Tag Archives: Ebola

Engaging the public on global health

This post originally appeared here.

A simple Google AdWords search of Ebola keyword searches in the past twelve months in the U.S. shows a general disinterest in Ebola all through the summer when cases were raging in West Africa and a sudden spike to 24 million searches in October 2014 just when cases were coming to the U.S. Similarly, average search volumes of “Ebola in Africa” are around 8,100 per month, while “Ebola in the U.S.” gets about 74,000 searches per month. Clearly, something is not right.

Yet the problem may not be exactly what we think it is. It is certainly not the case that people simply don’t care about global health and only become concerned when a disease encroaches on their own borders. In a Kaiser Family Foundation survey from 2012, 52% of people said that the media pays too little attention to health issues in developing countries. 50% of people said they paid at least some attention to global health issues in the news, 18% said they paid a lot of attention, and only 6% said they paid no attention at all. Lest we think people are merely self-interested, when asked why the U.S. should spend money on global health, 51% of people said it was because “it is the right thing to do”. Charitable giving statistics lend a bit more meat to this argument. In 2013, individual donation to health organizations in the U.S. amounted to a total of $31.86 billion, up 6% from 2012. Naturally, many of these health organizations have domestic missions. However, it does show concern about health in particular.

From these surveys and statistics, it would be difficult to argue that the American public has absolutely no interest in global health and international development. But there does seem to be a barrier to getting more involved in these issues: the way the information is presented. But the American public seems interested in knowing more about global health outside of these crises.

At the same time, it will be important to provide some more perspective on what the most pressing global health issues truly are. The same Kaiser survey found that when given a list of health issues in developing countries and asked to rank priorities, the public had a difficult time choosing, and about 1/3 of people claimed that all 12 named issues should be “one of the top” priorities. This finding suggests that although people want to engage more with global health, they feel overwhelmed by the number of issues that plague developing countries and have no reliable regular source of information to help them understand it all.

Engaging people on a regular basis in global health news and issues, as well as offering some perspective on what drives health crises in developing countries, might go a long way in mobilizing a group of people who want to help in some way but don’t know how. But whose responsibility is it to provide this kind of engagement, and how should it be done? Some possibilities include encouraging the media to make use of health crises in developing countries, such as Ebola, to more thoroughly explore and report on the contexts in which these crises arise. In a similar manner, these journalists should be engaging more extensively with local communities, and, perhaps more importantly, with local journalists, whose voices are very often absent from our news sources.

One interesting example of a current concerted effort to engage the public in dialogue about global health is the Wellcome Collection. The Wellcome Collection opened in 2007 and is described as a “free visitor destination for the incurably curious”. The Collection offers a wide range of information and exhibits related to science and medicine in general, but since the Wellcome Trust is such a major funder of global health, the collection also provides the public with a great deal of information on global health issues such as malaria, epidemics, and infant mortality.

In addition, health care companies and major foundations such as the Gates Foundation could make a more concerted effort to engage the general public in global health issues, especially during times of crisis when they already have an audience. This kind of engagement should go beyond statistics about various diseases and requests for funding to really making people aware of the entire political, social, economic, and healthcare context in which these epidemics arise. Perhaps this kind of regular engagement in global health issues might prevent the kind of needless and sometimes dangerous hysteria we witnessed with the Ebola epidemic and also target people’s attention and concern to where it would be most helpful.

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Is Margaret Chan Really to Blame for the Delayed Ebola Response?

This post originally appeared here.

January 6 article in the New York Times suggested that WHO Director-General Margaret Chan’s response to the Ebola crisis was woefully inadequate. The article notes that it took 1,000 Ebola deaths in Africa and the spread of the disease to Nigeria for the Chan to proclaim a global emergency. Citing criticisms of Chan’s response to the SARS epidemic as a public health administrator in Hong Kong, the article accuses the current WHO head of conceding too heavily to local governments. The article claims that she relied too heavily on African regional offices to manage the response when her agency should have stepped in more aggressively earlier. But the history of public responses to infectious disease announcements, as well as tragically underfunded global disease surveillance systems, suggest that, while Chan may not have done everything she could, the story is much more complex than it seems.

Image credit: star5112, Flickr

Sounding the alarm bell on an infectious disease threat and taking extreme measures such as quarantine and travel bans is not without risk. American history is littered with examples of harmful infectious disease panic. More often than not, American responses to infectious disease threats tend to tap into embedded racial tensions. We only need to look at vicious attacks on African boys at a Bronx, NY school in October, to the sounds of the nickname “Ebola,” to understand that these dynamics are still very much at play. Chan herself certainly knows the harms of acting perhaps too quickly in response to what seems like a global infectious disease crisis. In 2009, Chan was harshly criticized for supposedly “overreacting” to the H1N1 threat.

Image credit: Graeme Maclean, Flickr

Part of the problem is that our understanding of how regular people respond to risk is not entirely clear. Although we have a good theoretical understanding of the tenets of risk perception from the classic psychological work of scholars such as Paul Slovic, our understanding of how risk communication in contemporary health crises affects people’s decisions and emotions is not well-developed. People can react in surprising, emotional, and counterintuitive ways to images and information about diseases, and research has shown health risk communication can even have the opposite of the intended effect. So while Chan may have reacted too slowly and relied too heavily on over-burdened local governments, we must remember that if we want our public health officials to feel comfortable responding to infectious disease threats in situations involving limited information and unpredictable outbreak patterns, we must develop a much firmer understanding of what drives public hysteria surrounding infectious disease and how to quell the panic.

The Times article touches on one hugely important issue that gets overwhelmed in the article’s haste to place all the blame on Chan: the inadequacy of our current global public health surveillance systems. Surveillance systems in developed countries are often sufficiently robust, which is part of the reason why a case of Ebola in the U.S. is extremely different from a case of Ebola in Liberia. A case of Ebola in the U.S. will be rapidly identified and reported to authorities. Protocol will immediately kick in and complete isolation of the suspected case will begin almost instantaneously. In Liberia, a country with a poorly developed public health surveillance system, a case of Ebola may not be well-recorded, the information may not get to the appropriate authorities in a timely fashion, and advanced protocols might not exist to ensure the complete and rapid isolation of the sick individual.

Part of the problem here is a global culture that focuses on crisis and not prevention. Surveillance systems need to be built up in times of relative calm. Funding for surveillance systems, which can be significant, needs to appeal to people’s sense that they are preventing the next epidemic, not to their need to help a languishing, dying child in a moment of intense crisis. By the time the child is dying of Ebola, or flu, or malaria, or any other infectious disease, it is usually already too late, and the cost of helping the situation can be much more than investing in the proper public health infrastructure in times of relative calm.

As the Ebola crisis continues to fall out of the media spotlight, and even as the epidemic still rages in West Africa, we need to act immediately to maintain the momentum produced by this frightening epidemic not to point fingers at specific health officials but to figure out what went wrong on a more fundamental level. While Margaret Chan may in many ways be partly to blame, putting her at the center of the problem is not only misguided but also a waste of time and energy. We must recognize that if we are to improve the response to future epidemics, we have to do most of the work outside of times of crisis. Because once the index case of a major new epidemic is reported, it is already too late.

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