Dear Editor,
Gilmore. B., et al have highlighted that the community involvement is pivotal to improving on prevention and control of Covid-19. We believed that governments should implement strict policies, to foster a culture of compliance and trust, not infringing on human rights (B., 2009). Take Taiwan for example, who learned from their experiences with SARS in 2003, developed and implemented policies and infrastructure in 2004 to combat any similar outbreaks in future. In 2004, the year after the SARS outbreak, the Taiwan government established the National Health Command Center (NHCC). The NHCC is part of a disaster management center that focuses on large-outbreak response and acts as the operational command point for direct communications among central, regional, and local authorities (C. Jason Wang, Chun Y. Ng, & Robert H. Brook, 2020). Such a policy is able to encourage the dissemination of pertinent information to the people, increase transparency and build trust in the framework. Furthermore, the use of Info dynamics should take precedence to minimize the spread of misinformation among communities. In a 2020 issue, Tangcharoensathien V et al (Tangcharoensathien. V., 2020), the WHO presented a framework for managing the Covid-19 infodemic (G., 2020) which can continue strengthening on a trusting relationship among people and healthcare personnel. Therefore, rallying community members for various roles in disease prevention and control will be widely ac...
Dear Editor,
Gilmore. B., et al have highlighted that the community involvement is pivotal to improving on prevention and control of Covid-19. We believed that governments should implement strict policies, to foster a culture of compliance and trust, not infringing on human rights (B., 2009). Take Taiwan for example, who learned from their experiences with SARS in 2003, developed and implemented policies and infrastructure in 2004 to combat any similar outbreaks in future. In 2004, the year after the SARS outbreak, the Taiwan government established the National Health Command Center (NHCC). The NHCC is part of a disaster management center that focuses on large-outbreak response and acts as the operational command point for direct communications among central, regional, and local authorities (C. Jason Wang, Chun Y. Ng, & Robert H. Brook, 2020). Such a policy is able to encourage the dissemination of pertinent information to the people, increase transparency and build trust in the framework. Furthermore, the use of Info dynamics should take precedence to minimize the spread of misinformation among communities. In a 2020 issue, Tangcharoensathien V et al (Tangcharoensathien. V., 2020), the WHO presented a framework for managing the Covid-19 infodemic (G., 2020) which can continue strengthening on a trusting relationship among people and healthcare personnel. Therefore, rallying community members for various roles in disease prevention and control will be widely accepted and followed. (Gikmore. B., 2020).
References
B., R. S. (2009). Lessons from community participation in health programmes: a review of the post Alma-Ata experience. Elsevier, 32. doi:doi:10.1016/j.inhe.2009.02.001
C. Jason Wang, M. P., Chun Y. Ng, M. M., & Robert H. Brook, M. (2020). Response to COVID-19 in Taiwan Big Data Analytics, New Technology, and Proactive Testing. Viewpoint, 1341. doi:doi:10.1001/jama.2020.3151
G., E. (2020). How to Fight an Infodemic: The Four Pillars of Infodemic Management. Journal of Medical Internet Research. doi:10.2196/21820
Gikmore. B., e. a. (2020). Community engagement for COVID-19 prevention and control: a rapid evidence synthesis. BMJ Global Health, 1. doi:doi:10.1136/bmjgh-2020-003188
Tangcharoensathien. V., e. a. (2020). Framework for Managing the COVID-19 Infodemic: Methods and Results of an Online, Crowdsourced WHO Technical Consultation. J Med Internet Res. doi:10.2196/19659
It was interesting to read Roder-DeWan S et al.,(1) paper entitle Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap.
This paper focuses on problems with the current approach, discuss the feasibility of redesign, propose reforms to transform current health systems. We support the authors that health system redesign is needed to enhance people’s access to standard care and reduce newborn mortality rate especially in low- income country which is higher than in high-income countries about nine times(1). This is also in line with Sustainable Development Goal No.3 (SDGs) target 3.1 that by 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births(2). Gabrysch S et al,(2019) found in their study that giving birth in a health care facility does not necessarily gives assurance of a survival benefit for women or babies however it should be recommended in facilities capable of providing emergency obstetric and newborn care and capable of safeguarding uncomplicated births(3).
It is therefore important to reconsider the healthcare systems so that every pregnant woman receives the best of healthcare. Niyitegeka J et al,(2017) in a study conducted in Rwanda found out that women who had to travel more than 90 minutes to the nearest district hospital had significantly worse neonatal outcomes compared to those had Odds Ratio 5.12 times referred from health centers located on the same...
It was interesting to read Roder-DeWan S et al.,(1) paper entitle Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap.
This paper focuses on problems with the current approach, discuss the feasibility of redesign, propose reforms to transform current health systems. We support the authors that health system redesign is needed to enhance people’s access to standard care and reduce newborn mortality rate especially in low- income country which is higher than in high-income countries about nine times(1). This is also in line with Sustainable Development Goal No.3 (SDGs) target 3.1 that by 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births(2). Gabrysch S et al,(2019) found in their study that giving birth in a health care facility does not necessarily gives assurance of a survival benefit for women or babies however it should be recommended in facilities capable of providing emergency obstetric and newborn care and capable of safeguarding uncomplicated births(3).
It is therefore important to reconsider the healthcare systems so that every pregnant woman receives the best of healthcare. Niyitegeka J et al,(2017) in a study conducted in Rwanda found out that women who had to travel more than 90 minutes to the nearest district hospital had significantly worse neonatal outcomes compared to those had Odds Ratio 5.12 times referred from health centers located on the same compound as the hospital(4). The gap to high-quality care should be closed by health system redesign.
I write a quick note to correct what is probably an editing error. Both the abstract and the text state that under-five mortality has increased in sub-Saharan Africa 1990-2018, while decreasing in the rest of the world. In fact, the Unicef data referenced in the paper (https://data.unicef.org/topic/child-survival/under-five-mortality/) indicate that under five mortality has decreased from 178 per 1000 live births in 1990 to 78 per 1000 in 2018, a reduction of 100 per 1000 or 56%. The UN inter-agency group for child mortality estimation (IGME) has similar estimates (https://childmortality.org/data/SDG%20Regions%20%3E%20Sub-Saharan%20Africa).
Arnab and colleagues reported the findings from their research study in India, UK, and the USA that politicians are unlikely to be punished or rewarded for their failures or successes in managing COVID-19 in the next election. (1) By early September, India came only next to the US in terms of COVID 19 burden. Officially, India collects and reports data in terms of geographical variations, disaggregated by age and sex. India also reports the count of deaths among patients with and without comorbidities. However, none of the States report COVID 19 data disaggregated by social determinants, primarily castes and wealth quintiles, which are the most important determinants from an Indian perspective.
The caste system in India is a ‘disabling myth’ which contributes to preventable and inequitable mortality in women and children.(2) Globally, COVID 19 has once again exposed the vulnerability of disadvantaged groups due to ongoing social discrimination and economic deprivation.(3) Emerging data shows that the racial minorities in the US are disproportionately affected by the pandemic. Data shows that Non-Hispanic Blacks have five times the risk of hospitalization compared to non-Hispanic Whites (age-adjusted) and Hispanic and Latinos have 4 times the risk compared to non-Hispanic Whites.(4,5) However, realizing the importance of having more accurate data to understand the impact of COVID 19, foundations and agencies came forward to support and set-up mechanisms to track rac...
Arnab and colleagues reported the findings from their research study in India, UK, and the USA that politicians are unlikely to be punished or rewarded for their failures or successes in managing COVID-19 in the next election. (1) By early September, India came only next to the US in terms of COVID 19 burden. Officially, India collects and reports data in terms of geographical variations, disaggregated by age and sex. India also reports the count of deaths among patients with and without comorbidities. However, none of the States report COVID 19 data disaggregated by social determinants, primarily castes and wealth quintiles, which are the most important determinants from an Indian perspective.
The caste system in India is a ‘disabling myth’ which contributes to preventable and inequitable mortality in women and children.(2) Globally, COVID 19 has once again exposed the vulnerability of disadvantaged groups due to ongoing social discrimination and economic deprivation.(3) Emerging data shows that the racial minorities in the US are disproportionately affected by the pandemic. Data shows that Non-Hispanic Blacks have five times the risk of hospitalization compared to non-Hispanic Whites (age-adjusted) and Hispanic and Latinos have 4 times the risk compared to non-Hispanic Whites.(4,5) However, realizing the importance of having more accurate data to understand the impact of COVID 19, foundations and agencies came forward to support and set-up mechanisms to track racial disparity in COVID in the US. (6,7) Ongoing data collection shows that COVID-19 is affecting minorities the most and that Black people are dying at 2.3 times the rate of white people. (8) The same is the case with minorities in other countries including the UK.
The last round of India’s Demographic and Health Survey (National Family Health Survey, 2015-16), gives some indication of the differences in the risk between castes and wealth quintiles. (9) Hand washing is one of the most recognized and irrefutable preventive measures to avoid COVID. NFHS data shows that the upper castes have the luxury of soap and water in close to three-fourth of their households, while more than 60% of the scheduled tribes (most backward castes) and half of the scheduled castes (backward castes) do not have soap and water facilities. Every one-in-five households of schedules tribes didn’t even have water, soap, or other cleansing agents. This is almost four times more than the proportion among higher castes.
Ninety-three percent of households in the wealthiest quintile had soap and water, while not even a quarter of households in the lowest quintile had them. One in every five households in the lowest wealth quintile lacked water, soap, and other cleansing agents. The upper castes are predominantly rich (57% of the upper castes are in the richest two quintiles) while 70% scheduled tribes and 50% of scheduled castes belong to the lowest two quintiles.12
The startling disparity in having access to such simple preventive measures as soap and water for handwashing will have a differential impact on the burden of COVID among people in the lower castes and or wealth groups. Previous studies have shown that the difference persists in terms of access to care as well. (10) It is in this context that the lack of disaggregated data for COVID 19 in India, the second-largest population in the world becomes important. It’s high time that research agencies and philanthropies invest in and collect, analyze, and disseminate data on the caste and wealth differentials on COVID 19 including mortality rates. Bringing in such evidence also helps to increase the political relevance of public health issues.
Reference:
1. Arnab Acharya, Gerring J, Reeves A. Is health politically irrelevant? Experimental evidence during a global pandemic. BMJ Global Health. 2020;5(10):e004222. doi:10.1136/bmjgh-2020-004222
2. The Lancet. The health of India: a future that must be devoid of caste. Lancet 2014; 384: 1901. doi: https://doi.org/10.1016/S0140-6736(14)62261-3
3. Kirby T. Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities. Lancet Respir Med. 2020;8(6):547-548. doi:10.1016/S2213-2600(20)30228-9
4. Dorn AV, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. Lancet. 2020;395(10232):1243-1244. doi:10.1016/S0140-6736(20)30893-X
5. CDC. Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. Published February 11, 2020. Accessed July 6, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-...
6. Marguerite Casey Foundation Announces $3.5 Million in COVID-19 Grant Funding to Tackle Racial Disparities Resulting from Pandemic | Marguerite Casey Foundation. Marguerite Casey Foundation. Published April 23, 2020. Accessed October 24, 2020. https://caseygrants.org/who-we-are/inside-mcf/marguerite-casey-foundatio...
7. The Rockefeller Foundation Commits $1.5 Million to Support the Boston University Center for Antiracist Research - The Rockefeller Foundation. The Rockefeller Foundation. Published September 30, 2020. Accessed October 24, 2020. https://www.rockefellerfoundation.org/news/the-rockefeller-foundation-co...
8. The COVID Racial Data Tracker. The COVID Tracking Project. Published 2018. Accessed October 24, 2020. https://covidtracking.com/race
9. International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS.
10. Shaikh M, Miraldo M, Renner A-T. Waiting time at health facilities and social class: Evidence from the Indian caste system. Kamolz L-P, ed. PLOS ONE. 2018;13(10):e0205641. doi:10.1371/journal.pone.0205641
Williams et al. examined the cost-effectiveness of tranexamic acid treatment for traumatic brain injury (TBI) (1). Tranexamic acid was highly cost-effective for patients with mild TBI and intracranial bleeding or patients with moderate TBI. In addition, tranexamic acid was even more cost-effective with earlier treatment administration. In contrast, the cost-effectiveness for those with severe TBI could not be clarified. I feel that cost-effectiveness viewpoint is very important for distributing medial resources effectively, and I present recent inconsistent results for the safety and effectiveness of tranexamic acid in TBI patients with special reference to disease severity.
Rowell et al. conducted a double-blinded, randomized clinical trial to determine whether tranexamic acid treatment initiated in the out-of-hospital setting within 2 hours of injury improves neurologic outcome in patients with moderate or severe TBI (2). They concluded that tranexamic acid administration did not improve 6-month neurologic outcome as measured by the Glasgow Outcome Scale-Extended. A large effectiveness trial with optimized dosing protocols, a mortality end point, and specific focus on the TBI severity cohorts might be needed to verify the existence of benefits (3).
There have been some meta-analyses on the efficacy of tranexamic acid for TBI, and I recently presented a comment regarding inconsistent results of the association (4). Based on the report by Williams et al., the...
Williams et al. examined the cost-effectiveness of tranexamic acid treatment for traumatic brain injury (TBI) (1). Tranexamic acid was highly cost-effective for patients with mild TBI and intracranial bleeding or patients with moderate TBI. In addition, tranexamic acid was even more cost-effective with earlier treatment administration. In contrast, the cost-effectiveness for those with severe TBI could not be clarified. I feel that cost-effectiveness viewpoint is very important for distributing medial resources effectively, and I present recent inconsistent results for the safety and effectiveness of tranexamic acid in TBI patients with special reference to disease severity.
Rowell et al. conducted a double-blinded, randomized clinical trial to determine whether tranexamic acid treatment initiated in the out-of-hospital setting within 2 hours of injury improves neurologic outcome in patients with moderate or severe TBI (2). They concluded that tranexamic acid administration did not improve 6-month neurologic outcome as measured by the Glasgow Outcome Scale-Extended. A large effectiveness trial with optimized dosing protocols, a mortality end point, and specific focus on the TBI severity cohorts might be needed to verify the existence of benefits (3).
There have been some meta-analyses on the efficacy of tranexamic acid for TBI, and I recently presented a comment regarding inconsistent results of the association (4). Based on the report by Williams et al., the cost-effectiveness/cost-benefit analysis of tranexamic acid for the treatment of TBI by including variables of disease severity should also be conducted.
References
1. Williams J, Roberts I, Shakur-Still H, et al. Cost-effectiveness analysis of tranexamic acid for the treatment of traumatic brain injury, based on the results of the CRASH-3 randomised trial: a decision modelling approach. BMJ Glob Health. 2020;5(9):e002716.
2. Rowell SE, Meier EN, McKnight B, et al. Effect of out-of-hospital tranexamic acid vs placebo on 6-month functional neurologic outcomes in patients with moderate or severe traumatic brain injury. JAMA. 2020;324(10):961-974.
3. Cone DC, Spaite DW, Coats TJ. Out-of-Hospital Tranexamic Acid for Traumatic Brain Injury. JAMA. 2020;324(10):946-947.
4. Kawada T. The efficacy of tranexamic acid for brain injury. Am J Emerg Med. 2020 doi:10.1016/j.ajem.2020.07.048
To the editor
We read with interest the article by Büyüm AM, Kenney C, Koris A, et al. (Decolonising
global health: if not now, when? BMJ Global Health 2020;5:e003394. doi:10.1136/
bmjgh-2020-003394) Although it is not contested that Black, Indigenous and People of Color are most disadvantaged by structural oppression, we would argue that a human rights-based approach is a more inclusive approach to global health inequity than decolonising global health.
The economic impacts of COVID mediated by the structural determinants will see recent gains in poverty reduction lost (1). Structural determinants within key service institutions such as the police service, prison system as well as those affecting gender will result in widespread suboptimal health. For example, black people are 40 times more likely to be stopped and searched in the UK under powers that allow officers to search people if serious violence is anticipated (2). In the US, a study examining all fatalities resulting from the use of lethal force by on-duty law enforcement officers between 2009 to 2012 across 17 U.S. states found that while whites were killed more frequently, the fatality rate was 2.8 times higher among blacks than whites (3). In the US, the First Step Act prison reforms have resulted in some benefits for prisoners, but ironically, highlighted the disproportionate incarceration of blacks (38%) who comprises 13% of the US population (4). There is evidence COVID disproportio...
To the editor
We read with interest the article by Büyüm AM, Kenney C, Koris A, et al. (Decolonising
global health: if not now, when? BMJ Global Health 2020;5:e003394. doi:10.1136/
bmjgh-2020-003394) Although it is not contested that Black, Indigenous and People of Color are most disadvantaged by structural oppression, we would argue that a human rights-based approach is a more inclusive approach to global health inequity than decolonising global health.
The economic impacts of COVID mediated by the structural determinants will see recent gains in poverty reduction lost (1). Structural determinants within key service institutions such as the police service, prison system as well as those affecting gender will result in widespread suboptimal health. For example, black people are 40 times more likely to be stopped and searched in the UK under powers that allow officers to search people if serious violence is anticipated (2). In the US, a study examining all fatalities resulting from the use of lethal force by on-duty law enforcement officers between 2009 to 2012 across 17 U.S. states found that while whites were killed more frequently, the fatality rate was 2.8 times higher among blacks than whites (3). In the US, the First Step Act prison reforms have resulted in some benefits for prisoners, but ironically, highlighted the disproportionate incarceration of blacks (38%) who comprises 13% of the US population (4). There is evidence COVID disproportionately affects women (who are often managing unpaid work, including caretaking responsibilities, while continuing to engage in paid work), migrant workers, asylum seekers, and other marginalized groups (5). Global health organisations are often run by leaders who came from high-income countries and it is difficult for them to accept civil society representation on their boards (6). Even if they have diverse representation, many of those appointed do not have decision-making privileges (6). These are the “discriminatory social arrangement(s) that, when encoded into laws, policies and norms, unduly privileges some social groups while harming others” to which Buyum et al refer.
However, recent observations suggest that a human rights approach is needed in order to achieve equity for all. In September 2020 in Melbourne, Australia a man experiencing an exacerbation of severe mental illness was intentionally hit by a police car and kicked in the head by a police officer as he struggled on the ground (7). The police officers involved have been suspended on full pay pending criminal investigations but this excessive use of force is symptomatic of state-sanctioned violence within the Australian police force. An Australian nationwide survey of more than 6000 international students and other temporary migrants conducted during the pandemic found systemic racism against international students in Australia (8). The study revealed the depth of Australia’s racist COVID policies (8). Although there is anti-racist rhetoric in Australia, (e.g. the National Anti-Racism Strategy) (9), there are many cases of racial discrimination against Asian students, particularly during the pandemic (9). In early June, the Chinese Ministry of Culture and Tourism warned Chinese citizens about a significant rise in racial discrimination and violence against Chinese and Asian people in Australia as an impact of the COVID-19 pandemic (10). In addition, in many countries around the world the small progress that has been made in ensuring girls receive an education is predicted to be undone by the COVID shelter at home restrictions (11). Increased “household responsibilities, child labour, early marriage and teenage pregnancy may prevent many girls from returning to school” (11). Other structural determinants include prioritisation of funding to other economic activities, instead of education, as countries emerge from the pandemic. Among those girls who do return to school post COVID, gender norms may inhibit their ambition. Education for women is consistent with part of the solution posed by Buyum et al namely a ‘knowledge shift’ which makes education widespread, bi-directional, and inclusive of new learning.
A human rights-based approach is a conceptual framework that can be applied to a broad range of program areas, including health. It is informed by international human rights law (12). The approach asserts that the integration of human rights law and principles should be visible in all activities and should contribute directly to the realization of human rights. Key elements of a human rights-based approach include participation, accountability, non-discrimination, empowerment, linkage to rights and sustainability. Applying this to the case of police brutality against people with mental illness suggests police be called on to view those with mental illness as human beings first with entitlements rather than letting the stigmatization of mental illness drive their actions. Police brutality to a marginalized group with little accountability is discriminatory, disempowering and dislocated from international human rights. It is unsustainable, and is unacceptable. In the case of maternal education a human rights-based approach would recognize the right of girls to an education. It would recognize there are no human rights, as enshrined in the Universal Declaration of Human Rights and other humanitarian instruments, without their universal application, irrespective of gender, ethnicity, occupation, country of birth. More broadly a human rights-based approach to structural determinants would re-orientate key public services and structures across multiple jurisdictions to ensure equity in participation and treatment irrespective of human characteristics.
Dismantling structural oppression is indeed key to improving global health. A human rights-based approach for addressing structural violence is a way of achieving this.
Aarya Desai MPH Student
Sundeep Manoth MPH Student
John Oldroyd MPH Co-ordinator
Australian Catholic University, Fitzroy, Australia.
A need for better understanding old-age mortality dynamics
Sergi Trias-Llimós* & Iñaki Permanyer
Centre d’Estudis Demogràfics, Carrer de Ca n’Altayó, Edifici E2, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
* Corresponding author. Email: strias@ced.uab.cat
Correspondence letter in response to:
Bergeron-Boucher M-P, Aburto JM, Raalte A van. Diversification in causes of death in low-mortality countries: emerging patterns and implications. BMJ Glob Health. 2020;5(7):e002414.
Word count: 492
The recent paper by Bergeron-Boucher et al. published in this journal reports an increasing diversity of cause-of-death mortality in low-mortality populations during the last 20 years [1]. Bergeron-Boucher et al. found that the preponderance of mortality from cardiovascular diseases in the countries under analysis has gradually declined in favour of a wide range of causes of death, including mental and behavioural disorders, nervous system or ill-defined causes. The increasing variability of causes of death is an important matter of potential concern because (a) fragmentation in cause of death might hinder further improvements in life expectancy, (b) preventive health policies have to cope with a more variegated set of causes, which imply more costly and less efficient health policies.
Despite their enormous interest, these findings should be interpreted with caution. As the authors...
A need for better understanding old-age mortality dynamics
Sergi Trias-Llimós* & Iñaki Permanyer
Centre d’Estudis Demogràfics, Carrer de Ca n’Altayó, Edifici E2, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
* Corresponding author. Email: strias@ced.uab.cat
Correspondence letter in response to:
Bergeron-Boucher M-P, Aburto JM, Raalte A van. Diversification in causes of death in low-mortality countries: emerging patterns and implications. BMJ Glob Health. 2020;5(7):e002414.
Word count: 492
The recent paper by Bergeron-Boucher et al. published in this journal reports an increasing diversity of cause-of-death mortality in low-mortality populations during the last 20 years [1]. Bergeron-Boucher et al. found that the preponderance of mortality from cardiovascular diseases in the countries under analysis has gradually declined in favour of a wide range of causes of death, including mental and behavioural disorders, nervous system or ill-defined causes. The increasing variability of causes of death is an important matter of potential concern because (a) fragmentation in cause of death might hinder further improvements in life expectancy, (b) preventive health policies have to cope with a more variegated set of causes, which imply more costly and less efficient health policies.
Despite their enormous interest, these findings should be interpreted with caution. As the authors themselves illustrate, most of the action takes place at advanced ages, that is: increases in the causes-of-death diversity indicators are driven by the changing distribution of causes among the elder, but not by what happens among children, youth or middle-aged adults. Remarkably, most of the deaths registered in the 15 low-mortality countries analysed in the paper increasingly occur among the elder (81% of the deaths occurs in the 65+ age group). As mortality shifts towards older ages, the surviving population becomes increasingly heterogeneous in its mortality risks [2] – a phenomenon that has led to worldwide increases in length-of-life inequality among those who survive above retirement age (e.g. around 65 years) [3]. This implies that an increasing share of population suffers comorbidities and is affected by the coexistence of well-known risk factors (e.g. diabetes) associated with several major diseases. In this context, there is mounting evidence suggesting that, as individuals age, it becomes increasingly difficult and controversial to attribute their deaths to a single underlying cause of death [4].
Taken together, the evidence suggests that it is now more complex than ever to predict the underlying causes of death [5]. Further studies examining old-age mortality could move towards different and complementary directions that attracted rather little attention so far. On the one hand, performing more post-mortem examinations comparing their results with the data reported in death certificates would contribute to validate and potentially correct some of the inaccuracies filling cause-of-death documents. On the other hand, using all cause-of-death information in the death certificates would allow grasping on risk factors and main drivers contributing to cause-specific mortality. This is particularly relevant as the number of causes of death reported in the death certificate increases with age. Unfortunately, little research has explored these interrelations; and comparability research between post-mortem examinations and cause of death data are scarce.
Mortality at old age is increasingly becoming a relevant public health challenge, and therefore requires the resources and implication of professionals from different fields, including medical doctors, demographers and public health experts. Beyond the use of underlying causes of death, further efforts should be invested in exploring the role of comorbidities in the old-age mortality dynamics.
Funding
This research has received funding from the European Research Council (ERC-2019-COG agreement No 864616 lead by Iñaki Permanyer).
References
1 Bergeron-Boucher M-P, Aburto JM, Raalte A van. Diversification in causes of death in low-mortality countries: emerging patterns and implications. BMJ Glob Health 2020;5:e002414. doi:10.1136/bmjgh-2020-002414
2 Engelman M, Canudas‐Romo V, Agree EM. The Implications of Increased Survivorship for Mortality Variation in Aging Populations. Popul Dev Rev 2010;36:511–39. doi:10.1111/j.1728-4457.2010.00344.x
3 Permanyer I, Scholl N. Global trends in lifespan inequality: 1950-2015. PloS One 2019;14:e0215742.
4 Tinetti ME, McAvay GJ, Murphy TE, et al. Contribution of Individual Diseases to Death in Older Adults with Multiple Diseases. J Am Geriatr Soc 2012;60:1448–56. doi:10.1111/j.1532-5415.2012.04077.x
5 Alpérovitch A, Bertrand M, Jougla E, et al. Do we really know the cause of death of the very old? Comparison between official mortality statistics and cohort study classification. Eur J Epidemiol 2009;24:669–75. doi:10.1007/s10654-009-9383-2
We read with interest your Editorial on Global health and human rights for a postpandemic world and offering our comments on this important issue.1
COVID 19 has rampaged an unprepared world. With its high infectiousness, low virulence and asymptomatic transmission, it has crossed boundaries rapidly and affected millions. The mode of transmission of the disease, whether by large droplet (>5µm) as fomites through surface, short distance aerosol borne or long distance airborne by small particles (<5µm) is still being debated Containment and lock down strategies adopted by all affected countries to control the spread have shown mixed results but has devastated the economy and caused major societal disruptions. The policy makers aggressively contained densely populated urban areas, quarantined ships, care homes and jails but the disease has continued to spread rapidly. High fatality rates in hospitals with sophisticated infrastructures and health workers getting infected have exposed gaps in basic understanding of control of airborne diseases and their management in health care settings. The defence forces, specially the naval ships got affected all over the world. With history of pandemic diseases repeating at regular intervals, it is now amply evident that viral diseases will re-emerge in times to come, either in another novel form or as a bioweapon and effective and holistic mitigation measures will be crucial.2
We read with interest your Editorial on Global health and human rights for a postpandemic world and offering our comments on this important issue.1
COVID 19 has rampaged an unprepared world. With its high infectiousness, low virulence and asymptomatic transmission, it has crossed boundaries rapidly and affected millions. The mode of transmission of the disease, whether by large droplet (>5µm) as fomites through surface, short distance aerosol borne or long distance airborne by small particles (<5µm) is still being debated Containment and lock down strategies adopted by all affected countries to control the spread have shown mixed results but has devastated the economy and caused major societal disruptions. The policy makers aggressively contained densely populated urban areas, quarantined ships, care homes and jails but the disease has continued to spread rapidly. High fatality rates in hospitals with sophisticated infrastructures and health workers getting infected have exposed gaps in basic understanding of control of airborne diseases and their management in health care settings. The defence forces, specially the naval ships got affected all over the world. With history of pandemic diseases repeating at regular intervals, it is now amply evident that viral diseases will re-emerge in times to come, either in another novel form or as a bioweapon and effective and holistic mitigation measures will be crucial.2
Airborne or droplet borne. The infectiousness of a disease is determined by the ability of the primary case to cause secondary cases in a susceptible population. It is based on Susceptibility – Infectivity-Recovery/Death (SIR) model and is quantified by the reproductive number (R0). The R0 is dependent on the proportion of susceptible population in a given cohort and its density and reduces with decongestion.3 The initial R0 for SARS CoV 2 at Diamond Princess, a cruise ship was 14.8 and was lowered to 1.78 with disembarkation of passengers and prevented almost 2000 extra individuals from getting infected.4 The transmission onboard ships would be both airborne through ventilatory ducts and by droplet transmission because of the close environment.
High vs Low Viral Load. Contact tracing data have found the contacts to be located mostly near the cases and did not spread to the rest of the population in the 2.2 square km slum area. Moreover, such transmission zones are comprised of only asymptomatic, mild or moderate cases, who have low viral load. High level of infectiousness in clusters of close quarters of susceptible hosts explains droplet and short distance aerosol transmission as has been endorsed by World Health Organisation (WHO) in their recent statement.5 Breaking the chain of transmission in a densely populated slum would have been possible because of droplet transmission from mildly symptomatic and asymptomatic cases and absence of airborne transmission from them. In the hospital setting however, high viral load in severely symptomatic patients and aerosol generating procedures may be accompanied by airborne transmission. This has been emphasised by several studies and endorsed by WHO.6
Way Ahead. Non-pharmacological Interventions of maintaining social distance, wearing of masks will have to be habit forming in the community. The hospitals have to bring in architectural modifications in their wards to include negative air pressure isolation facility alongwith HEPA filters and use of UV lights. Proper protective gears for health care workers need to be emphasised at all levels. Food habits for the general population will include known immune boosting products, also antioxidants and avoid junk; this will not only reduce the co morbidities like obesity and diabetes but will prevent mild infectious diseases. Future mitigating measures will have to emphasise on alteration of residences with proper ventilation, enough exhausts in bathrooms, multiple air exchange air conditioning system, which are essential measures for prevention and control of airborne diseases.
References
1. Khosla R, Allotey P, Gruskin S. Global health and human rights for a postpandemic world. BMJ Global Health 2020;5:e003548. doi:10.1136/ bmjgh-2020-003548
2. Prem K, Liu Y, Russell TW, et al. The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study [published correction appears in Lancet Public Health. 2020 May;5(5):e260]. Lancet Public Health. 2020;5(5):e261-e270.
3. JK Aronson, Jon Brassey, KR Nahtani. When will it be over? An introduction to viral reproduction numbers (R0 and Re). Available at https://www.cebm.net/covid-19/when-will-it-be-over-an-introduction-to-vi.... Accessed on 14 Aug 2020.
4. Zhang S, Diao M, Yu W, Pei L, Lin Z, Chen D. Estimation of the reproductive number of novel coronavirus (COVID-19) and the probable outbreak size on the Diamond Princess cruise ship: A data-driven analysis. Int J Infect Dis. 2020;93:201‐204.
5. Coronavirus: What is the Dharavi model being praised by WHO chief Tedros Adhanom. Available at https://www.indiatoday.in/india/story/what-is-the-dharavi-model-being-pr.... Accessed on 11 Aug 2020
Svadzian et al. [1] noted that most universities in high-income countries (HICs) demand higher tuition fees from low- and middle-income country (LMIC) students for masters-level global health degrees – a problem potentially further exacerbated by COVID-19, with many HIC universities increasing international tuition fees to make up a resultant funding deficit. [2] While the paper only focuses on masters-level global health degrees, it should be noted that some HIC universities, such as York University in Toronto, have long-standing undergraduate-level global health degree programs. Taking significantly longer to complete than masters degrees, these problems are felt to a greater extent for LMIC students who want to study global health as their first degree.
The fundamental premise in their paper is that if HIC universities were serious about equity then they would be offering lower tuition fees (and scholarships to support living/travel costs) to students from LMICs. This presumes that merely lowering tuition or offering more scholarships would eliminate the primary access barrier for LMIC students, especially those from less privileged backgrounds. Unfortunately, this is sadly not the case. Even students with tuition waivers/scholarships can have difficulty obtaining visas to study at HIC universities.
Student visas are a regressive tax on LMIC [3] – the requirements to obtain numerous documents that require certification, additional fee payments to an HIC-af...
Svadzian et al. [1] noted that most universities in high-income countries (HICs) demand higher tuition fees from low- and middle-income country (LMIC) students for masters-level global health degrees – a problem potentially further exacerbated by COVID-19, with many HIC universities increasing international tuition fees to make up a resultant funding deficit. [2] While the paper only focuses on masters-level global health degrees, it should be noted that some HIC universities, such as York University in Toronto, have long-standing undergraduate-level global health degree programs. Taking significantly longer to complete than masters degrees, these problems are felt to a greater extent for LMIC students who want to study global health as their first degree.
The fundamental premise in their paper is that if HIC universities were serious about equity then they would be offering lower tuition fees (and scholarships to support living/travel costs) to students from LMICs. This presumes that merely lowering tuition or offering more scholarships would eliminate the primary access barrier for LMIC students, especially those from less privileged backgrounds. Unfortunately, this is sadly not the case. Even students with tuition waivers/scholarships can have difficulty obtaining visas to study at HIC universities.
Student visas are a regressive tax on LMIC [3] – the requirements to obtain numerous documents that require certification, additional fee payments to an HIC-affiliated third party months in advance, embassies can hold passports for long periods, with applicants needing to satisfy vague criteria that can allow visa officials to arbitrarily deny applications. Furthermore, LMIC students often have to apply multiple times (paying new fees each time) to obtain a visa – which can be denied – thereby leaving students dejected having to delay or abandon their education abroad.
LMIC students have particular issues satisfying visa criteria around financial sufficiency, intent of return to home country (including family ties), and lack of job prospects in home country. [4] These criteria are often subjectively adjudicated by immigration officers with arbitrary results – e.g., anecdotal reports of LMIC students with full scholarships being rejected on the basis of financial insufficiency. Thus, merely offering LMIC students visa support/advice is not sufficient. Change is required in immigration policy and practice in HICs, particularly in Canada, UK, and the USA [5], to ensure LMIC students wanting to study global health can gain entry.
There are also important regional differences in how this is experienced across LMICs, with African students being more likely to be refused visas. [5, 6] Students from Asian LMICs (e.g., China, Japan, India) tend to have the easiest time at getting student visa to study in HICs – which results in HIC universities tending to concentrate their recruitment efforts in these countries, further entrenching educational inequities among LMICs.
Achieving equity in global health education will be ultimately secured as it will be in global health practice – by adequately addressing the underlying structural conditions/drivers. While everyone should support lower tuition fees and increased scholarship support for LMIC students, without a fundamental change to the current discriminatory approach to visa issuance, we will not be able to achieve equity in global health education.
References
1. Svadzian A, Vasquez NA, Abimbola S, et al. Global health degrees: at what cost? BMJ Glob Health 2020;5(8) doi: 10.1136/bmjgh-2020-003310 [published Online First: 2020/08/08]
5. The Lancet Global Health. Passports and privilege: access denied. Lancet Glob Health 2019;7(9):e1147. doi: 10.1016/S2214-109X(19)30337-7 [published Online First: 2019/08/14]
The COVID-19 pandemic has taken the world by storm, Low- and Middle- Income Countries (LMICs) not withstanding. Cabore et al modelled best estimates for peak prevalence of the virus on the African continent to be projected at more than 37 million symptomatic cases, requiring 4.6 million hospitaliations. Current estimates by Africa CDC show over 1 million cases as of August 6th, 2020, and more than 22,000 deaths [1]. South Africa has the highest prevalence with more than half a million reported cases, followed by Egypt and Nigeria, respectively. While the actual incidence and mortality rates may be evasive given limited access to testing globally [2], it is clear that the disease has not been forgiving on African soil either.
Non-Communicable Diseases (NCDs) constitute the backdrop for worse outcomes among those infected with COVID-19 [3], and those with poorer access to care fare worse. While NCDs have gained increasing attention in the last decade, the current pandemic illuminates the alarming gap in data on the double burden of disease that is threatened by a continued lag in focus on NCDs – an improved understanding of which would have been critical in effectively addressing our current plight.
A prime example of this is in the case of research addressing NCDs in the emergency care setting, an area of research in global health that is virtually non-existent in many resource-variable settings like Kenya, which has the highest number of COVID-19 cases in Ea...
The COVID-19 pandemic has taken the world by storm, Low- and Middle- Income Countries (LMICs) not withstanding. Cabore et al modelled best estimates for peak prevalence of the virus on the African continent to be projected at more than 37 million symptomatic cases, requiring 4.6 million hospitaliations. Current estimates by Africa CDC show over 1 million cases as of August 6th, 2020, and more than 22,000 deaths [1]. South Africa has the highest prevalence with more than half a million reported cases, followed by Egypt and Nigeria, respectively. While the actual incidence and mortality rates may be evasive given limited access to testing globally [2], it is clear that the disease has not been forgiving on African soil either.
Non-Communicable Diseases (NCDs) constitute the backdrop for worse outcomes among those infected with COVID-19 [3], and those with poorer access to care fare worse. While NCDs have gained increasing attention in the last decade, the current pandemic illuminates the alarming gap in data on the double burden of disease that is threatened by a continued lag in focus on NCDs – an improved understanding of which would have been critical in effectively addressing our current plight.
A prime example of this is in the case of research addressing NCDs in the emergency care setting, an area of research in global health that is virtually non-existent in many resource-variable settings like Kenya, which has the highest number of COVID-19 cases in Eastern Africa. As with any pandemic, emergency care acts as the receptacle for patients in extremis, with severe cases of illness, including those with imminent oxygen needs and breathing support with COVID-19 - two needs highlighted by Cabore et al. This has occurred with COVID-19 [4], as in other public health crises before it. The spotlight on emergency care as a priority for government agendas globally in the 2019 WHA 72.16 [5] resolution was a step in the right direction for the progress needed in countries where neglect of emergency care infrastructure has been appalling, and even fatal. Further research on best practices for emergency care in LMICs, including responsiveness in crises, understanding burden of NCDs in the emergency care setting, and the effect of the double burden in populations seeking care there cannot be overstated. To that end, our recent study in the largest public emergency department in East Africa [6] called Kenyatta National Hospital, shows equal or worse outcomes for all NCDs and leading risk factors outlined by the WHO’s 2013 action plan [7]. All the same, the capacity to handle emergency cases in Kenya, like most African nations, remains dismal at best due to lack of prioritization: lack of basic resources like oxygen, lack of adequately trained emergency professionals, and lack of health system infrastructure that facilitates timely access for patients.
For the first time, the global health community may have realized the crux of emergency care: as the front-lines to our healthcare systems. Communicable disease pandemics, and NCD co-afflictions alike. The WHO’s emergency care office is home to many initiatives that advance this agenda. I would hope that the remainder of the global health community follows suit.
1. Coronavirus Disease 2019 (COVID-19): Africa CDC Dashboard. 2020; Available from: https://africacdc.org/covid-19/.
2. World Health Organization. (2020). Laboratory testing strategy recommendations for COVID-19: interim guidance, 21 March 2020. World Health Organization. https://apps.who.int/iris/handle/10665/331509. License: CC BY-NC-SA 3.0 IGO.
3. Yang, J., et al., Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis, 2020. 94: p. 91-95.
4. Giving Oxygen to COVID-19 Patients in Kenya. 2020 August 8th, 2020]; Available from: https://www.emergencymedicinekenya.org/oxygenmanifold/.
5. World Health Assembly, Resolution 72.16. Emergency Care Systems for Universal Health Coverage: Ensuring Timely Care for the Acutely Ill and Injured. 2019.
6. Ngaruiya, M., MSc, DTMH, Christine, et al., The last frontier for global Non-Communicable Disease action: the Emergency Department - a cross-sectional study from East Africa. medRxiv, 2020: p. 2020.07.29.20164632.
7. World Health Organization. WHO global action plan: for the prevention and control of noncommunicable diseases 2013-2020. 2013; Available from: http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf.
Dear Editor,
Show MoreGilmore. B., et al have highlighted that the community involvement is pivotal to improving on prevention and control of Covid-19. We believed that governments should implement strict policies, to foster a culture of compliance and trust, not infringing on human rights (B., 2009). Take Taiwan for example, who learned from their experiences with SARS in 2003, developed and implemented policies and infrastructure in 2004 to combat any similar outbreaks in future. In 2004, the year after the SARS outbreak, the Taiwan government established the National Health Command Center (NHCC). The NHCC is part of a disaster management center that focuses on large-outbreak response and acts as the operational command point for direct communications among central, regional, and local authorities (C. Jason Wang, Chun Y. Ng, & Robert H. Brook, 2020). Such a policy is able to encourage the dissemination of pertinent information to the people, increase transparency and build trust in the framework. Furthermore, the use of Info dynamics should take precedence to minimize the spread of misinformation among communities. In a 2020 issue, Tangcharoensathien V et al (Tangcharoensathien. V., 2020), the WHO presented a framework for managing the Covid-19 infodemic (G., 2020) which can continue strengthening on a trusting relationship among people and healthcare personnel. Therefore, rallying community members for various roles in disease prevention and control will be widely ac...
It was interesting to read Roder-DeWan S et al.,(1) paper entitle Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap.
Show MoreThis paper focuses on problems with the current approach, discuss the feasibility of redesign, propose reforms to transform current health systems. We support the authors that health system redesign is needed to enhance people’s access to standard care and reduce newborn mortality rate especially in low- income country which is higher than in high-income countries about nine times(1). This is also in line with Sustainable Development Goal No.3 (SDGs) target 3.1 that by 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births(2). Gabrysch S et al,(2019) found in their study that giving birth in a health care facility does not necessarily gives assurance of a survival benefit for women or babies however it should be recommended in facilities capable of providing emergency obstetric and newborn care and capable of safeguarding uncomplicated births(3).
It is therefore important to reconsider the healthcare systems so that every pregnant woman receives the best of healthcare. Niyitegeka J et al,(2017) in a study conducted in Rwanda found out that women who had to travel more than 90 minutes to the nearest district hospital had significantly worse neonatal outcomes compared to those had Odds Ratio 5.12 times referred from health centers located on the same...
I write a quick note to correct what is probably an editing error. Both the abstract and the text state that under-five mortality has increased in sub-Saharan Africa 1990-2018, while decreasing in the rest of the world. In fact, the Unicef data referenced in the paper (https://data.unicef.org/topic/child-survival/under-five-mortality/) indicate that under five mortality has decreased from 178 per 1000 live births in 1990 to 78 per 1000 in 2018, a reduction of 100 per 1000 or 56%. The UN inter-agency group for child mortality estimation (IGME) has similar estimates (https://childmortality.org/data/SDG%20Regions%20%3E%20Sub-Saharan%20Africa).
Arnab and colleagues reported the findings from their research study in India, UK, and the USA that politicians are unlikely to be punished or rewarded for their failures or successes in managing COVID-19 in the next election. (1) By early September, India came only next to the US in terms of COVID 19 burden. Officially, India collects and reports data in terms of geographical variations, disaggregated by age and sex. India also reports the count of deaths among patients with and without comorbidities. However, none of the States report COVID 19 data disaggregated by social determinants, primarily castes and wealth quintiles, which are the most important determinants from an Indian perspective.
The caste system in India is a ‘disabling myth’ which contributes to preventable and inequitable mortality in women and children.(2) Globally, COVID 19 has once again exposed the vulnerability of disadvantaged groups due to ongoing social discrimination and economic deprivation.(3) Emerging data shows that the racial minorities in the US are disproportionately affected by the pandemic. Data shows that Non-Hispanic Blacks have five times the risk of hospitalization compared to non-Hispanic Whites (age-adjusted) and Hispanic and Latinos have 4 times the risk compared to non-Hispanic Whites.(4,5) However, realizing the importance of having more accurate data to understand the impact of COVID 19, foundations and agencies came forward to support and set-up mechanisms to track rac...
Show MoreWilliams et al. examined the cost-effectiveness of tranexamic acid treatment for traumatic brain injury (TBI) (1). Tranexamic acid was highly cost-effective for patients with mild TBI and intracranial bleeding or patients with moderate TBI. In addition, tranexamic acid was even more cost-effective with earlier treatment administration. In contrast, the cost-effectiveness for those with severe TBI could not be clarified. I feel that cost-effectiveness viewpoint is very important for distributing medial resources effectively, and I present recent inconsistent results for the safety and effectiveness of tranexamic acid in TBI patients with special reference to disease severity.
Rowell et al. conducted a double-blinded, randomized clinical trial to determine whether tranexamic acid treatment initiated in the out-of-hospital setting within 2 hours of injury improves neurologic outcome in patients with moderate or severe TBI (2). They concluded that tranexamic acid administration did not improve 6-month neurologic outcome as measured by the Glasgow Outcome Scale-Extended. A large effectiveness trial with optimized dosing protocols, a mortality end point, and specific focus on the TBI severity cohorts might be needed to verify the existence of benefits (3).
There have been some meta-analyses on the efficacy of tranexamic acid for TBI, and I recently presented a comment regarding inconsistent results of the association (4). Based on the report by Williams et al., the...
Show MoreTo the editor
We read with interest the article by Büyüm AM, Kenney C, Koris A, et al. (Decolonising
global health: if not now, when? BMJ Global Health 2020;5:e003394. doi:10.1136/
bmjgh-2020-003394) Although it is not contested that Black, Indigenous and People of Color are most disadvantaged by structural oppression, we would argue that a human rights-based approach is a more inclusive approach to global health inequity than decolonising global health.
The economic impacts of COVID mediated by the structural determinants will see recent gains in poverty reduction lost (1). Structural determinants within key service institutions such as the police service, prison system as well as those affecting gender will result in widespread suboptimal health. For example, black people are 40 times more likely to be stopped and searched in the UK under powers that allow officers to search people if serious violence is anticipated (2). In the US, a study examining all fatalities resulting from the use of lethal force by on-duty law enforcement officers between 2009 to 2012 across 17 U.S. states found that while whites were killed more frequently, the fatality rate was 2.8 times higher among blacks than whites (3). In the US, the First Step Act prison reforms have resulted in some benefits for prisoners, but ironically, highlighted the disproportionate incarceration of blacks (38%) who comprises 13% of the US population (4). There is evidence COVID disproportio...
Show MoreA need for better understanding old-age mortality dynamics
Sergi Trias-Llimós* & Iñaki Permanyer
Centre d’Estudis Demogràfics, Carrer de Ca n’Altayó, Edifici E2, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
* Corresponding author. Email: strias@ced.uab.cat
Correspondence letter in response to:
Bergeron-Boucher M-P, Aburto JM, Raalte A van. Diversification in causes of death in low-mortality countries: emerging patterns and implications. BMJ Glob Health. 2020;5(7):e002414.
Word count: 492
The recent paper by Bergeron-Boucher et al. published in this journal reports an increasing diversity of cause-of-death mortality in low-mortality populations during the last 20 years [1]. Bergeron-Boucher et al. found that the preponderance of mortality from cardiovascular diseases in the countries under analysis has gradually declined in favour of a wide range of causes of death, including mental and behavioural disorders, nervous system or ill-defined causes. The increasing variability of causes of death is an important matter of potential concern because (a) fragmentation in cause of death might hinder further improvements in life expectancy, (b) preventive health policies have to cope with a more variegated set of causes, which imply more costly and less efficient health policies.
Show MoreDespite their enormous interest, these findings should be interpreted with caution. As the authors...
We read with interest your Editorial on Global health and human rights for a postpandemic world and offering our comments on this important issue.1
COVID 19 has rampaged an unprepared world. With its high infectiousness, low virulence and asymptomatic transmission, it has crossed boundaries rapidly and affected millions. The mode of transmission of the disease, whether by large droplet (>5µm) as fomites through surface, short distance aerosol borne or long distance airborne by small particles (<5µm) is still being debated Containment and lock down strategies adopted by all affected countries to control the spread have shown mixed results but has devastated the economy and caused major societal disruptions. The policy makers aggressively contained densely populated urban areas, quarantined ships, care homes and jails but the disease has continued to spread rapidly. High fatality rates in hospitals with sophisticated infrastructures and health workers getting infected have exposed gaps in basic understanding of control of airborne diseases and their management in health care settings. The defence forces, specially the naval ships got affected all over the world. With history of pandemic diseases repeating at regular intervals, it is now amply evident that viral diseases will re-emerge in times to come, either in another novel form or as a bioweapon and effective and holistic mitigation measures will be crucial.2
Airborne or droplet borne. The infectious...
Show MoreSvadzian et al. [1] noted that most universities in high-income countries (HICs) demand higher tuition fees from low- and middle-income country (LMIC) students for masters-level global health degrees – a problem potentially further exacerbated by COVID-19, with many HIC universities increasing international tuition fees to make up a resultant funding deficit. [2] While the paper only focuses on masters-level global health degrees, it should be noted that some HIC universities, such as York University in Toronto, have long-standing undergraduate-level global health degree programs. Taking significantly longer to complete than masters degrees, these problems are felt to a greater extent for LMIC students who want to study global health as their first degree.
The fundamental premise in their paper is that if HIC universities were serious about equity then they would be offering lower tuition fees (and scholarships to support living/travel costs) to students from LMICs. This presumes that merely lowering tuition or offering more scholarships would eliminate the primary access barrier for LMIC students, especially those from less privileged backgrounds. Unfortunately, this is sadly not the case. Even students with tuition waivers/scholarships can have difficulty obtaining visas to study at HIC universities.
Student visas are a regressive tax on LMIC [3] – the requirements to obtain numerous documents that require certification, additional fee payments to an HIC-af...
Show MoreThe COVID-19 pandemic has taken the world by storm, Low- and Middle- Income Countries (LMICs) not withstanding. Cabore et al modelled best estimates for peak prevalence of the virus on the African continent to be projected at more than 37 million symptomatic cases, requiring 4.6 million hospitaliations. Current estimates by Africa CDC show over 1 million cases as of August 6th, 2020, and more than 22,000 deaths [1]. South Africa has the highest prevalence with more than half a million reported cases, followed by Egypt and Nigeria, respectively. While the actual incidence and mortality rates may be evasive given limited access to testing globally [2], it is clear that the disease has not been forgiving on African soil either.
Non-Communicable Diseases (NCDs) constitute the backdrop for worse outcomes among those infected with COVID-19 [3], and those with poorer access to care fare worse. While NCDs have gained increasing attention in the last decade, the current pandemic illuminates the alarming gap in data on the double burden of disease that is threatened by a continued lag in focus on NCDs – an improved understanding of which would have been critical in effectively addressing our current plight.
A prime example of this is in the case of research addressing NCDs in the emergency care setting, an area of research in global health that is virtually non-existent in many resource-variable settings like Kenya, which has the highest number of COVID-19 cases in Ea...
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