Ms. Janna Murray is on a semester-long graduate internship with the Global Health and Education Projects, Inc., Washington, DC. She is a candidate for the Master’s of Public Health in the College of Public Health at the University of South Florida, Florida, USA. While on internship with GHEP, Janna is working on a number of public health tasks and will be completing final project exploring Under-5 mortality in 57 low and middle-income countries of the world.
Editor’s Note: In this Special Blog, we continue our series on the 4th of the 7 Great Achievements of Pediatric research. These achievements are brought to you courtesy of the fabulous work by the American Academy of Pediatrics (AAP) under its new campaign 7 Great Achievements in Pediatric Research.
No. 4: Saving Premature Babies by Helping Them Breathe
Problem
Prematurity is the main cause of global death in newborn infants.
In the United States alone, 1 in 9 newborns is born prematurely, about 450,000 children a year. Respiratory Distress Syndrome (RDS) is a life-threatening respiratory condition frequently diagnosed in premature newborns. Research showed that it develops when the immature lungs are unable to produce a compound known as surfactant in quantities needed for the infant to breathe.
Discovery
Studies demonstrated that instillation of surfactant to the lungs of premature animals reduced respiratory distress. Clinical trials of supplementary surfactant for newborns with RDS led to the medication’s approval by the FDA for widespread use in 1990.
Outcome
As a result of surfactant administration, newborn deaths from RDS have decreased by 41% between 1985-1991.
Editor’s Note: In this Special Blog, we continue our series on the 3rd of the 7 achievements of Pediatric research. These achievements are brought to you courtesy of the fabulous work by the American Academy of Pediatrics (AAP) under its new campaign 7 Great Achievements in Pediatric Research.
No. 3: Curing a Common Childhood Cancer
Problem
Acute lymphocytic leukemia (ALL) is the most common child- hood cancer. In the United States alone, about 2,900 children and adolescents are diagnosed with ALL each year. In 1975, a diagnosis of ALL often meant death in the near future. Only 60% of children under 15 years of age survived 5 years, and only 28% of 15-19 year-olds survived 5 years.
Discovery
Cancer research has led to the creation of various medications and treatments that destroy cancer cells.
Research into various combinations of medications to treat ALL has yielded the now standard protocol of induction chemotherapy, which consists of vincristine, L-asparaginase, and corticosteroid for a 2-3 year period.
Outcome
Because of the last 40 years of research, 90% of newly diagnosed ALL pediatric patients are expected to have greater than 5 year survival.
For more on these achievements, please visit AAP.ORG
Editor’s Note: In this Blog, we continue our series on the 2nd of the 7 achievements of Pediatric research. These achievements are brought to you courtesy of the fabulous work by the American Academy of Pediatrics (AAP) under its new campaign 7 Great Achievements in Pediatric Research.
Problem
Sudden Infant Death Syndrome (SIDS), also referred to as “crib death,” occurs without warning and is associated with a sleep period. A diagnosis of SIDS is given when no explanation can found for the baby’s death after a complete postmortem investigation. SIDS is the leading cause of death for infants between 1 month and 1 year of age. In 1993 alone, nearly 4,700 U.S. infants died from SIDS.
Discovery
Research found that if infants were placed to sleep on their stomachs, their risk of dying from SIDS increased by at least two-fold.
Outcome
As a result, the “Back-to-Sleep” Campaign was initiated in 1994 by a collaboration between the National Institute of Child Health and Development, the American Academy of Pediatrics (AAP), the Maternal and Child Health Bureau of the Health Resources and Services Administration and SIDS groups.
The focus of the campaign was to en- courage parents to put their babies to sleep on their backs in order to reduce the risk of SIDS. The AAP Task Force on SIDS published a policy statement in 2005 encouraging the practice of “Back-to-Sleep” for all infants.
Research showed that between 1993 and 2010 the percent of infants placed to sleep on their backs increased from 17% to 73%. Following the initiation of the “Back-to-Sleep” campaign, the number of infants dying from SIDS has decreased to 2,063 per year as of 2010.
Global health issues have a direct impact on U.S. domestic public health via its direct impact on medical care in the U.S. The more the connected the world becomes, the easier it is for disease to spread, thus increasing the potential for sickness. I believe that, s public health practitioners, we should be concerned with both domestic and global health as both are deeply intertwined.
PUBLIC HEALTH is a broad field that encompasses many disciplines. One of the major disciplines in public health, which has also identified as a core discipline, is the field of epidemiology. Epidemiology is concerned with the distribution and determinants of health-related states or events in humans, particularly human populations. The discipline of epidemiology as it applies to public health has been around for many years, and has continued to evolve since its inception.
In a brief article by Dr. Jonathan Borak of Yale University entitled “5 Classic Articles in Public Health, five publications that had significant impacts on public health are discussed. The first article is a publication by Bradford Hill outlining criteria recommended to be used when establishing a causal relationship. Hill’s criteria for causation are well-known in the epidemiology world, any epidemiology student has inevitably had at least some exposure to it, and are thought to be especially important for observational epidemiological studies that try to establish a relationship between two conditions. The second article describes how the analysis of cancer mortality statistics was used to generate the multistage theory of cancer and is a perfect example of how surveillance, a common tool used in the public health epidemiology field, can be used to generate further hypotheses and give further insight into diseases.
Two other articles, one dealing with the effect of lead on children’s neurobehavioral function and the other dealing with the health effects of air pollution, exemplify how epidemiological studies help to shape public health policy and actions. The last article discussed was a review article that illuminated the importance of understanding the public’s perception of risk both in qualitative and quantitative terms when planning and promoting public health. All of these articles have had great public health impacts and are just a few of many that have contributed to the advancement of the field of public health and epidemiology.
Public health is also closely tied with global health. In the last decade global health has become increasingly important to the field of public health. Dr. Cindy Howard of the University of Minnesota presented, in here Introduction to Global Health, why global health is important: humanitarian reasons, equity reasons, the direct impact on U.S. healthcare, and the indirect economic and political impact. In terms of humanitarian reasons, many persons in underdeveloped countries, especially children, die from undernutrition, a health event that is easily preventable and is tied to a number of diseases and thus is of utmost concern to global health. Global health is also important because it can help address the differences in health equity.
It is widely known that there is a big difference in the quality of care and the resources for addressing healthcare and that some countries bear a bigger burden of disease than others. Global health issues also have a direct impact on U.S. domestic public health via its direct impact on medical care in the U.S. As outlined, the more the connected the world becomes, the easier it is for disease to spread, thus increasing the potential for sickness. The final reason for why global health matters is due to its impact on the economy in terms of the increasing cost of treating diseases and the role that adverse health conditions play in poverty and political instability. These are but only a few reasons why global health truly matters. As an emerging public health practitioner, I believe that, as public health practitioners, we should be concerned with both domestic and global health as both are deeply intertwined. I think all practitioners should understand and realize this connection in their work.
About the Author
An investment and interest in global health not only aligns with the core values of wanting to help others or creating a better future, it makes practical sense. We are reflections of our environment, and as the global landscape becomes more connected, our inter-dependence on each other becomes even worthier of consideration.
AFTER learning about Dr. Cindy Howard’s call to be invested in global health, and reading about Dr. Jonathan Borak’s recommendations for five classic public health articles, I feel reassured and inspired by my new internship at the Global Health and Education Projects, Inc. (GHEP). Moreover, I feel ever more challenged by the opportunities and roles that will be given to me as a future public health specialist. More often than naught, I feel very small and modest in my abilities to help others and be a part of the health care community. Perhaps I can take some comfort in knowing that because this is public health, it takes more than one person to make a significant impact. Rather, it is the combined effort of many humble experts and specialists . Rather it takes whole communities. In this way of thinking, global health requires a global effort that is as diverse as the people of our world. No one person or effort is enough, but every person and every effort has significance.
Dr. Howard asks us to consider reasons why we should be interested in global health. For me, global health is a natural extension of public health, which in itself, is an extension of personal health. When the world around us has improvements in health, it is likely that we each benefit as well. Thus, an investment and interest in global health not only aligns with the core values of wanting to help others or creating a better future, it makes practical sense. We are reflections of our environment, and as the global landscape becomes more connected, our inter-dependence on each other becomes even worthier of consideration.
While Dr. Howard’s presentation gives me a broader framework for thinking about public health matters, Dr. Jonathan Borak’s recommendations gives me deeper insight into the impact of the field. Similar to Dr. Borak, I am struck by the simplicity, ingenuity, and resourcefulness of all these studies. He highlights how solutions do not have to be great in complexity, but still impactful and effective. He also mentions how the public health experts should be the bridge between the “public” and the “experts”, and I could not agree more. I feel this is a core duty of this profession, and I hope that I will continue to be able to learn how to fulfill this duty as I advance through the profession. For now, the five models provided by Dr. Borak have already given me some good guidance and wisdom.
From Hill’s address to the Royal Society of Medicine, I have learned how understanding causation, rather than association will most likely lead to the most effective public health action. From the Armitrage and Doll study on “The Age Distribution of Cancer and a Multi-stage Theory of Carcinogenesis,” I am provided another example of the power of the epidemiology. From the elementary school absences and environmental pollution study (Ransom and Pope, 1992) and classroom performance vs. lead levels study (Needleman et al., 1979), I am reminded of public health’s impact on the environment, as well as the environment’s impact on public health. Finally, from Slovic’s study on the “Perception of Risk”, I am re-affirmed of the need for public health experts.
In sum, I found the above works to be insightful and inspirational. I am left pondering about my future work in public health, and the kinds of contributions I hope to make. I am also wondering what I can do now, as a student and scholar. What kinds of contributions can I bring to my internship at GHEP? What can I gain from my internship that I can bring to others?
About the Author
Quynh-Anh Vu (Annie) was a global health intern with the Global Health and Education Projects, Inc., Washington, DC, completing in March 2015. Annie was a candidate for a Masters in Public Health at San Jose State University, California, USA. She graduated from the University of California, Berkeley, earning a Bachelor of Arts with a major in Integrative Biology. She went on to study the optometric sciences and completed internships in the allied health sciences – namely optometry and pharmacy. As a young scholar, she was instilled with a love and passion for pursuing knowledge, and was taught that knowledge is power. Her greatest passion lies in the arts, languages, and medical sciences. She hopes that to one day, her work will empower others.
No one organization can deal with public health alone; but by partnering with the community and other organizations, the Global Health and Education Projects (GHEP) positions itself to have a profound impact worldwide, says Janna Murray of the University of South Florida, USA.
PUBLIC HEALTH is a complex term that takes on a wide variety of definitions. I believe that one of the best definitions of public health comes from the World Health Organization (WHO) which defines public health as “all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole” (WHO, 2015). WHO further emphasizes that public health encompasses the total system, including the conditions and policies that can have an effect on the disease.
There are many organizations that deal with the field of public health field. If you google the term “public health organizations” you are given thousands of results. These organizations range from federal, state, and local entities and universities to non-profit organizations. Achieving a “healthy” world requires the input and work from all these players. Global Health and Education Projects Inc. (GHEP) is one of these players. GHEP is a non-profit public health organization with a specific focus in global health with an emphasis on addressing and eliminating health inequalities as well as inequalities in education. The organization was founded by a group of experienced public health practitioners who are committed to aiding in the elimination of health disparities worldwide. GHEP has a number of programs that include both domestic and global public health and health research programs as well as youth education and development programs.
Based in Riverdale, Maryland the organization is heavily involved in the community, both locally and globally. A prime example of GHEP’s community involvement is the Health, Environmental Education and Awareness (HEEA) event that they are hosting on Saturday, June 13, 2015. Through its partnership with the local Riverdale community in Prince George’s County, Maryland, USA, and other partners, GHEP has organized a free community picnic and health educational event that is focused on increasing the community awareness of environmental health effects.
In addition to its health and educational programs, GHEP also publishes a peer-reviewed, free open access journal, the International Journal of MCH and AIDS (IJMA). IJMA focuses on maternal, infant, and child health and HIV/AIDS, especially in areas with significant health disparities such as low-income countries, and includes of variety of manuscripts types including original research, review articles, commentaries, etc. The journal’s editorial team is comprised of a number of experts in global health from all around the world from about 50 countries. One very interesting aspect of the IJMA is that it includes a mentoring program, the International Peer Mentoring Program (IPMP), which helps researchers and scientists from developing countries with manuscript development. Mentees are partnered with an experienced mentor that help them hone on their technical writing skills and address areas where they are lacking in order for them to be able to publish quality articles.
GHEP is an example of how complex the public health arena and how much work it takes to address the issue of public health. No one organization can deal with public health alone and by partnering with the community and other organizations GHEP has positioned itself to have a profound impact worldwide.
About the Author
Ms. Janna Murray is a candidate for a Master’s of Public Health in the College of Public Health at the University of South Florida, Florida, USA. She graduated from Georgia Institute of Technology, Atlanta, GA, USA, earning a Bachelor of Science in Biology. She was a research fellow at the US Centers for Disease Control and Prevention (CDC). Her time at the CDC sparked an interest in public health and epidemiology. At CDC, Janna learned the importance of public health, the impact of health disparities on a number of populations, and that collaboration across multiple institutions is key. On coming to GHEP, she says, “I am excited about my internship with GHEP because not only will it allow me to apply what I have learned during my studies to the real world, but I will be working with an institution with a focus on addressing health inequalities.“
Global Health Reveals my True Nature, Not my Third Culture. What drew me to this particular field is not merely my desire to travel the world as a result of growing up as a third culture kid but also my need to answer the call to reduce health disparities worldwide. In an increasingly globalized world, borders no longer restrict diseases.
DECLARATION of one’s major is an inevitable task common to any student following a liberal arts and sciences program. For some, it is – and most likely has been – crystal clear for a long time what major to pursue. For others, like me, panic emerges when confronted with this seemingly impossible decision. How am I, as a nineteen-year-old, expected to know what I want my future to hold? Lo and behold, after much deliberation, I have officially declared my major: Global Public Health.
Dr. Cindy Howard’s presentation slides introducing the field of Global Health sparked some self-reflection. Evidently, this decision reveals my true nature. What drew me to this particular field is not merely my desire to travel the world as a result of growing up as a third culture kid but also my need to answer the call to reduce health disparities worldwide. In an increasingly globalized world, borders no longer restrict diseases. Furthermore, the global has become local as two million people cross international borders daily (refugees, immigrants, and international travelers). As evidenced by the MDG, health is no longer a concern from a national scale, but the only way to progress is indeed through global partnerships.
Having been assigned a myriad of readings including, but not limited to, scientific studies, ethnographies, and meta-analyses, many of my professors claim that said readings describe research that was pivotal in gaining new, paradigm-shifting insights. Similarly, Dr. Jonathan Borak wrote a paper describing five “classic” papers in the realm of public health and epidemiology. In summary, the first article described nine criteria put forward by Hill (1965) that have significantly impacted how inferences of causality from observational studies hold weight. Second, Armitrage and Doll (1954) found that the relationship between age and mortality rates were exponential across various types of cancer, thus providing a foundation of the multistage theory of cancer. Needleman et al. (1979) discovered that “subclinical” lead exposures harms neurobehavioral functions and has a negative influence on school performance in first- and second-grade students in Boston area schools. Results have serious public health implications of what should be considered safe levels of lead exposure. Fourth, Ransom and Pope (1992) found a significant association between PM10 levels and absence rates at two local schools in Utah, providing more information regarding exposure limits for air pollution policies. And lastly, Slovic (1987) summarized a selection of social and cultural factors that influence the ways in which the general public perceive risks. Instead of using quantitative measures, it is important for pubic health practitioners lend to non-quantitative concerns of the general public, bridging the gap of risk valuation between “experts” and “lay persons.” These five articles, in my opinion, could serve to inspire public health students, like myself, as our future research can have important implications in the public health realm.
In the third year of my current study, I am required to write a capstone, an individual research project. Developing a bachelor thesis that exhibits high levels of creativity, rigorous inquiry, and professional production can be a daunting task. After reading Dr. Borak’s article, it appeared to me that timelessly relevant research need not be overly complicated. But rather, important contributions can amount from data that is already available, perceptive observations, and analytical skills exhibiting ingenuity and original ideas. Needleman et al.’s (1979) results, for example, challenged preconceived exposure levels. Similarly, Ransom and Pope (1992) conducted a “natural” experiment in which they took advantage of the closing of the mill for 13 months, providing a control period to study air contaminants. In order to aid the pursuit of knowledge, new and continuous research should be encouraged, as contradicting or groundbreaking conclusions lead to great advancements in the scientific community and challenge previously ascertained knowledge.
Dr. Borak’s and Dr. Howard’s readings have prompted introspection in the context of my current education and experience. Global health matters and is a top priority in the global agenda. In such a broad and multidisciplinary field, the number of praiseworthy research articles is plentiful but more importantly the number of future articles that can be added to this list is endless. I hope to fulfill my duty to add to this ever-increasing pool of scientific research as I go ahead with my academic career.
About the Author:
Lily van Bilsen is a second year student in Leiden University College The Hague pursuing a major in global health with a minor in international development. Her diverse background has significantly influenced the tolerant and open-minded person that she is. Lily has lived in numerous parts of the world including Bahrain, England, the US, the UAE, Egypt, Turkey, and currently the Netherlands. As is evident, participating in volunteering, especially in the developing world, is of great importance to her. She has volunteered with numerous organizations in Cameroon, Tanzania, and the Philippines ans is fluent in English, Dutch, and French. Speaking of her passion in life, Lily says “My international upbringing and school career have instilled a passion for international development. In addition, I have a keen interest in global public health.”
GHEP Blog Showcases Powerful Reflections from our Global Health Interns From Around the World.
As part of its ongoing Global Health Capacity Development Project and commitment to developing the next generation of global health experts from around the world, GHEP enrolls a select number of top-flying students at different academic levels from around the world into its virtual Global Health Internship Program otherwise known as vGHIP.
vGHIP Interns undergo rigorous training using a well-designed internship curriculum. The curriculum, which is tailored according to the student’s academic level, includes rigorous readings, communication, data analyses, program planning, and other activities incorporating the key public health competencies under the supervision of accomplished public health experts. Interns also provide editorial support to the editorial board of GHEP’s signature academic journal–the International Journal of MCH and AIDS.
Supervisors provide regular feedback to interns using various modes of communication including face-to-face (if they are in the Washington, DC metro area), Skype discussions, emails, frequent feedback, and other emerging 21st century information technology tools.
Over the years, we have seen an emergence of a cadre of interns with powerful reflections of their views on global health issues and how they envisage their paths along public health and global health careers. The depth, diversity, and richness of these reflections are outstanding. Sometimes they’re breathtaking. They warrant wider dissemination.
Therefore, beginning in May 2015, GHEP Blog will feature reflections and writings from our interns and supervisors exploring their thoughts and reflections on key readings and projects completed during their internship program.
We hope you will join us by reading and commenting on these blogs as well as sharing them with your networks around the world. We are moving onwards! Join us.
You can also learn more about vGHIP.
About the Author:
Dr. Romuladus ‘Romey’ Emeka Azuine is the founder and Executive Director of the Global Health and Education Projects, an international 501(c)(3) non-profit organization based in Riverdale, Maryland, USA. Romey can be reached at info@globalhealthprojects.org
Editor’s Note:
It is not very often that we, as public health researchers and practitioners, sit back and take stock of what we’ve achieved–how we’ve changed the world–with our careers and God-given talents. This is even truer for researchers who toil everyday breaking new grounds, transforming how we live our lives without sitting back to trump their chests on their achievements. To take a departure from this, this blog will, in the next few weeks, begin the publication of seven key ways in which researchers in the field of maternal and child health helped to transform the lives of children and families around the world–forever! These achievements are brought to you courtesy of the fabulous work by the American Academy of Pediatrics (AAP) under its new campaign 7 Great Achievements in Pediatric Research. We hope after reading these achievements you will sit back and say, yes, we did! On a personal note, I am so grateful to God for giving me the distinct opportunity to be part of 2 of these 7 achievements. I am so humbled and grateful to all individuals who gave me the opportunity to be part of these transformations of human life, albeit in very modest ways. With tears of gratitude in my eyes, I bring you the first of the 7 Great Achievements.
NO. 1: PREVENTING DISEASE WITH LIFE-SAVING IMMUNIZATIONS
What was the Problem?
Rotavirus infection remains the leading cause of severe diarrheal illness and dehydration in children worldwide.
In 2008, about 450,000 children worldwide under 5 years old died from vaccine-preventable rotavirus infection. Prior to vaccine development, rotavirus caused 20-60 deaths each year in U.S. children under 5 years of age. Haemophilus influenzae type b (Hib) is a bacteria that causes many different types of disease in children younger than 5 years of age, including brain infection (meningitis), lung infection (pneumonia), and severe throat infection (epiglottitis). Prior to the Hib vaccine, about 20,000 U.S. children had Hib infections every year, and up to 1,200 children died.
What was the Discovery?
Vaccine research includes developing vaccines in laboratories, testing effectiveness in humans, testing ways to get children vaccinated and reducing barriers to immunizations.
Research into the development of a vaccine to protect against rotavirus infection started in the mid- 1970s. Studies elucidated the effect of rotavirus on a child’s immune system and how initial exposure to the virus protected that child from future illness.
Once the prototypal rotavirus vaccine was created, subsequent research tested ways of improving its efficacy while maximizing safety. Following research and many efficacy and safety studies, the first rotavirus vaccine for widespread public use was approved in 2006.
Studies showed that the most severe infections from Hib tended to occur in young infants, due to their immature immune systems. A multi-dose vaccine schedule was created in order to maximize the protection of infants from infection with Hib, with the first dose given at 2 months of age.
How did the Discovery Change the World?
Receiving the full schedule of rotavirus immunization decreases the occurrence of gastroenteritis by 86% and required hospitalization for gastroenteritis by 96%. Since the administration of the vaccine, the yearly cases of Hib infection have decreased by 99%. Currently, most mortality from Hib occurs in developing countries, where vaccination is not routine.
For more information about the 7 Great Achievements of Pediatric Research visit AAP website.
The death on September 1, 2014, of Andrea Kid-Taylor, PhD, one of the most-committed lecturers at the Morgan State University School of Community Health and Policy, Baltimore, Maryland, USA, is a loss not only to public health, but for health disparities among underserved communities in United States and around the world. It is a sad day for all those who knew her and passed under her tutelage in one fashion or the other. Dr. Kidd-Taylor was a calming voice in the midst of anxiety, and tenderness in the midst of pressure and tension.
My first contact with Dr. Taylor was in 2006 at Howard University, Washington, DC. She was an environmental public health guest lecturer at the HU College of Medicine-operated public health program. In her presentation, she depicted every ounce of a true bastion of public health and environmental activism. At the end of the class, a throng of students lined up to have a chat with her—and I was one of them. For every student that came, she had the same level of mien: an engagement, and presence that was neither rushed, nor frizzled. This was late in the night. This is significant given the fact that she was in Washington, DC and would be commuting to Baltimore, Maryland the same night—a commute that was very long. She made a personal connection with each of the students that she met that night. For every student in that hall that day, Dr. Taylor left a message, don’t stop at the master’s level, go on get your doctorate; public health needs you and the minorities need to address health disparities. And I know I am just one of the students that she touched with her motivational embrace. Evidently, there are hundreds of us out there who have been touched by her light of motivation.
Dr. Kidd-Taylor, an erudite scholar and public health professional, who believed what she preached, will be sorely missed. But we are encouraged by her legacies which will live on in the field of public health. For many of us who moved on to do and continue to do great things as agents of social change around the world, Dr. Kidd-Taylor’s gentle voice will remain evergreen in our hearts. Her gentle voice will motivate us to pass that touch yet to another generation because the work of eliminating health and education disparities in our communities here in the United States and around the world is not yet done. Your comments and thoughts of Dr. Kidd-Taylor are most welcome!
Romuladus Emeka Azuine, DrPH, MPH, RN
Executive Director
Global Health and Education Projects, Inc.
Washington, DC, USA
September 7, 2014