The New York Times, November 2014
In India, experts gathered for a conference entitled "Stop...
Communications Officer Sushmita Malaviya interviews James Chauvin, President of the World Federation of Public Health Associations and Co-Chair of the 14th World Congress on Public Health, which will be held in Kolkata in 2015: www.14wcph.org.
Your comments on India reaching its MDG goals?
While I am no expert on India, I would like to say that I am impressed with the Government of India’s efforts on health. It is also important to commend the support of Indian civil society towards reaching these goals. India is seen as a model for others, because of the 50 percent decline in infant mortality. This is an amazing achievement. Although there have been big challenges at the national level there have been remarkable progresses too.
However, it is important to look at these achievements through the equity lens to understand where these benefits have gone. Have all socio economic levels been covered? Are there some population groups and ethno-cultural communities that have been left out?
While a few countries like Rwanda are close to achieving their MDGs, it is important to understand the MDGs are milestones. They are not the end of the road. The MDGs should not stop Governments from continuing to invest in health, housing, education and job security, all of which have an impact on health.
Your views on India’s stride on public health, vis a vis maternal, newborn and child related diseases.
India has made great strides in areas such has immunization especially in the difficult to reach populations. This has to be appreciated, given its great geographical breath and width, its diverse population. India has also done very well on reproductive health by introducing new services and this has made it a role model for many other countries. It has also had considerable progress in childhood vaccine preventable diseases.
One area though that I feel India and many other countries need to work on is the issue of violence against women and girls. It is one thing for governments to pay lip service to this issue; but real progress has to be made at the front line. I would also add that it is also important to factor in mental health issues.
On the battle against diarrhea and pneumonia
Essential elements of water and sanitation a key way to prevent these diseases. In this direction, a lot has been done for access to safe drinking water, but work on sanitation remains. Not much attention has been paid to sanitation and there is still too much sensitivity around the subject. Attitudes around this have to change, we have to domore about sanitation. The returns on investment on sanitation are phenomenal.
What is a close link with your work and you as a person?
For 25 years I was involved in organizational and community capacity building and this has been my passion. The strong civil society voices around public health policy and best practices that are emerging are essential for democracy and a healthy society.Read more
In February, the Global Public-Private Partnership for Handwashing hosted a Handwashing Behavior Change Think Tank. This event gathered handwashing experts from the public and private sectors to take stock of the best, identify the gaps, and articulate the way forward for handwashing behavior change. The Think Tank covered handwashing-related topics such as the latest research, determinants of handwashing, social norm formation, and the role of technology in handwashing. In addition to the participants in the room in Washington, D.C., we engaged with virtual participants around the world. We have two interesting findings we’d like to share here—one relating to the ‘software’ or behavioral component of handwashing and the other focusing on the ‘hardware’ or infrastructure component.
Social norms are a powerful behavioral motivator. A social norm is a rule by which group or community members abide. Ignoring a social norm could have consequences, such as social exclusion or censure. For example, if a community’s social norm is that people do not smoke in the home, then an individual who visited a neighbor’s home and smoked might be asked to stop, to leave, or perhaps would not be invited over again. A strong handwashing social norm can encourage and sustain improved handwashing behavior in a community. Social norms are inherently dependent upon the interaction of people; therefore, being alone or unobservable might decrease someone’s propensity to abide by the norm.
This is a challenge for handwashing as it is often a private, hidden behavior. Research indicates that people are less likely to wash their hands with soap after using the restroom if they are alone in the restroom and unable to be observed by a peer. In fact, there is evidence that even the illusion of being watched can improve handwashing behavior. Some programs have actually put cartoon eye stickers on the wall near handwashing facilities to cue people to wash their hands. Making this typically private act a public one can increase handwashing frequency. As a result, Think Tank participants were challenged to consider how we can make handwashing more visible as a way to foster a strong handwashing social norm.
Another area of interest to participants was regarding the ‘hardware’ component of handwashing behavior change, which includes water, soap, and a device for washing hands. There was broad agreement that while building and installing handwashing devices won’t lead to handwashing behavior alone, it is a vital part of changing behavior and one that we should focus on as a sector.
If there is no affordable, durable, and attractive device available for handwashing, it is likely to be a difficult behavior to sustain. Tippy-Taps are an easy “small doable action” that can facilitate handwashing initially, but according to findings presented at the Think Tank, Tippy-Taps often don’t last and are not used after a few months. In Kenya and Cambodia, two new, more durable commercial handwashing devices are being tested in the market. We will track the progress of these devices in the coming months and years to see if similar commercial devices are viable alternatives in other markets.
Through exploring the components of handwashing behavior change at the Think Tank, we learned about both the social and environmental drivers of handwashing behavior to help implementers find practical ways to increase handwashing in their community. To learn about additional findings please visit us online.
Photo credit: PATH/Gareth Bentley.Read more
One of my brothers recently asked me, “What was the happiest day of your life?” My response: “The days your sons were born!” My happiness was directly linked to boys’ safe delivery and arrival in this world. I adore my nephews – now one and three – and love being such an active part of their lives.
Imagine the harsh reality for the 2.9 million familieswhose days were vastly different; in 2012, their newborns died after only one month. It may be surprising to learn that many of these deaths were due to things we often take for granted in the developed world: safe drinking water, sanitation, and hygiene (WASH). Quite simply, these deaths could have been prevented.
Birthing conditions in much of the world are often unhygienic. Many women give birth at home on the floor or in hospitals and clinics on dirty tables. Umbilical cords are cut with dirty knives, and infants are bathed in contaminated water. In some cultures, it is common to apply substances to the cord cutting such as ash or mud. Without running water and soap, birth attendants and family members can unknowingly pass on bacteria. All of these conditions lead to dangerous infections for both infants and their moms.
Making it safely through delivery doesn’t mean a baby is out of danger. In areas without adequate sanitation, the water quality is often poor. Formula mixed with unsafe drinking water can cause diarrhea, the second leading killer disease in children under five. A recent study found that infants without piped water or toilets who were not breastfed are five times more likelyto die after one week that those who were breastfed.
The news isn’t all gloomy! There are simple solutions that can help newborns in their first weeks. Handwashing with soap is one of the most cost-effective health interventions. A study in Nepal showed that handwashing by birth attendants and mothers helped reduce newborn deaths by 41 percent. Breastfeeding can also reduce WASH-related disease in newborns by decreasing exposure to harmful bacteria in food and water and improving resistance to infection.
Improved access to water, sanitation, and hygiene (WASH) can help improve newborn survival, and international health experts are starting to pay attention. Here are three examples:
1) Of the ten recommended actions to save and improve the lives of children in UNICEF’s A Promise Renewed 2013 progress report, three are related to WASH:
- Have children drink water from a safe source, including water that has been purified and kept clean and covered, away from fecal material.
- Have all children wash their hands with soap and water especially before touching food, after going to the latrine or toilet and after dealing with refuse.
- Have all children use a toilet or latrine, and safely dispose of children’s feces; prevent children from defecating in the open.
These interventions are all doable… provided a community has access to WASH.
2) The Every Newborn Action Plan– which launches this spring at the World Health Assembly and will be highlighted at The Partnership for Maternal, Newborn & Child Health (PMNCH) Partners’ Forum this summer – incorporates WASH.
3) PMNCH will launch a “knowledge summary” on WASH and MNCH this spring which calls for increased efforts to integrate programming.
Newborn deaths are preventable. Babies do not need to die because of poor WASH. Please join me in supporting these initiatives and helping to ensure more aunts like me get to watch their nephews (and nieces!) grow and thrive.
Rebecca Fishman focuses on the importance of water, sanitation, and hygiene to the health, education, empowerment, and safety of women and children for WASH Advocates.Read more
Think about all the ways you used water in your daily routine this morning. You probably showered, brushed your teeth, used the toilet, washed your hands, all before making a cup of coffee with water whose safety you assumed without question. It is easy to forget that we didn’t always have such immediate access in the United States.
As we began to learn that these simple precautions kept us healthy, and in extreme cases, kept highly contagious diseases from decimating entire communities, this evidence informed our policies: today, businesses and schools require public restrooms, and urban infrastructure must meet pre-determined health standards for waste and sewage management. Prioritizing public access to safe drinking water, clean toilets, and hand washing facilities lead to laws that protect us daily, whether or not we realize it.
As a global health advocate, I believe in the power of policy. Policies can seem like pieces of paper tucked away on a shelf until we stop to consider how much they shape the fabric of our everyday lives. And I believe one of the most practical ways to promote healthy families and communities is through investment in safe drinking water, sanitation, and hygiene (WASH).
Our common need for WASH begins as soon as we are born, when sanitary conditions prevent infection in already vulnerable groups: mothers and new babies. Access to WASH is particularly vital in the first five years of a child’s life, when pneumonia and diarrhea – the leading killer diseases of children globally – pose the greatest threat to underdeveloped immune systems. In fact, if everyone had access to safe water, almost 90% of diarrhea deaths could be prevented.
WASH continues to play a protective role as a child develops. Without it, repeated bouts of diarrhea can threaten physical and cognitive development and exacerbate the effects of malnutrition. Without it, girls sacrifice education – and along with it, many future opportunities – in pursuit of water for their families. So much of a person’s – so much of a nation’s – ability to survive and thrive is contingent upon access to WASH.
In Camobodia, a village health volunteer educates mothers about basic hygiene practices.
In these ways and others, investments in WASH bolster broader global health efforts. For example, PATH’s diarrheal disease programs in Cambodia, Kenya, and elsewhere show that an integrated prevention and treatment approach yield the greatest results. In fact, the demonstrated value of incorporating WASH activities into these programs helped convince policymakers in these countries to include WASH as a key component of their national diarrheal disease policies.
Every $1 spent on WASH yields a $4 return on investment, and the Senator Paul Simon Water for the World Act represents an opportunity to stretch our dollars even further, all without spending extra money. It’s about working with what we have to improve coordination, target resources to the areas of most need, develop robust monitoring and evaluation systems to ensure sustainability, and integrate WASH with complementary programs like global health.
Staff from PATH's Washington, DC office joins the global toast to water.
I believe in policy, and I believe in the power of advocates to shape policy. Social media gives us unprecedented potential to spark change from our homes and workplaces. This month, raise a glass with PATH and others and say #cheerstoH2O in a virtual, worldwide toast to celebrate World Water Day and create momentum around the Water for the World Act.
When we toast, we say, “To your health.” And when it comes to water, I can’t think of a more appropriate sentiment.
Photo credits: PATHRead more
Pneumococcal disease prevention is a key component of the integrated effort to reduce child mortality from pneumonia and diarrhea—the two leading killers of children. The global health community is hitting these diseases from all sides with a suite of prevention and treatment interventions that leverage common resources, including immunization resources, to enhance efficiency and save more lives. Dr. Alderson sheds light below on the power of current and future pneumococcal vaccines to change the face of child health.
Pneumonia is a clever killer, responsible each year for the deaths of more than a million children under five years old, most of them in the developing world. If you want to know how serious this respiratory disease is, consider one fact: pneumonia kills more young children worldwide than any other disease.
Because pneumonia has many different causes, no one intervention is enough to outsmart it. We need a diverse set of defenses to beat pneumonia, and vaccines top the list as the most cost-effective means of prevention. If we’re to outwit pneumonia over the long term, however, the vaccines we have now must continue to evolve and improve.
Vaccination against the leading cause of pneumonia, the pneumococcus bacterium, is essential for controlling pneumonia. In fact, vaccines against pneumococcus help save thousands of children each year—children who likely would have died before these vaccines became available more than a decade ago.
Pneumococcus, however, is a complex bacterium, with more than 90 varieties that vary by region. As a result, prevention to date has required the development of complex vaccines. Pneumococcal vaccines available today use an elaborate and expensive manufacturing process that essentially combines vaccines for either 10 or 13 pneumococcal varieties into a single injection. While these vaccines are saving many lives, they do not provide universal coverage against all disease-causing pneumococcal strains. In addition, it’s hard for low-income countries to afford them.
At PATH, we’re advancing the next generation of pneumococcal vaccines to broaden protection against pneumonia—and to ensure accessibility for even the poorest children. One of these candidates, which we’ve developed in partnership with Boston Children’s Hospital, is an inactivated whole cell vaccine designed to generate immunity across virtually all pneumococcal strains. Moreover, it’s simple to manufacture, which translates to low overall costs.
Early-stage clinical evaluation in adults in the United States has already shown the whole cell vaccine to be safe and to elicit immune responses thought to be protective. Next, we’re planning to test the vaccine in adults and then children in a low-resource country. If the vaccine is eventually licensed, its affordability and broad coverage could make it a versatile option virtually anywhere in the world.
Pneumonia has killed with impunity for most of human history. But we’ve become smarter about how to fight it—especially through the use of vaccines. Adding a weapon like this new vaccine candidate to the arsenal could help us more quickly make widespread childhood pneumonia deaths a thing of the past, and help end pneumonia’s reign as the top childhood killer.Read more