The rise and fall of a global health success story, and how the G8 can bring it back

This article was also published in The Huffington Post on May 23, 2011.

Lancet once called it “potentially the most important medical advance of the 20th century.” But in the 21^st century, oral rehydration therapy (ORT) — a simple, cost-effective treatment given at home using either packets of oral rehydration salts (ORS) or a simple home solution of sugar, salt and water — seems to be on life support. The result is the unnecessary deaths of children under five.

ORT and ORS are indisputable bright spots in global health: Almost a billion episodes of child diarrhea are treated with ORT annually, reducing child deaths from diarrheal disease by more than 50 percent, according to the U.S. Agency for International Development.

Since the 1970s, ORS has saved an estimated 50 million lives, costing less than US $0.30 per sachet, reported the World Health Organization in 2009. Among major causes of child death, it is now tied for second place, at 14%, with pneumonia.

ORT is also highly cost-effective. A 2005 British Medical Journal paper found that ORT was one of the interventions that “would be chosen on purely cost effectiveness grounds for any level of resource availability.” But after the success of ORT, its uptake has slowed and even reversed in some countries.  A 2008 analysis of the change in ORS use in children under 3 between 1992 and 2005 found declines in 23 countries and increases in only 11. Declines in ORT use seemed to occur despite overall improvements in awareness of ORS.

Mali: One of many African malaria success stories

This blog was published on The Huffington Post on April 25, 2011.
 
One night, as a young development worker in Mali 20 years ago, I engaged in high-risk behavior in a village west of Bamako -- I slept without a mosquito net in the middle of the rainy season.

I came to regret my lapse: I was struck down with a severe case of malaria a week later in Morocco, a country where malaria is not endemic, and the doctor I consulted in Casablanca could not diagnose it. Initially, I thought it was some form of flu, but soon realized it was much worse, and that I had carried it with me from Mali.

David as a young development worker in Africa.

Malaria was the most debilitating illness I had ever experienced. Usually when I am sick, I enjoy reading, or at least watching TV. But malaria made me feel more awful, more lethargic than I ever had in my life and I felt like doing nothing except staring at the ceiling.

In those days, mosquito nets were hard to come by for anyone, but especially if you were a poor, rural Malian. And most Malians were poor and rural.

Much has changed. A 2010 Roll Back Malaria report shows that Mali is part of a pan-African malaria success story: In 2000, there were an estimated 22,663 malaria deaths among children 1 to 59 months in Mali. From 2001 to 2010, the global investment in malaria control prevented 65,065 malaria deaths, more than any of the 34 malaria endemic countries in Africa studied in the report.

My condom wars with Catholics on three continents

This blog was first published in the Huffington Post on Dec. 3, 2010.

Pope Benedict XVI’s comments last month that condom use can be justified in some cases to help curb the spread of AIDS were surprising to me only because they came from the very top of the Catholic Church. But in my 10 years of managing condom social marketing programs for HIV prevention and family planning, I have come across shocking discrimination as well as enlightenment and compassion from Catholics working with people at the grass roots.

Almost precisely 18 years ago, on World AIDS Day 1992, I launched “Maximum” condoms (“Strong for Maximum Protection, Sensitive for Maximum Pleasure”) in Zambia, a country that had double digit HIV prevalence but no reliable source of high quality, low-priced condoms. Zambia also had a newly-elected president, Frederick Chiluba, who was a born-again Christian and stridently anti-condom.

We had a big launch event at the Pamodzi Hotel with lots of speeches and exhortations on the importance of using condoms. Surprisingly to me, we also had a Catholic priest and nun in attendance. They had come separately and neither was wearing religious attire.

YouTube + Wikipedia = Social Change

WASHINGTON, DC -- What do you get if you combine the video-sharing power of YouTube, the depth of information of Wikipedia and the social change aspirations of an advocacy website? Something called ViewChange.org, as I found out last week when I attended its formal launch at AED headquarters here.

U.S. independent television broadcaster, Link TV, launched “the next generation multimedia platform for global development” that combines powerful video stories with the latest “semantic” technology that allows a person, after viewing one of the many powerful short videos showing "good news" development stories, to extract more information about that issue, and then to take action in a variety of ways. ViewChange.org is funded by the Bill & Melinda Gates Foundation.

After watching a video, you have three options: “Watch More” (as in, watch more videos), “In the News” (to explore an issue in more depth) and “Take Action” (which presents you with a variety of concrete actions ranging from taking political action, donating to a cause or writing a letter to the editor). Every video is tied specific actions that the viewer can take.

ViewChange.org goes way beyond YouTube, where the end point is the merely emotion elicited by the video. With ViewChange.org, the idea is that after the viewer is moved emotionally, the viewer will be moved practically to action.

Two continents, one AIDS epidemic

WASHINGTON, D.C. - The speakers talked about a society with an AIDS epidemic driven by a devaluation of girls and women, young people denied evidence-based sex education, parents in denial about their children’s behavior and religious leaders who sometimes do more harm than good.

They were talking about sub-Saharan Africa.

And they were also talking about the District of Columbia.

The most striking fact to emerge from a panel discussion at Howard University this week on “UN Millennium Development Goal #6: Combating HIV/AIDS” was how similar some of the drivers of HIV/AIDS are in Africa and in Washington, D.C. Indeed, it was said several times that D.C. has the HIV prevalence of a developing country. The event was organized by the D.C. League of Women Voters, Howard University Hospital and the United Nations Association in observance of United Nations Day.

Women heroes of conservation are also improving health

WASHINGTON, D.C. - Earlier this month, I stepped out out of my comfort zone and went to an event on Capitol Hill that had nothing to do with global health, at least not directly. The event, “Women Heroes of Global Conservation,” honored six women who had done extraordinary things to save the planet.

Truth be told, I went to see Wangari Maathai, the 2004 Nobel Peace Prize winner for her work transforming women’s lives and the environment of her country Kenya through the Green Belt Movement she founded in 1977 and which has spread to 15 countries in Africa. Ms. Maathai was ill and could not be present but I heard from five other equally amazing women.

The overall event reinforced my perception that conservation and the environment has a lot to do with health. More and more, I see the links between health, climate change and the environment. We heard from these “Women Heroes of Global Conservation”:

* Mary Mavanza, Tanzania, manager of the TACARE program of the Jane Goodall Institute, has helped hundreds of Tanzanian women start environmentally sustainable business through microcredit loans and training. By improving economic conditions among women in and around Gombe National Park, the TACARE program has protected nearly 200,000 acres of forests and worked with 22 villages to create land use plans.

* Suzan Baptiste, Trinidad, founded Nature Seekers in 1990 and stopped turtle poaching. NatureSeekers is the largest employer in her region of Trinidad and has reforested large areas by hiring women to rehabilitate areas that were destroyed by fires or logging companies. She was named a CNN Hero in 2009.

* Sangduen “Lek” Chailert, Thailand, challenged and transformed traditional wildlife management techniques by setting up elephant sanctuaries and ecotourism program in northern Thailand, a country where there were once 300,000 elephants and now are not more than 3,000. Ms. Chailert has expanded this work to other areas of Thailand.

* Habiba Sarabi, Afghanistan, is the governor of Bamyan Province, the country’s first and only female governor. To improve the lot of women and communities, Governor Sarabi has increased tourism through conservation by creating Afghanistan’s first national Park, Band-e-Amir, protecting 220 square miles of pristine lakes and limestone canyons.

* Lucy Aquino, Paraguay: I was especially keen to hear from Ms. Aquino, who comes from Paraguay, a country where I lived four years and which has a special place in my heart. As the Paraguay director of the World Wildlife Fund, she has improved conservation and empowered women and communities for nearly 30 years. Paraguay once had had one of the highest rates of deforestation in the world in the Atlantic Forest Region, a highly threatened region where indigenous communities have been displaced with the men often going to work on cattle ranches or soybean farms, while their wives and children go to the cities to engage in begging, or worse. Ms. Aquino helped establish a Zero Deforestation Law, which resulted in a reduction in deforestation rates by 85%.

Several speakers, including Ms. Maathai, lamented the fact that the U.S. does not have a conservation strategy. “The U.S. has a thoughtful strategy for improving the well-being of women and girls around the world,” wrote Ms. Maathai in her statement. “It also has a global food security strategy, a global health strategy and a global climate change strategy. It will soon have a global development strategy. But because natural resources underpin each of these goals, there must also be a conservation strategy. None of these other strategies can truly succeed over the long term with one.”

To that end, Democrats and Republicans in the Senate and the House have come together to propose the Global Conservation Act of 2010 to prevent the destruction of our world’s forests, reefs and other ecosystems. On June 17, 2010, Senators Tom Udall, a liberal Democrat, and Sam Brownback, a conservative Republican, introduced legislation that would coordinate the work of all U.S. agencies involved in international conservation and establish a national strategy for promoting conservation.

According to the Alliance for Global Conservation, the main organizer of this event, health is one of the major benefits of conservation. Half of the new drugs created in the past 25 years have an ingredient derived from nature, according to the Alliance, and over 70% of all cancer drugs are based on natural compounds.

As the most senior representative of the U.S. government at the event, Undersecretary of State for Democracy and Global Affairs Maria Otero recounted a personal manifestation of climate change: The mountain she used to ski on when she was a child in her native Bolivia is now brown and barren of snow, she said.

Undersecretary Otero said that the U.S. is committed to international conservation, spending $300 million on it every year, and mentioned one recent example — the announcement of a Global Alliance for Clean Cookstoves, a public-private partnership led by the United Nations Foundation and several U.S. government agencies, to save lives, improve livelihoods, empower women and combat climate change by creating a market for clean and efficient cookstoves. Exposure to smoke from traditional stoves and open fires accounts for nearly 2 million premature deaths annually, with women and young children the most affected, according to the World Health Organization. This is one of the many ways conservation can improve human health.

So if you support global conservation, you are also supporting global health.

What does Syrah wine have to do with pneumonia?

NEW YORK, NY — In June, New York Times Wine Critic Eric Asimov started his wine column with a joke: “What’s the difference between a case of syrah and a case of pneumonia? You can get rid of the pneumonia.”

That column, which analyzed why American Syrah wine, which can be superb, had never achieved much success, has led to one of the strangest partnerships in global health — a coalition fighting child pneumonia and the Rhone Rangers, America’s leading non-profit organization dedicated to promoting American Rhone varietal wines such as Syrah.

Last month, I witnessed the partnership in a wonderful event in the New York Times Center here on the first day of the United Nations Summit on the Millennium Development Goals cleverly marketed as “Pneumonia’s Last Syrah,” a wine reception and photography exhibit, which displayed striking images and stories that provided a window into the human face of pneumonia and the burden of the disease.

After sampling the wares of the 12 Syrah producers present at the event (11 from California, one from Virginia) , which were all excellent, the audience was educated about pneumonia:

* It is the leading cause of death among children under 5, with more than 1.5 million dying from it every year.

* Vaccines against two of the main causes of life-threatening pneumonia are used throughout the developed world. However, millions of children in developing countries still lack access to these vaccines.

* Life-saving antibiotic treatment for serious pneumonia typically costs less than one dollar. However, only an estimated one of every five children with pneumonia receives antibiotics.

Wine Critic Asimov, who helped ferment this partnership, spoke at the reception, saying he was humbled to be part of such a significant issue while he usually spent his time worrying about nothing more than excessive oakiness in chardonnay.

The Global Coalition against Child Pneumonia, made up of more than 100 organizations, will mark World Pneumonia Day on Nov. 12 to bring attention to pneumonia and promote policies that will prevent the millions of avoidable deaths.

The Global Coalition suggests five things people can do to take action. One of those things is to buy a case of American Syrah wine during the month of November from one of these producers, and they will donate $10 to provide pneumonia vaccines to children in the world’s poorest countries.

This will help save the American Syrah wine industry, but it will produce the even happier effect of saving the lives of children who might have died from pneumonia.

Disclaimer: I won a large bottle of Syrah wine in the raffle at the event but these opinions were in no way influenced by that fact. I was going to write this anyway.