Tag Archives: global health

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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The importance of improving mental health research in developing countries

Originally published at The Pump Handle

In response to the realization that between 16% and 49% of people in the world have psychiatric and neurological disorders and that most of these individuals live in low- and middle-income countries, the World Health Organization (WHO) launched the Mental Health Gap Action Programme to provide services for priority mental health disorders in 2008. This focus on services is essential, but the WHO ran into a significant problem when confronting mental health disorders in the developing world: lack of research made it difficult to understand which mental health disorders should be prioritized and how best to reach individuals in need of care.

In 2011, The World Health Organization (WHO) embarked on a report entitled “No health without research.” The release of the report was recently postponed, but the problem identified by the report remains no less dire. In order to improve health systems in low- and middle-income countries, support for more research in epidemiology, healthcare policy, and healthcare delivery within these countries is essential.

Over the course of the past year and a half, PLoS Medicine has published a series of papers corresponding with this theme. In one paper, M. Taghi Yasamy and colleagues emphasize the importance of scaling up resources for mental health research in particular. This research, they explain, will help policymakers determine directions for improving policy and delivery of mental healthcare. Advancing this research will be challenging, though, because good governance for mental health research in developing countries is lacking.

Some of the most immediate problems with mental health research in developing countries are financial. Most developing countries lack institutions like the National Institute of Mental Health (NIMH) to help fund and structure research. Physicians and mental health professionals often have no incentive to conduct research because providing other health services is much more lucrative. In some cases, as in many countries in Latin America, researchers must fund their own research and experience no financial gain as a result of conducting research.

Yet financial reasons are not the only reasons for lack of mental health research in developing countries. Restructuring medical education could go a long way toward preparing physicians to participate in research. While research is valued as a key part of medical education and success in the United States, research is not a determining factor for getting into residency or achieving academic success in low-income countries. Many physicians-in-training thus encounter a lack of incentive to contribute to research initiatives. Making research a fundamental part of success in medical training could help make universities in low- and middle-income countries the research centers they are in high-income countries.

Even when clinicians and scientists in low- and middle-income countries are able to conduct mental health research, they often find it difficult to publish their findings in prestigious, widely circulating international medical journals. Researchers from developing countries often struggle to meet the requirements of indexed journals because of lack of access to information, lack of guidance in research design and statistical analysis, and difficulty communicating in foreign languages. Researchers in developing countries often work in research centers or universities that are not considered “prestigious” on an international scale and may not garner the attention of international journals. Editors may be more likely to give serious consideration to submissions from authors at big-name universities. Another serious problem with publication of research from developing countries in prestigious medical and scientific journals is the language barrier, with most top journals being English-language. Procuring better translation services for scientists in developing countries could be key in overcoming the dearth of publications from these areas of the world.

Policymakers and providers in developing countries may also struggle to learn about findings published in expensive journals for which their institutions cannot afford subscriptions. Open access policies represent one way to alleviate some of the problems mental health researchers in developing countries confront. Free access to a wider body of research published in highly-regarded journals could vastly improve mental health research in developing countries and help researchers attract the attention of these high-level journals.

Mental health interventions that truly help communities in low- and middle-income countries cannot succeed if data on epidemiology of mental disorders, current problems in the delivery of healthcare services, and evidence-based solutions are not available. A survey of mental health research priorities in low- and middle-income countries in 2009 found that stakeholders and researchers ranked three types of research as most important: epidemiological studies of burden and risk factors, health systems research, and social sciences research. Researchers and stakeholders agreed that attending to the growing problems of depression, anxiety, and substance abuse disorders, among other frequently occurring mental disorders, was dependent on procuring better resources for research.

Improving service gaps in mental healthcare is vital, especially in light of a growing epidemic of mental illness globally. But this work cannot be done without more research to identify the problems and evidence-based solutions that will help bring mental healthcare to all those in need.

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