Food Shortage in Ethiopia

As a result of poor harvest yields and food shortages, food prices have increased 52 percent between 2007 and 2008, according to the Food and Agriculture Organization (FAO). Areas of Asia, the Pacific, and Sub-Saharan Africa are experiencing particularly large increases in food costs. The Humanitarian Practice Network reports that for individuals with limited means, these higher prices make it difficult or impossible to meet their food needs. The FAO indicates that the number of people classed as under-nourished worldwide increased by 75 million in 2007, reaching a total of 923 million individuals. Women-headed households, the urban poor, and those affected by conflict situations or natural disasters are among those most likely to be affected by food shortages.

The World Food Programme (WFP) has identified 30 countries and territories as being “in crisis” with regard to food shortage and other humanitarian concerns. Ethiopia, Africa’s second most populous country, is among the countries for which food shortages and rising prices are a pressing concern. 4.6 million Ethiopians are threatened by hunger and malnutrition, and 10 million have been affected by droughts. In addition to six major droughts in the last two decades, the region has been denied access to the ports of Eritrea following a border war. The BBC reports that following the United Nations’ food deliveries to Ethiopia this month, no further deliveries will be made until September or October. Because of worldwide food shortages, the UN has stated that it has “no option but to cut back” on the provisions, which have already been reduced by a third since July 2008.

In areas like Ethiopia where food and medications as well as medical services are often scarce, telemedicine initiatives may allow for the provision of better care to those suffering from illnesses related to malnutrition and/or poor quality food and drinking water. By utilizing the Internet, telemedicine programs like iConsult make it possible to provide humanitarian healthcare assistance without the cost and risk associated with traveling to conflict-affected areas.

Find out more about iConsult

Food and Agriculture Organization - United Nations World Food Programme - BBC News Report on Food Shortage

Jaspars, S. and Wiggins, ODI, S. (2009). “The global food crisis: an overview” Humanitarian Exchange. Humanitarian Practice Network, Number 42.

Image from a report on hunger in Ethiopia from The Economist

Global Healthcare Worker Shortage

The World Health Organization (WHO) reports a shortage of healthcare workers worldwide, especially in rural areas. Healthcare workers are defined as those whose main activities are aimed at enhancing health – including doctors, nurses, and laboratory technicians, as well as management and support staff. Of the estimated 59.3 million healthcare workers worldwide, approximately two-thirds (39.5 million) provide health services. Rural areas of the United States are facing a shortage of healthcare personnel, and 57 countries throughout Africa and Asia are facing a severe healthcare workforce crisis. The WHO estimates that in order to fill the gap, at least 2.36 million service providers and 1.89 million support staff are needed. Between developing and developed nations, a large imbalance can be seen in the healthcare staff available. For example, in sub-Saharan Africa, an area with 11 percent of the global population, there are only three percent of the world’s healthcare providers.

According to the Grosse Pointe News, Institute of Medicine figures indicate that by 2030 77 million Americans will be 65 or older. For the nearly 20 percent of these individuals who have five or more chronic health conditions, access to healthcare workers able to provide elder care is essential. Further, a report from Minnesota Public Radio indicates that though 13 percent of the state’s population lives in rural areas, only five percent of the physicians practice there. This shortage of doctors and other healthcare providers in rural areas is a national trend, and ultimately causes patients to experience longer non-emergency wait times, providers who are fully booked and/or not accepting new patients, and more care provision by mid-level practitioners. CNN reports that the findings of Barbara Starfield at the Johns Hopkins University Bloomberg School of Public Health indicate that an increase of one primary care physician per 10,000 people would result in a 34.6 fewer deaths per 100,000 people at the state level.

Increasing the availability of healthcare and health services is a major aim of the Millennium Development Goals (MDGs). The Goals also seek to reduce child mortality, improve maternal health outcomes, combat HIV/AIDS and diseases like malaria and tuberculosis, and ensure the availability of medications. In order to increase the availability of healthcare in rural areas, the WHO suggests a number of measures, including reassignment of needed healthcare workers during conflict situations. While this may increase the health outcomes for the population in the region, it also poses a risk to the providers – one that could be avoided through the use of telemedicine and teleconsultation programs like iConsult. Through teleconsultation, specialty care physicians can remotely provide advice and support to doctors within a region.

Find out more about how iConsult can help

WHO Information on Healthcare Worker Shortage - Grosse Pointe News - Minnesota Public Radio - CNN Report

Health Among Aboriginal Populations

Rural areas often do not have the same quality of resources – especially health resources – available to urban areas. Among indigenous groups such as the Aboriginal and Torres Strait Islander populations of Australia, this is a particularly pressing problem. According to the Australian Government’s Australian Institute of Health and Welfare, as of 2001 an estimated 2.4 percent of Australia’s population identified as being of “Aboriginal origin,” “Torres Strait Islander origin,” or both. Around 25 percent of the indigenous Australian population – compared to two percent of the non-indigenous population – lived in areas classified as “remote” or “very remote.” As in other nations, non-urban areas often are not surveyed regularly, so gaps in health and welfare information are not sufficiently monitored or addressed.

The Australian Medical Association reports that representatives from the Indigenous Dentists’ Association have called for measures to improve oral health among indigenous groups such as the fluoridation of community water supplies. Per Medical News Today, the Dietitians Association of Australia indicates that due to the lower economic means of many people living in remote areas, high-quality nutritious food is not always available. Further, items such as sodas, sweets, and fried food are more available in rural areas and are lower-cost. Since one in every three Aboriginal people over the age of 15 worries about going without food, making healthy food options more available and affordable is a major concern to improving the overall health of the population.

Areas like the Northern Territory, where around 29 percent of the population are indigenous, also face a shortage of medical professionals to treat the conditions exacerbated by poor-quality food and lack of appropriate medical and dental care. Telemedicine programs such as iConsult provide opportunities to improve medical care in these areas and treat or lessen the severity of many conditions.

Find out more about iConsult

CIA World Factbook – Australia - Australian Medical Association (Healthcare Providers) - Medical News Today (Food and Nutrition)

Medical Social Networking

Social networking websites have become increasingly popular in recent years. Kerri Breen of the CBC News reports that YouTube has become the third most popular website in the world, Facebook now has over 200 million users, and Twitter has grown 2,565 percent in the past year. Through the new channels offered by these social networking websites and tools, users can discuss anything from cat toys to a bothersome rash on their arms.

The ever-increasing popularity of these Web 2.0 sites offers new opportunities for their application to improve health and medical care. The New York Times reports that during the last week of April, “Swine Flu” was the most searched term on Yahoo, the Wikipedia page on “Swine influenza” received 1.3 million page views, and an estimated 125,000 tweets a day on Twitter mentioned the illness. Despite this increase in discussion about the virus, Alessio Signorini, a PhD candidate in Computer Science at the University of Iowa, told the NYT that this “noise” does not indicate actual trends in the spread of the virus. Dr. Philip Polgreen further explained that by tracking indicators within popular search terms, such as symptoms of a condition or virus, it is possible to better track its spread and plan more effectively for inoculations.

Growth in Internet use has also led to a rise in self-diagnosis and/or self-prescription. Through tools like Twitter or Facebook, individuals can simply state that they do not feel well, and are much more likely to do so than to visit a doctor. While this could potentially lead to their not getting necessary treatment, other forms of web use may help to ease discomfort, physical and/or psychological, caused by certain conditions. A number of websites have been introduced which allow patients with specific conditions (e.g., MS, diabetes, eczema) to form a community. ABC Health and Wellbeing reports that research indicates that patients with psoriasis indicated their perceived quality of life had improved following the use of these online support websites. Center for Connected Health and Boston’s Massachusetts General Hospital researchers have also found that these online networks provide a valuable base of information and support to patients, and that health outcomes can be further improved through physician involvement.

A number of social networking websites have also been developed to allow physicians, clinicians, researchers, and medical specialists to link to one another and discuss various areas of their practice. In addition to sites which allow doctors to create social connections, others, like iCons in Medicine, provide the opportunity for healthcare providers in remote or medically underserved areas to request assistance on difficult cases from physicians in 30 medical specialties. Through these teleconsultations and the social networking tools provided by programs like iCons in Medicine, doctors can collaborate on difficult cases and improve patient health at the point of care.

Find out more about iCons in Medicine

CBC News - New York Times - ABC Health and Wellbeing

Public Health in Iraq

The United Nations High Commissioner for Refugees (UNHCR) reports that there are currently 31.7 million uprooted or stateless people worldwide. Refugees are defined by the U.S. Bureau of Population, Refugees, and Migration as: “any person who is outside any country of such person's nationality…and who is unable or unwilling to return to…that country because of persecution or a well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion.” Refugee status may be due to conflict situations, natural disasters, or other factors, but regardless of the cause, refugees and internally displaced persons face a number of health concerns.

In areas ravaged by war, poor quality food and water and nearly non-existent sewage treatment are major concerns. A 2007 World Health Organization (WHO) report indicated that nearly two million Iraqis are internally displaced persons and an additional two million have left the nation and are living as refugees in Syria and Jordan. Due to growing public health concerns in Iraq and the deterioration of the healthcare system, these numbers are expected to continue to increase. Seventy percent of Iraqis in-country do not have regular access to clean water, and 80 percent lack sewage facilities that do not contaminate sources of drinking water. As a result, in 2007 diarrhea and respiratory infections accounted for approximately two-thirds of the deaths of children age five and under.

The UNHCR reports that the majority of deaths of children under five living in refugee situations in developing countries are: malaria, malnutrition, measles, diarrhea, and respiratory tract infections. Priority is often given to controlling communicable diseases and epidemics, however public health surveillance is also important to ensure these potentially non-lethal conditions are controlled. Immunization, HIV/AIDS programs, reproductive health services, chronic disease management, mental health support are critical to ensuring that conflict-effected and refugee populations are able to survive.

Through online forums like those provided on iCons in Medicine, it may be possible to address and track public health concerns and outbreaks. By presenting these items to the group of volunteer medical experts participating in the iCons in Medicine program, perhaps we may begin to uncover ways of lessening the severity of these situations, or even halting them.

Contribute to the iCons in Medicine Forums

United Nations High Commissioner for Refugees - The U.S. Bureau of Population, Refugees, and Migration - WHO Report on Public Health in Iraq

Using Telemedicine to Treat Chronic Disease

Chronic diseases pose a threat worldwide, particularly in the developing world. Heart disease, cancer, diabetes, and other chronic diseases account for over half of all deaths each year - double the number of deaths caused by infectious diseases, maternal and perinatal conditions, and nutritional deficiencies combined. Developing nations are facing an epidemic of non-communicable chronic diseases as risk factors such as obesity, lack of physical activity, and tobacco use continue to increase. Contrary to the popularly held belief that infectious diseases are the leading cause of death in the developing world, 80 percent of chronic disease deaths occur in low and middle income countries.

International attention and funding has primarily focused on communicable disease, and as a result the healthcare systems of developing nations are not well equipped to manage chronic conditions. For example, the World Health Organization spends only 50 cents per person on chronic disease (excluding mental health) per year, compared with $7.50 for the major infectious diseases. Regular doctor visits are necessary for proper treatment and management of chronic diseases, but most low- and middle-income countries have not developed the necessary infrastructure or network of specialty physicians to provide this type of care.

Telemedicine and teleconsultation programs offer a cost-effective solution to this problem. Through initiatives like iConsult, healthcare providers in remote or medically underserved areas can consult with specialty physicians over the Internet to gain access to their clinical expertise. By utilizing iConsult, an Endrocrinologist in New York City or Cardiologist in Portland would be able to offer assistance to a provider in a clinic in Chad, and ensure that a patient with diabetes or high blood pressure receives the highest quality of care.

Find out more about the iConsult program

Reports indicate a nutritious diet, physical activity, avoiding alcohol and tobacco use, and regular medical exams help decrease the risk of developing a chronic disease.

CDC Report on Chronic Disease - WHO Report on Chronic Disease - Report from SciDev Net

See also:
Nugent, R. (2008). Chronic diseases: a growing problem in developing countries. DiabetesVoice, 53, 17-20.

WHO Report on TB and HIV

A recent report from the World Health Organization (WHO) indicates that though the total number of new cases of tuberculosis worldwide remained stable in 2007, the population becoming ill with TB has continued to decline slowly since 2004. However, the 2009 global TB control report also indicates that one of every four TB deaths is HIV-related – a figure that is twice what was previously recognized.

In 2007, there were an estimated 1.37 million new cases of TB among HIV-infected individuals and approximately 465,000 deaths. As quoted in the WHO report, Dr. Margaret Chan, Director-General of the WHO stated that "These findings point to an urgent need to find, prevent and treat tuberculosis in people living with HIV and to test for HIV in all patients with TB in order to provide prevention, treatment and care. Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases.”

Many areas have begun to see increases in HIV testing among people being treated for TB, especially in African nations. Where just 4 percent of TB patients were tested in 2004, 37 percent were tested in 2007 with several countries testing more than 75 percent of TB patients to determine their HIV status. This increase in testing has led to an increase in the number of people receiving appropriate treatment, though it is still only a small fraction of those who need care. Despite increases in testing, the co-infection of HIV and drug-resistant forms of TB presents one of the greatest treatment challenges. The WHO report indicates that in 2007 there were an estimated 500,000 people who presented with multidrug-resistant TB.

Due to the high cost needed to ensure that treatment can be delivered in the ninety-four countries in which 93 percent of the world’s cases of TB occur, additional funding will be needed by the Stop TB Partnership’s Global Plan to Stop TB. Though “remarkable progress against both TB and HIV [have been made] in the last few years…TB still kills more people with HIV than any other disease,” said Dr. Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

See the full 2009 WHO Global TB Report
Learn more about how you can help improve global health by becoming a part of iCons in Medicine