The NEJM paper shows that hypertension care delivered at home by community health workers (CHWs) delivers better results than care delivered through a clinic. It is reporting on interventions in rural South Africa. The team that did the research comes from the University of KwaZulu Natal and Harvard. Do not, though, expect to see people in Massachusetts benefit from the findings any time soon.

In the most sophisticated community model in South Africa, 83 percent of trial participants had their blood pressure under control after six months, an outcome that was sustained after a year. In that model, patients were seen by a nurse with decision-making authority; they were given an automated blood pressure monitor that sent regular messages to an app used by the nurses; CHWs — lay health workers who live in the communities where they work — helped patients use the machines and delivered medicines that the nurses had prescribed. The nurses got reminders about regular review of readings, prompts from a national management protocol and suggestions about prescribing updates. Medicines were sent automatically to the CHWs, who delivered them to patients.

In the world’s most expensive healthcare system, about 60 percent of Americans with hypertension knew they had it in 2024. About half of them were taking treatments and about 20 percent had their hypertension under control. Unsurprisingly, heart disease and stroke are the leading causes of death in the United States and hypertension is a major risk factor for both.

In a 2010 report, over 40 percent of Americans with hypertension were managed by internists, who now earn over $250,000 a year on average, although about one in eight were managed by cardiologists, with an average salary of about $420,000. A Journal of the American Medical Association paper in late 2024, reported that, “70% of adults with uncontrolled hypertension who were aware of their condition reported taking antihypertensive medication.”

Crudely — and I appreciate that we shouldn’t compare data from very different sources and different populations — Americans are about a quarter as likely to have successful treatment of their hypertension as are rural South Africans in this pilot. The Americans pay a fortune; the SA government pays very little, but uses technology wisely. This should not come as a surprise. It follows closely the track record of the two countries in treating HIV.

In 2022, 90% of South Africans living with HIV knew they had it; 91% of those aware of their status were on effective treatment (highly-active antiretroviral therapy or ART); and 94% of those on ART were virally suppressed. Suppression means that the virus cannot be detected in the person being treated; that the disease is unlikely to progress; and that it is virtually impossible to transmit it to another person. South Africa’s success is mostly the result of good community care, efficient delivery of medicines to convenient pickup points and strong leadership. It is doing well, especially given the vast number of its citizens living with HIV, but most of its neighbours are doing better.

The US Centers for Disease Control do not report data in the same format, but in 2023, only 67% of Americans living with HIV were virally suppressed. About a quarter received no medical care at all that year. A US government webpage lists at least 10 kinds of professionals who may make up an HIV care team. Almost all will include an infectious disease doctor, who earns about $250,000 a year, a bargain in American terms.

I could keep giving examples — open heart surgery in a production line model for under $2,000; one-stop breast care clinics to diagnose early-stage breast cancer and manage it; AI-powered skin lesion analysis by CHWs. All deliver better results at a fraction of the cost. We should also not just pick on the USA as a comparator: France and Germany don’t do much better. Worst of all, some of these examples are over a decade old but entrenched medical interests have stopped advanced economies from adopting models of frugal innovation that would improve quality of life and avoid premature deaths.

There are examples in the other direction. For example, about 90 percent of children with cancer survive at the very best treatment centres in the USA; fewer than 20 percent do in some low-income countries. (A coalition involving St Jude Children’s Research Hospital, the WHO and partners are working on exactly this) The patterns are not so stark in adult cancers and neurological diseases, but also clearly favour the advanced economies. However, risk stratification based on big data, standardised treatment protocols and the rapid introduction of some new diagnostics all seem likely to happen faster in middle-income countries than outside centres of excellence in high-income ones.

There is little appetite to take on the vested interests in most countries and concern over making so much current investment redundant. For example, many GPs in Ireland, where I live, won’t rely on validated smartwatch readings to monitor blood pressure because all have bought devices that patients take home for 30 hours and that inflate a cuff every hour.

Change will accelerate rapidly from here on. The innovators will come from middle-income countries without our sunk investment or our abundant human resources. If we, in the advanced economies, want to be early adopters or even part of the early majority, we’ll need to be more willing to disrupt entrenched and dysfunctional systems.

The post Restrictive practices in medicine are holding high-income countries back appeared first on Medika Life.

Founded in 1948, WHO is a United Nations agency whose charter is to plan and coordinate the international response to health emergencies and help countries monitor, prepare for, and recover from disease threats. 

While not without controversy, WHO is the single best forum for predicting and planning for events affecting the health of humans across the planet.

Media coverage of the US withdrawal has focused on political rancor (Trump believes WHO mishandled the pandemic) and funding (While the US is one of 194 participating countries, it funds almost 20% of the agency’s $6.8 billion budget).[i]

As the new Administration gives up America’s seat for global health planning, its important to shine a light on real issues impacting Americans’ health and well-being. They are worth public scrutiny and debate, starting with this statement:

America is a First-World Nation Battling its Own Third-World Health Crises

America’s health care system is the most expensive in the world. It’s staffed with some of the world’s best health and medical talent. Despite this, we are at the bottom of the list in overall health compared to all developed nations. This includes access to care, administrative efficiency, equity, and health care outcomes. ^[ii]

• Americans are among the least healthy people in the rich world and among the most likely to die early.
• The richest men in America live longer than the average man in any country. The poorest have life expectancies comparable to men in Sudan and Pakistan.[iii] 
• If you are a citizen of Mississippi, you probably won’t live as long as someone from Bangladesh. [iv] [v] [vi]

• Maternal mortality rates for American women are worse than in most third-world countries. Even more unexplainable is that Black women are three times more likely to die of childbirth than White women. This gap is worse today than it was when we began keeping records in the early 1900’s.[vii] 
• America is a global leader in avoidable amputations. This is mainly due to the improper management of diabetes, which impacts 38.4 million Americans.[viii]
• 30 million Americans die prematurely each year from preventable diseases. Twenty-seven percent of US health-care spending goes to managing health conditions that are preventable.[ix]

As the World Health Organization focuses on increasing its investments in global Public Health, it’s important to note that America’s investment in similar Public Health services is declining.

Winston Churchill once said, “Healthy citizens are the greatest asset any country can have.”  And so, as we discuss and debate America’s role in creating a healthier world through organizations like WHO, let us actively debate and decide what priorities we will invest in to improve the health of the 330 million people who call America home.

[i] https://www.msn.com/en-us/politics/government/what-is-the-world-health-organization-and-why-does-trump-want-to-leave-it/ar-AA1xFf0l?ocid=BingNewsSerp

[ii]Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System,  Commonwealth Fund, September, 2023, https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024

[iii] Raj Chetty, Michael Stepner, Sarah Abraham, Shelby Lin, Benjamin Scuderi, Nicholas Turner, Augustin Bergeron, and David Cutler,  Income and Life Expectancy in the United States: Executive Summary,  The Health Inequality Project, April 2016, https://www.healthinequality.org/documents/paper/healthineq_summary.pdf 

[iv] NICHOLAS KRISTOF, How Do We Fix the Scandal That Is American Health Care? New York Times, https://www.nytimes.com/2023/08/16/opinion/health-care-life-expectancy-poverty.html?smid=em-share

[v] Life Expectancy at Birth by State, National Center for Health Statistics, https://www.cdc.gov/nchs/pressroom/sosmap/life_expectancy/life_expectancy.htm (cdc.gov)

[vi] Life Expectancy at Birth – Bangladesh, World Bank Group https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=BD

[vii]Achievements in Public Health, 1900-1999: Healthier Mothers and Babies, Centers for Disease Control (CDC), Achievements in Public Health, 1900-1999: Healthier Mothers and Babies (cdc.gov)

[viii] NICHOLAS KRISTOF, How Do We Fix the Scandal That Is American Health Care? New York Times, https://www.nytimes.com/2023/08/16/opinion/health-care-life-expectancy-poverty.html?smid=em-share

[ix] Sandro Galea, Nason Maani, The Cost of Preventable Disease in the US,  The Lancet, October, 2020, https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30204-8/fulltext

The post The Real Conversation We Should Be Having as the United States Pulls Out of the World Health Organization appeared first on Medika Life.

At the forefront of these preventable tragedies is pneumonia, a leading cause of death that can often be averted through inexpensive vaccines and antibiotics. Immunisation campaigns and community health programs can ensure that treatments reach those in need, transforming a potential death sentence into a manageable condition. Simple practices, such as promoting exclusive breastfeeding, can also bolster a child’s immune system against pneumonia and other diseases.

Diarrheal diseases, closely linked to poor sanitation and unsafe water, are another major threat to young lives. However, the provision of oral rehydration solutions (ORS) and zinc supplements offers a beacon of hope. These treatments, costing mere cents per dose, can swiftly restore hydration and save lives. Moreover, investing in clean water initiatives and basic hygiene education provides a sustainable path to disease prevention.

Malaria, a relentless killer in many low-income regions, particularly Sub-Saharan Africa, can be effectively combated with insecticide-treated mosquito nets and prophylactic antimalarial medications. These interventions, surprisingly affordable, can drastically reduce malaria incidence and mortality among vulnerable infant populations.

Neonatal conditions, such as complications from preterm birth, infections, and birth asphyxia, highlight the critical need for improved maternal and newborn care. Skilled birth attendance, a cost-effective strategy, can prevent many such deaths. Additionally, kangaroo mother care (skin-to-skin contact) and basic neonatal resuscitation techniques offer low-cost, high-impact solutions to neonatal mortality.

Lastly, malnutrition — a pervasive threat to child survival — can be addressed through nutrition education, support for exclusive breastfeeding, and the provision of vitamin A and micronutrient powders. These interventions prevent death and promote healthy development, all at a minimal cost.

The narrative of child mortality in low-income countries is not solely one of despair but also one of hope and opportunity. By implementing these low-cost interventions, the global community can make significant strides in saving lives and nurturing the potential of millions of children. It is a testament to the power of simple, affordable solutions facing daunting challenges, offering a brighter future for the world’s most vulnerable populations.

Low-cost interventions that save lives

Pneumonia

• Vaccination: The pneumococcal and Hib vaccines can prevent many pneumonia cases. The cost can vary, but Gavi, the Vaccine Alliance, has negotiated prices as low as USD 1.5 per dose for some vaccines in low-income countries.
• Exclusive Breastfeeding: Encouraging exclusive breastfeeding for the first six months of life can significantly improve a child’s immunity. The costs here are more about education and support systems for mothers.
• Access to Antibiotics: For cases where pneumonia develops, timely administration of antibiotics can save lives. A full course of antibiotics for pneumonia treatment can cost less than USD 0.50 per child.

Diarrheal Diseases

• Rotavirus Vaccination: Rotavirus vaccines effectively prevent the most common cause of severe diarrhoea in children, with costs in Gavi-supported countries around USD 1–3 per dose.
• Clean Water and Sanitation (WASH): Providing access to clean water and promoting handwashing can drastically reduce diarrheal diseases. The cost per child can be very low when spread across communities but varies widely depending on the specific intervention and infrastructure development.
• Oral Rehydration Salts (ORS) and Zinc Supplementation: These are highly effective treatments for diarrheal diseases, costing as little as USD 0.50 for ORS packets and zinc supplements for one treatment course.

Malaria

• Insecticide-Treated Nets (ITNs): Mosquito nets treated with insecticide are a simple, effective way to prevent malaria. The cost per net is typically around USD 2–3, and each net can protect up to two children for up to three years.
• Indoor Residual Spraying (IRS): Spraying the inside of homes with insecticides can also reduce malaria transmission. The cost varies but is generally between USD 3–7 per person per year.
• Antimalarial Drugs: Prophylactic antimalarial drugs for pregnant women and young children in high-risk areas can prevent illness. The cost per treatment is around USD 0.50 to USD 1.
• Artemisinin-based combination therapies (ACTs) are the cornerstone of malaria treatment recommended by the World Health Organization (WHO) for uncomplicated Plasmodium falciparum malaria. The cost of ACTs in low-income countries varies, influenced by factors such as local policies, subsidies, the involvement of global health initiatives, and whether the drugs are purchased in the public or private sector. A typical course is just three days of treatment, and the cost to the healthcare system is less than USD 1.
• Anti-malarial vaccines: The R21 vaccine is the second malaria vaccine recommended by WHO, following the RTS,S/AS01 vaccine, which received a WHO recommendation in 2021. Both vaccines are shown to be safe and effective in preventing malaria in children and, when implemented broadly, are expected to have a high public health impact. Three to four doses are administered at USD 2 — USD 4 per dose.

Neonatal Conditions

• Skilled Birth Attendance: Ensuring that births are attended by skilled health personnel can significantly reduce neonatal deaths. Training community health workers can be relatively low-cost, with significant returns in reduced mortality.
• Thermal Care: Simple practices like kangaroo mother care (skin-to-skin contact) can prevent hypothermia in newborns with negligible cost.
• Basic Neonatal Care: Including clean delivery practices, proper cord care, and early breastfeeding initiation. The cost here is more about training and education than direct intervention costs.

Nutritional Deficiencies

• Exclusive Breastfeeding: Promoted for the first six months to provide all necessary nutrients and improve immunity.
• Vitamin A Supplementation: This can significantly reduce child mortality from all causes, with each dose costing as little as USD 0.02 to USD 0.30.
• Micronutrient Powders: Sprinkle on foods can combat malnutrition, costing about USD 0.03 to USD 0.10 per sachet.

How many children between the ages of zero to five live in low-income countries

Unfortunately, there isn’t a single, definitive source with data on the exact number of children aged 0 to 5 living in low-income countries. This is due to a few reasons:

• Defining “low-income countries”: Different classifications are used by organisations like the World Bank. These classifications can change over time.
• Data collection challenges: Gathering accurate data in low-income countries can be difficult due to resource limitations and infrastructure issues.

However, we can look at child poverty data as a proxy. UNICEF reports that 333 million children live in extreme poverty worldwide, meaning they lack necessities like food, shelter, sanitation, healthcare, and education. This data can give us a general idea of the magnitude of the problem.

What can be done?

Governments, NGOs, and civil society play pivotal roles in mitigating child mortality in low-income countries, leveraging their unique positions to initiate, support, and scale up various interventions. Here are ways these entities can collaborate and contribute effectively:

Strengthening Healthcare Systems

• Governments can allocate increased funding to health services, ensuring that healthcare facilities are adequately staffed, equipped, and accessible to the population, including remote areas.
• NGOs often work to fill gaps in healthcare provision, providing training for healthcare workers, supplying medical equipment and medications, and setting up mobile clinics to reach underserved communities.
• Civil Society can advocate for improved healthcare policies and transparency in healthcare funding, ensuring that resources are allocated effectively and equitably.

Promoting Preventative Measures

• All three can collaborate on vaccination campaigns to protect against pneumonia and measles. Education campaigns to promote breastfeeding, proper nutrition, and hygiene practices can also substantially impact the situation.
• NGOs and civil society can support the distribution of mosquito nets and conduct awareness campaigns on their use to prevent malaria, a leading cause of child mortality.

Improving Water, Sanitation, and Hygiene (WASH)

• Governments can invest in infrastructure to provide clean water and sanitation facilities, which are crucial for preventing diarrheal diseases and improving overall health.
• NGOs frequently engage in WASH projects, constructing toilets and facilitating access to clean water through wells and filtration systems.
• Civil Society can mobilise community involvement in maintaining and protecting water and sanitation infrastructure and promote hygiene practices.

Ensuring Food Security and Nutritional Support

• Initiatives to improve access to nutritious food can significantly impact child health. Governments can implement policies and programs to support agricultural productivity, subsidise essential foods, and ensure nutritional programs reach vulnerable populations.
• NGOs may provide direct food aid, support school feeding programs, and teach sustainable farming techniques to communities.
• Civil Society can raise awareness about malnutrition, advocate for policy changes, and support community-based nutrition and gardening projects.

Education and Empowerment

• Educating girls and women has a profound impact on child health outcomes. Governments can ensure equal access to education, while NGOs can provide scholarships or support for girls’ education.
• Civil society, including local communities and parent groups, can advocate for educational reforms and support initiatives that empower women and girls.

Advocacy and Policy Influence

• Civil society organisations can lobby for policies prioritising child health, including environmental protections to reduce pollution and combat climate change, which impacts children’s health.
• They can also be crucial in holding governments and international bodies accountable for their commitments to child health and rights

Collaboration across these sectors is crucial for creating sustainable change. By pooling resources, sharing knowledge, and coordinating efforts, governments, NGOs, and civil society can significantly reduce child mortality rates and improve health outcomes for children in low-income countries. Their combined efforts can address the root causes of child mortality, ensuring that children have the chance to lead healthy, productive lives.

Concluding

The stark reality of child mortality in low-income countries, particularly among infants aged 0 to 5, represents a profound global health challenge. Yet, as outlined, the breadth of low-cost, highly effective interventions available to combat this crisis offers a beacon of hope. These interventions, ranging from vaccinations and exclusive breastfeeding to access to clean water and nutritional supplements, underscore a critical truth: the power to reduce child mortality significantly is well within our grasp.

Moreover, the detailed strategies for pneumonia, diarrheal diseases, malaria, neonatal conditions, and nutritional deficiencies illustrate a clear path forward. The low-cost solutions presented are feasible and offer a high return on investment regarding lives saved and improved health outcomes. The role of artemisinin-based combination therapies (ACTs) in treating malaria, the impact of skilled birth attendance on neonatal survival, and the potential of vitamin A supplementation to bolster child health further highlight the array of tools at our disposal.

The task ahead requires a concerted effort from governments, NGOs, and civil society. Through increased funding, the implementation of health programs, advocacy, and education, these stakeholders can change the trajectory of child health in low-income countries. The call to action is clear: by embracing these low-cost interventions and fostering collaboration across sectors, we can address the root causes of child mortality and ensure that every child has the opportunity to thrive.

This collective endeavour presents a compelling opportunity to redefine the future for millions of children in low-income countries. As we move forward, let the narrative of child mortality be one not of despair but of hope, action, and profound transformation. Together, we can turn the tide against these preventable tragedies, paving the way for a healthier, brighter future for the world’s most vulnerable populations.

The post Main Cause of Death in Infants Ages Zero to Five in Low-Income Countries; Hope for a Better Future appeared first on Medika Life.

There are myriad diseases that are currently linked to the impact of environmental toxins, but it doesn’t end there. There are more important long-term issues that will only grow progressively more challenging in the coming decades. These exist alongside the toxic climate we have created for our health. Issues like access to clean potable water, population density, plastics, and a host of other challenges.

Alongside these issues, racial disparities in health and society disproportionately shift the outcome of these pollutants and challenges onto the shoulders of racial minorities. Wealth acts as insulation, allowing access to superior levels of care, organic foods, and healthy lifestyle choices, including the ability to locate your family to areas where pollutants are less dense.

Poorer communities are however locked into a narrow band of choices, none of which are beneficial to their health.

These issues must be addressed. We can no longer afford to ignore them as chronic disease becomes our new normal. We believe that this is where the real challenge to our societal and global health will lie in the coming years. We also believe we’ve passed a tipping point and only desperate and immediate action will enable us to claw back a vestige of the damage we have inflicted, both to our home and ourselves.

If like us, you have concerns or would like to raise awareness, share a passionate and well-researched point of view on diseases and the environment, or other relevant environmental issues, then we would love to provide an audience for your thoughts. We’re also really big on solutions, which are in short supply, and FINN Partners is offering an added incentive to the best article we receive.

Our appreciation to frequent Medika Life contributor Gil Bashe, FINN Partners, Global Health Chair, and colleague Bob Martineau, JD, Senior Partner, Environmental and Sustainability, for their articles, commitment to EcoHealth, and support for this new editorial section.

A word from FINN Partners

For decades we have thought, written, and studied how environmental conditions and social determinants influence public health. Now as fires rage across the Pacific Northwest United States and floodwaters rise in Central Europe we see how environmental sustainability impacts human survival across developing and developed nations. 

Environmental health links directly to global public health. Medika Life has been serving as an editorial meeting ground for health professionals across the spectrum to explore how health is central to all human progress and continuity. 

Medika Life’s editors determined we will champion greater editorial discussion with a new section dedicated to EcoHealth. To encourage editorial submission, Medika Life and FINN Partners will honor an outstanding editorial contribution with a $500 donation made in the author’s honor to a global non-profit dedicated to environmental public health. 

Submissions

If you are active on Medium, please submit a draft of your work to Medika’s publication on Medium, BeingWell. If you’re not already a contributing author, please reach out to BeingWell’s EIC, Dr Jeff Livingston who will happily assist you in the process.

You can email Jeff at jefflivingmd@medika.life or reach out to our other editors, Dr. Hesham A. Hassaballa, Lisa Bradburn or Dr. Patricia Farrell.

If your article is one of those selected it will be published immediately on Medika Life and scheduled for subsequent publication on BeingWell. We will set up a dedicated author profile for you or your organization on the Medika site and you can submit additional material at your convenience.

Please note that as Medika caters to medical and health professionals, we will only consider materials from appropriately qualified authors and stakeholders. If you have questions or pitches you’d like to discuss, you can contact Medika’s EIC, Robert Turner, or reach out via email to robertturner@medika.life.

If you are not on Medium, you can submit articles directly to Robert on the email above. Please submit attachments in Word format or you are welcome to provide a link to a shared Google document.

The winning article will be selected by an editorial team from both Medika Life and Finn Partners and will be announced on the 31st of August, 2021. The relevant author will be notified by email and the article will be extensively advertised across social media. 

All rights are retained by authors on materials published to Medika Life.

The post The Environment and Our Health. Medika’s Open Call for Articles from Stakeholders appeared first on Medika Life.