Posted tagged ‘global health’

A look at health care reform — in China

September 6, 2017

Photo courtesy of Karen Eggleston

The struggles with health insurance reform here in the United States piqued my curiosity about what we could learn from other countries. I reached out to Karen Eggleston, PhD, a senior fellow at the Freeman Spogli Institute for International Studies at Stanford, who researches health care systems and health reform in Asia, especially China.

What is health insurance like in China?

“The original system was linked to the centrally planned economy. Communes in rural areas supported the barefoot doctors and state-owned enterprises provided people with health care coverage in the urban areas. But when China converted to a market-based economy, this had to change. So long story short, they’ve put into place a new system of health coverage based on government subsidized insurance for rural and non-employed urban populations, as well as an employee-based medical insurance for the employed urban population. As I like to tell my US colleagues, if you think providing coverage for 40 million uninsured people is a challenge then think about covering over 800 million uninsured — that’s what China was dealing with.

Many westerners would be surprised to know that Chinese have almost complete freedom when choosing their doctor or hospital.”

How has this expanded coverage impacted health and survival?

“There is a lot of evidence that the expanded health insurance improved access to care and helped protect households from high health care expenditures, but it’s actually pretty difficult to pin down the effects on health and survival.

In a recent study in Health Affairs, we looked at the New Cooperative Medical Scheme that provides health insurance to rural areas. We used the fact that it was introduced over time in different counties to look at the effect it had later, correlating this data with cause-specific mortality data from China’s CDC. We didn’t see a significant impact on mortality rate due to expanded medical coverage.

This was and wasn’t surprising. It may take a long time for the results to manifest. But it’s also quite well known in health economic research that health and survival are often shaped by non-medical factors like lifestyle.”

What are some of the biggest health care challenges in China?

“As China urbanizes hundreds of millions of people at a time, they are changing their diet and living a more sedentary lifestyle. As a result, they’re now getting what are sometimes called the diseases of affluence, such as diabetes. Like many developing countries, China’s healthcare system was setup to deal primarily with acute conditions and to control infectious diseases. Now, they need to sustainably finance and manage programs to prevent and care for people with chronic diseases.

A lot of China’s care is also based in hospitals, so they need to strengthen primary care — ironic for a country so famous for barefoot doctors. Physicians’ career trajectories are better in urban hospitals and patients know that’s where the best physicians are. But new policies are trying to lure patients and doctors to primary care.”

What other factors are affecting health in China?

“China has a rapidly aging population — largely due to their triumph in extending lives by controlling infectious diseases and lifting millions out of poverty, and also related to low fertility. This demographic change reinforces the challenge of preventing and controlling chronic disease.

We also know that people with more education tend to have better health and survival than people with lower education. China’s economic growth has brought a rapid increase in living standards but also a rise in inequality, in both rural and urban areas. One of the best ways to address this is to improve opportunities of education for the disadvantaged. This isn’t typically thought of as a health policy, but actually studies have shown education can have long lasting effects on health and survival.”

This is a reposting of my Scope blog post, courtesy of Stanford School of Medicine.

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Sick people are worse for the environment, a study shows

April 13, 2017

Photo by ryan harvey

Environmental degradation is widely recognized to contribute to human illness. However, little research has been done to investigate the impact of human illness on the environment. This is a critical question particularly for the millions of people around the world who depend on natural resources for food and income while coping with high burdens of infectious diseases.

When people are sick, they often alter their use of natural resources in ways that harm the environment, according to a new study reported in the Proceedings of the National Academy of Sciences.

Specifically, the researchers examined how illness influenced fishing practices in the community around Lake Victoria, Kenya, which has high rates of HIV and other illnesses. They interviewed about 300 households several times over 16 months, collecting and analyzing data about household fishing habits and mental and physical health. They found that healthy people are better for the environment.

“Studies suggest that people will spend less time on their livelihoods when they are sick, but we didn’t see that trend in our study. Instead, we saw a shift toward more destructive fishing methods when people were ill,” said lead author Kathryn Fiorella, PhD, a postdoctoral scholar at Cornell University, in a recent news release.

The study found that sick fishermen were less likely to legally fish in deep waters or overnight to target the more sustainable mature fish. Instead, they used destructive fishing methods that were concentrated along the shoreline — such as using a beach dragnet that captures a high proportion of juvenile fish and disturbs shallow fish breeding habits.

Basically, sick fishermen just wanted to get their catch quickly with less energy. They were focused on their short-term goal and not worried about depleting the fish stock.

In light of this study, the authors suggest that institutions and organizations focused on protecting the environment may need to more deeply consider the health of communities. The paper concludes, “Our study emphasizes the importance of considering health, governance, and ecosystems through an integrative lens.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Low-cost “magic box” could decontaminate water in rural communities

April 4, 2017

Photo by Shawn

More than a billion people drink water that is contaminated and can spread deadly diseases such as cholera, dysentery, hepatitis A, typhoid, polio and diarrhea.

Most contaminated water could be purified by adding hydrogen peroxide, which safely kills many of the disease-causing organisms and oxidizes organic pollutants to make them less harmful. Hydrogen peroxide disinfects water in a similar way as standard water chlorination, but it leaves no harmful residual chemicals. Unfortunately, it’s difficult to make or obtain hydrogen peroxide in rural settings with limited energy sources.

Now, researchers from Stanford University and SLAC National Accelerator Laboratory have developed a portable device that produces hydrogen peroxide from oxygen gas and water — and it can be powered by a battery or conventional solar panels. You can hold the small device in one hand.

“The idea is to develop an electrochemical cell that generates hydrogen peroxide from oxygen and water on site, and then use that hydrogen peroxide in ground water to oxidize organic contaminants that are harmful for humans to ingest,” said Christopher Hahn, PhD, a SLAC associate staff scientist, in a recent news release.

First, the researchers designed and synthesized a catalyst that selectively speeds up the chemical reaction of converting oxygen gas into hydrogen peroxide. For this application, standard platinum-mercury or gold-plated catalysts were too expensive, so they investigated cheaper carbon-based materials.

Next, they used their carbon-based material to build a low-cost, simple and robust device that generates and stores hydrogen peroxide at the concentration needed for water purification, which is one-tenth the concentration of the hydrogen peroxide you buy at the drug store for cleaning a cut. Although this device uses materials not available in rural communities, it could be cheaply manufactured and shipped there.

Their results were recently reported in Reaction Chemistry and Engineering. However, more work needs to be done before a higher-capacity device will be available for use.

“Currently it’s just a prototype, but I personally think it will shine in the area of decentralized water purification for the developing world,” said Bill Chen, first author and a chemistry graduate student at Stanford. “It’s like a magic box. I hope it can become a reality.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine. For more details, please read my SLAC news release.

Project aims to improve well-being in rural Mexican communities

September 20, 2016

san-miguel-peras_jshTo improve the health and well-being of people around the world, researchers must first understand what it means to be well and whether this has the same meaning for everyone.

A Stanford team at the Wellness Living Laboratory (WELL) is working to define and measure wellness by identifying the factors that help people maintain it and by testing new interventions. As announced earlier this week, they’re engaging thousands of participants from around the world, including the U.S., China and Taiwan, with the ultimate goal of optimizing everyone’s health and well-being.

Nicole Rodriguez, a research assistant with the Wellness Living Laboratory at the Stanford Prevention Research Center, recently extended this work to Mexico in conjunction with Stanford’s Community Health in Oaxaca program. This summer Rodriguez carried out a new research study with a team of Stanford undergraduates to explore the well-being of two impoverished, rural communities in Oaxaca, Mexico; I recently spoke with Rodriquez about her work.

How do you define “well-being”? Why is it important to study this worldwide?

“Well-being is about considering the whole person, where health extends beyond physical health to encompass emotional health, social connectedness, lifestyle behaviors and even factors like sense of purpose and creativity.

It’s important to consider what factors contribute to universal well-being — across cultures and socioeconomic gradients. Studying well-being helps us understand what people in diverse parts of the world care about the most and how they prioritize aspects of their lives and health. Understanding what motivates and drives people then allows for more targeted and efficient public health efforts.”

What inspired you to work in Oaxaca?

“I’ve been working with underserved Hispanic populations throughout Santa Clara County doing WELL research, and I was curious to learn more about the cross-cultural well-being in Latin American populations.

Seven years ago, I participated as an undergraduate in Stanford’s community health overseas program in Oaxaca with Gabriel Garcia, MD and Ann Banchoff. The class launched me on a career working to address health disparities among marginalized populations. This year, I returned as a program assistant to help build the research portion of the course. It was an honor to give back to the program and revisit the place and people that shaped my aspirations in medicine.”

What did the research group do in Oaxaca?

“We worked with a partnering non-profit organization, Niño a Niño, to carry out a project that would help the non-profit and community leaders better understand the community’s needs and priorities. Our group carried out a well-being study with 38 participants in San Miguel Peras and Pensamiento, two rural communities living in extreme poverty.

The first part of the study was an open-ended interview aimed at understanding individual perspectives and priorities surrounding well-being, which was modeled after the WELL measures process developed by Cathy Heaney, PhD. The second portion of the study incorporated the citizen science process developed by Abby King, PhD, which empowers community residents to capture the barriers and facilitators to their health and well-being — by carrying out a tablet-based environmental assessment, taking photos and recording audio narratives — and then engage in community advocacy. Lastly, we conducted WELL’s core well-being questionnaire that is being used on an international scale.

I think looking at well-being is especially important in low-resource settings because communities have to think carefully about how to allot and prioritize limited resources, people and time. Niño a Niño is going to use the data about community priorities to plan out its community-based efforts for the upcoming year.”

What was it like in these remote rural communities?

“Political protests and unrest across Oaxaca complicated the decision to bring the students to Mexico this summer. The city was generally calm while we were there, but we did face some shutdowns of public transportation, clinics and hospitals. I think it provided good exposure to how governmental issues can impact critical public services like healthcare.

The students also learned about community health fieldwork in marginalized and remote villages. After a rocky two-hour bus ride through muddy unpaved cliffs, we arrived in the village center. A group of children greeted our team to lead us to the family homes where we would carry out the interviews. Assuring us that the homes were close by, the children led us on an uphill scramble for about an hour to reach the families. We crossed rivers, slipped on fresh clay and mud, and held on to rocks and branches for balance as we worked our way up to the homes — while our young guides hopped gracefully through the paths.

In these rural impoverished settings, well-being was about meeting the basic necessities of daily life — having enough water in the rainwater catchment tank and enough food to put on the table. Whereas a lot of our Santa Clara County interviewees discussed issues like balancing work, personal life and health, the conversations in Oaxaca revolved around meeting fundamental necessities. Exploring issues of well-being in these communities helps us think about what is truly essential for health and well-being.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Stanford otolaryngologist champions ultrasound imaging

August 31, 2016
Photo, of Lisa Orloff performing an ultrasound exame, by Stuart Kraybill

Photo, of Lisa Orloff performing an ultrasound exam, by Stuart Kraybill

Patients with thyroid nodules — extremely common lumps on the thyroid that are usually benign, but can be malignant — are typically sent for ultrasound imaging to evaluate the size and structure of their thyroid and nodules. A radiologist’s report is then sent to the treating physician, who discusses the report with the patient and recommends next steps.

Lisa Orloff, MD, director of the endocrine head and neck surgery program at Stanford, doesn’t follow this traditional procedure: she performs her own ultrasound exams in the office and is training other head and neck surgeons to do the same. I recently spoke with Orloff about the role of ultrasound imaging in her practice.

Why do you primarily use ultrasound imaging to diagnose head and neck disease?

“My clinical practice focuses on the surgical management of thyroid and parathyroid disease, especially thyroid cancer. In the head and neck region, ultrasound imaging has long been recognized as the ‘go to’ study if you want to evaluate the structure, size and content of the thyroid gland. What’s been recognized more recently is how great ultrasound is for most of the head and neck structures. So we’re moving into an era of ‘ultrasound first:’ See what you can see with ultrasound, and then decide if you need additional cross-sectional imaging to corroborate or complement the ultrasound findings. For patients with thyroid cancer, ultrasound is extremely useful for evaluating not only the thyroid, but the rest of the neck for aggressive features including possible metastases.

Ultrasound is a low risk, low cost and very high yield imaging study that better characterizes the details within thyroid nodules or lymph nodes; whereas, CT and MRI often rely more on size to say whether or not a thyroid nodule or lymph node is suspicious. It’s really phenomenal what you can see with modern, high-resolution ultrasound equipment.

However, ultrasound has been blamed for the recent increase in incidence of thyroid cancer, which is largely due to increased detection. Even malignant thyroid nodules can sometimes be very indolent cancers that may not require intervention, but can be monitored. A major challenge in thyroid cancer care is distinguishing potentially aggressive tumors from those that are very low risk.”

Why is it helpful to have a clinical doctor, instead of a technician, perform ultrasound?

“When used at the point of care — performed by the clinician who is taking care of the patient — ultrasound enables the treating clinician to immediately investigate and answer questions with ultrasound information, and then implement treatments. It’s sort of one-stop shopping.

There’s an invaluable connection made with the patient when the treating physician performs the ultrasound exam, while explaining findings to the patient and discussing whether and how to treat them. I think it translates into improved patient care. If I’m the one doing the ultrasound exam, I can plan and execute surgery better with first-hand knowledge of what lies beneath the surface — rather than relying on images that someone else captured. I can perform ultrasound-guided biopsies and treatments in the office. I can also judge firsthand when an intervention or even biopsy isn’t necessary.

At present, I’m the surgeon in the head and neck division who routinely uses office-based ultrasound to evaluate patients, many of whom are referred to me specifically for that reason. But my colleagues in comprehensive ENT also perform ultrasonography [ultrasound imaging], as do our fellows and residents. We’re very motivated to train the next generation of otolaryngologists so it becomes more widely practiced in the office setting. We want to reduce the need for multiple appointments and more costly or invasive studies.”

I heard you recently traveled to Zimbabwe. What did you do there?

“My department has developed a relationship with the only medical school in the country, the University of Zimbabwe. I spent two weeks this summer, mainly teaching ultrasonography to residents in both otolaryngology and surgery — introducing the concept of point-of-care ultrasound to a low-resource practice environment where this has the potential for even greater impact. Most patients there don’t have ready access to get an expensive CT or MRI scan. I think ultrasound has a particular application in that setting, because it’s inexpensive, portable, fast and so user friendly. It’s also painless and non-threatening — you can do it on kids without having to anesthetize them to stay still.

Going over there to teach was a really rewarding experience. I hope to go back soon. We were very fortunate to have ultrasound equipment loaned for teaching purposes by GE based in South Africa. My next goal is to raise funds for an ultrasound machine to equip the Zimbabwe program with this wonderful tool for their continuing use.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Water purification: tiny solar device may have global impact

August 18, 2016
IMG_2636

Photograph, of researcher Chong Liu holding their nanostructured device, by Jin Xie.

Millions of people in developing countries lack access to safe drinking water, a primary cause of disease. Now, researchers from Stanford University and SLAC National Accelerator Laboratory have developed a tiny gadget that may help address this huge global health issue.

Their device — the size of half a postage stamp — uses solar energy to more efficiently purify water.

Solar energy is already commonly used to disinfect drinking water, particularly in areas with limited fuel to boil water. However, solar disinfection mostly relies on killing pathogens in the water with ultraviolet light, which represents only 4 percent of the sun’s total energy. This slow and inefficient purification process takes six to 48 hours.

The Stanford research team devised a new material that can significantly speed up this process by harvesting the whole spectrum of visible light, which corresponds to over 50 percent of solar energy. As reported this week in Nature Nanotechnology, they were able to disinfect nearly all of the bacteria in a small water sample in just 20 minutes.

“Our device looks like a little rectangle of black glass. We just dropped it into the water and put everything under the sun, and the sun did all the work,” said Chong Liu, PhD, lead author and postdoctoral researcher in materials science and engineering at Stanford, in a recent news release, which describes the device:

Under an electron microscope the surface of the device looks like a fingerprint, with many closely spaced lines. Those lines are very thin films — the researchers call them “nanoflakes” — of molybdenum disulfide that stacked on edge, like the walls of a labyrinth, atop a rectangle of glass.

By making their molybdenum disulfide walls in just the right thickness, the scientists got them to absorb the full range of visible sunlight. And by topping each tiny wall with a thin layer of copper, which also acts as a catalyst, they were able to use that sunlight to trigger exactly the reactions they wanted — reactions that produce “reactive oxygen species” like hydrogen peroxide, a commonly used disinfectant, which kill bacteria in the surrounding water.

Although promising, the researchers’ method doesn’t remove chemical pollutants and it has only been tested on three strains of bacteria mixed with less than an ounce of water in the lab. The next step will be to test the device in a real-world stew of contaminants.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.


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