2015 Feb 14. PMID: 25687029. Jin, H., & Lu, Y. (2021). SAR-Gi*: Taking a spatial approach to understand food deserts and food swamps. Applied Geography, 134, 102529. https://doi.org/10.1016/j.apgeog.2021.102529 Wang, Y., & Chen, X. (2011). How Much of Racial/Ethnic Disparities in Dietary Intakes, Exercise, and Weight Status Can Be Explained by Nutrition- and Health-Related Psychosocial Factors and Socioeconomic Status among US Adults? Journal of the American Dietetic Association, 111(12), 1904–1911. https://doi.org/10.1016/j.jada.2011.09.036 ‌ Stalsberg, R., & Pedersen, A. V. (2018). Are Differences in Physical Activity across Socioeconomic Groups Associated with Choice of Physical Activity Variables to Report?. International journal of environmental research and public health, 15(5), 922. ‌ https://doi.org/10.3390/ijerph15050922 http://www.facebook.com/pages/Food-Empowerment-Project/9151801106. Food Deserts* - Food Empowerment Project. Food Empowerment Project. Published 2021. Accessed April 12, 2022. https://foodispower.org/access-health/food-deserts/

Mental Health Treatment in Areas of Low Socioeconomic Status

Background information Mental health can have a physical effect on your health. Depression has been linked to causing side effects such as headaches, digestive disorders, and fatigue while anxiety has been linked to an increased risk of hypertension, insomnia, and nausea among other issues. On a general health level, the effect of our minds is quite large.

By: Gabriella Gmyrek By: Gabriella Gmyrek

Why is it an IGCH issue? The reason that the effect of socioeconomic status on mental health is a global health issue is that the challenges that members of different socioeconomic statuses face and their access to treatment greatly affect their mental health outcomes. For members of less financially secure communities, the struggles are even greater and the opportunities for treatment are much lower

Who Is Affected? Mental health affects every individual, but in this case, most of the research found will be aimed toward individuals that are in or were raised in more challenging socioeconomic situations. The reason is that individuals growing up with fewer resources have a higher likelihood of developing stress-related disorders and depression. For those members of the community that are in poorer-quality housing, there was a marked increase in feelings of distress, and those growing up in areas with poorer school funding were found to have higher rates of developing mental health issues. “the prevalence of severe mental health problems was around three times higher among children in the bottom quintile of family income than among those in the top quintile”

Efforts and Solutions? Many organizations have been trying to help aid members of low-income communities in obtaining access to mental health treatment and care. Unfortunately, this is mostly done on a smaller scale or volunteer basis. However, in many cases, it is up to the individual PCPs to take on the role of both counselor and psychiatrist. Overall, there need to be services put in place to increase the presence and affordability of psychologists, psychiatrists, and counselors in these underserved communities. Moreover, there needs to be a concrete plan to be increased funding to allow better mental health programs within title-1 schools.

Leah Askarinam NJ. Schools in poor areas have more students with mental health needs. The Atlantic. https://www.theatlantic.com/politics/archive/2016/01/schools-in-poorareas-have-more-students-with-mental-health-needs/458808/. Published January 13, 2016. Accessed April 11, 2022. Mental health statistics: Poverty. Mental Health Foundation. https://www.mentalhealth.org.uk/statistics/mental-health-statistics-poverty. Published January 16, 2020. Accessed April 12, 2022. 713-743-4248 ST. Improving access to mental health services in low-income communities. University of Houston. https://uh.edu/news-events/stories/2021/july2021/07202021-improving-mental-health-access-for-low-income-communities.php. Published July 20, 2021. Accessed April 12, 2022.

Professional Opinion In my opinion, there needs to be more done starting at a younger age to help children in impoverished communities to have greater access to mental health support growing up. Additionally, there need to be more programs that work to help connect members of underserved communities with mental health professional -G. Gmyrek

Communication Difficulties & Socioeconomic Status (SES)

Sarah Tofilska, BSPS Student

Background SES is a known factor that affects not only people's lifestyles, but also determines their abilities to age in a healthy manner. Various studies indicate that lower SES is associated with worse health outcomes for reasons such as how it influences patient health literacy and overall physician-patient communication.

Those Affected

Health Literacy and Language Barriers

According to the Centers for Disease Control and Prevention, health literacy is the degree to which individuals have the ability to find, understand and use information and services to make health based decisions and actions. Studies show that low SES has a strong correlation with lower levels of education and poor health literacy. As a result, patients with lower SES are more susceptible to poorer health outcomes. Graph obtained from blogs.worldbank.org In addition, one major issue that is created when The people who are most affected are those of low SES around the world; healthcare is taken among cultures is difficulty in it is predicted that nearly 700 million people live in extreme poverty as of communication due to language barriers. It has been 2021. determined that language barriers contribute to reducing patient and medical provider satisfaction by diminishing the quality of healthcare provided. A person with less education Efforts Made and cultural experience may be less knowledgeable about medical terminology or lack the ability to understand another The U.S. department of Health and Human Services released the person speaking a different language. Health literacy and National Action Plan to Improve Health Literacy. The plan consists of 7 language barriers related to SES are global health issues goals that promote changes in the healthcare system by making health because they affect everyone around the world that is and safety information more available and supporting local efforts to restricted by communication difficulties in healthcare. provide adult education.

Patient Perception Patient perception focuses on the overall communicative interaction and experience that occurs between a patient and a physician. Studies have determined that patients with lower SES receive less positive socio-emotional utterances and a more directive and less participatory consulting style. In addition, these patients’ encounters were also detailed with less information giving and less directions. The connection between patient perception and low SES is associated with the communicative relationship between a patient and a physician; patients from higher SES tend to communicate more actively and show more effective expression which elicits more information from the physician and therefore increases the quality of care provided. In contrast, patients with lower SES often receive less information from their physicians because of the physicians’ misperceptions of the patients' desires and needs for information in connection with their abilities to partake in the care process.

There are many steps that can be taken to improve patient perception, which include: - Providers can lead with a language the patient understands by using effective communication skills - Providers can encourage transparency - Providers can have the same enthusiasm and approach to patients regardless of patients’ SES and attitude towards consultations Opinion: Many studies have shown the negative impact SES can have on patients' health outcomes. Factors such as health literacy, language barriers and patient perception all become issues when connected with low SES. More action needs to be taken to improve the healthcare provided to patients of low SES to ensure their health is well taken care of, especially because this affects a large population worldwide. ~S. Tofilska

Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S., & Al Kalbani, T. (2020). Implications of language barriers for Healthcare: A systematic review. Oman Medical Journal, 35(2). https://doi.org/10.5001/omj.2020.40 .S. Department of Health and Human Services. (n.d.). National Action Plan to Improve Health Literacy. National action plan to improve health literacy. Retrieved March 29, 2022, from https://health.gov/our-work/national-healthinitiatives/health-literacy/national-action-plan-improve-health-literacy pdated estimates of the impact of covid-19 on global poverty: Turning the corner on the pandemic in 2021? World Bank Blogs. (n.d.). Retrieved March 29, 2022, from https://blogs.worldbank.org/opendata/updated-estimates78 impact-covid-19-global-poverty-turning-corner-pandemic-2021

Unintentional and Intentional Injuries

More than five million people die each year as a result of injuries. According to the World Health Organization (WHO), on average every six seconds, someone in the world dies as a result of injury PHRM 485 Spring 2022 1- Background Information 2 - Substance Abuse 3 - Road Traffic Injuries and Car Accidents 4 - Homicide

Injuries and Violence the Facts. World Health Organization. Published 2014. Accessed April 11, 2022. https://apps.who.int/iris/bitstream/handle/10665/149 798/9789241508018_eng.pdf

Naomi Davis (BSPS candidate) Chinedu Ebube (BSPS student) Kade Kade (BSPS/PH candidate Yunyi Pei (BSPS candidate) 79

Unintentional injuries and its prevention effort. In the U.S., unintentional injury is the top cause of death in the population of age 1 to 44, and the fourth leading cause of death in the whole population in 2020.

Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System https://wisqars.cdc.gov/fatal-leading

Unintentional injury is a global health issue. According to WHO’s report in 2014, on average every 6 seconds an individual in the world dies from injury. Everyone is at risk of one or multiple forms of injuries. Injuries are not accidents: They are definable, correctable events. Several generations of models have been used to address unintentional injuries. ❖ Domino theory by Heinrich (1940s~1950s) ➢ “Humans” were the focus of injury prevention ❖ Biomechanical model (1950s) ➢ Consider injury as a result of energy transfer beyond tolerable threshold. ❖ Haddon matrix (1960s) — where we are at now Haddon countermeasures: 10 countermeasures used as guidance for preventing injuries. Prevent creation of hazard Reduce the amount of hazard Prevent the release of hazardous material Modify the rate or spatial distribution of the release of energy from its source Separation by interposition a “barrier” Separate the energy released and susceptible entity Modify the basic structure of the hazard Strengthen the susceptible entity Counter the damage continuation and extension Stabilization and rehabilitation

Author’s opinion: Injury prevention still has a way to go. Besides legislative actions, public health communications should be stronger in effort of reducing unintentional injuries. For example, if a drug has significant adverse effects, the risk should be managed and communicated. -Y. Pei Reference: Haddon W. Energy damage and the 10 countermeasure strategies. 1973. Inj Prev. 1995;1(1):40-44. Accessed February 17, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1067540/

Naomi Davis

Substance Abuse What is Substance Abuse? Substance abuse is the act of someone using alcohol, prescription medication, and other substances outside of it's intended use. This can vary from taking too much or taking it for reasons other than what it is intended for. Typically this condition can cause significant problems or distress in everyday life. Typically someone will abuse medications that have the ability to change the natural chemistry of the mind and body. The user gets addicted to the pleasure they get from taking the substance. The longer a patient is on heavy therapy such as an opioid, it is easy to develop an addiction, even if it's unintended. The opioid medication can block pain signals and release large amounts of dopamine. The body may get used to those effects, and the patient will begin to develop an addiction or dependency on the medication

Stats There have been around 700,000 drug overdose deaths in the US since Over 70,000 drug overdose deaths occur in the US annually It is estimated that of the 246 million people worldwide who used drugs in 2013, around 27 million people have drug use disorders

Treatment To help those suffering from substance abuse there are Relapse Prevention Models. These models consist of strategies such as psychoeducation, understanding highrisk situations, coping skills, changing lifestyle behaviors, and drug/alcohol monitoring. To achieve this goal patients will have to go through serious counseling Rawson, Obert, J. L., McCann, M. J., & Marinelli-Casey, P. Relapse Prevention Models For Substance Abuse Treatment. Psychotherapy. 1993;30(2): 284–298. https://doi.org/10.1037/0033-3204.30.2.284

Impact Substance abuse is a global issue and can affect anyone, regardless of race, socioeconomic status, location, etc Substance abuse disorders are more likely to affect young males The average life expectancy in the US declined between 2015 and 2017 due to opioid overdose deaths High-risk behaviors and substance abuse result in higher chances of contracting viral infections such as hepatitis or HIV. Substance abuse affects symptoms and adversely changes the outcome of infectious diseases. Several studies show a close link between illicit drug use, crime, sexual abuse, and interpersonal violence

Substance Abuse and Addiction Statistics. National Center for Drug Abuse Statistics. Published February 8, 2022. Accessed February 17, 2022. https://drugabusestatistics.org/

Pharmacy Viewpoint Substance abuse is a global health issue that impacts people from a wide range of backgrounds. There is a serious need to educate patients about substance abuse and how it can happen. I especially believe that in circumstances where a patient is given a high abuse drug, they are properly counseled and warned. Lastly, there should be universal help to help those suffering from drug addiction or substance abuse. World Drug Report. United Nations. https://www.unodc.org/unodc/en/data-andanalysis/wdr2021.html. Published 2021. Accessed April 5, 2022.

Homicide, Suicide, and Self-Harm

Canva Graphics

What is Homicide?

Global Statsistics and Facts

As reported by Cornell Law School, "Homicide is when one human being caused the death of another." Homicide can be unintentional or intentional committed by a person or a group of people. Homicides occur worldwide, and although there are higher rates of homicide in more troubled areas, it can affect several people regardless of their environment and their background.

In an article written in 2019, it was found that 464,000 people around the world fell victim to homicide. 80% of the victims were men and 20% were women. Of the 464,000 homicides the most common weapons used were guns, knives, and poison.

Chinedu Ebube

Punishment and Prevention Prevention: Education is viewed as a major factor in molding the levels of homicide in several countries with a low homicide rate in Asia like China and Japan. At a school in Chicago, Illinois, an afterschool program was implemented called BAM (Becoming a Man). This program was used to aid teenage boys who were at risk of joining Gangs or committing violent crimes. The placement of properly trained law enforcement in communities with high crime and homicide rates also tends to lead to an overall drop in those rates. Punishment: In the United States, Capital Punishment is typically used to punish those who've committed homicide-related crimes. In Norway, someone who is convicted of homicide is typically locked up for 21 years depending on if they're a threat to society at the end of their time served. When looking at Uzbekistan women tend to have a lesser maximum sentence than men.

https://worldpopulationreview.com/country-rankings/murder-rate-bycountry

Countries like El Salvador, Jamaica, and South Africa have homicide rates all above 30 deaths per 100k people compared to places like Japan, China, and Norway which have a homicide rate of under one death per 100k people.

https://www.unodc.org/unodc/en/data-and-analysis/global-study-on-homicide.html

http://cdn.statcdn.com/Infographic/images/normal/15390.jpeg

This image shows how men are generally more likely to commit suicide than women. It's also seen that countries such as the US, South Korea, South Africa, and Russia have the highest rates of suicide for men all of which are above 20 deaths per 100k people.

What is Suicide?

Suicide is a global issue defined by the CDC as, “death caused by injuring oneself with the intent to die. A suicide attempt is when someone harms themselves with any intent to end their life, but they do not die because of their actions.” Self-Harm is defined by the Crisis Text Line as “any form of hurting oneself on purpose.”

Warning Signs for Suicide and Symptoms of Self-Harm Suicide: Warning signs for suicide include feelings of hopelessness, increased use of alcohol and drugs, extreme mood changes, withdrawal from interpersonal relationships, and talking about wanting to die or killing oneself. Self-Harm: Some symptoms and warning signs for self-harm include scars, fresh cuts, burns, bruises, struggling with interpersonal relationships, Behavioral and emotional instability or impulsiveness, and feelings of helplessness or worthlessness.

Prevention and Treatment

https://media.istockphoto.com/vectors/anxiety-woman-fears-and-phobias-thoughts-get-confused-and-crushed-vector-id1288872979?k=20&m=1288872979&s=612x612&w=0&h=_SWfXheBkSR0Jztn-rMzgpgM9HpVfDDm9nLWRNK6eU4=

Limiting access to objects that can lead to suicide (pesticides, firearms, medications, etc.) It's important to reach out to 24 hr. hotlines such as the National Suicide Prevention Lifeline and Veterans Crisis Line or tell a trusted family member or adult in your life. Another option Seek counseling or therapy to sort through traumatic experiences, emotions, or urges that caused you to self-harm or feel suicidal, along with equipping mechanisms to help you in case you feel suicidal or have self-harm urges in the future. Monitored medication can be beneficial for some people who are at risk for suicide or self-harm.

Canva Graphics

Author's Opinion

I believe that homicide, suicide, and self Harm are major issues that affect everyday people. Specifically, the fact that several young adults harm themselves and see suicide as the only option is incredibly concerning. I think that while there are good resources to turn to when someone is suicidal or looking to self-harm, there's a major stigma of seeking help in our nation for fear of being deemed crazy which leads people to suffer in silence. Even in our schools, the resources are quickly breezed through and not emphasized nearly enough when going through the syllabus. In general, having a bigger conversation about what causes people to be suicidal or self-harm needs to be had, and properly trained counselors/therapists who are less dismissive should be implemented in the workplace and schools. ~ C. Ebube

References: Global Study on Homicide. United Nations : Office on Drugs and Crime. https://www.unodc.org/unodc/en/data-and-analysis/global-study-on-homicide.html. Published 2019. Accessed March 6, 2022. Suicide. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/suicide. Published June 17, 2017. Accessed March 6, 2022. Self-harm. Crisis Text Line. https://www.crisistextline.org/topics/self-harm/#symptoms-of-self-harm-3. Published August 4, 2021. Accessed March 24, 2022.

Road Traffic Injuries by Kade Kake (BSPS/PH candidate)

Background: In our everyday life, everywhere in the world we deal with many types of vehicles on the road. These include cars, buses, trucks, motorcycles, mopeds, pedestrians, animals, taxis, and other guests. Most unintentional deaths occur due to injuries resulting from traffic accidents. Injuries resulting in DALYs resulting from disability are the most common injury-related disability. Additionally, they affect an enormous amount of people economically and socially. However, RTIs remain a neglected public health issue, particularly in low- and middle-income countries. Risk factors Global health issues • Speeding & Roads with poor design and maintenance According to the Center for Disease and Prevention: • Driving under the influence of alcohol and other • Worldwide, there are 1,35 million road fatalities each psychoactive substance year. • Nonuse of motorcycle helmets, seatbelts, and child • Nearly 3,700 people die every day in car, bus, restraints. motorcycle, bicycle, truck, or pedestrian accidents • Distracted driving like using cellphones, eating while worldwide. Most of the victims are pedestrians, driving. motorcyclists, and cyclists. • Inexperience and youth, • Children and young people 5–29 years of age are • Leakage of Hazardous material and Unsafe vehicles more likely to die from crash injuries than any other • Inadequate post-crash care and law enforcement of traffic age group and crash injuries are estimated to be the laws. eighth most common cause of death worldwide. Current effort/ Response/ Intervention Crashes now kill more people than HIV/AIDS. • Vision Zero, the Safe System Approach, and Road to Zero. • A crash injury that results in a death or non-death is • Save LIVES: a road safety technical package is an estimated to cost the global economy $1.8 trillion. evidence-based inventory of priority interventions with a • Males are more likely to be involved in road traffic focus on Speed management, Leadership, Infrastructure crashes than females design and improvement, Vehicle safety standards, • low- and middle-income countries Enforcement of traffic laws and post-crash Survival. o Road traffic injury death rates are highest in the • United Nations (UN) Decade of Action for Road Safety African region. • 3rd Global Ministerial Conference on Road Safety Prevention Methods Personal: I believe paying more attention to the risk factors is • Seat belts should be worn on every trip, no matter how crucial to minimize RTIs. Construction of highways and roads short or in which part of the vehicle you are traveling. • Children should always be buckled up in an appropriate that are walkable can help reduce car accidents in low- and seat belt, booster seat, or car seat that is appropriate for middle-income countries. their age, height, and weight in the back seat. • When riding a motorcycle, motorbike, or bicycle, always wear a helmet. • Avoid driving with an impaired driver, and do not drink or take drugs before driving. • Drive within the speed limit. • Avoid distractions while driving. Don't text or use your cell phone while driving, for example. • Particularly if you live in a country where motorists drive on the left side of the street, be alert when crossing streets. • Don't take unmarked or unofficial taxis. Seat belts should be available in all seating positions in taxis and ridesharing vehicles. • Avoid overcrowded, overweight, or vans with tops that are too heavy. Reference: Global Road Safety. Centers for Disease Control and Prevention. https://www.cdc.gov/injury/features/global road-safety/index.html. Published December 14, 2020. Accessed April 11, 2022. Road traffic injuries. World Health Organization. Source: Richard. The modern killer. Kids Non-Profit Organization. https://www.who.int/news-room/fact-sheets/detail/road- https://knpo.org/blog/2013/6/6/the-modern-killer. Published June 29, traffic-injuries. Accessed April 11, 2022. 83 2013. Accessed April 11, 2022.

Intercultural and Global Health Issues Spring 2022

Articles inside

Lordez Asafo-Boakye, Lauren Davidson, Brittany James, Trang Nguyen, Conrad Sander

Michael Franks, Gabriela Gmyrek, Nathan Mast, Tofilska

Naomi Davis, Chinedu Ebube, Kade, Kake, Yunyi Pei

Miles Anderson, Bryce Colón, Nolan Isaacs, Thao Nguyen

Jason Chen, Brooke Grigsby, Krista Ico, Chris Nguyen, Ruolong Zhu

Diana Dinh, Raegan Meyers, Ayush Kaw, Jordan Keuneke, Bryce Poindexter