Lord Nigel Crisp's report into how the UK can contribute to health in developing countries was published today online at the DOH website. The wide-ranging and comprehensive document is the result of consultations since May 2006.

Lord Crisp was invited to carry out the review by the Prime Minister as part of the commitments set out in the commission for Africa and the G8 Gleneagles summit in 2005. It finds a vast array of organisations, enthusiasm and work already being done in the arena of international development, but a need for greater coordination and strategic partnerships between these groups.

The media can take on many forms. Television, radio and the press have been supplemented by the advent of the internet, along with activist and specialist publications, in informing the public about issues of everyday life. So it is surprising that on looking into what research has been conducted into the media’s reporting of health issues, there is relatively little that tells us how they do so, how likely it is that they will report them accurately and how much its influence affects the public’s perception of such issues.

Concerning global health, there is even less. To begin, defining what comes under the global health banner has its own problems. A few texts and articles have mentioned the media’s reporting of issues surrounding vaccination and infectious disease. Avian influenza is the most recent example of a major global health issue reported widely in all forms of media, but as yet there has been no analysis of this coverage. Infectious disease and vaccination are traditionally areas that receive a lot of media coverage for one reason or another, and some of the coverage of these issues has been analysied. Examples include, MMR(1-3) and Pertussis(4) vaccinations, the advent and continuing plight of HIV/AIDS(5) and the original ‘great influenza’ of 1918-19 (6).

Medical journals will inevitably report such issues more widely than the mainstream media. Furthermore, we are taught to see global health as being influenced or directly affected by issues of politics, economics, education and international relations. So when looking at ‘global health’ issues in the media where do we draw the boundary? For the purposes of studying media coverage of global health issues, it must be kept to reports directly involving health to avoid an impossible and unfocused task.

What has been written on how these issues have been covered in the media has not been complimentary. Local newspapers in numerous cities around the United States downplayed, or in some cases failed to mention, the extent of the influenza epidemic in 1918(6). The majority of media coverage surrounding the MMR controversy failed to make clear that evidence lay in favour of the vaccination not causing Autistic Spectrum Conditions (ASC) or Inflammatory Bowel Disorders (IBD)(1, 3). During the late eighties and early nineties, a debate arose surrounding the role of the HIV virus in causing AIDS. It has been noted that the role of the media in the rise of Peter Duesberg in the
public consciousness was substantial(5).

But to decipher how much the media influence public opinion on these issues is much harder. Coverage of an issue can be shown to balance in certain ways. One study has even shown that a locality subject to a campaign against MMR vaccination had significantly lower rates of MMR coverage than its surrounding areas(7). Compare this to the justified terror and panic that spread through American cities during the great influenza pandemic, where corpses were rotting in houses because of the backlog in undertaker’s parlours. Despite the lack of press and radio coverage or proclamations that the spread of the virus was minimal, the public knew better and became distrusting of what they read and heard in these mediums(6).

But a causal link between media coverage and human behaviour is not possible through such studies and observations. It would take surveys from the public of what influences their opinion and studies of opinion in comparison to what information individuals are exposed to. These kind of studies have begun to appear, albeit with a broader focus than the media’s influence alone(8). Only with this kind of data could the true influence of the media be discovered, as well as informing health professionals what other factors come into play from the public’s point of view.

Indoor smoke from cooking fires claims over 4000 lives a day in the developing world, yet the international community is failing to act. Join Practical Action in campaigning for urgent action to tackle the killer in the kitchen.

Around the world, poverty condemns nearly half of humanity to cook using fuels that produce smoke when burnt - fuels such as wood, dung, crop-waste and coal. Over 1.5 million people die every year from illnesses caused by this smoke – a life lost every 20 seconds.

Smoke is not an indiscriminate killer – it hits women and small children the hardest. Women across the developing world typically spend three to seven hours a day cooking by the fire, exposed to levels of smoke over 100 times the recommended limits. Illnesses caused by smoke include chronic bronchitis, acute lower respiratory infections such as pneumonia, and lung cancer. There is also increasing evidence linking it to asthma, TB and low birth weight.

We had a good response to our call for input into Global Health Watch 2007-2008. The steering committee met in March to finalise the broad framework for the next edition. We have tried to incorporate as many suggestions as possible while bearing in mind that the document should not be too long and reminding ourselves that with limited time, budget and resources we cannot cover everything!

We continue to get emails from people and organisations that want to collaborate in developing the next report.

Overview of proposed contents and process:
Broadly speaking the contents will cover similar themes to the last Watch. The Sections will include:

The reciprocal benefits of sustained partnerships between health professionals in developed countries and their counterparts in poorer countries are considerable, a conference in London last week was told. Such partnerships may also help stem the migration of health professionals from poor countries—sub-Saharan Africa in particular, where a shortage of health workers is contributing to the crisis in health.

The conference, which was held at the Royal Society of Medicine and which followed the simultaneous launch in London and Lusaka of the World Health Organization’s 2006 report Working Together for Health (BMJ 2006;332:809, 8 Apr), explored these claims and discussed the links fostered by the Tropical Health and Education Trust (THET) International.

US$106 billion is spent annually on research for health. It seems like a colossal amount, however what is really interesting is where this money is spent. Despite new technologies and knowledge which offer the potential to vastly improve health and life expectancy worldwide, only 10% of global health research is devoted to conditions that account for 90% of the global disease burden. (read more about the 10/90 gap)

Professor Stephen Matlin, Executive Director of the Geneva-based Global Forum for Health Research says, “The rich and the privileged enjoy much better health and live much longer than their poorer neighbours, especially those discriminated against because of their caste, class, ethnicity, race or religion,” The Global Forum for Health Research aims to highlight these discrepancies and bring about change.

Their new report, Monitoring Financial Flows for Health Research: behind the global numbers, looks at exactly where this $106 billion comes from:

• Public or private sector in low-, middle- and high-income
  countries?
• How much does each source provide, where does the money go and how well are the allocations aligned with health research priorities at global and local levels?

Logo:

Name of Organisation:
The Disease Control Priorities Project (DCPP)

www.aidsmap.com/en/news/DC0E377B-1BC0-4BCA-A86C-8A96A734D99A.asp?wk%3d1

Theo Smart, Tuesday, January 10, 2006

Contrary to expectations about the expense of antiretroviral therapy (ART), using ART in people with AIDS should be cost-effective for South Africa’s public health sector according to a study published in January’s PLoS Medicine (an 'open-access' medical journal). The cost of not using ART to treat people with AIDS is significantly greater — as patients with AIDS required more expensive time in the hospital and other medical care.

In less ill patients with HIV, the study also found that using ART was still less expensive than medical care without ART, but only if lower cost generic drugs rather than brand name drugs are used.

Is there a need to train doctors in international public health? Some would argue that countries like the UK have enough public health challenges without its doctors worrying about the state of the world outside. Rebecca Hope opens the debate.

2005 was a remarkable year for global health with issues of development and health in the headlines throughout the year. This was in part due to the Make Poverty History campaign, but also sadly due to health emergencies like the tsunami, the earthquake in Pakistan and avian flu outbreaks. There has, though, in recent years been a surge of interest in global health by professionals and students in countries like the UK. Medical journals increasingly feature articles on issues relevant to the developing world, such The Lancet’s Global Health articles collection . Global health issues are finding more place in the undergraduate nursing, nutrition and medical curricula and medical students can now do BSc’s in International Health. A new F2 programme in international public health begins this year for junior doctors in North Central London Foundation School.

Health professionals working overseas is not a new phenomenon, but could the increasing awareness of the health challenges in low-income countries inspire more people to take on humanitarian work? And has this contributed to the increase in courses and training in international health? This article asks the question why health professionals in the West should be interested in global health and how is it possible to combine your interest with UK training?

Read on for the perspectives of nurse and midwife and the new Director of Medact, Marion Birch for her views and advice.

In this issue’s Advocacy feature, Aska Leslie takes a look at another perspective of the ‘brain drain:’ the problems faced by doctors who have been forced to flee their home and their jobs to seek asylum in the UK and their struggle for professional recognition…and employment.

Introduction

According to a recent article in the Lancet, almost half of the 16000 staff expansion of the NHS came from the recruitment of health professionals trained outside the UK and Europe [1]. A third of practising doctors have been trained overseas. This of course brings up issues related to the impact of such a ‘brain drain’ on the countries that these staff originate from, many of these countries being resource-poor anyway. However, it is also worth considering that a proportion of overseas qualified doctors come to the UK out of necessity, rather than choice i.e. to escape conflict and persecution. These doctors are often met with difficulties in accessing employment, despite having considerable clinical experience in their home countries.