Category Archives: Health equity

Should doctors make “house calls” again? Preventive hot spotting and early active intervention

In the olden days, doctors would travel from house to house when community members fell ill. Now, we usually expect patients to come to our office-based clinics. The modern model of care is certainly more efficient for us as physicians. But it’s also a barrier for patients to receive medicine; the highest-risk people usually make it to our clinics after being discharged from their first or second hospitalization, well after high blood pressure or diabetes has already taken its toll on their bodies. Our latest research suggests that we can statistically predict which people are most likely to end up having chronic diseases five or ten years from now. We can pinpoint these people right down to which house they live in. Such predictive models present a new opportunity to prevent disease before it becomes costly or deadly. In this week’s post, we look at a new idea for community-based disease prevention in medicine: the geographical mapping of chronic disease risks, and preemptive visits of healthcare workers to households where people are likely to become ill in the future.

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The largest famine in decades hits Somalia, Sudan, Ethiopia and Kenya… why?

While US newpapers have been infatuated with hourly stock price fluctuations, the press has almost totally ignored the start of the biggest famine in decades—a humanitarian crisis larger in scale than the Japanese tsunami and Haiti’s earthquake. In this post, we take a look at the available data on the emerging famine in the Horn of Africa, and its drivers.

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Three decades of HIV …and still learning

On June 5, 1981, five cases of Pneumocystis carinii pneumonia were reported among young men in Los Angeles, in what was to become the first account of AIDS. The pandemic that transformed Earth now marks its thirtieth anniversary this month. And while much attention is appropriately being paid to declarations made about the Millennium Development Goals and reports on the broad state of the disease in different continents (see the mortality graphs below), it’s easy to forget some of the critical lessons we’ve learned over the years from this unparalleled pandemic. In this week’s blog post, we’ll revisit some of the historical lessons we’ve learned HIV: from the redefinition of the behaviorist model of health promotion, to the detailed tax records of the pharmaceutical industry.

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Food insecurity and the irrigation of food deserts

Michelle Obama has reincarnated the food pyramid as a “healthy plate“. The plate is divided equally between fruits, grains, vegetables and protein–a balanced dinner plan to lead the nation towards a leaner and less diabetic future. As part of applying this new plate method to the real world, a patient of mine came to clinic with a map of our city.

“This is what I’d need to do buy everything on a healthy plate,” he said.

How much would he have to spend for this trip to the grocery store? Given public transport and food costs, about $25–twice his post-rent, post-tax daily income. And the trip would require 49 minutes of transportation time, each way.

This patient, like many others, lives in an American “food desert”: a neighborhood that features more liquor shops and gas stations than it does produce stands or grocery stores. In today’s post, we explore the data behind food deserts, some of their politics, and think about how to intervene in the midst of dilemmas about food price spikes and recessions.

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Advancing primary care in global health – avoiding past mistakes

The President’s Global Health Initiative (GHI) has outlined a new U.S. strategy for global health. Secretary Clinton recently described the GHI as aiming to bolster health system development and particularly primary care, tackle health problems that can be eliminated with relatively little investment (for “sustainability”), and focus on maternal and child health (MCH).

To an outsider, this all sounds pretty good; but to those who are familiar with the history of global health, the rhetoric around the GHI ominously harks back to past mistakes. In this blog entry, we discuss the history behind primary care in global health, to explain why previous attempts at “health systems development” perversely backfired in the 1970s, 80s, and 90s.

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The health impact of recession – a look at the data

The financial crisis beginning in 2007 is thought by many economists to be the worst recession since the Great Depression. Early on, the World Health Organization warned us that “it should not come as a surprise that we continue to see more stresses, suicides and mental disorders”; “the poor and vulnerable will be the first to suffer”; and “defending health budgets” will become more difficult. But the report was remarkably vague (in fact, totally absent of any data), so it was difficult to truly understand what the detailed impact of recession would be on public health – and therefore, what we should do about it.

Well, the data are in…and they don’t look pretty.

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Have health inequalities worsened in South Africa since apartheid?

We’ve all heard about the infamous apartheid-era health system in South Africa. As a middle-income country, richer than many in sub-Saharan Africa, the Republic of South Africa provided world-class care for White elites, including the world’s first heart transplant. But the majority of people were denied appropriate access to health care. Spatial segregation between populations was a prominent method to sustain inequality during apartheid, with racially-biased policies leading to the creation of ‘‘Black homelands’’ that detached the poorest areas from regions with better health care infrastructure.

What’s happened since apartheid ended? Has health care access improved for the poor in South Africa? In a recent analysis of health system data from the country, we found a surprising result: an inverse and worsening relationship between health care allocations and disease burden after apartheid.

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