Tag Archives: Xian Zhang

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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Postcard: Wilson Center

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Greetings from the Director’s Office, here in the Wilson Center! Located in the same building as USAID and snuggled next to the Dept of Commerce, IRS, EPA, and the White House, the WC is a bipartisan research and policy center that is also the official living memorial for our 28th president. The Wilson Center provides a strictly nonpartisan space for the worlds of policy-making and scholarship to interact.  By hosting experts and scholars from around the world, releasing critical reports, and hosting events, the Center convenes policy-makers into a dialogue about the challenges facing the US and the world today. My impression so far is of a collegial environment, where colleagues interact in a very egalitarian and genial way. The institutes and programs are run hyper-efficiently, with little bureaucracy in sight.

Our boss, Jane Harman, has been serving in her current role since 2011, and is the Center’s first female Director, President and CEO. As a former Congresswoman, she served on all major security committees, and is recognized as a national expert on the nexus of security and public policy. She has received the Defense Department Medal for Distinguished Service, the CIA Seal Medal, the CIA Director’s Award, and the National Intelligence Distinguished Public Service Medal. Nowadays, in addition to running the Center, she serves on the policy boards for the Dept of State, Defense, Homeland Security, Director of National Intelligence and the CIA. As queen of networking, she maintains close contacts with people as diverse as Secretary Hagel to Wolf Blitzer to ambassadors to supreme court justices. She appears often on CNN and Fox News, and travels regularly to attend events both domestically and internationally. The energy and passion she demonstrates in her work is incredible.

As her interns, our main role is to stay on top of news and current research. For example, we recently received the Presidents of Somalia and Burkina Faso. When these events were upcoming, we kept busy monitoring and synthesizing information from the relevant regions, and processed it into internal memos for her situational awareness and public talking points. I guess if you boil it down, our role is to make sure she always looks good. It’s been such an engaging experience, as I’ve gained more institutional knowledge into areas such as cybersecurity, the NSA, and the ME/NA region. So much of foreign policy is simply staying on top of the news and commentary surrounding critical issues. In between large tasks, my fellow intern and I keep our eyes out for free food from Wilson Center events, and are always busy with random assignments. I’ve called an Italian hotel long-distance. We took a call from Secretary Kerry’s office. For high-level visits, I went to IKEA to pick up a new tea cart, which I’ve never been in the market for. When picking up a delegation of Egyptian politicians from their hotel, I memorized how to say “Good morning” in Arabic, and loved that the men could walk arm in arm.

Every morning, I walk past President Wilson’s bronze cast in our lobby, and always appreciate the impact he had on US foreign policy. I’ll leave you with some of his words, for all you practioners of international affairs and rights and security:

You are not here merely to make a living. You are here in order to enable the world to live more amply, with greater vision, with a finer spirit of hope and achievement. You are here to enrich the world, and you impoverish yourself if you forget the errand.

Now if only Congress could get their act together, we can finally move forward in that errand together.

Be well,
Xian Zhang

This post reflects the author’s opinion only, not the official views of the Wilson Center. All photos are credited to the Wilson Center. 

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The Question of the Day

Win McNamee/Getty Images

General Martin Dempsey, Secretary John Kerry and Secretary Chuck Hagel testify in front of the Senate Foreign Relations Committee. (Win McNamee/Getty Images)

XIAN ZHANG

As a complicated issue of how to uphold an international chemical weapons convention, without becoming entrenched in a foreign country’s civil war, Syria is a fine balance between doing too little and doing too much. Toss in broad uncertainty towards the parameters of a limited kinetic mission, and it is unsurprising that it has managed to unite bipartisan support, both for and against US intervention.

Opponents of the resolution question whether US strategic interests are truly at risk, what the limited military response would accomplish, and why more states have not pledged their participation when this is not only President Barack Obama’s red line, but “the world’s red line, humanity’s red line,” according to Secretary of State John Kerry. They also question the timing, and what precedent this sets for American intervention in the future. Some Congressional members are skeptical of whether either side is worth supporting, perceiving a dictatorial regime on one hand, and rising radicalism among the rebel groups on the other.

Sec. Kerry and Secretary of Defense Chuck Hagel responded that the focus is not upon choosing a side, but upon what the US should do in direct response to the breaking of an international agreement. Their main strategic goal for this limited military strike is to detract from President Assad’s ability to utilize chemical weapons in the future. It is clear the Obama administration would like to avoid involvement in a civil war that is in desperate need of a political solution. Sec. Kerry and Hagel also repeatedly asserted that it is in our best interests to enforce an international standard that protects American soldiers and allies in the region. Iran and North Korea were evoked, as cheerleaders of US inaction. Sec. Kerry goes on to assure representatives that, based upon current intelligence, he is 100% confident President Bashar al-Assad will continue to utilize these weapons routinely, if the US remains idle.

The global response has been lukewarm. The UK voted down military action, Russia continues to question who utilized the weapons in the first place, and Turkey, Jordan, Lebanon and Iraq have petitioned for greater international action against President Assad. As neighbors of Syria, they hope to avoid an increased volume of refugees and are one “stiff breeze” away from future chemical attacks. Members of the Arab League have pledged “significant” funding for US action, with France, Canada, and Australia pledging public support as well. As heads of state convene upon St. Petersburg, the intervention issue is sure to overshadow economic discussions at the launch of the G-20 summit today.

So, what do you think? It seems the flight of a few cruise missiles is nearly inevitable, but do you believe it should happen? Is this an issue of the US being led by emotion – having to prove its credibility, or are we discussing the larger issue of reinforcing international conventions? Unpredictability and risk abound, but there is one thing we do know for certain: the US will be criticized regardless of what it decides, so will we be paralyzed by the no-win scenario or will we show a higher caliber in the American decision-making process?

It is also important to note, in such a simplified poll, that two people who have the same answer may have wildly divergent reasons for those responses. As noted above, Syria’s ongoing civil conflict remains a complex issue with many moving parts, and strong regional, international, short- and long-term ramifications, so it is not surprising that individual American responses to our upcoming actions in the country will be equally mosaic.

To see how your responses compare to a national survey, here is what the Pew Research Center found among American adults between August 29th – September 1st. 

For live updates on this dynamic issue, the New York Times maintains highlights and breaking news on its dashboard, “Crisis in Syria.”

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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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Eradication, Interrupted

XIAN ZHANG

For the first time in six years, the wild poliovirus has been recorded in Somalia. The first reported case occurred in a 2-year-old girl near Mogadishu, who became paralyzed on May 11th. According to the World Health Organization (WHO), Somalia has the 2nd worst polio vaccination rate in the world, leaving immunity gaps – swathes of susceptible and unvaccinated people. This one case quickly became what is currently the worst polio outbreak in the world, with 65 cases reported since May. After genetic testing, the WHO concluded that the strain in Somalia was linked to those circulating in Nigeria.

Infamous for its rapid transmission rate, the virus quickly crossed borders. A week after the Mogadishu case, a 4-month-old girl in eastern Kenya became paralyzed by polio, with two caretakers testing positive for the virus as well. Kenya’s last recorded case was in 2011. Before these outbreaks, it seemed the end of polio was within reach.

In 1988, the WHO set the ambitious goal to eliminate polio. Since then, the reported number of transmissions have been decreased by 99%. By 2012, there were just 223 cases reported worldwide, a record low. Since 1988, $9 billion has been poured into this global effort, with another $5.5 billion needed to finish the job. Why does it cost so much at the end? Those last few hundred people are the hardest to reach, and have missed previous waves of vaccination efforts. Spreading through the fecal-oral route, polio is a disease of access – vaccination workers can’t get to at-risk populations, who in turn can’t get to adequate sanitation infrastructures.

However, when India – previously accounting for 50% of all polio cases – was taken off the list of endemic countries in 2011, the end became tantalizingly close. If such a large country, with a high migrant population, urbanization, and marginalized populations could do it, there was promise that others could follow. That year, polio cases were reported in 11 countries. Promisingly, by 2012, only 4 countries reported cases, with polio endemic in just two regions: northern Nigeria and the border between Afghanistan and Pakistan.

That is why the new cases reported in Somalia and Kenya have been such a huge setback for global eradication efforts. The issue is not only the individual case numbers, but how they will spread. When Nigeria stopped vaccinating from 2003 to 2004, 21 previously polio-free countries became reinfected. From just a few cases, the Horn of Africa, a region with extensive migration, refugee movement and large immunity gaps, is now at high risk for a polio outbreak.

The disease also highlights the complex ties between global health, diplomacy, development and security. It acts as a common thread through India and Pakistan, bringing the arch-rivals into bilateral cooperation that would have been previously unfathomable. In Pakistan, the CIA made the decision to send a polio vaccination team into the suspected town where Osama Bin Laden resided. Those efforts and positive DNA samples led to his eventual capture, while simultaneously harming legitimate efforts to reach rural communities. While the Taliban renounced their war on polio health workers – even encouraging its fighters to aid in efforts when possible – two polio volunteers were shot in Pakistan last month.

To reach the global target of eradicating polio by 2018, every single stakeholder must work seamlessly together: the United Nations as coordinators, donor governments as financial backers, engineers as facilitators of sound sanitation systems, armed groups that respect the neutrality of health workers, and the dedication of the communities themselves to stamp out this virus once and for all. After smallpox, polio is poised to become just the second infectious disease ever eradicated. With so much at stake, its future lies upon the ability of the international community to work together in this pivotal moment.

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