Through a research opportunity, I have begun working with some very remarkable people with great ideas about health system strengthening. Andrey Ostrovsky is one of them. Check out his presentation on an innovative Health Card Report he helped develop. The idea of connecting health initiatives through the web is a great idea to collaborate all the health efforts in a community and strengthen access to health.

This presentation was titled “San Francisco Community Vital Signs: Implementing Policy and Innovating for Health.” Andrey Ostrovsky, a fourth year medical student at Boston University and a 2009-2010 Doris Duke Foundation Fellow at UCSF, outlines the process of creating an online tool that evaluates and strengthens the local public health system in San Francisco. Ostrovsky also describes the lessons learned from operating at the intersection of social missions, entrepreneurship, and politics.

I have come across my share of public health advertisements during my short time in the public health program at BYU, and these short clips are some of my favorites!  I hope they not only entertain, but manage to educate.

Great Britain’s Coughs and Sneezes 1945

http://www.youtube.com/watch?v=3h6jw4Fni-w

Australia’s The Sneeze

http://www.youtube.com/watch?v=qKiQA5e-fPg&feature=related

Embrace Life – Always Wear a Seatbelt – the following link no longer works, but if you have the time, I would recommend searching for this commercial, it is that good!

http://www.youtube.com/watch?v=2vOHmwyIt5M&feature=fvst

The Truth Campaign anti-smoking in U.S.

http://www.youtube.com/watch?v=c4xmFcrJexk

http://www.youtube.com/watch?v=gJTCWtcAews&feature=related

and then this is just funny:

http://www.youtube.com/watch?v=XY66ZJ0TFUI&feature=related

Global health issues arise from a number of issues; we’ve already discussed poverty and poor health systems as contributing factors.  Many people would also name drug abuse as a contributing factor to the unhealthy world we live in. 

A less understood issue arising from poor health systems is that our use, or rather abuse, of perscription drugs has the potential for more harm than good.  Thankfully, there are resources available to us as consumers to know what to watch for and how to improve our use of drugs. 

Drugwatch.com is a comprehensive web site featuring extensive information about medications, drug interactions, and drug side effects to aid in the protection of patients and consumers.  By providing FDA alerts, drug interactions, and potential side effects on the site, patients have access to valuable knowledge that could enhance their ability to voice concerns with their doctor and improve their quality of care.

A side note:  the correct use and disposal of prescription drugs are also critical to controlling some of the harmful results.  If we will make sure to follow the directions for taking the prescription drug and then dispose of them at an established waste collection site (and NOT down the toilet or straight into the garbage), we can better prevent not only the reselling of left-over prescription drugs, but also the development of resistant strains of bacterial/viral diseases and the pollution our drinking water and natural environment.  The presciption drug trafficking issues globally can also be better managed as we learn to manage our own use of prescription drugs. 

See www.drugwatch.com and http://www.whitehousedrugpolicy.gov/about/index.html for more information!

“Give a man a fish, he will not go hungry for a day, but teach a man to fish, and he will not go hungry for a lifetime.”  Despite the commonality of the above statement, the Grameen Foundation has really taken this simple truth to heart. 

The Grameen Foundation works to combine the power of microfinance and technology to defeat global poverty.  They target the poorest and those living in harder to reach areas and provide them with microfinancing and technology to help them overcome their own poverty and move themselves to a better life.   Their cutting-edge resources have helped 45 million poor people, mostly women and children, to improve their lives through the following ways:

1. They create economic opportunities for the world’s poorest.  The Foundation provides access to capital needed for the poor to use to develop or expand a small business.

2. They  build large-scale, easy-to-replicate solutions to end the cycle of poverty in developing countries around the world.  With the re-paid loans, they then recycle the funds into new loans, thus perpetuating the program for new clients.

3. They leverage the knowledge and expertise of local partners to create the most effective programs possible.  They support and strengthen local organizations while respecting cultures and traditions.

4.  They lead the industry in measuring impact and delivering results.  Their Progress Out of Poverty Index^TM simply but accurately measures poverty levels of the 23 countries they serve, as well as to determine the clients’ needs, the effectiveness and efficiency of programs, and how quickly people move from poverty to financial self-sufficiency.

Millions have already benefited from this Foundation and others using microfinancing as the path out of poverty.  Can you imagine the good we could do by donating just a dollar to the fund?  A dollar we might waste on a candy bar here in America could very well be part of the fund that pulls a family out of the slums and into a functioning and sustainable lifestyle!

“Developing Countries Lead Recovery, but High-Income Country Debt Clouds Outlook”

I came across this news article on the World Bank website.  Reported June 9, 2010, it discusses the economic recovery advancement on the global scale.  According to the World Bank’s latest Global Economic Prospects 2010, developing economies are expected to grow, while high-income countries will grow, but not enough to undo the contraction in 2009. 

Justin Yifu Lin, the World Bank’s Chief Economist and Senior Vice President, Development Economics sees this as a good thing and an opportunity.  He says that “the better performance of developing countries in today’s world of multi-polar growth is reassuring, but, for the rebound to endure, high-income countries need to seize opportunities offered by stronger growth in developing countries.”

Despite the growth projected for developing countries, they may feel the serious ripple effects of the struggles in high-income countries they are closely related to in trade and financial connections. 

As explained by Andrew Burns, manager of global macroeconomics at the World Bank, “developing countries are not immune to the effects of a high-income sovereign debt crisis, but we expect many economies to continue to do well if they focus on growth strategies, make it easier to do business, or make spending more efficient. Their goal will be to ensure that investors continue to distinguish between their risks and those of these high-income countries.”

Many developing countries may continue to face serious financial gaps, and the fight against poverty over the next 20 years will face great obstacles as high-income countries fight to overcome their own financial crisis.  If financial aid flows decline with the financial slump, this could affect the long-term growth rates in developing countries and potentially increase the number of extremely poor in 2020 by as much as 26 million.  What an even greater reason now to improve health systems in the context of the developing community so that they can function independent of extra aid.

Inspired by a comment previously made, I decided to look into an example of what religious organizations can do to help strengthen health systems.  The Church of Jesus Christ of Latter-Day Saints is just one of many religious groups who has worked to unify the world population of its members to save lives and build hope for all those in need through a number of programs within the LDS Philanthropies. 

One such program is called the LDS Charities.  Through donations, this group helps people become self-reliant and improve their quality of life through initiatives such as clean water, neonatal health, vision treatment, wheelchair production and food production.  LDS Charities also responds in emergencies to relieve suffering by providing life-sustaining support.  In the 150 Day Report, they have already donated 1.5 million pounds of food and supplies in emergency relief responses to Haiti and Chile.  In 2009:

1. 27,242 people in 30 countries benefited from the neonatal resuscitation program,

2. 989, 571 people in 24 countries benefited from the clean water programs,

3. 223,242 people in 23 countries benefited from the vision care program,

4.  8,400 people in 54 countries benefited from the food production program,

5. 56,017 people in 56 countries benefited from the wheelchair program,

6. and LDS Charities was able to respond to 102 disasters in 48 countries.

This is just one religious group, so imagine the service done by the religious groups in communities worldwide.  As you can see from the above examples, many of the services were focused in areas where lasting and sustainable improvements and changes were made.  It is inspiring to see how, through unified efforts, we can all make a lasting difference in someone’s life.

In our discussions of how to strengthen health systems, I find it fascinating to consider all the different health systems there are in the world, with equally diverse health care systems.  With the recent debates and changes in the United State’s health care, we have had many opportunities to consider what other methods are used by other countries and their overall quality.

In a recent class lecture, Dr. Gordon Lindsay of BYU brought up some excellent points about our measure of health and how economics plays a role in it.  First of all, it is important to realize that America is by far the nation that spends the most on health care ($6,719 total expenditures PPP). 

For expending so much on our health care, how would our life expectancy then compare with other countries?  If wealth spent on health care systems really did mean better health, then we could conclude that Americans would have the longest life expectancy.  According to the CIA‘s World Factbook, the U.S. is ranked at 49th. 

I know there are more factors that play a part in determining the health of a nation, however, I agree with Dr. Lindsay that more is involved in health care than how much we pay for it.  By looking around us at other nations and their health care systems, and by re evaluating our health systems, we can improve and strengthen our own health system.

Unfortunately, the evidences of weakened and inefficient health systems are all around us.  Perhaps fragmented information and multiple patient records will hinder a doctor’s ability to make the best diagnostic and care decision.  If a program is under resourced, certain standardized care processes can be neglected.  Family Health International explains that a health system is a complex organization, and so its performance will depend on man components and their interactions.  In order to strengthen this complex of components in the health system, you must be able to identify issues that interfere with provisions of services and then introduce systems changes that will result in sustainable improvements (not quick fixes). 

Before being able to address how to strengthen health systems, it may be wise to consider what factors make up a functioning health system.  You can’t strengthen something you don’t understand.  The World Health Organization has recently defined the six building blocks of a health system in their report “Everybody’s Business:  Strengthening Health Systems to Improve Health Outcomes“:

1. Health services must be efficient, effective, and accessible.

2. A number of well-trained staff should be available.

3. Health information systems should generate useful data on health determinants and health system performance.

4. Access to medicines, vaccines, and medical technologies must be equitable.

5. Health financing systems must raise adequate funds for health, ensuring that people can access affordable services.

6. Leadership must guarantee effective oversight, regulation, and accountability.

Using these six blocks to first evaluate the health system of a community or developing country will better allow us to know where the greatest need for improvement is in the system and then better strengthen that aspect.  

Take a moment to consider how your community’s health system compares to the six blocks.  Are you provided with a functioning health system?

While many realize the need to improve health on a global scale, and recognize that strengthening health systems is a proactive approach to addressing this, one may still wonder how to strengthen health systems? 

In the Health Systems 20/20 Project funded by USAID, they offer support to developing countries to help them address and solve problems in the following areas:

1. health governance:  to broaden the leadership and invite the community to have more of  a hand in governance operations, especially in community health services.

2. finance:  to increase funding and better allocate resources and services to the neglected in the population.

3. operations:  to improve financial management and better manage human resources so that services are more efficient.

4. capacity building:  to build the community’s capacity to tap funds and technology to enhance their health system to meet community health needs.

Working through these four dimensions of strengthening health systems helps focus on building capacity for long-term sustainability of system strengthening efforts.  This is only a five-year program, but hopefully the work done in developing countries who take advantage of this program will be as sustainable as they hope through addressing needs in the above four areas.

I actually initially became interested in the concept of health system strengthening from a lecture given by Dr. Chad Swanson in my Health 100 class.  He talked about the importance to improve health through addressing the places where the delivery of health services are in crippled.  He actually has a blog of his own at http://ghsia.wordpress.com/ where he researches, tracks, and discusses the progress made to better understand how to strengthen health systems. 

He made a post a couple of months ago about the need for the strengthening of health systems movement to mirror more of a social movement in passion, leadership, and ambition emulation.  In the efforts to improve equality and protect civil rights globally, we have seen passionate leaders such as Martin Luther King, Jr. and Gandhi make great sacrifices and effect great change for the freedoms of others.  Our fight to improve health equality across the globe fits right in with their arguments, social mobilizations, and visions. 

In saying this, we address the question of whether or not health is a right rather than a privilege.  Living in our current health care system, you may wonder if it is a right to receive basic health care needs if you can’t afford it.  Do we all deserve to be healthy, just as we all deserve the freedoms of equality?  I think the answer is obvious.  With the millions who suffer and die needlessly every day, the need to fight for the attainment of health equality is at its greatest now!  We need to learn from the social movements of before to help build a unified force to tackle present global health issues.  As Dr. Chad Swanson says, ” we need charismatic leaders, committed, passionate, volunteer followers, and an organized strategy.”   We have so many international and local organizations working to alleviate suffering on a global scale in different areas: cancer, AIDS, malaria, etc.  What we need now is to unify our efforts and coordinate our programs to effect the greatest change.  With passion and a unified front, we can change the world!