Essays, poems and Stories of an African-American

Monday, 5 October 2015

US National HIV/AIDS Strategy From a Public Health Perspective

Knowledge of strategies and outcomes of National Health Programs is a crucial point if a health care provider is to remain relevant and effective. 

Tracy (not real names) is  a 22 years Transgender Male to Female identifying person living with HIV (undetectable). HIV diagnosis was made at 17 years.

Jones Cornelius 55 years (not real names) has an SRO in Chinatown San Francisco. HIV diagnosis was done at 30 years when he started getting unexplained and unresolving illnesses.

John (36 years) and Jane Doe (27 years) are an African-American couple living with HIV diagnosed 5 years back.

"One (1) in eight (8) people with HIV still go undiagnosed. Only  three (3) in ten (10) people with HIV have suppressed the virus in their system, lowering it to an undetectable level," (President Obama, July 30th 2015). 

All four people have five things in common as far as HIV/AIDS goes:

1. They started HIV treatment very early. This ensured that opportunistic infections were avoided.
2. They are active members to their support groups. This means they are beneficiaries of such initiatives that look forward to an HIV free world.
3. They have never missed their doctors' appointments. They are able to have plan with their provider in a mutually friendly way.
4. They feed regularly. Feeding as a source of energy foods, nutritious feeds and necessary elements that body requires.
5. They are committed to activities suppressing viral load. They are taking the highly effective medicines regularly

All this was possible, thanks to a robust and friendly National HIV/AIDS Strategy that emphasizes:
  • Early HIV treatment
  • Early pre-exposure prophylaxis (PrEP)
  • Focus on heavily affected groups including: young gay men, transgender women, African-Americans, Immigrants, young couples.
  • increased percent of people with HIV who know their serostatus to at least 90%
  • reducing number of new infections by 25%
  • increasing the percentage of newly diagnosed people linked to HIV medical care within one month to 85%
  • increasing the proportion of HIV-positive people with viral suppression to at least 80%
  • reducing the death rate among people with HIV by at least 33%

Knowledge of strategies and outcomes informs one on how to best design messages, interventions and key areas of support. This helps a Public Health Practitioner to remain relevant and effective.

Religion from a Public Health Perspective

Do you think religion plays a role in the way individuals lead their lives? Should we assume that religion is a direct indication of civilization which in turn means a universal hygiene standard? Do you think Public Health Practitioners should link hands with the faith-based organizations, clergy or indigenous Traditional religious leaders to promote health? Do you see government and religion playing roles in promoting public health?

I started this short write up with the above questions because it was what I was asking myself as I thought up this topic for the series of Public Health Perspective.

"Cleanliness is next to Godliness." This is an oft repeated saying. A clean or tidy person is said to be godly. At the individual level, right from childhood we are brought up knowing we have a responsibility to look after ourselves as far as hygiene is concerned.

Religion is a powerful tool for social mobilization and organization. Through religion people can be mobilized to get behind a given activity such as hand-washing, wearing masks in case of flu or attending such services that promote quality livelihoods.

Religious organizations are linked to a social development agenda and many are behind the construction and maintenance of facilities such as: hospitals, clinics, counseling units as well as providing a relief for many who may seek solace in prayer when they are downcast.  Religious organizations are major employers the world over. This means that they are contributing to numbers of people who can afford a better living standard, have access to health coverage and services.

Unfortunately, religion can be a stumbling block to public health or in other circumstances public health can clash with morals and values of religions ( e.g., pro-choice, planned parenthood, family planning, use of organs..). Some catastrophic strifes around the world are as a result of religion, e.g., Boko Haram, Militia groups in Central African Republic and ISIL. There are many examples where religion has been used to justify violence, radicalization, anti-muslim sentiment, anti-semitism, abuse of women and racial segregation.

Secretary of State John Kerry states that "one of the most interesting challenges we face in global diplomacy today is th need to fully understand and engage the great impact that a wide range of religious traditions have on foreign affairs." He continues to assert that "religious beliefs shape the views of public and change-makers near and far."

"Religious advocacy groups have long raised awareness about famine and human rights violations abroad.; Buddhist nuns in Nepal play a crucial role in natural disaster recovery efforts; and religious organizations have been essential to providing humanitarian support to Syrian refugees," Secretary John Kerry continues.

Religion can lay the grounds for:

1. driving the economy
2. addressing corruption
3. combating terrorism
4. mitigating conflict, encouraging pluralism, valuing tolerance and democracy
5. advance women and children rights
6.pacifying warring sides
7. address poverty
8. build structures of responsibility towards one another
9. create greater understanding among peoples and countries
10. addressing the global impact of religion, relations and cooperation among people

In understanding the role of religion, a public health practitioner is able to plan how well to involve religious leaders or understand how religion can help in promoting public health.

1. America (National Catholic Review) September 14, 2015
2. Office of International Religious Freedom, US
3. U.S Strategy on Religious Leaders and Faith Community Engagement

Sunday, 4 October 2015

The Global Goals From a Public Health Perspective

There is an interconnectedness between Public Health Principles and the recently agreed upon/adopted UN Global Goals. These, are also known as Sustainable Development Goals (SDGs). 

This prompted me to think that most of our actions (governance, leadership, housing, exercise, nutrition, health-care..) as being processes that ensure quality livelihoods for all people whether in homes, schools, hospitals, dormitories, cities, trains, ship and airplanes. There are definitions I want to first refer to:

Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases (WHO).
Public health is the science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention and detection and control of infectious diseases. Overall, public health is concerned with protecting the health of entire populations (CDC).
Public health is the health of people in general; the science of caring for the people of a community by giving them basic health-care and health information geared at improving living ( MERRIAM-WEBSTER).

On 19 July 2014, the UN General Assembly's Open Working Group on Sustainable Development Goals (OWG) forwarded a proposal for the SDGs to the Assembly. The proposal contained 17 goals with 169 targets covering a broad range of sustainable development issues. These included ending poverty andhunger, improving health and education, making cities more sustainable, combating climate change, and protecting oceans and forests.[1] On 4 December 2014, the UN General Assembly accepted the Secretary-General's Synthesis Report which stated that the agenda for the post-2015 SDG process would be based on the OWG proposals.[2]

The Intergovernmental Negotiations on the Post 2015 Development Agenda (IGN) began in January 2015 and ended in August 2015. Following the negotiations, a final document was adopted at the UN Sustainable Development Summit September 25–27, 2015 in New York, USA.[3] The title of the agenda isTransforming our world: the 2030 Agenda for Sustainable Development[4][5]
The Sustainable Development Goals (SDGs), also called Global Goals,[6] and Agenda 2030 [7] are an inter-governmentally agreed set of targets relating tointernational development. They will follow on from the Millennium Development Goals once those expire at the end of 2015.[8] The SDGs were first formally discussed at the United Nations Conference on Sustainable Development held in Rio de Janeiro in June 2012 (Rio+20).

The definition "Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases," makes me contemplate on the following 17 measures as aspirations I want to pursue as a Public Health Practitioner:

1. End poverty in all its forms everywhere.
2. End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.
3. Ensure healthy lives and promote well-being for all at all ages.
4. Ensure inclusive and quality education for all and promote lifelong learning.
5. Achieve gender equality and empower all women and girls.
6. Ensure access to water and sanitation for all.
7. Ensure access to affordable, reliable, sustainable and modernenergy for all.
8. Promote inclusive and sustainable economic growth, employment and decent work for all.
9. Build resilient infrastructure, promote sustainableindustrialization and foster innovation.
10. Reduce inequality within and among countries.
11. Make cities inclusive, safe, resilient and sustainable.
12. Ensure sustainable consumption and production patterns.
13. Take urgent action to combat climate change and its impacts.
14. Conserve and sustainably use the oceans, seas and marine resources.
15. Sustainably manage forests, combat desertification, halt and reverse land degradation, halt biodiversity loss.
16. Promote just, peaceful and inclusive societies.
17. Revitalize the global partnership for sustainable development.

The knowledge of, owning the right set of Public Health skills as well as a continued cognizance of the interconnectedness and intersectionality between the 17 measures will go a long way to make me a more effective Public Health Practitioner.

3.  World leaders adopt Sustainable Development Goals"United Nations Development Programme. Retrieved25 September 2015.
4. Transforming our world: the 2030 Agenda for Sustainable Development".United Nations - Sustainable Development knowledge platform. Retrieved 10/04/2015.
7. Harris, Gardiner (27 September 2015). "Obama Tackles Poverty and Sexism in U.N. Speech". New York Times. Retrieved 29 September 2015.

Table Salt From a Public Health Perspective

Jane is someone who has never had her barbecued and roast beef without salt. She would use all sorts of expletives or profanities loudly enough if you dare hide salt. She asks in her husky whisky scarred voice out loud: "what would we be without salt?"

In humans, the craving for salt can be traced to the taste buds. Yes, you read right. The sweet, sour, bitter,salty taste buds.

But, what is this salt (table salt)?

Salt is Sodium Chloride [NaCl]. Sodium'schemical symbol comes from the Latin word for sodiumcarbonate, natrium. DiscoverySodium was first isolated by Sir Humphry Davy in 1807 using electrolysis of caustic soda, although it had been long recognized in compounds. Sodium is a soft, bright, silvery metal that floats on water ( for more see: Google).

First and foremost, a person needs from 1,500mg-2,500mg of salt daily (31-41% of a teaspoon). "People need about one and one-half teaspoons of salt per day. Anything less triggers a cascade of hormones to recuperate sodium from the waste stream, hormones that make people vulnerable to heart disease and kidney problems" (Sally Fallon Morell, president of the Weston A. Price Foundation ¹, 1991).

In one study by Harvard researchers, a low-salt diet lead to an increase in insulin resistance, which is a risk factor for type 2 diabetes -- and the change occurred in just seven days! Other research has found salt restriction may play a role in:
  • Increased death rates among people with type 1 or type 2 diabetes
  • Increased falls and broken hips, and decreased cognitive abilities, among the elderly
  • Giving birth to babies of low birth weight
  • Poor neurodevelopmental function in infants

There is also a condition in which you have too little sodium is known as hyponatremia, where your body's fluid levels rise and your cells begin to swell. This swelling can cause a number of health problems, from mild to severe. At its worst, hyponatremia can be life threatening, leading to brain swelling, coma and death. But mild to moderate hyponatremia has more subtle effects that you or your health-care provider may not even connect with a sodium-deficiency problem, including some or all the following:
1. Nausea
2. Loss of appetite
3. vomiting
4. Loss of energy
5. Muscle weakness
6. Spasms
7. Headaches
8. Fatigue
9. Confusion
10. Incontinence
11. Mood changes
12. Poor clotting of exposed wounds/ulcers

We do need this salt in the right quantities.
A high salt intake and high blood pressure can cause too much calcium to be excreted by the kidneys into the urine, leading to a buildup of calcium and therefore kidney stones. They can be very painful and in some cases can lead to kidney disease.
The Dietary Guidelines for Americans recommend limiting sodium to less than 2,300 mg a day — or 1,500 mg if you're age 51 or older, or if you are black, or if you have high blood pressure, diabetes or chronic kidney disease.
Salt helps maintain the fluid in our blood cells and is used to transmit information in our nerves and muscles. It is also used in the uptake of certain nutrients from our small intestines. The body cannot make salt and so we are reliant on food to ensure that we get the required intake.

Jane has a point in as far as appetite goes. But perhaps appetite is a motivation for us not to deprive the body of the other uses of salt. Salt in the right amounts, helps in metabolism. However, in very low or high amounts it can be a risk.

1. FDA Warned on Dangers of Salt Restriction