When Samuel Morse left his New Haven home to paint a portrait of the
Maquis du Lafayette in Washington DC, it was the last time he would see his
pregnant wife. Shortly after his arrival in Washington, his wife developed
complications during childbirth. A messenger took several days on horseback to
relay the message to Mr Morse. Because the trip back to New Haven took several
more, his wife had died by the time he arrived at their home. So moved was he by the tragedy of lost time
that he dedicated the majority of the rest of his life to make sure that this
would never happen to anyone again. His subsequent work on the telegraph and in
particular the mechanism of communication for the telegraph resulted in Morse
code – the first instantaneous messaging system in the world.
Mr Morse’s pain is not foreign to us in the 21st century. We feel the loss of new mothers so deeply that, when earlier this year new statistics on the rate of maternal death were released and suggested that American women died at three times the rate of other developed countries during child birth, doctors, patient advocates, and even Congress seemed willing to move heaven and earth to fix the problem. As someone who cares for expectant mothers at high risk for cardiovascular complications, I too was moved. But beyond the certainty of the headlines lay the nuance of the data, which seemed to tell a murkier story.
First at issue was the presentation of the data. Certainly, as a rate
per live births, it would seem that the United States lagged behind other OECD
countries – our maternal mortality rate was between 17.2 and 26.4 deaths per
100,000 live births, compared to 6.6 in the UK or 3.7 in Spain. But this
translated to approximately 700 maternal deaths per year across the United
States (among approximately 2.7 million annual births). While we would all agree
that one avoidable maternal death is one too many, the low incidence means that
small rates of error could have weighty implications on the reported results.
For instance, an error rate of 0.01% would put the United States in line with
other developed countries.
Surely, the error rate could not account for half the reported
deaths, right? Unfortunately, it is difficult to estimate how close to reality
the CDC reported data is, primarily because the main source data for maternal
mortality is a single question asked on the application for death certificates.
The question asks whether the deceased was pregnant at the time of death,
within 42 days of death, or in the 43 to 365 days prior to death. While
pregnancy at the time of death may be easy to assess, the latter two categories
are subject to significantly more error.
What are the challenges of getting imaging to Africa? In this episode of Radiology Firing Line, I convene a panel of experts in Africa. We discuss the challenges of bringing new technology to Africa, the new need for imaging driven by public health gains and increased longevity of Africans, the insalubrious practice of “equipment dumping”, amongst others.
Kassa Darge, MD PhD, is Professor of Radiology and Radiologist-in-Chief at Children’s Hospital of Philadelphia. He is also Honorary Professor of Radiology in the Department of Radiology at Addis Ababa University in Ethiopia.
Omolola Mojisola (Monica) Atalabi MBBS MBA, is Professor of Radiology and Chief of Pediatric Radiology at University College Hospital, Ibadan, Nigeria. She is President of both the Association of Radiologist in Nigeria and the World Federation of Pediatric Imaging.
William Sykes is the CEO of Tecmed Arica – a medical equipment, device, service and training provider in the Southern African region.
By FELICIA D. GOODRUM STERLING, PhD and HEIDI L. POTTINGER, DrPH, MPH, MA
The measles outbreak in Washington state this week has brought new attention to the anti-vaccine movement. In fact, the World Health Organization recently identified “vaccine hesitancy” as one of top threats to global health. In the US, the number of unvaccinated children has quadrupled since 2001, enabling the resurgence of infectious diseases long-since controlled. In fact, the WHO claims a staggering 1.5 million deaths could be prevented worldwide by improved vaccination rates.
Amidst the media and public health outcry, a mystery persists: Why has vaccine hesitancy continued, despite years of vigorous debunking of shoddy science? The answer may lie in a deeply-rooted distrust of doctors and science.
One of the authors of this article, Dr. Pottinger, surveyed hundreds of Arizona parents, from schools with exemption rates greater than 10%, about their perceptions on vaccines. Pottinger and colleagues found the vast majority of the parents surveyed who delayed or chose not to vaccinate their children did so because of true personal beliefs and not convenience. Specifically, they tended to distrust physicians and information about vaccines or held misperceptions about health and disease, including the idea that immunity by natural infection is more effective or that vaccine-preventable diseases are not severe.
These beliefs, stoked by a fraudulent 2010 study, have proven almost impossible to shake—despite the fact that the debunked study, based on 12 children, was retracted due to serious ethical violations and scientific misrepresentation; authors cherry-picked and fabricated data, and the first author had undisclosed business interests in the vaccine industry.
Last year, about 43 million people around the globe were injured from the hospital care that was intended to help them; as a result, many died and millions suffered long-term disability. These seem like dramatic numbers – could they possibly be true?
If anything, they are almost surely an underestimate. These findings come from a paper we published last year funded and done in collaboration with the World Health Organization. We focused on a select group of “adverse events” and used conservative assumptions to model not only how often they occur, but also with what consequence to patients around the world.
Our WHO-funded study doesn’t stand alone; others have estimated that harm from unsafe medical care is far greater than previously thought. A paper published last year in the Journal of Patient Safety estimated that medical errors might be the third leading cause of deaths among Americans, after heart disease and cancer.
While I find that number hard to believe, what is undoubtedly true is this: adverse events – injuries that happen due to medical care – are a major cause of morbidity and mortality, and these problems are global. In every country where people have looked (U.S., Canada, Australia, England, nations of the Middle East, Latin America, etc.), the story is the same.
Patient safety is a big problem – a major source of suffering, disability, and death for the world’s population.The problem of inadequate health care, the global nature of this challenging problem, and the common set of causes that underlie it, motivated us to put together PH555X.
It’s a HarvardX online MOOC (Massive Open Online Course) with a simple focus: health care quality and safety with a global perspective.
What can a microlending bank in Bangladesh teach us about trimming healthcare costs in New York City? Perhaps much more than we think.
Nobel Peace Prize-winning economist Muhammad Yunus founded Grameen Bank, revolutionizing the fight against poverty by handing out “micro” loans of less than $30 to Bangladeshi women during the mid 1970s. He went on to spread microfinance around the world, including to Queen’s, New York, where the flagship Grameen America office serves 12,000 women.
Now, he’s piloting a breakthrough health program aimed at dramatically cutting costs while improving the health of those borrowers in Queens. It’s a tall order, given that these women are mainly immigrants, single working mothers, and living on $20,000 a year or less.
What’s more, the program is designed to become self-sustaining. The borrowers will pay for some of the services from the start. Over time, their payments will cover more of the costs. That, Yunus argues, is the only way programs for the poor can be long lasting and deliver the quality of service people want. Even the wealthiest nations, Yunus says, are starting to realize that their “free” health systems are still too expensive to pay for.
Healthcare insiders will be incredulous. How in the world will the priciest healthcare system serve people living below poverty without relying mainly on charity? Yunus answers that question, and explains why he’s going into health care in the first place, in a recent Financial Times op-ed [i].
In his work with the world’s poor, Yunus has been continually rankled by the fact that health care costs are such a burden to so many and are continually rising. For the poor, health costs are an especially serious threat, because even small bills can cause financial ruin. To someone living on $25 per day, for example, a $300 prescription represents weeks of food and transportation. Continue reading…
The promising platform is called Guahao (挂号网) and it claims to be China’s largest online appointment registration system. With a national network of nearly 4,000 hospitals, 600 being Level-3 hospitals, and over 300,000 specialists, it is hard to dispute it’s size.* Guahao began development in Shanghai 2010 in collaboration with the Chinese Health Education Network, Fudan Hospital and Healthcare Management Co., and the Chinese Hospital Association, and later expanded nationally. Guahao attempts to alleviate the bitterness patients endure during a typical hospital visit.
*It should be known that there are actually several online appointment registration systems in China; However, most are small, regionally splintered and have questionable legitimacy. Guahao is by far the largest and most well supported system in China.
China historically has not had a call-ahead appointment scheduling system. Patients throughout China have long lamented the country’s hospital queuing system, or the lack thereof. Patients arrive at the hospital, literally take a number, and wait for their turn – sometimes for over 24 hours. It is not uncommon to see throngs of patients and their family members outside of the hospital, camping out in makeshift beds to see a physician. A lack of appointment system puts pressure on the hospital’s health workers. Patient scheduling provides predictability of patient flow and allows for more efficient allocation of healthcare resources. Not to mention it makes for a much more patient-centered approach to healthcare delivery.
In 2003, 168 countries signed the world’s first public health treaty: the Framework Convention on Tobacco Control (FCTC). The FCTC legally bound countries to enforce major tobacco control measures, ranging from tobacco taxes to regulations on public smoking. Through a massive international effort, the FCTC has assisted countries to improve their tobacco prevention programs, and the treaty continues to be a basis for many new programs that are implementing evidence-based tobacco control strategies.
In an article in PLoS Medicine, we publish new data showing that the food and beverage industry’s activities in low- and middle-income countries parallel that of the tobacco industry in years past; moreover, as cardiovascular disease and diabetes rates rise in poor nations, junk food, soda, and alcohol are statistically the major factors giving rise to deaths among working-age populations, and the newest evidence suggests that educational programs alone aren’t effective when markets are drowned by imports of cheap, unhealthy food and readily-accessible booze. So should the public health community push for a nutritional treaty or governance structure that parallels the successful introduction of the FCTC, but addresses “unhealthy commodities” like junk food? If so, what would such a structure look like?
Zooming out from the debates about soda taxes and similar public health controversies that pit individual freedom against public health desires to reduce disease rates, there are really a few core public health problems now facing global food systems: (1) that undernutrition and famine persist as over-nutrition (malnutrition in the direction of obesity) has appeared in the same poor households in many countries; and (2) that climate change has forced us to think about how to produce food for the world’s 9+ billion people in a manner that is environmentally sound (as highlighted in our recent discussion of Oxfam’s GROW campaign).