Category Archives: Global Health

All Quiet on the Non-Communicable Disease Front

XIAN ZHANG

In Uganda, a mother of five has been waiting all day to see a doctor, with no success. The story normally ends here. In delay. Frustration. But bolder than her peers, she takes matters into her own hands, and confronts a doctor in the hallway by ripping open her blouse. Exposed is a breast mostly ulcerated, eaten by cancer. Sadly, what shocks the doctor is her directness, not the late stage of the disease, which is common among the disadvantaged in the country. She received chemotherapy that same day.

Infectious diseases such as malaria and TB will continue to remain highly relevant for many years to come in countries such as Uganda, but there are already international organizations dedicated to combating these ailments. Less attention has been paid to non-communicable diseases (NCDs), which have been rising at an unprecedented rate, and are by far the leading causes of death in the world. For the first time in human history, more people live in countries where obesity kills more than starvation. 63% of us will die of one of the “big four”: cardiovascular disease, cancer, respiratory disease, and diabetes. These are not simply unavoidable deaths due to over-consumption and old age: 80% of people who die of NCD-caused deaths live in low- and middle-income countries (LMCs), and a large proportion strikes those under 60. We can even put a mortality rate on inequality: 20 million, or a third of all global deaths, are preventable. That’s the difference between death rates in high-income countries and all other regions of the world.

A cancer diagnosis does not necessitate a death sentence, but in an LMC, it can when the illness is exacerbated by the environment. The Ugandan case above helps us unpack the multitude of issues that contribute to the problem – inefficient health systems, replete with endless waits, shortages of everything, hidden fees and lost lab tests – that compound the stigma and poverty that prevent the sick from going to the clinic. The inequalities of access that have plagued efforts to address infections are only going to be more apparent when applied to the longer-term NCDs. And according to a report by the World Economic Forum and the Harvard School of Public Health, “the cumulative costs of NCDs will be at least $47 trillion from 2010 through 2030, with mental illnesses accounting for more than one-third of the cost. This is a low-end estimate.”

This is all fundamentally important because it necessitates a shift in global health governance, whose architecture has been designed to combat urgent and communicable disease. The annals of public health have a storied history in lepers, and smallpox, and the great killers – the Spanish flu and bubonic plague. Some of these continue to evade our efforts. However, NCDs will be a growing problem because the international response to address them will be more difficult, time-consuming, and costly than many of the other public health campaigns undertaken in the past. NCDs have longer timeframes, less direct causation, are less visible and will need to engage not only public, but private actors, as well as societal change.

Their cause goes beyond individual choices, with larger, structural forces at work, shaping our longevity. A poor national health care system is one such example. But on top of that, we must consider the impact that multinational systems of economics and trade have had upon the rise of NCDs. John Norris writes about an example in a recent Foreign Policy article: the saga of Samoa and the American turkey tail. These tidbits, at 40% fat, are a byproduct Americans do not want. After WWII, marketers for the poultry industry began dumping them in Samoa, where they became a local delicacy. By 2007, Samoans were eating more than 44 pounds of turkey tails every year, and obesity rates reached 56% by 2008, as the tails and other imported foods edged out the local diet. Many Samoans believe that foreign goods are superior to locally-produced items. Samoan officials tried to ban turkey butt imports in 2007, pleading with the WHO for help in combatting American poultry companies. Meanwhile, the WTO blocked Samoa’s application for membership. The debacle bogged down Samoa’s WTO application for years, until it agreed to open itself back up to the fatty imports in 2011. The president of the USA Poultry & Egg Export Council stated “we feel it’s the consumers’ right to determine what foods they wish to consume, not the government’s.” NCDs do not always have direct correlation with one specific food or product, but that does not discount that our international trade and corporate practices are having a definite impact on waistlines around the world.

Hope lies in the fact that there are spaces in which communicable and non-communicable diseases overlap, and best practices from one field can be applied to the other. There are direct correlations found between the two (see: the HPV virus and cervical cancer.) Regardless of whether we’re facing a case of river blindness or pre-diabetes, we will always need a robust health system, that is fully-staffed and sustainably financed, that individuals can access without barriers or stigma. Public health initiatives will need to target issues of prevention more than ever before, and we’ll need to better highlight the linkages between corporate, government, and personal entities that contribute towards our declining health, to find opportunities where programming such as support groups and other platforms can counter them.

P. S. If you fall on the same side as the USA Poultry & Egg Export Council, and paternalism holds you back from supporting more government initiatives against NCDs, I would insist that there is already paternalism in the choices that have been determined for us before we were born. Our work schedules. The costs of seeing a doctor. The costs of educating a doctor. Profit margins. Did you know that companies such as Kraft and Nestle have entire research wings dedicated to engineering a food’s “bliss point,” which is achieved when a consumer’s brain receptors will continue to crave that food without ever triggering the mechanism of feeling satiated? These are just examples of some larger barriers that limit our options in making healthy decisions. It wasn’t until my freshman year of college that I learned there were so many more varieties of apples than I’d seen in grocery stores, after we looked at an heirloom seed catalog in an honors class. For 17 years, those alternatives had been hidden behind a corporate curtain that limited my choices down to those types that are easiest to grow and ship. The Granny Smith. Fuji. Pink Lady. Those were all choices pre-determined for you. And because just a few corporations produce almost all personal consumer products we buy, this pre-selection matters because these goods go directly in or on your person. Public governance is in a unique position to counter corporate influence in a way that individuals alone cannot.

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ALEXANDER BOWE

"Protect Medical Workers' Safety." Courtesy of Caixun.

“Protect Medical Workers’ Safety.” Courtesy of Caixun.

In the fall of 2009, I interned in the traumatology ward of Hangzhou Chinese Medicine Hospital in order to study sports medicine as part of my martial arts practice. I had hoped to see bone-setters at work, but the overwhelming majority of the patients were simply elderly people with bone spurs or degrading artificial hips that were giving them trouble. Unfortunately, the only thing that could be done for most of those patients was to give them herbal poultices and/or modern painkillers; I was told by the doctor whom I shadowed that back in the seventies and eighties – when the country was first beginning to develop – doctors saw a lot of car accidents and other industrial injuries. These days, however, all they got was old people with disintegrating bodies – great for China, but not so great for my ambitions of studying traditional bone-setting. Then, one day, a woman was rushed into our ER. She had been bitten by a poisonous snake while laboring in a field; she was still dressed in her work clothes and her hand had swollen up to twice its normal size. She had been driven into the city from her hometown, several hours away from our hospital. I asked why she hadn’t just gone to a more local facility and was told, “No one trusts rural clinics. They all think that you have to go to a big one in the city to get any kind of decent help.”

Many Chinese are extremely dissatisfied with the state of China’s healthcare system. The world has seen in the last couple of weeks just how frustrated some in China are over its healthcare situation, which causes many people to act under the same assumptions as the anecdotal snake-bitten farmer. China’s urban hospitals are constantly overwhelmed by patients who have traveled great distances, resulting in an even higher strain on the already insufficient system. The too-few doctors are being spread far too thin to be effective: according to the Wall Street Journal, in 2010 there were only 1.4 doctors per 1,000 Chinese, meaning that average appointments only last a few minutes. Chinese doctors are even notorious among expatriates for making shoddy diagnoses with potentially severe ramifications. China’s medical system has been broken for quite some time, in fact. Rising costs and under-trained professionals are just the tip of the iceberg.

During the Cultural Revolution, rural China relied on so-called “barefoot doctors” (chijiao yisheng), minimally trained medical workers whose expertise mostly covered basic hygiene, preventive healthcare, and family planning, since professionally trained doctors were rarely willing to work in remote areas. This system was highly effective in many areas but ceased in 1981 as part of China’s larger shift away from collective-based management. As a result of the shift from healthcare provided by collectives to privately managed healthcare, coverage in rural China dropped from 90% in 1981 to just 7% of all counties by 1999. Since 2002, government-funded rural health insurance in the form of collective medical schemes (CMS) that mimic the old barefoot doctor system in some ways has significantly increased rural coverage: by 2009, 94% of rural counties offered coverage under CMS. The amount of coverage provided under these schemes, however, is still relatively low: current premium subsidies are about ¥80 (roughly $13) per capita. The legacy of poor coverage since collectivism effectively ended and the current low coverage levels are some of the factors that drive rural Chinese to ignore their rural providers and travel to cities instead, which results in the overwhelming of urban infrastructure.

The rising costs of healthcare in China remain a huge obstacle even where coverage is available. By 2020, total healthcare expenditure is expected to hit $1 tn as China continues to modernize its infrastructure. A great part of this cost is due to the increasing ubiquity of Western medicines. Traditional Chinese medicine (TCM), which relies mostly on formulas composed of plants, animals, and minerals, all of which are collectively referred to as “herbs,” is still common and is generally less expensive than allopathic medicine since it does not rely on costly chemical processing and manufacturing. However, the use of allopathic drugs has shot up over the last couple of decades while the prevalence of traditionally trained TCM doctors has declined: as of 2007, there were only 270,000, half as many as in 1949, while the number of Western-trained doctors had increased by a factor of twenty to approximately 1.7 million. Currently, as much of 40% of China’s healthcare expenditure goes to medicine, compared to 10-12% for most Western countries. Part of this abnormally high cost, as has been revealed in the wake of the ongoing GlaxoSmithKline pharmaceutical scandal, is due to corruption and bribery aimed at increasing profits. Public hospitals are often encouraged to over-zealously prescribe medications to patients in order to gain more revenue; this, combined with the high prices, amounts to an extraordinarily high overall expenditure on medicine.

The high cost of medicine and lack of sufficient coverage, however, are only two of the problems confronting China’s healthcare. The recent hostility toward medical workers has exacerbated doctors’ resentment of the poor working conditions that the overcrowded hospitals have created. In addition to the widely-publicized fatal stabbing in eastern Zhejiang on Friday, October 25, there has been a rash of attacks at Chinese hospitals over the last few years: in 2010, there were more than 17,000 attacks spread across 70% of China’s hospitals.According to a 2013 survey of doctors by the Chinese Medical Doctor Association, 80% of the respondents said that they would not want their children to enter the medical industry, up from a 2009 survey in which 62.5% of respondents gave the same answer. The number of responding doctors which expressed this opinion has consistently increased each time the survey has been administered since 2002. Most of the doctors who responded also indicated that their salaries “didn’t match how much work they put into their jobs, and that tense doctor-patient relationships and enormous amounts of pressure at work are creating a negative attitude toward their jobs.”

Clearly, both patients and medical staff are extremely dissatisfied with the current state of China’s healthcare infrastructure. It will be absolutely necessary to continue to modernize and ramp up government spending in order to both make care more affordable and to decrease the individual workloads of doctors. This will be especially crucial in the coming years as China gets older and thus becomes more susceptible to chronic degenerative diseases. In addition to the rising risk of cancer and heart disease, which are now China’s top killersaccording to a new study, half of all adult Chinese may be pre-diabetic, meaning that many Chinese will likely depend even more heavily on the medical infrastructure in the near future than they do now. At its current levels of coverage and quality, the system just won’t cut it. It is often said of China that its main problem is “getting old before it gets rich”; getting sick before it gets rich may be more than the system can handle, and it may once again become the “Sick Man of Asia” but in a more literal sense than ever before.

Alexander Bowe has an MA in International Studies from the Korbel School and is currently a doctoral candidate in Political Science at Tsinghua University.

Preexisting Conditions: A Brief History of the Modern Chinese Healthcare System

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Meet me where I’m at

MAJO ALDANA

A lot has been written about barriers to accessing health.  There are many journal articles and research papers on this topic, and on ideas of how to overcome them.  I’m not trying to reinvent the wheel, so this is simply an attempt to write about some of the things I have seen in the past months. While working at HIPS, doing direct services with different sub-populations in Washington DC, I’ve learned about barriers to health and simple (and complex at the same time) ideas to start addressing these barriers.

I recently went to a talk on Hepatitis C (HCV) and how it is disproportionately affecting African Americans in the United States.  According to the CDC, more than “75% of adults with Hepatitis C are baby boomers, i.e., born from 1945 through 1965” and within “the African American community, chronic liver disease, often Hepatitis C-related, is a leading cause of death among persons aged 45-64 years”.  Many of the clients that HIPS serves fit into this category.  One of the health services HIPS provides is HCV testing and counseling, and although we are reaching a lot of people, there is still a lot to do in the city.  As I was listening to the different speakers, I just kept on thinking about our clients, and how we could talk about HCV and encourage more people to access testing.  But testing for HCV is not the hardest part. It’s what happens next: whether the results are negative or positive.  How can people remain HCV negative, what can they do to reduce the health risks, how can they access treatment and accompaniment if they are positive, and how can we reach out to that percentage of the population who doesn’t even know they could have HCV?

A few days after the HCV talk, while doing night time outreach with HIPS around DC, I encountered several Latino clients, who were happy and even relieved that there was someone who could give them information and answer a bunch of questions they had about safer sex practices in Spanish.  One man, originally from Mexico, was very shy at the beginning, but after being surprised I was a native Spanish speaker, started asking me questions about different condoms, HIV testing, and risky behaviors.  He shared some concerns regarding his health, and that of his partner, so I shared some information, specifically about organizations that were closer to where they live in the city and that have Spanish-speaking staff. He told me, “Oh, I know about that clinic, but I lost my health insurance, and they won’t cover us for that.  Plus it’s really hard to go to some places, with our work schedules.”  After giving him other referrals and answering his follow-up questions, we left to keep on with our night route.  I couldn’t stop thinking about him and his wife, and how they were so frustrated, confused and fearful for several weeks, because they had not been able to get information or health services according to their needs.

These brief examples illustrate many of the barriers that people face to accessing health.  And although they seem very clear, they are complex in so many ways.  Outlining them is important, so that we can start thinking about possible alternatives to addressing them.  Some of the most important and interconnected barriers I could identify (and I’m sure there’s more I have overlooked) are the following:

  1. Limited access to education, and specifically health education and information.
  2. Limited access to prevention, treatment and post-treatment care (this includes hindered access to health insurance).
  3. Generational gaps and differences between age groups.
  4. Ethnicity and race, and the social constraints that are embedded in these.
  5. Language.
  6. Citizenship and immigration status.

And so, we could start addressing these complex barriers to accessing health by taking some simple and complicated issues into consideration.

Talking to people in their language.  By this I don’t only mean to talk to people in a language that they can understand because that’s their first or native language, I also mean talking to people using intelligible vocabulary.  If you are trying to reach out to an African American man in his late 60’s, veteran, currently using intravenous drugs . . . talk to him in his language.  If you are trying to reach out to an undocumented working Latina in her forties who thinks she is HIV positive . . . talk to her in her language. Meet them there, at this point of their life’s journey, acknowledging that they have knowledge and power. Knowing that you have the privilege to be sharing health information with them, meet them at their education level, generational understanding of well-being and health, and socioeconomic status.  Start there.

Promoting spaces for people to ask questions.  People know what they want and need. Ask them.  Listen.  Meet them there.  Provide as many safe spaces as possible for dialogue, health education and information sharing.  Design education materials and strategies taking into consideration important characteristics of the populations you are trying to reach (and ask people what characteristics are important for them in the first place).  How can we convey the important message of HCV testing within the 45 to 65-year-old generation among African Americans in DC?  Start by asking them.  We must pay attention to the social and cultural contexts of populations, so that the educational strategies are more effective and efficient.  And provide information so that people can make better informed decisions, without forgetting that people can decide whatever they want.

If I was trying to access a health service or ask questions about my health to a service provider, I would like her or him to meet me where I am at.  I would want that service provider to not patronize me, to understand that I am an empowered individual in some areas of my life, and that there are some barriers (that I might be able to point out on my own) for accessing health.  I would want that health service provider to talk to me as a person.  If you wanted to access health services, you would want to be treated in a similar way.  So let’s do that for others.  Meet clients, patients, and community members where they’re at in terms of their health, their needs and their context.  Let’s start there.

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China’s Main Internal Challenges In the Next Decade

ALEX BOWE

As China’s celebration of Golden Week, the holiday commemorating the founding of the People’s Republic on October 1st, 1949, winds down and millions of Chinese return to their everyday routines, it is a time to consider the obstacles that the world’s most populous nation currently faces. China’s famed economic growth has been slowing recently and many wonder if Beijing will be able to persist and maybe eventually overtake the United States. In a recent book, Yan Xuetong, the Dean of Tsinghua University’s International Relations Department and one of China’s most prominent public intellectuals, optimistically forecasts that China will, in fact, be able to maintain its growth. Yan argues in History’s Inertia (lishi de guanxing), his new book, that China should be able to maintain its economic boom over the next decade and maintain an annual growth rate of roughly 5% after that, which will be enough to see China become a global superpower. The key to achieving this, Yan asserts, is introducing substantive reforms that will allow the country to adapt and overcome circumstances just like during the “reform and opening” that Deng Xiaoping oversaw in the 1980s. Those reforms allowed China to recover from decades of stifling central control and grow into the powerful nation it is today. Here is a rundown of some of the main issues these new reforms will have to address in the coming years. All of these topics are worthy of extensive and in-depth exploration, but a brief overview will suffice for now.

Corruption: This is probably the most serious issue because no matter what reforms Xi Jinping and co. introduce, nothing will happen if Beijing can’t enforce them adequately and uniformly, and local government officials are notoriously evasive when it comes to doing things that they don’t exactly want to. As I predicted in an earlier post, Beijing seems intent on demonstrating that it is serious about cracking down on high-profile corruption; Bo Xilai’s life sentence, which was harsher than many expected, is a strong indicator of this seriousness. Beijing’s merciless conviction of one of the nation’s most well-loved and well-pedigreed rising political stars should have sent a clear message to those who might consider graft or using their offices for personal gain. Xi has gone on the record saying that tackling corruption is his highest priority; taking down a highly visible crook is one thing, but most Chinese are more concerned about small-time official corruption than headline-grabbing national cases. The local corruption cases are the cause of most of the things that make the Chinese lose faith in their government, such as poorly constructed infrastructure projects that collapse, contamination of food due to poor industrial oversight, and a general lack of faith in the justice system. For real success over the long term that will help maintain the public’s confidence in the government, Beijing needs to keep doing more to create a pervasive anti-corruption culture in all levels of government, not just catch the big fish.

Population and labor force: China’s population is expected to peak at 1.4 billion around 2026. While a population as large as this brings its own particular problems, the biggest threat to continued Chinese growth and stability stemming from this is the dependency ratio. The dependency ratio is the number of non-workers (i.e., dependents) to workers in an economy and is a crucial indicator of growth prospects; an economy that is too weighed down by elderly and children will have difficulty accumulating savings, among other things. China is aging quickly, setting up a series of major problems later on. This is tied to the fertility rate, which has been falling for decades and is currently 1.56. China’s labor force peaked in 2011 and saw a decline of .6% in 2012. As the labor force continues to shrink, China will be hard-pressed to keep up its economic growth. Beijing has been thinking about reforming the One Child Policy for some time but has only adopted the mildest of modifications. Improvements will not happen overnight even if radical policy changes are made; indeed, with a chronic problem like this, only long-term solutions can work, so radical adjustments would not help even if the Party wanted to take that route. Since there will not be enough working-aged adults in China to comfortably support both themselves and dependents in coming years, one solution may be to allow in more immigrants, but given the already huge population, this is politically sketchy at best. There have been other consequences of China’s artificially manipulated fertility, such as gender-based selective abortions that have caused men to severely outnumber women, but arguably the labor force issue is poised to create the biggest stumbling block for the country.

Pollution: China’s pollution problem includes both air quality and contamination of other natural resources. As was mentioned in an earlier post, Beijing is planning a massive 1.7 trillion RMB initiative to combat smog. This plan will reduce PM2.5 contamination by 25% , lower Beijing coal use by 50%, cap the number of vehicles at 6 million, and force 1,200 companies to either close up or meet stricter standards by 2017. This plan, if successful, could prove to be a model for the other Chinese cities that suffer the most from smog – Beijing isn’t even the most polluted – and go a long way toward satisfying the demands of the increasingly well-off urban middle class for cleaner living. The more the government is associated with unclean air, the less legitimacy it will retain in the eyes of the public as the effects become increasingly visible. Cleaning up the air and water will be crucial both to maintain the Communist Party’s legitimacy and to keep the health of the Chinese people from being harmed any further than is already unavoidable.

Water: China has about 6% of the world’s fresh water supply and has to provide for a fifth of the entire human race with that amount. According to the Wilson Center, however, one out of every two gallons of water in China is polluted. Half of all groundwater and 2/3 of all surface water is contaminated. This is largely from industrial pollution but also from power generation: 70% of all power in China comes from coal, consumption of which will increase as much as 30% in the near future. What’s more, the processing and use of coal requires a great deal of water, which is already scarce in much of China: 80% of the nation’s coal comes from water-scarce regions. Further complicating this is the fact that most of China’s water is in the south, whereas most of its agricultural land is in the north. The government has just finished a massive undertaking to re-route water from the southern, more heavily populated regions to the relatively sparsely populated north… in order to grow the food with which to feed the population-heavy south. China, as the world’s largest grain producer, desperately needs water to grow its food but at the same time is increasing its use in power generation, which demands more water, leaving less for domestic use. At current rates, China is expected to be more or less out of water as soon as 2030. Beijing desperately needs a solution here since water is literally the sine qua non of everything else it might wish to do: without a stable water supply, no country can hope to survive. A good place to start would be to cut back on energy that requires water – the tricky part is that most methods of conventional power generation also require water, not just hydropower – and to import more grain while decreasing domestic production, but this problem has no easy solution and few hard ones.

Human rights: Yan Xuetong believes that as China’s power draws nearer to the US’s, the differences in the ideological aspects of their political institutions will weaken, which will include their views on human rights. For the time being, however, Beijing is infamous for its problematic relations with ethnic minorities, its issues with human trafficking, and its harsh crackdowns on political dissenters. In order to be viewed as legitimate in the eyes of the world, Beijing must attempt to resolve these matters favorably. Even the issues that seem simple, however, like internet restrictions, are politically difficult: as long as the Party fears that an open and free internet will undermine its power, net access will remain restricted. Some observers were hopeful that a new free trade zone in Shanghai with unrestricted internet access might herald a new liberality in this regard, but these reports were ultimately proven false for now.

Much of early Chinese political thought strongly emphasizes the aspect of morality in the leadership of a state; if a state is governed with morality, others will naturally be drawn to it and validate its authority without a need for subjugation by force. In the 7th century BCE, Guanzi wrote, “If a country is large but governed by one who is petty, the country will be governed in accordance with that man; if the country is small but governed by a great man, the benefit to the country will be great.” Without this element of morality, only military strength will be able to maintain a country’s status, which will fade as its power does. This is the difference between “humane authority” and a hegemony or tyranny. If China is to become (and remain) a superpower over the next decade, humane authority will be the only way to both overcome its current obstacles and remain stable in the future. If it tries to hold onto power merely through sheer force and fails to address its underlying critical contradictions, as other superpowers have tried to do in the past, it may end up on the ash-heap of history, after all.

 

Alexander Bowe has an MA in International Studies from the Korbel School and is currently a doctoral candidate in Political Science at Tsinghua University.

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Should We Fear the GMO?

Photo source: AP.

MORGAN DAY

Few debates in the realm of agricultural development are more challenging (and aggravating) than that surrounding genetically engineered crops. Largely, the debate has been reduced into “point-counterpoint” style argumentation—should GMO foods be labeled?  Are GMOs detrimental to human health and/or the environment? Are GMOs the economic answer for agricultural and food security growth throughout the developing world? You likely have your own answers to some of these questions, with reasonable explanations for why you fall down on one side or the other.

My key frustrations with the GMO debate derive from an overwhelming  “us versus them” mentality in which “my team” has to win, even if the “other team” has some good ideas or points. As Jonathan Foley once said, “You’re either with Michael Pollan or you’re with Monsanto, but neither paradigm can fully meet our needs.” This is a nuanced issue, but the politicization of GMOs often results in emotionally-charged, ideologically-hard lined discussion. I certainly have my own biases, and generally am more in favor of traditional crossbreeding techniques than genetically engineering (GE) crops or animals. And I understand why GMOs are scary—there are many areas of uncertainty or of potential negative impact in their use. But fear alone should not be the driving reason behind opposing their use. In my time working and debating at The World Food Prize Foundation in Des Moines, IA, and over the course of my studies at the Josef Korbel School, three key “fears” surrounding GMO use arise again and again

1. Fear of environmental impact.
Remember Gregor Mendel and his pea plants? While he methodically selected for genetic robustness in his crops, he was not a genetic engineer in today’s sense of the term. GE or GMO crops, “are plants or animal created through the gene splicing techniques of biotechnology” which cannot otherwise occur naturally or through traditional crossbreeding techniques. This leads to philosophical questions about our role in modifying nature—do we get to play God(s)?—and if these modifications pose true threats to our environment and our health.

Apart from potential existential crises caused by considering our role in modifying (or not modifying) nature, GMOs do pose a threat to naturally-occurring flora and fauna, as their introduction to stable ecosystems can result in outcrossing or loss of biodiversity. For instance, many GMOs are created to be weed- or pest- resistant. Introduction of these resistant crops may lead “the [natural] development of more aggressive weeds or wild relatives with increased resistance to diseases or environmental stresses.” Biodiversity loss is a complex issue in and of itself, but increased GMO is one of the many drivers that leads to “the displacement of traditional cultivars by a small number of genetically modified cultivars,” either through farmer selection to grow GMOs, by GMO cross-pollination, or by market- and price-based marketing and consumer decisions to prefer GMO products over traditional cultivars.

For many fearful of GMOs’ environmental impact, the use of pesticides and fertilizers necessary to maintaining healthy GMO crops is the most alarming. Although many biotech firms maintain that their product lines both effectively control weeds and decrease the overall use of pesticides, herbicides, and other harmful chemicals, studies show that GMO technology has risen since the wide-spread availability and use of GMO crops. (This impact has been most studied on RoundUp Ready crops). When considered in the context of general problems with commercial agriculture—labor codes or lack thereof, poor safety precautions for workers, environmental regulations to monitor and control agrichemical run-off into waterways—there are a number of negative impacts on environmental and human health inevitable with increased use of GMOs.

2. Fear of health impact.
Many of the environmental fears dovetail with fears about GMOs’ impact on human health. (We’ll side-step the issue of animal health for the time being, as the implications for animal well-being warrant their own nuanced debate). The World Health Organization determines the safety of GM foods by investigating “(a) direct health effects (toxicity);  (b) tendencies to provoke allergic reaction (allergenicity); (c) specific components thought to have nutritional or toxic properties; (d) the stability of the inserted gene; (e) nutritional effects associated with genetic modification; and (f) any unintended effects which could result from the gene insertion.” GMOs which are currently on the market have passed these investigations, and are currently deemed safe for human consumption. However, rigorous scientific studies have produced mixed results on whether GMO foods are safe for humans: “some have vindicated no safety differences between GE and non-GE varieties, while others have demonstrated potential harm.” This ambiguity among the scientific community about the safety of GM products (and about the best methods to test for safety) has led to fears about ingesting GM foods. Caution in this instance is sound, but I find myself wondering why consumers are eager to trust science to make us more healthy through pharmaceuticals, innovative surgeries, and other medical means, but not through directly modifying our food sources.

3. Fear of dependency or economic oppression.
Part of the argument in favor of GMO use is the promise of increased crop yield through minimizing pestilence and maximizing the amount of crop grown per acre or hectare. This has clear positive impacts for farmers, especially for smallholders with small amounts of land and resources. By growing more of a crop, farmers are able to maximize their economic gain, to reinvest in the farm, and to purchase necessities for their family like schooling, food, health care, clothes, and shelter upgrades. This can also result in an increase stock of food at local, national, and regional levels, allowing consumers access to more food and allowing governments more security in protecting national food stocks against the vicissitudes of the international commodities market. These impacts of GMO use seem relatively positive. Poor farmers can grow more, make more money, and potentially generate more food for their fellow man.

In the context of human and economic development, fear of GMOs is based on a fear of creating dependency on GMO crop inputs and the multinational agribusiness firms which purvey them. Agribusiness firms which sell GMOs and their associated products—seeds, pesticides, herbicides, fertilizers, etc.)—often carry strict patents and intellectual property protections which necessitate annual rebuying of seed (and the fertilizer, pesticide, and herbicide made specifically to complement and support the seed), or the payment of a technology royalty to the company to continue using patented seeds. (As an aside, not all GMO seeds are sterile, although the technology to create sterile seeds exists. Many so-called “facts” about GMO seeds are actually more myth than reality, as Dan Charles’ article outlines.) Given the protections on seed technology and their relatively high level of enforcement, many fear that a dependency on agribusiness firms and their wares will outweigh the potentially positive outcomes of GMO use for farmers.

These fears exist for legitimate reasons, and I am truly concerned about GMOs’ impact on the livelihoods of smallholder farmers, and on the environment. But we know these risks, and in identifying an ill we have the power to alleviate or eliminate that ill. As with any technological breakthrough, we should exercise an abundance of caution in how it is woven into the fabric of society. GMO use has resulted in Norman Borlaug’s Green Revolution in the 1960s, to increased crop yields and increases in farmer livelihoods, and to more abundant food stocks in countries once depending on imports for the majority of their food. And what’s more, each GMO presents its own unique case, making it dangerous to declare all GMOs safe or unsafe. For each positive outcome GMOs have brought, there are hidden risks and obvious costs. But the moment we allow our fear of the unknown to deter scientific advancements—advancements with life-saving capabilities for huge numbers of people in the developed and developing world—is the moment that we give up on developing a better global food system, and a less-hungry world.

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The Korbel Report’s Weekly Link Roundup

The staff of The Korbel Report spends its fair share of time on the internet staying up-to-date on a wide-range of international news and trends.  Here’s a list of the articles, blog posts, and resources we found interesting, enlightening, or infuriating this week:

Did we miss your favorite link from this week?  Let us know in the comments, on our Facebook page, or Twitter @korbelreport.

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Understanding HIV/AIDS: The Treatment Cascade

SOPHIE DILA

The global HIV/AIDS epidemic does not seem to be a major threat anymore. These days, we see increasing news coverage about declining HIV rates, innovations in treatment, and even HIV cures. These success stories highlight incredible strides made over 30 devastating years of the pandemic, but the fact remains that there is so much work left to be done before we can even begin to contemplate an AIDS Free Generation.

The concept of global health is relatively new within the international relations and security spheres. Indeed, the HIV/AIDS pandemic was one of the first major examples of a disease that knows no borders and can affect anyone – gay or straight, Black or White, drug users or high-profile celebrities. Global health has profound implications for international relations practitioners. Whether you’re a Peace Corps Volunteer working in an HIV endemic area in Ukraine, a diplomat working at an embassy in Botswana, or a humanitarian aid worker assisting in a refugee camp in Lebanon, you will encounter global health issues, including HIV/AIDS.

Even within the US, 50,000 people continue to become infected with HIV each year, despite major advances in the struggle against AIDS. There has been no significant reduction in the disease rates in recent years, and it appears that despite our best efforts, HIV prevention has come to a standstill. If we can’t get to zero new infections at home, how are we expected to achieve an AIDS Free Generation globally?

Here is a new way of understanding the epidemic – it’s called the HIV Treatment Cascade. Watch the video, it’s great.

This waterfall concept clearly identifies the major pillars of HIV prevention, treatment and care that we need to focus on to successfully target and eliminate the drivers of HIV risk. HIV/AIDS is still a major global threat. We need to transform and revolutionize our response to this disease to meet individuals where they’re at in their unique circumstances. If we can improve health systems, link more people to HIV care, keep those people in care, expand treatment and bolster adherence support – all the while keeping in consideration the individual, cultural, social and economic context – then maybe someday we can get to zero new infections.

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The Korbel Report’s Weekly Link Roundup

The staff of The Korbel Report spends its fair share of time on the internet staying up-to-date on a wide-range of international news and trends.  Here’s a list of the articles, blog posts, and resources we found interesting, enlightening, or infuriating this week:

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To Call Or Not To Call

MARIA JOSE ALDANA

You are at a house party of a friend, of a friend, of a friend.  It has been a crazy night, and you go upstairs to take a break and wash your face in the sink.  When you open the door to the restroom, you find a person who is overdosing. What do you do? Do you call 911?

According to the CDC, “deaths from drug overdose have been rising steadily over the past two decades and have become the leading cause of injury death in the United States”.  Many of these deaths could be prevented if people could receive timely medical attention.  However, the fear of police involvement and potential arrest or prosecution, stops many people that witness an OD to call 911.

I just moved to Washington, D.C. to work with an organization called HIPS, which works from a harm reduction approach to promote healthier behaviors in individuals that engage in sex work and drug use.  Just last week, I learned about a new law that was passed in DC this year.  A representative of the Drug Policy Alliance came to the office to speak about the 911 Good Samaritan Overdose Law.  Any Good Samaritan Law aims to protect those who offer assistance to people who are injured or in danger of peril, from arrest or prosecution from “wrongdoing”.  In this particular case, if you witness an OD and report it to 911, this law protects you from being arrested or prosecuted for drug possession.  New Mexico was the first state to pass a Good Samaritan law, in 2007, and today, a total of fourteen states plus DC have passed it so far.  The law protects “only the caller and overdose victim from arrest and/or prosecution for simple drug possession, possession of paraphernalia, and/or being under the influence”. Continue reading

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Breastfeeding: Nourishing the Future

Promoting healthy motherhood saves lives. 222,000 lives, in fact, if all babies are breastfed within the first hour of birth and given only breastmilk for their first six months.

Promoting healthy motherhood practices saves lives. 222,000 lives, in fact, if all newborns are breastfed within the first hour of birth and given only breastmilk for their first six months.

XIAN ZHANG

Think about the most magical liquid you have ever interacted with. Does your brain drift to something alcoholic? Is it water? Or something more technical and hydraulic-y and tech-specific? Few people may land upon breastmilk. But this humble substance has hidden, mystical properties. This food source does more than sustain: it is the Vishnu of multi-tasking – stimulating the baby’s gastronomic tract, promoting the child’s metabolic efficiency and immune system, and helping the mother lose weight and reduce the risk of cancers and anemia, all at once. Did you know that breastmilk changes its composition to suit the baby’s needs? And contains more than 700 types of bacteria? And that newborns can touch a surface contaminated with germs, then return to their mother, at which point, the mother’s skin picks up on what germs the grubby one has brought back, and her body produces antibodies in the breastmilk to help the child combat those germs? Newborns often spit up, and parents believe this is a normal step of feeding. However, it is because their stomachs are the size of marbles, and cannot stretch. In the first few days after birth, the mother produces colostrum, which is thick, yellow, packed with the appropriate nutrients and antibodies, and the perfect amount for that marble-sized stomach. Breastmilk can do all of these incredible things because it co-evolved with human beings to ensure that our newborns were provided with the most essential biological tools when they are the most vulnerable. Continue reading

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