A Public Health Blog

Andrew Lansley. Greedy Andrew Lansley TOSSER. The NHS is not for sale you grey haired manky codger.

2011-03-25T09:50:00.000+01:00

US State Department announces World Press Freedom Day: A superlative for hypocrisy is needed

2010-12-09T12:49:00.006+01:00

Having spent the past two weeks doing everything it can to shut down some creepy man's website and his access to his funds, the US State Department in its wisdom found today to be the day to announce that the US will host the World Press Freedom Day next year, which will focus on freedom of information on the internet . In the announcement they voiced their concern "about the determination of some governments to censor and silence individuals, and to restrict the free flow of information.”

From the official announcement:
The theme for next year’s commemoration will be 21st Century Media: New Frontiers, New Barriers. The United States places technology and innovation at the forefront of its diplomatic and development efforts. New media has empowered citizens around the world to report on their circumstances, express opinions on world events, and exchange information in environments sometimes hostile to such exercises of individuals’ right to freedom of expression. At the same time, we are concerned about the determination of some governments to censor and silence individuals, and to restrict the free flow of information. We mark events such as World Press Freedom Day in the context of our enduring commitment to support and expand press freedom and the free flow of information in this digital age.

In January, Hillary Clinton gave a powerful speech on the internet, calling it the 'iconic infrastructure of our age' and warning that "As in the dictatorships of the past, governments are targeting independent thinkers who use these tools." She meant China and other undesirables of course, not herself and her department.

Calling it hypocritical doesn't quite cut the mustard - it's time to coin a superlative.

To a add a significant caveat: placing so many private individuals unredacted names on the web, as the US embassy cables do, displays deplorable recklessness . These people have families and careers one presumes that they wish to protect and nurture. This is not the first time that Wikileaks has recklessly placed people at risk, e.g. Amnesty International's unheeded warning that publishing the names of Afghan's working for US and other foreign forces puts them in immediate danger of assassination.

to state the obvious: Wars cause Disease

2010-12-06T18:28:00.032+01:00

UNICEF are calling for a cease-fire in order to administer polio vaccinations in war-torn regions of the DR Congo as the disease makes an aggressive return in the area. Polio vaccination teams have struggled for many years to get to war-torn areas, leaving large segments of the population unvaccinated against the highly contagious disease.

But the break-down of basic health services is by far not the main cause of war-time disease. Armed conflicts have long been associated with disease outbreaks by creating the necessary conditions for epidemics to explode: destruction of infrastructure including water supply and sanitation facilities, displacing civilians and creating refugees who are often driven into overcrowded and unsanitary settlements.

Dormant diseases can surge back to life in the event of war, as in the case of typhus which after an absence of twelve years broke out in the refugee camps created during the Burundi civil war in 1993.

Malaria has also shown to spike when populations are displaced, as refugees travel they are exposed to strains to which they have little resistance and then transmit the disease to populations that they come in contact with as they continue their trek. Regnol-Querol found that 1000 civil war refugees raise the incidence of malaria in the recipient country by 1400 cases. The upheaval and massive population movements during the Russian Civil War caused a major malaria epidemic in Volga basin, which stretched northward as far as the Arctic Circle - hard to imagine in a disease which we now view as tropical.

Soldiers are of course no less susceptible to war-time epidemics than the civilian population. For example, it is estimated that during the American Civil War malaria killed three out of five Federal casualties and two out of three Confederates. In the Russian-Finnish conflict in the 40's malaria was also a major cause of death among the troops.

Conditions of war not only exacerbate endemic disease but can also cause new disease to appear. Armed conflicts in the Great Lakes region in Africa have displaced millions in the last few decades, many of whom have been driven into normally uninhabited jungle where they come into contact with the natural animal hosts of hitherto unknown diseases; disease which they may contract and pass onto the general population. This is likely the cause of the Ebola, first identified in the DR Congo In West Africa the increase in outbreaks of new haemorrhagic fevers are likely to have first been introduced to humans from monkeys when refugees in Liberia and Sierra Leone were displaced into the surrounding jungles

The 1918 Flu pandemic, which killed at least 40 million people was a new and terrifying strain believed to have emerged from over-crowded training camps and barracks in the UK, where there were reports of young men dying soon after first displaying symptoms of a pneumonic, flu-like illness. When the men were sent off to the front, they came in contact with hundreds of thousands of other soldiers, allowing the virus to spread, change and mutate and become even more virulent. The frontlines had all the conditions of refugee camps, with hundreds of thousands of young men living in squalid unsanitary, overcrowded camps, ideal areas for the spread of disease. When the soldiers left the frontlines and returned home, they came back carrying more lethal forms of the virus which they re-introduced into the civilian population.

How to write about Africa

2010-12-06T13:16:00.002+01:00

I just came across this fantastic satrical piece on cliches of Africa written by Binyavanga Wainain and published in Granta Magazine:
.

Always use the word ‘Africa’ or ‘Darkness’ or ‘Safari’ in your title. Subtitles may include the words ‘Zanzibar’, ‘Masai’, ‘Zulu’, ‘Zambezi’, ‘Congo’, ‘Nile’, ‘Big’, ‘Sky’, ‘Shadow’, ‘Drum’, ‘Sun’ or ‘Bygone’. Also useful are words such as ‘Guerrillas’, ‘Timeless’, ‘Primordial’ and ‘Tribal’. Note that ‘People’ means Africans who are not black, while ‘The People’ means black Africans.

Never have a picture of a well-adjusted African on the cover of your book, or in it, unless that African has won the Nobel Prize. An AK-47, prominent ribs, naked breasts: use these. If you must include an African, make sure you get one in Masai or Zulu or Dogon dress.

In your text, treat Africa as if it were one country. It is hot and dusty with rolling grasslands and huge herds of animals and tall, thin people who are starving. Or it is hot and steamy with very short people who eat primates. Don’t get bogged down with precise descriptions. Africa is big: fifty-four countries, 900 million people who are too busy starving and dying and warring and emigrating to read your book. The continent is full of deserts, jungles, highlands, savannahs and many other things, but your reader doesn’t care about all that, so keep your descriptions romantic and evocative and unparticular.

Make sure you show how Africans have music and rhythm deep in their souls, and eat things no other humans eat. Do not mention rice and beef and wheat; monkey-brain is an African's cuisine of choice, along with goat, snake, worms and grubs and all manner of game meat. Make sure you show that you are able to eat such food without flinching, and describe how you learn to enjoy it—because you care.

Taboo subjects: ordinary domestic scenes, love between Africans (unless a death is involved), references to African writers or intellectuals, mention of school-going children who are not suffering from yaws or Ebola fever or female genital mutilation.

Throughout the book, adopt a sotto voice, in conspiracy with the reader, and a sad I-expected-so-much tone. Establish early on that your liberalism is impeccable, and mention near the beginning how much you love Africa, how you fell in love with the place and can’t live without her. Africa is the only continent you can love—take advantage of this. If you are a man, thrust yourself into her warm virgin forests. If you are a woman, treat Africa as a man who wears a bush jacket and disappears off into the sunset. Africa is to be pitied, worshipped or dominated. Whichever angle you take, be sure to leave the strong impression that without your intervention and your important book, Africa is doomed.

Read the rest at Granta Magazine.

An HIV/AIDS Reading List

2010-11-23T23:52:00.005+01:00

In the formidable The Invisible Cure, Helen Epstein chronicles our failure to do the right things to curb the HIV/AIDS epidemic in Eastern and Southern Africa - impeded as we are by too much ideology and too much political correctness. It's not spoiling the ending to tell you that the cure in the title refers to cutting down on concurrent sexual partnerships.

In the equally formidable The Wisdom of Whores, Elizabeth Pisani.Pisani chronicles our failure to do the right things to curb the epidemic in S.E. Asia - impeded as we are by too much ideology and too much money. Here is Pisani talking at TED:

Having just read these two back to back, their similarities are stark. The message in both is - follow the data, not the ideology. But they do discuss two very different epidemics - in S.E. Asia HIV is concentrated in high risk groups with little danger that the epidemic will explode in the general population. Politcal squeamishness and voter disapproval of directly addressing injection drug use and risky sex has led to health messages which largely miss the point.

Conversely, in Southern Africa, Epstein laments the focus that has been placed on high risk groups despite the vast majority of new infections being transmitted through heterosexual sex within long-term relationships, meaning not only that the health messages miss their target, but they also add to shame and stigma, which further aids transmission. One irritating thing about the Invisible Cure is Epstein's frequent talk of 'Africa', I'm sure she knows it's a big continent and that lots of it has about as much HIV as Switzerland. To quote Hans Rosling; 'we have to stop talking about Africa as if it's one place, it's not very respectful and it's not very clever'.

Read both if you can. If you can't, then read The Invisible Cure.

Saturday is for funerals by Unity Dow and Max Essex is a very different book. Dow writes true stories of lives ravaged by AIDS in Botswana, with each short story followed by scientific commentary by Essex. Half-way through I became indignant of how anyone could write about HIV/AIDS while barely mentioning sex, but this is a book about the disease of AIDS and it's impact on the lives of Botswanans, not about the spread of HIV. An exploration of how and why such a prevalent disease (one which in the years before widespread anti-retrovirals took up every Saturday for funerals) can be such an impenetrable taboo is unfortunately lacking. But it is a moving, compassionate and insightful book. I recommend it to people looking to learn a bit, but not too much, about AIDS.

Postnote: The Wisdom of Whores is available free of charge as an e-book for the month of December

Thailand's phenomenal success using the Salt'n'Pepa approach

2010-10-17T14:18:00.003+02:00

Really impressive and funny enough to momentarily distract Mr. apublichealthblog from playing football on the playstation:

Mechai Viravaidya: How Mr. Condom made Thailand a better place

And yes, I have just worked out how to embed videos

rswhat? RSS

2010-10-16T12:30:00.006+02:00

It's come to my attention that many of my readers could benefit from knowing what rss is. It's a way of getting updates to blogs and other sites that you regularly visit without having to actually visit them to check if there's anything new. Here's a video, in German because all the English ones I came across were quite annoying. To read about it in English go here.

As I have a yahoo email account, I use My Yahoo to see the rss updates, but google reader (not email account related) seems to be the most popular. Set up an rss feed, I dare you. It's not revolutionary, but if you regularly check more than one site (which surely everyone with internet access does) it will make your life a little easier. And remember to add this blog to your feed by clicking the little orange button on the top right:)

The good news of the decade?

2010-10-14T14:53:00.005+02:00

Hans Rosling,everyone's favourite Swedish statistician, presenting the big picture of the Millenium Development Goals.

I especially like that he doesn't talk of women and children as if they are interchangable

Do they not have condoms in New York?

2010-10-14T13:49:00.009+02:00

Gossip Girl, for those not in the know, is a massively popular high school/university drama set in a very affluent New York where everyone sleeps with everyone. In this week's episode Serena (on the right) was 'accused' of having an STD which sends the guys she's slept with and their current girlfriends into a panic. Nothing in the episode questions the stigma and shame she feels or the blame that others direct at her. At one point she pleads with one ex-boyfriend: 'Dan, you KNOW it's not true' - as if through knowing her goodness he should know that she is morally and biologically incapable of contracting an infectious disease.

The message is clear – STDs bring stigma, shame and blame, which is a worrying enough message in itself, seeing as young people who view STDs as stigmatizing have a reduced likelihood of being screened, but equally worrying is that the possibility of safe sex is never alluded to. We are led to believe that this group with their ever-changing sexual partners have never heard of condoms. There's definitely a way of blaming George Bush for this, if you're that way inclined.

Gossip Girl faces great disapproval in the US due to its teen sex story-lines and even uses this disapproval to market itself, so its particularly disappointing that they didn't develop a safe sex story-line out of this episode, seeing as sex education and condom use would fit with the show's image of being the antithesis of the puritanical sensibilities of the bible-belt.

I enjoy Gossip Girl as a fantasically silly, glossy teen drama, but I'm significantly older than the target audience who don’t think it’s so silly, and it's a shame that instead of developing their risque image to embrace safe sex, they retreated to the age-old STD stigmas while simultaneously forgetting that condoms exist.

Which brings me on to another lack of condoms on-screen. A porn actor working in the San Fernando valley, the heart of the US porn industry has tested positive for HIV. Porn actors undergo mandatory testing every month in the valley and this is the first time since 2004 that one has tested positive. For a time after the 2004 scare, actors used condoms but this was scraped due to it's believed connection to a drop in sales. Under California law employers must safeguard their workers against the exchange of bodily fluids. However, most studios bypass the requirement on the grounds that the actors they use are self-employed.

James, the actor at the centre of the 2004 events, told the Los Angeles Times that he was dismayed by the lack of progress on the issue in the past six years. "The actors … they're not getting the protection that they need. There should have been mandatory condoms," James said. "I knew it was going to happen. And how many years has it been? Again. They went right back to the same habits. Good grief, it's like my deal, all over again. I hate that." (Most of the last two paragraphs have been copied from this article in the Guardian)

The Poor Little Women and Children

2010-09-24T13:57:00.004+02:00

The Millenium Development Goals Summit is being held in New York this week, and is bringing with it an onslaught of ridiculous platitudes about how important women and children are. This is one from our man Ban Ki Moon:

“Women and children play a crucial role in development. Investing in their health is not only the right thing to do – it also builds stable, peaceful and productive societies.”

Even with female infanticide and selective abortions, there are still about 1% more females in the world than males. If we say that a child is a person under 15 years old, then children make up about 30% of the world's population. This is a very rough estimate, but adding the boy children to the female total gives 66% of the world being women and children.

So what he's saying is that two thirds of the population being healthier is good for society. Whoever would have thought!

Oxfam, among many many others are at it with the pointless good-will platitudes as well:

'When women and children thrive, so will our world.'

Gee, thanks for the gob-smackingly obvious.

I'm really tired of women's and children's health being treated as one and the same issue. They are of course related but then it's called reproductive health and/or maternal and infant health. Of course I know that many women suffer greatly under oppressive patriarchal cultures and can be vulnerable in ways similar to children, but don't women have more in common with men, being grown-ups and all, than with children? I certainly feel I do.

A pint and a fight

2010-09-24T11:03:00.007+02:00

A while ago I was at a bar in Graz when something that is extremely rare in Austria happened: two men got into an arguement and then one hit the other over the head with a beer bottle. After a cursory glance to check that he wasn't unconscious or bleeding and that he had vaguely sober friends with him, I went to continue my conversation. The guy I was talking to was very disconcerted by my lack of concern.
Him: 'I'm upset, I think I have to leave. Aren't you upset?'
Me: 'Well...ummm ...no. I'm British'

I don't know, perhaps I am unusually desensitised even for someone who grew up
in Britain, where glass is the by far the most common weapon in pub fights and
where 300 people are treated for injuries caused by glass ('glassings') every

week. Many are scarred for life, not too few are blinded and if a major artery is hit, some die.

This week, accident and emergency doctors, the British Medical Association and the Royal
College of Surgeons are called for all glasses to be replaced by shatter-proof
plastic tumblers. The town of Hull has been on a glass-free trial since 2008 and
since then nobody has been injured because of "glassing" and the local NHS has
saved £7.2m in eye surgery costs.

It's compelling evidence. But to my knowledge people don't get routinely attacked with glass
outside of Britain. Somehow I don't think that the glass is the problem.

Mapping a wormy world

2010-08-23T14:00:00.005+02:00

Being under-researched and poorly controlled, many helminth (worm) infections find themselves on the Neglected Tropical Diseases list. Of these, soil-transmitted helminths (roundworm, whipworm and hookworm) and schistosomiasis (a waterbourne infection also known as bilharzia) contribute most to the global burden of disease. It hardly needs saying that these infections are most pravelent in the poorest communities where sanitation is inadequte.

The just released Global Atlas of Helminth Infections , which provides open-source maps of disease pravlence and control programmes and is a single database of all available information on the four dominant worm infections, is an important contribution to making these tropical diseases not quite so neglected. The atlas was produced by an international collaboration lead by the London School of Hygiene and Tropical Medicine and the Partnership for Child Development at Imperial College London. For a decade, the group has been gathering data from more than 10,000 surveys to describe the distribution and prevalence of worm infection. It currently covers the African continent, with work continuing on mapping other areas of the world.

The maps are useful for policymakers, practitioners and researchers for planning, implementing and advocacy and provide information otherwise not usually accessible.

Dr Simon Brooker from the London School of Hygiene and Tropical Medicine, said“Worm control is like a journey. The extent and location of the problem need to be mapped out in order to get treatment to where it is needed most. Until recently, much worm control has been a journey without reliable maps.”

Pakistan: Flood Waters and Pestilence

2010-08-17T15:09:00.008+02:00

In any natural disaster, various infectious disease outbreaks follow hot on the heels of the immediate deaths and injuries. These are linked to lack of shelter, clean water, sanitation and basic health care services.

The UN's announcement yesterday that 3.5 children in Pakistan are at imminent risk from fatal infectious diseases accompanied the news that the first cases of flood related cholera have been confirmed. Water borne diseases like cholera, dysentery, typhoid fever and hepatitis, can all increase amongst the susceptible populations in flood-hit areas. Risk of malaria and other mosquito borne diseases increase as flood waters stagnate and provide breeding grounds for the vector.

Water-borne diseases take a while to set in after flooding, which means major outbreaks can be avoided entirely through the rapid provision of shelter, clean water and latrines. If only there were enough cash being handed over. Neva Khan, Oxfam's country director in Pakistan, said: "The speed with which the situation is deteriorating is frightening. Communities desperately need clean water, latrines and hygiene supplies, but the resources currently available cover only a fraction of what is required"

The UN has appealed for an initial £295m to provide relief, but only 20% of that has so far been given. The ever-enthusiastic graphic designers at the Guardian have created this visualisation of countries that have donated thus far. Surprise surprise, Austria doesn't feature.

For individual donations- here's a list of organisations currently providing aid relief in Pakistan and awaiting our contributions.

The scourge of Neglected Tropical Diseases (NTDs)

2010-08-16T15:24:00.005+02:00

AIDS, tuburculosis and malaria are far from the only diseases causing suffering in developing countries, although their domination in public discussion and global funding may cause the casual western reader of current affairs to believe that they are. Many of the other endemic diseases reside together under the very aptly named Neglected Tropical Diseases (NTDs) umbrella. They are disabling, disfiguring, and somtimes deadly diseases which as with most bad things, affect the poorest people of the poorest countries the worst. The WHO estimate that over a billion people suffer from one or more of the diseases on this sorry list. Ninety percent of the global burden of NTDs is caused by a group of seven highly prevalent diseases: onchocerciasis, lymphatic filariasis (LF), trachoma, schistosomiasis, and the three major soil-transmitted helminth (STH) infections (hookworm, roundworm, and whipworm).

NTDs contribution to the global burden of disease is massive so it is always a bit shocking to hear examples of just how they neglected they are: to give one - dispite chagas disease affecting 8-10 million people and causing 20,000 deaths anually there is not even a test for it. Meaning among other things that a recovering patient doesn't know if it's really gone or just currently asymptomatic.

This commentary piece summarises the politics and state of NTDs, why they need to be treated, and the hope for the future. If you want to find out more about NTDs, that's a great place to start.

The control of NTDs is currently enjoying a much needed surge of interest. This has mainly manifested in biomedical and pharmaceutical responses rather than tackling the social determinants of health such as clean water, sanitation, good housing, and community education. Whether or not this is the best approach is discussed by advocates of the different camps here. As I know my public health history, I am firmly in the 'social determinants' camp for the long-term control of these diseases, but concede that the vaccine and annual de-worming approach can provide swifter (if donor-dependent and thus unsustainable) respite from their scourge.

Fences make very comfortable seats.

It's all about the money: AIDS 2010

2010-07-25T18:56:00.012+02:00

It's been a packed and confusing week in Vienna, which had the audacity to host the AIDS 2010 Conference despite Austria having contributed the paltry amount of €800,000 only once (ONCE!) to the Global Fund to fight AIDS, TB and Malaria back in 2002. With all the income that must come with hosting so many delegates, it would seem that Austria somehow wangled itself into being an indirect receiver of AIDS funds rather than a donor. After coming under pressure throughout the week, Austrian politicians made positive noises about contributing in the future. The Global Fund next meets in October for a fresh round of pledges - please put pressure on the government to pay up; this situation is far, far beyond embarrassing.

While Obama was (unfairly?) the target of most of the protests against the decrease in AIDS funding, European countries show signs aplenty of vacillating in their often measly commitments, as several countries decrease their oversees aid budgets in the face of the financial crisis. Die Zeit reports that it is likely that Germany may eschew the Global Fund entirely in favour of funding single projects. This 'whatever takes the international development ministers fancy' style of funding is exactly what the Global Fund was set up to avoid and turning away from it would set a very worrying precedent.

China, India and other emerging markets which have until now been solely receiving rather than donor countries, were called upon to start making a contribution to AIDS funding. China, currently the world's banker and biggest funder of our debt, is reported to be considering it.
In turn, the Global Fund came under criticism for wasting funds on too many plane tickets, unnecessary meetings and writing unread reports. I'd like to add ridiculously big and expensive four-wheel drives to that list.
These biannual events are always more political than scientific and inevitably produce some memorable protests, one in particular this year being delegates from the middle-east and north Africa marching silently in front of the podium during a session on the Global Fund with taped mouths, baring the slogan 'We want to be eligible'. The demanding conditions for receiving AIDS funds effectively shut out many worthy grassroots organisations from the money. Excellent coverage here.
If you are interested in international AIDS funding and spending, I highly recommend this analysis in the Financial Times.

Excellent Field Epidemiology Resource

2010-07-20T09:53:00.003+02:00

I've recently had reason to learn about field epidemiology (read outbreak investigation), which for some reason seems to be entirely neglected in both under- and post- graduate epidemiology courses, including the fancy-pants ones. If you would like to learn about it, make your first stop the comprehensive and easy to read Focus on Field Epidemiology series downloadable from the North Carolina Center for Public Health Preparedness.

Sunday Sundry

2010-07-10T22:12:00.027+02:00

Cheryl Cole (Austrian readers may know her merely as the singer of the Germany's Next Top Model theme song, but in the UK she's practically an industry unto herself) contracted malaria while on a visit to Tanzania, which has created a flurry of articles in the British press on malaria control. Here an opinion piece from the Guardian, and an article from the Telegraph written by Mark Honigsbaum, author of 'The Fever Trail: In Search of the Cure for Malaria'. His film on malaria, The Killing Season, can be viewed on Aljazeera.net.

In some countries women have a 1 in 8 chance of dieing in childbirth in their lifetime. Of the estimated 1,000 women who die from pregnancy-related causes in the world each day, postpartum hemorrhaging (PPT) kills more than any other complication. Most of these deaths take place in houses and huts, far from access to medical intervention. There is a cheap pill, Misoprostol, which has a long shelf life and needs no refridgeration that stops the bleeding quickly. It's been around for a long time, but has yet to be widely distributed. The main policy problem is that it can also be used to abort a pregnancy. Read a history of Misoprostol and discussion of it's future here. It's a confusingly structured article, but well worth the effort.

On a related note, here's a short documentary on the decreasing rate of newborn death in Malawi and Nepal.

Listen to Cityscapes, a panel discussion on how to create healthier cities for 2020. Might have been worth their while to hire a proper sound engineer.

There's renewed hope for an HIV vaccine with the discovery of three antibodies that block 90% the virus from entering human cells under laboratory conditions. Gary Nabel, a leader of the research said 'We're going to be at this for a while' before any benefit is seen in the clinic.

The Uninsured of Austria: A Non-Evidence-Based Rant

2010-07-10T15:36:00.018+02:00

There are people without health insurance in Austria, of whom I'm occassionally one. I've read various figures – 3% of the population over 15 years, 2% of the whole population, 1.2% of the whole population. Whatever the exact figure is, it's likely among the highest in the EU (I compared the rates once from various Health Systems in Transition reports and found no country with a higher rate, but as the title of this post indicates, I don't intend to back up my arguments too well today). I think ~2% is a lot. Given that Austria is one of the wealthiest countries in the EU, a political entity that claims/aims to have universal health coverage, ~ 2% with no health insurance is unacceptably high.

Basically the reasons for not being insured are usually a combination of poverty, fecklessness, atypical or insecure employment arrangements and an inability to navigate what is a very complex system.

The hot off the press Public Health in Austria report states on page 190 that 'social insurance has tried to extend coverage to as many people as possible'.This may be true at a managerial level, but it is not a policy which is felt on the ground.

Health insurance information and forms seem to be written and presented with the objective of having as few people understanding them as possible. And having spent an inordinate amount of time at the self-insurance desk at the GKK (the main insurance body) in Graz I can only describe the atmosphere there as fraught. The people who man the desks are on the whole entirely uninterested in guiding the confused people who ask for their advice and act not occasionally like bullies. Perhaps they started off as pleasant people but the culture of the GKK changed them – a la the Stanford Prison Experiment. I've seen a few people brought to tears and barely a visit has passed without someone in the room raising their voice in anger.

I haven't been there in a while, perhaps it's different now. But if it's not, I have some suggestions which I'm sure if implemented would halve the number of uninsured people within a year:

Publish information and forms in easy to read German (and possibly, but by no means necessarily in Turkish, English and The Language Formerly Known as Serbo-Croat).
Train the help-desk workers on customer service
Establish clear rules of conduct.
Sack any who don't revolutionise their approach to customer service within 3 months and replace them with nice people

The firing may seem harsh, but being routinely rude to people who are only trying to find a way to get themselves into the universal health care system is not acceptable. Unfortunately, in the current climate of the Graz GKK help-desk, it seems to be.

Post Note: 22.07.2010. I just went to the GKK with a fairly atypical request and all three of the staff members I spoke to were helpful and even friendly. I saw one of the help desk men talking very slowly and simply to a person whose German was poor, which you may think is normal human behaviour, but I've never seen it at the GKK before. She was a very pretty young woman though, which may have had something to do with it. Everyone seemed to be going about their business very peacefully - there were even a couple of people leaving with appreiciative smiles. Perhaps the revolution has already been. I'm reserving judgement for now.

New Home

2010-07-06T10:12:00.004+02:00

I've moved from my very short stay at Vox and brought the posts below with me. I moved because it's easier to leave comments here. But not everything is easier - how do I set up an RSS feed?

Monday Melange

2010-07-06T10:05:00.006+02:00

A Report found that the life expectancy gap between rich and poor is widening in England, with people in the northern, working class town of Blackpool dieing 10 years earlier than people in Chelsea, which is in the red area of this astute map of London (by Ellis Nadler) The reaction to this at the moment seems to be to call for increased prescription of blood pressure and cholesterol drugs, which is largely missing the point I think.

HIV/AIDS experts call for a Safe Sex/ No Sex Month in the hope that widespread adherence would act as a fire break in stopping the onslaught of new infections in hyper-epidemic countries. More on this from me later in the week.

A thorough and interesting, if un-proofread (I'm offering my services!) report on public health in Austria, written in collaboration with the London School of Economics.

The WHO have reported that Human African Trypanosomiasis (Sleeping Sickness) is at a 50-year low. They attribute the success to “Strengthened control and surveillance efforts by national sleeping sickness programmes in endemic countries over the past 10 year''. Excellent and brief analysis of these efforts here. And a BBC World documentary on sleeping sickness in the DR Congo here

A new report on the ever growing obesity epidemic in the US. It has lots of statistics, one I found particularly interesting being that 84 percent of parents believe their children are at a healthy weight, even though a third of children and adolescents are considered obese or overweight.

This reminds me of Michelle Obama's story from a few months ago of how her children's doctor warned her that her children were starting to get fat, which shocked her in two ways; first with the idea that her children weren't slim, then with the thought that she hadn't been able to see it herself. It's a story I suspected of being more invented to provide a teachable moment for the nation than of being actually true. But teach away Michelle, it's obviously needed.

Guinea Worm Eradication

2010-07-06T10:04:00.007+02:00

Or - How to avoid spending a month or two pulling a metre-long worm out of a gaping hole in your foot.

In a world of nasty infectious diseases, guinea worm has got to be in the Top 3 Nastiest.

This video has a pretty cool animation of the worm's life-cycle.

In 1986, Guinea worm was endemic across large areas of West and Central Africa, the Horn of Africa, Yemen and Pakistan with a estimated 3.5 million cases in that year. By 2010, it has been eradicated from all those areas except Ghana and Southern Sudan. Last year there were an estimated 3200 cases. This steady elimination has been acheived through a combination of very low-tech solutions and simple health education. Namely, teaching people to filter their drinking water.

Once guinea worm has been eliminated in those last strong-holds, it will become the second infectious disease ever to have been entirely eradicated (humans are the only vectors, so once it's gone it really is gone). And whereas smallpox eradication was dependent on vaccination, guinea worm eradication will have been achieved through health education and behaviour change – which will surely give a much deserved morale boost to the health educators and health promoters of the world.

The Carter Center (the foundation of the former US president Jimmy Carter) has been the main actor in Guinea Worm eradication. A recently released film called Foul Water, Fiery Serpent documents the work of a team of health workers in Ghana and Sudan as they “distribute filter cloths, treat water sources with safe pesticide, educate villagers about avoiding the worms, and treat victims suffering from the disease”. All vital, but hardly the stuff of drama and definitely not glamourous, so it's great to see a film which celebrates this work and also manages to inject a bit of both.

I do have a few mild complaints though. I'm sure it's a cultural thing, but I find the blow-your-own-trumpet-ism and over-the-top-ness of the website and film trailer a bit off-putting. Each paragraph on the website is drowned in adjectives, with 'epic' featuring particularly heavily.Half way through the trailer the words 'The Heroes' are emblazoned across the screen, and just in case the combined forces of mythology and hollywood have not been successful in instructing you on the demographics of heroes, three images follow in quick succession – white men walking through crowd and waving magnanimously, intrepid white man walking through such tall corn he may as well be exploring jungle, white man looking simultaneously concerned, compassionate and fearless. Although in fairness some female and black 'heroes' are allowed speaking parts shortly afterwards.

But despite my reservations on some of the language and imagery, it's a compelling film. There are plenty more tropical diseases to eradicate and this door-to-door, community education stuff is what much of it will look like.

Hijacked at the Lights

2010-07-06T09:59:00.002+02:00

I've always been interested in food and cooking, so it took me a while to realise that lots and lots of people don't know the basic components of the foods they eat. As a teenager I was confused when cakes and biscuits were described by the cooking teacher (or home economics teacher as the poor woman was then known) as containing 'hidden fats'. 'How can they be hidden?' I wondered, 'What do people think is in cake otherwise?' While baking a cake with a friend a few years later I finally realised that the teacher had been right. This friend had never made a cake before and was horrified by the amount of fat and sugar I was instructing him to put in. He was a university-educated, middle-class young adult and had no idea how energy-dense cakes were. To me it's mystifying, but I did slowly learn to accept that great swaths of the population are not particularly interested in food and therefore don't know what's in the stuff they eat.

Until now there has been no legislation on front-of-pack nutritional labeling, which has led to some very confusing sights, particularly in the UK:

An even worse howler are the '73% fat free' labels that you might have seen. I've asked a few people over the years if they realise that that means it is 27% of it is fat, but no-one I asked had taken the label to it's logical conclusion. Because they aren't interested enough in food to think about it.

The traffic light system; whereby foods high in salt, fat and sugar are labeled red and foods on the low end are labeled green, with amber for foods which are somewhere in between, was developed to simplify labeling, so that consumers can quickly and easily get an overview of the nutritional value of a product. This simplistic scheme is of course not without critics, but numerous studies have shown it to the most understandable system to consumers. A recent Australian study for example found that people who read the traffic light labeling were five times more likely to be able to identify healthier food products than those that tried to understand the GDA system (GDA system requires numerical skills and effort to understand). They were also less likely to want to buy products marked in red or amber.

Despite the call from medical, dietetic, and public health organisations across Europe for the EU to legislate for the implementation of the traffic light system, the EU voted against it last week, banning also it's implementation at national levels and voting instead for industry backed GDA's (Guideline Daily Amount) – this came after a €1 billion lobbying effort by the food industry. It's believed to be the biggest lobbying effort in the history of the EU.

€1 billion spent on lobbying one piece of legislation? That's some mighty industrial resistance to simple, understandable labeling.

The food industry's umbrella association, the CIAA, called it an “endorsement” by MEPs, and “a positive step in the right direction.

Well yes, a positive step in the right direction for you. But a positive step for Europe, whose obesity rates have tripled since the 1980's and still continue to rise sharply? I would suggest not.