Global Health Blogs with Professor Swahn

Student Reflections on Topics Covered in our Class

Global Health Blogs with Professor Swahn

Tips for Social Distancing & Quarantine: The COVID-19 Work Book

October 8, 2020 · No Comments · COVID19, Uncategorized

The COVID-19 pandemic and the effort to contain the reach of the coronavirus has highlighted the significance of social contact in our everyday lives. In response, compromises have been made in employment, travel, education, entertainment, transportation, and nearly every sector of our lives. Many people have had to grapple with unexpected losses of jobs, with entire industry’s, such as delta, being forced to lay off a large number of its workforce. Many Americans are finding themselves losing their job or livelihood through no fault of their own, and still having to worry about costs of living, including potential medical expenses, which they may no longer have insurance to cover. One of the most important compromises people are having to make is social distancing. This protocol is required to limit close face to face contact with others and proves the best way to reduce the spread of the virus while we do not have a vaccine available. Quarantine protocols are being used to keep those who may be infected/exposed to COVID-19 away from others. The idea behind the quarantine protocol is that it prevents the spread of disease before the person knows they are sick, which in the case of COVID-19, can occur before the onset of symptoms. Isolation protocol is being used to keep someone who is infected away from others. 

Social Distancing, Quarantine, and Isolation

You may still be asking yourself “Who needs to quarantine?”

  • Quarantine is for those who have been in CLOSE CONTACT (within 6 feet for 15 minutes) with some who tested positive for COVID-19.
  • This excludes those who had tested positive within the last 3 months.
  • People who have tested positive for COVID-19 do not need to quarantine.

Updates for COVID-19 in Grant County, WA | Granthealth.org

 

Managing COVID-19 stress requires healthy habits, news in moderationMany Americans are finding themselves needing to develop new ways to destress during isolation. How about a guide to tolerate distress and uncertainty during these times? The Book “Tolerance for Uncertainty: A COVID-19 Workbook“, is full of daily activities that will help you remain in control of your life despite not knowing what lies ahead. The book will provide you with tools you can use to manage stress, such as healthy coping ideas, a daily planner, sleep hygiene tips, and common coping pitfalls. One of the main takeaways you should derive from this book, and many others is that yes humans are susceptible to many different infectious diseases, as we have seen during this COVID-19 pandemic, and worrying about infection is a normal human reaction. Although, excessive worrying about disease infection can affect both our physical and our mental health.

 

Don’t have time to read a book, here are some more takeaways from the book.

  1. Get informed with the right information –Coronavirus: Call for apps to get fake Covid-19 news button - BBC News Ensure you are accessing trusted sources for all COVID-19 and health-related information. (CDC, State Health Department, World Health Organization). There are many sources and research articles available on the internet, ensure that you are receiving your information from a trusted source to prevent spreading misinformation. Start with the CDC website, it offers simple guidelines such for every COVID-19 related such as how to know which kind of mask to purchase, what to be cautious of when you leave the house, and of course signs and symptoms of COVID-19
  2. Understand History – Understand outbreaks like COVID-19 follow a predictable and studied path, Public Health professionals are on the case just like they have been in all the international outbreaks going 50 years back. The human race has endured outbreaks of cholera, the black death, the Spanish flu, ebola, HIV, all of which we have learned from. Remember there is no vaccine made widely available for COVID-19 yet, once it has been made widely available we will start to see cases drop and the pandemic come to an end.
  3. Balance your thoughts – thinking about whether you’ve been exposed or work in an environment where there is a risk of infection can become negative quickly. Challenge your thoughts, ask yourself what evidence you have that won’t allow you to cope. Whenever you generate a negative thought, counter it with a realistic though.Free Vector | Concerned unhappy people feeling anxiety
  4. Shut down the noise – Allow yourself to tune out the world, especially the media, news, and even the radio, for a portion of your day. Remember stress is infectious. A lot of information is circulating about COVID-19, some fo it is true, some of it may be misinformation.
  5. Remember who you are – during times of high stress, we may tend to act in ways that challenge our values. Remember other people are stressed as well, try to care for others in a kind and sensible way. Your response to the stress of the COVID-19 pandemic depends on many factors such as your history, social support system, your personal financial situation, of course, your health, and your emotional background and community you live in.

Remember quarantine and isolation protocols are vital to containing this outbreak before we have a vaccine available. However, be aware that social isolation carries a long-term and immediate risk to your health. Plenty of evidence has been published, linking social isolation to an increase in mortality from all causes, as well as increased morbidity in physical health outcomes. humans are a social species, that is why many Americans are exCan Stress, Loneliness and Sleep Deprivation Make You More Prone to COVID-19? | Discover Magazineperiencing increased stress due to social distancing. The immediate effects of this stress have been reported, with mental health, substance abuse, and domestic violence. all experiencing a surge. Both long term and short term public health concerns will emerge if adequate steps are not taken to reduce the burden. Seeking assistance from an abusive situation can be difficult for many people for a number of people, such as a lack of finance, no support system, or fear. To add, during the COVID-19 crisis, an additional economic crisis has been triggered, making it even more challenging for victims to seek help or leave. Remember to check in on your family members and friends. Remember that stress related to COVID-19 social isolation can increase susceptibility to substance misuse, addiction, and relapse. Remember a number of resources are now available to help. Remember a number of people are susceptible to the COVID-19 pandemic in many ways. During the remainder fo this crisis, try to be sensitive to those suffering from COVID-19 related stress and show support where you can.

 

People who may struggle with stress during the COVID-19 crisis include: 

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What may explain the relatively low burden of COVID-19 in Africa?

October 7, 2020 · No Comments · COVID19, Uncategorized

           

         Individual death rates in many African countries have  turned out to be much lower than initially feared.  As predicted by the South African experts ,” the number of infections dips sharply in South Africa.” “Experts are now exploring  and starting to shift their focus ; experts here are starting to explore in different cities and different states; they they are focusing on a hypothesis, “ According to Andrew Harding; a correspondent for BBC in Africa”

 

(https://www.bbc.com/news/world-africa-53998374)

 

  •      Some experts are now posing the question, “what if the opposite is also true? “ I offer; “what if those crowded spaces are pretend”  Many times we leave our location and simply come back”  What if those same crowded conditions offer a possible solution to the mystery that has been unresolved for months? What if those conditions can provide protection to people in South Africa, and in similar settings globally, for some extra protection against Covid-19.

 

     

                   According to data from CDC National Center of  Health Statistics;  COVID 19 is caused by a numerous amount of factors in our body. If you are diabetic or have type 2 diabetes and other metabolic conditions you are at higher risk of complications from COVID-19. The evidence is clear! Underlying risk factors are contributors to COVID-19!      Other things to keep in mind:

 

  • Stress management: Acute stressors may temporarily Enhance immune functions, chronic stressors will likely diminish them (immune function)! “Worrying about the stock market, stressing about having enough toilet paper, focusing on the uncertainties of the future can raise cortisol levels, which can all negatively impact our immune function. ” One study showed medical students with increasing stress levels before their final exams had decreased function of natural killer cells, the cells that are the “first responders” of our immune

 

  • A positive mindset is vital for health and well-being. Research shows that positive thoughts reduce stress and inflammation and increase resilience to infection — while negative emotions can make you more susceptible to the common cold and flu.

 

http://kmc-clinic.com/blogSingle/Boosting-Immune-System-to-Prevent-COVID-19

 

           Now my thoughts on all of this are as such.  “I see things more spiritual.” I believe that if we are hungry; we are more in our nature. We have a heightened sense of awareness, and perception; meaning; we develop! I offer; that if you are hungry you will take the lead on things you’re usually not sure about when faced with an empty stomach; suddenly you become an expert at controlling your mind!

          Now a joke: Have you ever met a hungry man in a dessert? I say: he pays attention to everything just to make sure he finds his way home to the pond! I’m surprised; which is why I offer that fasting has been proven to strengthen your mind. It can also enhance your vitality, overall strength , and energy: You get a new pair of shoes when you drop your luggage.  Many people fast for these reasons alone!

Now ….

         Evidence of a natural intervention triggering stem cell-based regeneration of an organ or system, a study in the June 5 issue of the Cell Stem Cell shows that “cycles of prolonged fasting “not only protects against immune system damage — a major side effect of chemotherapy — but also induce immune system regeneration, shifting stem cells from a dormant state to a state of self-renewal.

https://news.usc.edu/63669/fasting-triggers-stem-cell-regeneration-of-damaged-old-immune-system/

      Furthermore; I am from Ethiopia. In Ethiopia;  we know of a war that happened between two parties in which the “Tigray”  regime won! This battle lasted for  17 years! The soldiers were blessed because they survived in the forest on fasting alone! 1 tablespoon of sugar; per soldier; per day! How would I know this? Simple! My uncle was one of them; he was in the forest hiding; living amongst the other soldiers in (A.) Very crowded space and (B.) Disease prone environments! Surprisingly enough; no one got sick; they all thought positively and overturned the opposing regime/ government! There are many secrets to fasting/ and thinking positive which the world does not know.

 

  •      Tying this back to our reading; countries like South Africa are Golden! They eye the beat!  They have  gained the wisdom of a “safe immune system!” Their bodies are much  lighter which allow for healthier antibodies ; and more viral protection. Just as the readings above have shown, Certain diseases will harm you if you are not in a positive mindset or if you are simply stressed or have not fasted; we have an option;

 

           Furthermore; I will add many homeless people have not been as sick as others during this pandemic. it’s always the busy ones; you know the ones who travel from here and there . When there damaged of course  they slow down; but their minds are always Racing. This is key to damaging a good immune system ! We have a choice; places East think very simply ; they have truths but they never suffer them! I have travelled to Ethiopia : Nepal : and many developing nations in my time;  so the “Mystery of why there is a relatively low burden of COVID-19 in Africa” is no mystery to me; because sometimes the simplest answers are the best.  There is great potential in the positive power of our minds and ways we can strengthen our immune systems.

 

 

 

 

 

 

 

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COVID-19: Is This The “New Normal?”

October 7, 2020 · 1 Comment · COVID19, Uncategorized

COVID-19 is not a new name in today’s time. There is hardly any individual who is not aware about the deadly coronavirus. Millions of lives are affected worldwide regardless of age, sex, race/ethnicity, or nationality. The coronavirus or first covid-19 case was detected in Wuhan, Hubei province of China around December of 2019. Not long after that, on March 11th of 2020, World Health Organization (WHO) declared it a Pandemic. Each nation tried to respond to these unprecedented events considering their social, cultural, infrastructural, and political compass. Some countries have performed better compared to others in containing the community spread of infections. Currently, the United States tops the list in terms of positivity rates followed by India.

 

Cultural and Behavioral Changes

We are in the fourth quarter of the year (2020) and if someone asks, what did you do this year? I guess the answer will be: stayed home, maintained social distancing, wore masks, sanitized the house and washed hands. Jokes apart, year 2020 taught us to value our health, family and more so life. The pandemic made us take the less explored paths and try to set “New Normals” for everyone. Working remotely, wearing mask and hand gloves, schools offering online learning sessions, a group huddle in conference room shifting to virtual meetings rooms, etc. became the “New Normals.”

A handshake which was a normal etiquette within society and an acceptable gesture in mostly many cultures have been transformed and some traditional or innovative greeting gestures such as “Namaste (joining hands),”  a “bow,” “footshake,” “the wave” etc.  have been the current trend.

 

 

How is Mental Health Affected?

To contain the spread of virus, many countries such as China, Italy, Africa etc. passed mandatory public quarantine/lockdown orders soon after an initial spike in coronavirus cases. However, even though quarantine is the best and most recommended option to stop the rapid spread of infections, it may have some downside to it. This lockdown might cause collateral damages to the conditions of people that are at high risk such as older people, those with hypertension, cardiovascular diseases, patients with respiratory disease, and mental illness. This tsunami of behavior and cultural changes highlighted the underlying mental health issues which might have been ignored so far. The prolonged isolation, loss of employment, financial stress, increased anxiety and severity of existing condition and the trauma of losing a loved one has worsened the health care gaps. Border closures and travel bans have separated families. All this has added “fuel to the fire.” Research and epidemiologic evidence suggest that physical activity and good diet might help reduce stress levels and cope with the challenging times.

 

 

 

Some basic coping mechanisms include:

 Breathe. Reflect

Connect with others

Keep to a healthy routine

Be kind to yourself and others

Reach out for help if you need it

  

 

 

 

 

 

 

How is Physical Health Affected?

The pandemic has not only affected the mental health but also physical health. As a result of mandatory quarantine or lockdowns, people have been home bound. Two things immensely increased during the “stay homes” 1) Binge watching (television) 2) Binge eating. The normal or minimal physical activity that might have been a part of the routine before covid-19 struck has diminished. Individuals that are usually active were restricted due to gym, malls, and other local park closures. Individuals who were barely active became much less active following the lock down orders. Also, people stockpiled foods, non-perishables (usually high in fats, sugars, and salts) for most part, along with “toilet paper” (just kidding).  

To add to this impulse buying and less physical activity, the unhealthy commodity industry has transformed the pandemic into a marketing opportunity and has mislead the citizens. The junk food and alcohol brands turned this pandemic to be the world’s largest marketing campaign. These unhealthy products have been known to worsen the non-communicable disease burden, however the respective companies such as Krispy Kreme, Coca-Cola, and many more have ironically positioned themselves as pandemic heroes or partners and interfered in public policies that are aligned to protect the population health.

The Future:

 What happens tomorrow depends on what we do today!

We can only assume what the future holds. Epidemiologists and biostatitians have been busy developing models to depict the trends of coronavirus and make appropriate recommendations. But no one knows for sure what scenarios we will face. There might be a vaccine that can immune everyone for lifetime or may be for six months. May be the vaccine might eradicate the virus forever or may be not. May be coronavirus is here for a long haul. May be the cultural and behavior changes persist after the virus is gone. May be the new etiquettes will only include “elbow shake” and “foot shake.” May be a “handshake” be gone with the wind. There are many “may be” and few answers. It is imperative to make real-time decisions and move with the flow. The pandemic is for real and we cannot “Sit back, Relax, and Enjoy the Flight (of covid).” We all, as responsible citizens need to be meticulous about taking precautions and shaping our habits such as frequent hand washing, wearing masks, sanitizing often used surfaces and maintaining physical distancing outside of home. We should also be well informed and up to date on new measures and guidance to avoid the spread of infection. This includes being able to identify symptoms related to covid-19 and getting tested if any symptom persists. At community level, we should adopt the new behaviors and avoid handshaking and hugging. Also, if one is exposed, it is necessary to follow appropriate quarantine/self-isolation guidelines to protect ourselves and others. As consumers, we should be aware about the several marketing tactics of corporates and industries to avoid being misled. And last but not the least, physical and mental health are of utmost importance and everyone should indulge in healthy lifestyle behaviors to keep our mental and physical well-being at par and the virus as distant as possible!

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COVID-19 and the World: Reflections from a Case Investigator in Fulton County

October 2, 2020 · No Comments · COVID19, Uncategorized

COVID-19, also known as Coronavirus, is an infectious disease that is spread through close contact with other people, and through the air from sneezing and/or coughing. This disease comes from the family Coronaviridae and is caused by SARS-CoV-2. 

Coronaviruses come from different animal species, such as bats, cattle, cats, and camels. COVID-19 is said to have started in Wuhan, China in 2019. World Health Organization (WHO): This novel coronavirus disease was first declared a pandemic in March 11, 2020 (please see timeline below):

Another timeline:

[This timeline came from Dr. Senait Kebede, a public health expert who has worked at the Africa CDC]

Below you’ll see the different symptoms people have experienced because of COVID-19, such as the main reported ones or the more common ones and other symptoms that may not be as common among positive cases. This information comes directly from people who tested positive whom I had the pleasure of speaking with.

Most common symptoms:

  • Temperature of over 100.4 degrees Fahrenheit
  • Fever
  • Chills
  • New loss of taste & smell
  • Nausea or vomiting & diarrhea
  • Cough
  • Sore throat
  • Shortness of breath

Other symptoms:

  • Muscle Aches
  • Abdominal Pain
  • Feeling weak/tired/fatigued 
  • Dizziness
  • Loss of appetite
  • Irritated eyes

The information below is a small guide and useful information to help people prevent and/or limit the spread of COVID-19:

  • Wear a mask that covers the nose and mouth
  • Practice social distancing by staying at least 6 feet away from others and for less than 15 minutes
  • Wash your hands often with soap and water and for at least 20 seconds
    • If using hand sanitizer, make sure if contains at least 60% alcohol
  • Do not hang out in groups of over 10 people
  • Stay isolated if you test positive for COVID-19 for 10 days and if you haven’t had a fever in 24 hours – recently updated by the CDC
  • Do not have contact with people who are sick or who are positive
  • Cover your mouth and nose when you cough and sneeze
  • Do not touch your face after touching other surfaces
  • Disinfect your home, car, etc. frequently

What it was like being a Case Investigator for Fulton County:

As I mentioned earlier, I obtained some of this information from people who tested positive with COVID-19. This past summer, May-August 2020, I had the pleasure of working with the Georgia Department of Public Health and the Fulton County Board of Health as a COVID-19 Contact Tracer and Case Investigator. About 95% of my time as an intern consisted of conducting case investigations among the Hispanic or Latino community. The interviews included questions such as the symptoms they had, their medical history & pre-existing conditions, any close contact they may have had with people who tested positive (i.e. work, home, get-together, etc.) and whether or not they were hospitalized. We also had to ask if they had come into close contact (within 6ft. of each other for over 15 minutes) with anyone so that we could then call those new contacts and tell them that they had been exposed. Of course, all the information was confidential and the names of the positive cases were never shared with the contacts, we just advised and suggested they get tested and stay in quarantine for 14 days. When calling contacts, we also had to ask if they had any symptoms, and regardless of their response, we would monitor their symptoms (or lack thereof) through a call or a text for the next 14 days after their initial exposure. I also had to tell the positive cases to isolate and with the CDC guidelines rapidly changing, I had to be sure to give them the latest information and guidance. At the end of each call, I’d ask them if they had any questions and I would text them the testing sites and the Spanish resources that were available at the time, while ensuring them that all their information was kept confidential. 

COVID-19 and noncommunicable diseases:

Noncommunicable diseases (NCDs) are chronic diseases that affect many people around the world; they include heart disease, diabetes, and high blood pressure. In 2017 alone, NCDs accounted for 70% of deaths globally. COVID-19 has especially been affecting the health of individuals with these pre-existing conditions because they are more at risk for more severe symptoms and outcomes if they get infected with the virus. This article describes how NCDs has globally impacted those individuals who get the virus. The article states that COVID-19 is associated with cardiovascular disease and stroke. Furthermore, as the population ages, more and more people will have multiple chronic conditions that will result in a negative outcome for COVID-19 infections.

How COVID-19 has changed the world:

Furthermore, COVID-19 is affecting people all around the world, not only from the disease itself, but from the economy. For example, many people have been left unemployed and have had to make drastic changes to their lives. Many students have had to adapt to online learning, so they’ve (or their caregivers) had to buy a computer or a laptop, which might be out of their budget. Not only that, but kids are having to learn how to use technology at such a young age. People all over the world have also been in quarantine and have not been able to see their friends or family. It is sad that people have not had the chance to say their final goodbye to some of their loved ones due to having to social distance. In addition, many small businesses have had to close due to lack of customers and revenue. The physical and mental health of people has also been in jeopardy because of the stress they’ve been dealing with from the virus. 

Protecting each other:

Everyone has been trying to adapt to everything, such as working and learning from home, wearing a mask, and not going out to eat or for entertainment. Everyone is still learning about the virus and how it affects humans in the long run. Some people still believe the virus is a hoax, but everyone should be taking the necessary precautions to protect themselves and those around them. COVID-19 goes beyond community and national strategies in trying to combat the disease, this needs a global health approach by taking the steps mentioned earlier regarding limiting the spread of the virus. Everyone needs to do the right thing and wear a mask and social distance to help save lives. Such decisions can help stop the spread of COVID-19.

 

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The SDGs -It is Up to You(th)!

September 26, 2020 · No Comments · SDGs, Uncategorized

Blog 1: It’s up to YOU(TH)!

Although the only time you’ll hear about them is at a charity event or a specialized course, sustainable development goals are an important subject and should be a topic of conversation for all ages in the U.S. The U.N. has coined the phrase “Sustainable Development Goals” as “the blueprint to achieve a better and more sustainable future for all.”( https://www.un.org/sustainabledevelopment/sustainable-development-goals/). These goals are meant to address the challenges that we face as a global population, and include everything from climate change to inequality, although there are 17 “goals” total. With the youth population of the world being at its largest that it has ever been, making up an entire quarter of humanity, (https://www.oxfam.org/en/supporting-todays-youth-best-chance-end-poverty-tomorrow ), they certainly have the numbers to make a difference. Youth are not only able to be leaders in this movement, but are pivotal in seeing the changes that we hope to see to make a difference for future generations.

Youth in development: 'We're tired of being the topic, not the leaders' | Global Development Professionals Network | The Guardian

(Photo obtained from https://www.theguardian.com/global-development-professionals-network/2016/aug/17/youth-in-development-were-tired-of-being-the-topic-of-the-discussion-not-the-leaders-of-it)

 One of the 17 sustainable development goals is to “help educate children in your community” (https://www.un.org/sustainabledevelopment/education/), which is ironic, because educating our youth is what is necessary to begin making a dent on these monumental problems we’re working to rectify. The youth of this generation are the future: the ones who have truly will have the biggest impact on what this planet looks like in 50 years. This truth is concerning though, given that an incredible almost 260 million children were out of school in 2018 (http://uis.unesco.org/en/topic/out-school-children-and-youth) , which of course, means a less educated youth that we must leave our planet to. But then again, the education they are typically receiving isn’t inclusive enough of this information for youth to make the changes that we hope to progressively see. I certainly don’t remember learning much, if anything, about the 17 Sustainable Goals in school. Do you? The fact that this information is not often taught as part of a regular curriculum in the United States is part of the problem that needs to be spotlighted and changed.

  Another reason why it is clear that youth not only can be, but must be, leaders in this Sustainable Goals movement is because they are already on track to be more bold and actionable towards the movement than ever before, and we as a population mustn’t let that momentum stop. An example would be the incredible, knowledgeable, and TIME Magazine’s 2019 “Person of the Year” Greta Thunberg (pictured below).

Photo obtained from:https://time.com/person-of-the-year-2019-greta-thunberg/ Climate activist Greta Thunberg photographed on the shore in Lisbon, Portugal December 4, 2019Photograph by Evgenia Arbugaeva for TIME

Beginning by skipping school to protest the lack of action being taken to reduce climate change, Greta has gotten the world’s attention about how important it is for us as a country to recognize that climate change is not an “opinion”, but science. If the world’s temperature continues to rise at its current rate, around 120 million people will soon be pushed into poverty by drought by the year 2030 (https://time.com/person-of-the-year-2019-greta-thunberg/ ). Young Greta inspired over 4 million people to join her global climate strike in September, and is expected to continue to inspire children and adults alike all over the globe to not just pay attention to climate change, but make an effort to do something about the looming danger that it brings before it is too late.

                               

Unfortunately, however, youth in our country are frequently excluded from decision making. From the simple question of “What will we have for dinner?” to the complex question of “How do we end world hunger?” children’s voices are for the most part completely ignored. The adult-centric policy of the United States typically relies heavily on the belief that children are meant to be “seen, but not heard”. But then we have to ask ourselves…why is that? Is it fair, or does it even make sense, considering that they will inherit whatever of the planet we leave to them? Is it wise to not consider their voice, when they will inevitably have to endure the awful effects of climate change that we as adults are worsening day-by-day? To me, the answer is clear: it isn’t- we are repetitively undervaluing the voice and potential of our youth. Our youth possess everything that is needed to be a strong, influential powerhouse already in them. The energy, passion, and creativity that is needed for change, but that adults tend to lack more and more of as they get older. They have the ability to create out of the box solutions, and think about problems in critical ways. However, that can only get them so far, can’t it? There is a reason they are expected to be supervised until the age of 18- they need us adults too. But not to do these things for them, of course not. Most are capable little humans- but the youth that will be the change of this Earth need our support and our solidarity. We need to be there to help them get the education they need about all of the sustainable goals, from gender equality to avoiding wasting water. If we as their providers, their caretakers, and their mentors do not take the initiative to involve them in this extremely important discussions about the big impacts these goals are having and what steps we as humans can do to make a difference, then who will? It is up to them to lead this next generation into change, this is true, but while we as adults are still on this Earth, it is up to us to lift them up as high as we can, and give them that gentle push that they need to make that world of difference-literally.

Give young people a voice on global issues | Child in the City

Photo obtained from: https://www.childinthecity.org/2018/06/22/give-young-people-a-voice-on-global-issues/

 

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COMMERCIAL DETERMINANTS OF HEALTH! – Never heard of them? Read on to find out!

September 26, 2020 · 3 Comments · CDoH, Uncategorized

We all have heard about social determinants of health but what a lot of people do not know about is- Commercial determinants of Health (CDoH)! CDoH are factors that influence which stem from the profit motive and the practices that corporations use to maximize revenues, market share, and political influence. In other words, CDoH includes not only products but also approaches used by the private sector to maximize profit and capital while producing and promoting products and choices that are detrimental to the health of the community. CDoH not only includes unhealthy products such as sugary beverages, alcohol, tobacco, processed food products but also includes unsafe work conditions, pharmaceuticals, advertisements, gaming industries, low wages, outsourcing to save funds, for-profit health insurance, etc.

Private corporations use marketing through social media platforms or advertisements as one of the main channels of promoting their product, and they are successful which is not surprising because they target the right audience for the product. Additionally, companies expanding globally, especially in low- and middle-income countries is also one of the most crucial drivers. Furthermore, based on the company’s revenue and reach, they influence political activity as well. That is not all though. Such corporation makes large funding to universities thus gaining financial leverage thereby turning research activities, and courses in their favor. Thus, private companies employ a wide range of tactics and approaches to promote their products, thereby promoting unhealthy behavior patterns, and increasing the risks of a lot of diseases.

 

An amazing article published in ‘The Irish times’ clearly explains how big brands use social media platforms such as Facebook to target young adults, and the need to expand the existing curb on television advertising to other media platforms as well. Neither do children understand the subtle way such promotional posts market their product nor do parents understand the impact of advertising through social media platforms.

According to a report by eater.com, the food and beverage industry spent more than $33 million on lobbying in 2015. Be it lobbying to evade providing health insurance to full-time employees or to lobby for less restrictive rules to increase the sale of their product, such as by McDonald’s and Dunkin’ Donuts, all of these are examples of approaches by corporations to maximize on profits while promoting unhealthy products.  

The next important question is why is studying CDoH necessary? The most crucial reason to make ourselves familiar with the topic of CDoH is for the fact that such products and approaches are hidden in our day to day life so secretly as to make them almost impossible. For instance, sugar loaded flavor in the name of orange juice. Juices that are marketed as 100% pure fiber and fruit are actually full of added sugars or flavored yogurt for that matter. But most of us do not look at the contents of every product we get in a supermarket.

Secondly, the strategies used by big private sector companies target a specific population, mainly targeting kids and people from the low socio-economic stratum. The products promoted by these companies exacerbate the burden of non-communicable diseases (NCDs).

As mentioned by Dr. Paichadze, low and middle income countries like China, Viet Nam, India, and Egypt show a very rapid projected growth in consumption of such products by 2030 which is particularly detrimental to the health of those already suffering from one or multiple NCDs. On the other hand, less growth is projected in high income countries.

 The risk of such products is particularly increased in the past few months. With people across the globe home bound with the pandemic, tobacco, and alcohol industry, corporations selling unhealthy food products, have begun to capitalize on the current scenario by philanthropic actions. In the name of so-called donations and funding for healthcare workers and the health industry, such brands have witnessed a growth in the sale of their products. These corporations are least bothered by the health of the people. For instance, Cadbury India, owned by Mondelez International Inc. has started selling chocolates with a wrapper that says ‘Thank you’ in all local languages as a note of gratitude for the relentless efforts of healthcare workers. In reality, such philanthropic efforts are just a way of increasing revenue and profits.

 

The report ‘Signaling Virtue, Promoting Harm: Unhealthy commodity industries and COVID-19’ by NCD Alliance was an eye opener. The way food and beverage industries, gaming industries, junk food chains, and formula milk companies are targeting the people, especially during such unprecedented times is shocking. Whether it is McDonald’s offering free thank you meals to frontline workers in exchange for a selfie or Red Bull Australia providing free energy drinks for health workers or subway Canada offering a free facemask with the purchase of two sandwiches, these big brands are taking advantage of the current situation to sell their products or improve their image. Other brands such as Krispy Kreme and Burger King are not far behind. Either through free products or through funding, these brands are gaining financial leverage which will help them promote unhealthy products not just now but for the years to come as well.

An important point to remember here is the fact that people with NCDs are more likely to be infected by the COVID-19 virus and succumb to it. Promotion of burgers and fries and energy drinks, which are full of trans fat and sugar is only increasing the NCD crisis. Understanding CDoH is an important first step in designing interventions particularly suited to prevent and control NCDs. As explained by Dr. Freudenberg in Global Health Promotion journal, understanding how CDoH function and interact with each other is critical to better identify vulnerable population groups. . Years and years of efforts by the community and public health workers is at stake during such tough times. What we require urgently is a wake-up call. People need to realize how such brands are capitalizing on their emotions.

 

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“Essential Checklist: Water? Check. Bread? Check. Soda? Check.”

September 26, 2020 · 2 Comments · CDoH, Uncategorized

By: Taelor Moran

You remember it. It wasn’t too long ago the panic struck…before masks and sanitizers became our new normal. It was only March or April when people were sent home from work from fear of spreading a new virus, and when stores were continuously out of stock of paper towels and toilet paper. If you need a reminder, its here: Toilet Paper Craze Captured on Video . Fed by competing information from news sources, and the sudden changes imposed on the public, the American people were all experiencing a broad range of the same valid emotion: fear. Commodity industries, however, had a different thought blooming in their minds: opportunity. Quite a few industries who’s items of sale are considered Commercial Determinants of Health have been using this pandemic as a way to boost their own pockets. And the kicker? The government is letting them!

Commercial Determinants of Health (or CDoHs for short) are, according to WHO, “factors that influence health which stem from the profit motive” (https://www.who.int/bulletin/volumes/97/4/18-220087/en/#:~:text=Commercial%20determinants%20of%20health%20are,promotion%20and%20pricing%20of%20consumables ) . Usually these are products that don’t influence our health in a good way. Now that I’ve described it for you, do a couple come to mind? Perhaps you passed a few of them on your way home, like a McDonald’s or a Wendy’s. Or maybe you have some in front of you now, like a carton of cigarettes or a cup of soda. Sporting events often have large advertisements of them from start to finish, and the jingles from their commercials are well known by kids and adults alike. The marketing of these harmful items or negatively affecting our health on the regular. However, instead of this time of uncertainty being used to focus on encouraging the American people to get and stay healthy, corporations have been using this time to not only make more money, but to groom the economy so that it stays  this way. One of the ways that corporations are doing this is by going above and beyond to identify themselves as “essential”. That’s right- Coke is claiming that it is just as essential as your toilet paper and sandwich bread. Alcohol, tobacco, and packaged foods worked hard to make sure that the government gave them the essential title, so that their manufacturing, distributing, and sales process would not be paused or inconvenienced during the pandemic (Collin, 2020). Although this does sound like a very American thing to happen, characteristically, this was happening all over the world.

Buying Cigarettes High Resolution Stock Photography and Images - Alamy

Purchasing tobacco in Bangladesh (https://www.alamy.com/stock-photo/buying-cigarettes.html)

               Tobacco is huge in the market of Bangladesh. So, even though the Bangladesh health ministry requested that tobacco production and sales be stopped during the COVID lock down, the decision was turned down by the Ministry of Industries because it was felt that Bangladesh would “lose valuable foreign exchange and revenue” (Collin, 2020). The fear the tobacco industry in Bangladesh had over possibly losing business (although it would likely be in exchange of saving lives) can be read more about here:  https://thefinancialexpress.com.bd/economy/it-is-not-possible-to-shut-down-tobacco-industry-in-a-hurry-1589996715.  When compiling their official list of essential items and services, Kenya’s government included not just highly processed foods and drinks, but tobacco and alcohol as well, claiming these products are “essential to the sustenance of lives and efforts” (Collin, 2020). Nestle (yes, the people that make the chocolate snacks), also boldly claimed that snacks are “just as important as essential nutrients” (Collin, 2020). Even when workers were calling, no- begging for halt in the production of products so that they could self-quarantine with their families, FoodDrinkEurope encouraged Europe’s government to “recognize the entire food supply chain as essential”, which included processed foods and alcohol (Collin, 2020). The link to read the full article about this is here: https://web.archive.org/web/20200824113108/https:/spirits.eu/upload/files/publications/GEN.DOC-013b-2020%20COVID%2010%20Point%20ACTION%20PLAN_FINAL.pdf . Spirits Europe demanded something similar, wanting to be recognized as a “part of the food supply chain, including the spirits sector, as an essential activity.” (Collins, 2020).

Shocked yet? Governments using their power of authority in, and responsibility to inform, the public by saying that these products that are easily identified as harmful are deemed as necessary to survive. Which is an utter lie. Going the entire time of the COVID lockdown without soft drinks being available would have only helped the health of the general public. As I read the article cited here for the first time, I could not believe what I was reading. Drinking alcohol considered an ‘essential activity’?! If anything, it should be considered merely a social one, and that is only when it is consumed safely and responsibly. As someone learning and working in the public health field, I can’t help but to wonder what differences could have been made if we as a society had taken this forced change in our lifestyles that COVID brought as an opportunity be healthier. There are reports from all over the world about environmental issues that have gotten better since people have stayed mostly indoors for months. The air was a little cleaner, the water a little clearer, and animals have populated areas they haven’t in years thanks to a lack of human intervention. Unintentionally, we let the Earth heal a bit from all the damage we do to it every day, but we continued to do the daily damage to our bodies that consuming high-processed foods and alcohol, and using tobacco does. And the government, who we are supposed to trust to lead us in times of fear, and do what is best for the people seems to be most concerned with doing what is best for their pockets instead.

 

Sources

Collin J; Ralston R; Hill SE, Westerman L (2020) Signalling Virtue, Promoting Harm: Unhealthy commodity

industries and COVID-19. NCD Alliance, SPECTRUM

 

Imam, S. H. (2020, May 20). ‘It is not possible to shut down tobacco industry in a hurry’. Retrieved September 22, 2020, from https://thefinancialexpress.com.bd/economy/it-is-not-possible-to-shut-down-tobacco-industry-in-a-hurry-1589996715

 

Ireland, R., Bunn, C., Reith, G., Philpott, M., Capewell, S., Boyland, E., &amp; Chambers, S. (2019, March 26). Commercial determinants of health: Advertising of alcohol and unhealthy foods during sporting events. Retrieved September 22, 2020, from https://www.who.int/bulletin/volumes/97/4/18-220087/en/

 

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Commercial Determinants of Health: Applying a Systematic Approach for Better Health

September 26, 2020 · No Comments · CDoH, Uncategorized

Commercial Determinants of Health

 

What are CDoH?

Commercial determinants of health are under a huge umbrella of contributors to our health. It is the private sector’s overall effects on community health. These effects are often negative as they are created with profit in mind rather than well being of consumers. The obvious type of corporations that come to mind are those that directly sell unhealthy and nutrition poor foods. These are fast foods, soft drinks, high sugar snacks and even products marketed in healthy ways like juices. What doesn’t come to mind are corporations that deal with technology, oil and the waste products from those or the conveniences they allow that may contribute to sedentary lifestyles or straining on the eyes. We are surrounded by products pushed by corporations that we may need but the health effects are not really thought out when considering them. They have many different strategies in order to best garner profit. This effort focuses on marketing, consumers, and politicians. They use lobbying to get policies approved that work for them. One example is the huge tax break given to corporations by President Trump. Taxes went from 35 to 21 percent for these large corporations leaving the burden of taxes on people with lower income. This huge tax break falls on citizens of lower socioeconomic status.

Why is it important?

Referencing my last blog on the sustainable goals for the world I mentioned the importance of placing large corporations in a responsible role to combat the negative impacts they create environmentally. Regarding the commercial determinants of health, corporations that create food products that adversely affect the health of the nation need to be held accountable for their contribution to damaging health. Of course, we must acknowledge our personal responsibility to make healthier choices but when surrounded by unhealthy choices and things like financial pressures, it is almost inevitable that the wrong choices will be made. Corporations manipulate our “free will” and exploit the systemic conditions we are placed in.

How to approach this problem

Tackling this huge issue with so many facets can be overwhelming but its about placing efforts where there is the most impact as well as understanding where the power can shift away from these conglomerates. We spoke in my fundamentals of health systems course on how taking a systematic approach has a much greater impact versus focusing on the individual efforts towards better health. Creating community awareness of these subtle psychological tricks and its huge impact on our overall health is very important for us as a community to make informed decisions when it comes to voting for policies regarding corporations. It is also needed to really understand how these corporations gain power and how to redistribute this power back to the consumers. This requires tremendous group efforts and community centered thinking to really make any change. This mindset is needed for most of the problems of this world.

 

Healthcare as commercial product

In the United States, healthcare is treated more as a commercial product than a community responsibility which is the opposite in many other countries. Looking at the healthcare system, many products are priced higher when compared to other parts of the world. The health insurance companies also are an industry that is run like a business in order to gain profit. This puts consumers, those who need healthcare services at a disadvantage because the only options are expensive. Pharmaceutical companies in particular create drugs that are very similar to drugs already available and the price is increased. Doctors then prescribe these higher priced drugs and it creates a heavy burden to those that depend on them in their daily lives. Many people even fly to other countries to get healthcare services because traveling and receiving care is still cheaper than the charges here in America. This shows a weakness in the priority of life in America. These priorities need to be shifted.

 

Potential

Dr.Nino Paichadze’s presentation in our global health course really enlightened me to the potential of these corporations. The potential things corporations can do but don’t, due to their perceived profitability or lack thereof was one of the angles I hadn’t really thought of before. The ideas that could be brought forth more out of compassion than money would really be world altering. These types of thoughts and innovations should be more valued in order to create the solutions needed for things like the sustainable goals and to find solutions to many of the world’s problems.

 

Economic Shift

Changing the whole system so it doesn’t support prioritizing profit over well being would be the most ideal. Forming some type of scale where there is sort of positive incentives for those corporations actively work against negative commercial determinants. The American economy supports industry, entrepreneurship and large businesses. This is good to a certain point by allowing consumerism and access to many needed goods. It also gives consumers some power in market changes but it has a very negative effect without proper limitations. These lack of limitations and increased control given to these corporations by increasing wealth in the top 1% through policies lobbied have caused a huge wealth gap.

This type of vast systematic change can be implemented slowly through introductions of subtle policies followed by a firm stronger policy to really gain some momentum. These alterations are far from impossible. The power that we attribute to the majority of citizens is really undervalued and underestimated. Before now many would not be able to imagine defunding and altering the role the police force holds in our society. With consistent strong efforts from people all around the world let alone the country, new strategies are being put in place to put more efforts and funds into social services. These social services are more positive to our society and appropriate for the expertise needed in various situations previously mishandled by the police force. This is not quite comparable to creating an entire new economic system, but really represents the power of the people and the influence we have over our own lives.

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How Commercial Determinants of Health Affect Us Every Day

September 26, 2020 · No Comments · CDoH, Uncategorized

The World Health Organization (WHO) defines Commercial Determinants of Health (CDoH) as “factors that influence health which stem from the profit motive” (WHO, 2019). Corporate influence is typically exerted through four main ways: advertising, lobbying, corporate social responsibility, and improved supply chains (Ndebele et al., 2020). But when these products produced by companies are harmful for our health, who is at fault? This post will focus on the two biggest commercial determinants of health (in my opinion) that affect us every day.

Advertising is easily seen throughout everyone’s daily lives. Every day on social media platforms, television commercials, and even billboards, we are bombarded with messages from many different companies. Advertising can be potentially harmful to people in at risk areas, the youth, the elderly, etc. In other countries, tobacco companies are still allowed to advertise heavily in areas especially among the poor. Tobacco companies make their products seem as if everyone is using them and skirt around the risks and health hazards of smoking. Companies are also able to track what products you look up and websites you visit on your mobile phone, computer, tablet, and any other internet accessible device. This allows the companies to spam the consumer with more ads of new or different products that are related to the products that you have already searched for. The advertising on television is typically for products that are not beneficial to the health of the consumer that is viewing it. For example, during the Super Bowl, the majority of the advertisements during the commercial breaks were for unhealthy food options such as junk food and sugary beverages. Usually there is a sweet, sentimental message in the advertisement during the Super Bowl especially, but this only masks the hidden message from the company that is you should buy the company’s product. Other major advertisements that are on television are paid for by big pharmaceutical companies. The purpose of the advertisement is to compel the individual to ask their healthcare practitioner for this brand new (and probably expensive) drug.

                 

Another major problem in the consumer world is the “Illusion of Choice”. This phenomenon is when the consumer thinks that there are many different brands or options to choose from, when in reality most brands are owned by a few “parent” companies. For example, the parent company General Mills owns the different baking product companies Betty Crocker, Bisquick, Gold Medal, and Pillsbury. These companies are all branded differently and advertised differently. There is even overlap in the products that these different “brands” produce (like cake mixes for example). But because there is different advertising and different labeling, this gives the illusion of choice to the consumer. Even though the person will still be giving money to the same company General Mills and getting arguably the same product, the consumer thinks they are making a decision when choosing between a Pillsbury or Betty Crocker cake mix.

                               

Companies spend massive amounts of money on lobbying. Lobbying is more of a “behind the scenes” type of commercial determinant of health. Lobbying is not seen by the average individual because it involves companies donating large sums of money to political parties, individual policymakers, and other influential people that can affect the policies, regulations, or other things directly related to the company’s products. Companies are allowed to donate to political campaigns because they are considered a single entity (aka a person), even if the employees of the company do not necessarily agree with the viewpoints of the person who is running for office. In the political world, there is such a thing called a super political action committee (pac). A super pac is basically a massive collection of money even though there are also human members. The super pacs are typically what get political candidates into office. Look for more information on super pacs here. Typically, these groups are the ones who write the bill that they want to be passed by the representative (whose campaign they funded). This is EXTREMELY problematic. It is a problem because the representatives are not working for the people they are supposed to represent anymore, but rather these giant corporations. The company is only interested in the company’s profit. Many companies will have other positive, altruistic messages, but the bottom line in a for-profit company is money and how to increase profit margins.

Companies are not necessarily the bad guys in this situation (even though they really sound like it). People make up companies and these people want and need to make money. People vote in representatives that are paid for and influenced by these companies. If people boycotted politicians that did not take money from super pacs, large corporations, etc. then there would be people in power who are rooting for the working class (“little guys”). It is also ultimately up to the consumer on the products that they choose to put into their body or give their money to. We are our own judge on what we want to do and support. I personally love a nice cold Sprite every once in awhile but I know that it is not good for my health or good for me to drink every day. But I make these decisions for myself and need to educate myself on what is good and what is not for my body and ignore all the persistent advertisements.

References:

Ndebele, P., Shaikh, H., Paichadze, N., Bari, I., Michaels, D., Burgoa, C. S., & Hyder, A. A. (2020).  Commercial determinants of health: An ethical exploration. International Journal of Public Health, 65(7), 1123-1132. doi:10.1007/s00038-020-01427-x

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“In Times of Crisis They Will Come out Stronger”

September 26, 2020 · 2 Comments · CDoH, Uncategorized

“In Times of Crisis They Will Come out Stronger”

 

 

I invite you for one moment to look at the picture above. I know this is something we are totally used to – nothing special – just one Pepsi commercial during a football game. Again nothing special – but if we think closely, there is something that does not match. Sport is a healthy habit, promoting sports means promoting a healthy lifestyle, meanwhile the advertisement is about a non-alcoholic, sugar-sweetened beverage, higher consumption of which will lead to health problems. So, how can these two stand together?

Well, welcome to commercial determinants of health (CDoH). First of all, according to WHO  social determinants of health are conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes.

 Meanwhile commercial determinants of health (CDoH) have been defined as factors that influence human health which stem from the profit motive and include strategies and approaches used by the private sector to promote products and choices that are detrimental to health (Kickbusch et al.). I have italic some keywords which are: influence human health, stem from profit, strategies and approaches by the private sector, to promote products and choices. 

Returning back to our example. It now makes sense why we can consider it as CDoH; is a promotion of a product, used by the private sector to generate profit, and it influences human health. The strategy and the approach that they are using is: advertisement through partnerships with sport companies. 

Companies that produce alcohol, sugar-sweetened beverages and fatty foods often enter into sponsorship deals and market their products through professional sports leagues, in competitions and events across the world (Ndebele et al 2020). 

These commercial determinants of health not only increase the burden of chronic disease and disability but they also impact the early life experiences of children, which has been shown to influence the weight gain of children through to adult life. 

“Junk food advertising during sporting matches builds positive associations between their sporting heroes and unhealthy food and drink brands,” – said The Obesity Policy Coalition’s Executive Manager Jane Martin.

But, advertisements are not the only way corporations are impacting our health. Their strategies are extended through other channels like lobbying, corporate social responsibility and improved supply chains. (Read more here)

 

“In Every Previous Crisis, Military, Economic or Pandemic, in the Last 134 Years, the Coke Company Has Come out Stronger.” – CEO of Coca-Cola

 

We have been surrounded all of our life by CDoHs, but during the COVID-19 pandemic, CDoHs emergeded themself even more, and found ways to be “the heroes” at the expense of public health.

A report  published by the NCD Alliance and Spectrum claims that these corporations used the crisis to boost partnerships with governments and increase brand loyalty within desperate communities.

Some examples mentioned in the report include:

 McDonald’s “Loving Southeast Missouri” campaign offered healthcare workers a free “thank you meal” if they would post a selfie of themselves with the meal, while McDonald’s in Guatemala delivered meals to healthcare staff who were at the frontlines of COVID-19.

PepsiCo in China celebrated care workers and hospitals by having a limited edition of new soda label cans.

Cadbury in India, re-branded their package with a small “Thank You”as an honor to medical heroes.

Furthermore, a lot of these companies promoted themselves as critical frontline workers and they were telling consumers “We got you America” or #HereforYou.

They took part in campaigns promoting social distancing, staying home (they will deliver food for you) even promoting no-hands challenges on social media, and donations to Save the Children for the first 1M video uploads.

Chocolates in Israel “fought” the virus by removing the world “Keef” which means  high five, to promote no touching. No more “Keef-Kef”, only “Kef” now. While Brazil suggests that “Good beer is like air: you can’t live without it”  and the three tips to survive are isolate, use sanitiser and drink beer for fun. 

 

                                         “The problem was championed as the solution”

 

All of these corporations offered themselves as solutions while the truth is that most of what they promote (alcohol, junk food, sweetened beverages) are in the deep roots of the problem. Constant studies have shown that non-communicable diseases (NCDs) are the causes of high death rates globally, and people with NCDs are at a higher rate to suffer more complications from COVID-19 and have higher mortality rate from the disease.

 

Unhealthy diet, harmful use of alcohol, physical inactivity and tobacco are among risk factors to develop NCDs such as: obesity, cardiovascular diseases, diabetes.  

 

“These industries are gaining more grounds and winning the trust of people through their actions-’so called kind gestures’. They are deliberately and consciously penetrating into the hearts and minds of the people. A contributing factor for the high increase in NCD cases.” – Labraham Musah, Ghana NCD Alliance 

 

We covered only the marketing strategies that these industries are using to play “the champion”, but the techniques they used go on with philanthropy, voluntary actions that claim to be used in the public interest, and establishing partnerships with governments and civil society. ( Read the full report here)

 

 In Times of Crisis they … might come out Stronger… but it is our moral duty to protect our health. Being in a pandemic is not a justification to go back on years of improvement. There are ethical frameworks that need to be considered in every new marketing strategy, every new initiative or collaboration even when they are done for the “sake” of the pandemic. A not-healthy approach to deal with this problem, will lead us to a new one in the near future, -the “NCDs pandemic”.

PS: If you know more examples of unhealthy corporations actions, please contribute to the gathering here.

 

 

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