Weekly Health Roundup

As November winds down, we are turning our focus this week to December 1 and World AIDS Day.

In the days leading up to December 1, The New York Times published a piece exploring how expanding technology has changed the nature of India’s sex industry. Women are experiencing both increased autonomy and financial benefits, since they no longer have to rely on brothels. However, this autonomy may pose long-term problems for a country who was once predicted to ultimately become the “focal point” of the AIDS epidemic, and to see 25 million people with AIDS by 2010. Targeted outreach to high-risk groups, including prostitutes were hallmarks of the country’s success. In addition, foundations such as the World Bank and the Bill and Melinda Gates Foundation, provided ample financial resources in support of these efforts. Today, India is dealing with approximately 1.5 million cases of AIDS, a staggeringly different number from what was predicted. However, Gates foundation funding is poised to stop in the coming months. In addition, the fear is that technology will disperse one of the country’s most vulnerable populations, and make education and prevention almost impossible.

But that doesn’t mean groups will stop trying. Yesterday, US Secretary of State Hillary Clinton released the “PEPFAR Blueprint: Creating an AIDS-free Generation”. The plan’s overall vision is that while “smart investments based on sound science and a shared global responsibility” will be key if we want to “save millions of lives and achieve an AIDS-free generation. The plan sees a path to this vision through five over-arching goals:

• Make strategic, scientifically sound investments to rapidly scale-up core HIV prevention, treatment and care interventions and maximize impact.
• Work with partner countries, donor nations, civil society, people living with HIV, faith-based organizations, the private sector, foundations and multilateral institutions to effectively mobilize, coordinate and efficiently utilize resources to expand high-impact strategies, saving more lives sooner.
• Focus on women and girls to increase gender equality in HIV services.
• End stigma and discrimination against people living with HIV and key populations, improving their access to, and uptake of, comprehensive HIV services.
• Set benchmarks for outcomes and programmatic efficiencies through regularly assessed planning and reporting processes to ensure goals are being met.

You can read through the entire PEPFAR Blueprint here.

We have reason to hope. The PEPFAR blueprint comes on the heels of “Results”, a November 20 report released by UNAIDS that finds, among other things, that “between 2001 and 2011, HIV incidence in 25 countries declined by more than 50 percent and decreased by 20 percent worldwide. Since 2005, the number of AIDS-related deaths has declined by almost one-third.” 

Weekly Health Roundup

A message from Adelphi’s Center for Health Innovation

More than two weeks have passed since the devastation caused by Superstorm Sandy swept through the area. As the region begins to repair and rebuild our altered landscape and tattered neighborhoods, we pause to acknowledge the emotional toll imprinted on the survivors. The superstorm, nor’easter, and their aftereffects damaged more than our powerlines and buildings; they further battered an already hardened New York collective psyche. Yet for many, the most fulfilling path to inner healing is to extend a hand outward to aid our neighbors who have lost so much of their livelihoods.

Adelphi is assisting in disaster relief efforts in many ways, from blood and donation drives that address physical needs, to counseling services to address the psychological aftereffects. The University is coordinating volunteer efforts at hard-hit sites on Long Island and Queens, including Long Beach, Oceanside, Island Park, and Breezy Point (visit the link above, then click How You Can Help, then Volunteering at Disaster Locations for more information).

As we prepare for Thanksgiving next week, many area organizations and businesses are working to bring Thanksgiving meals to many still without power, as well as those displaced by the storm. There are bountiful other opportunities to help our neighbors in need throughout the affected areas.

Wishing you the gifts of health, love, and gratitude this holiday season.

Training health professionals for a new normal

by Philip Alcabes, Ph.D.

The public policy scholar Robert Puentes (a Senior Fellow at the Brookings Institution) has advised that we look at extreme weather events — like last month’s Hurricane Sandy — as part of the “new normal.”  To which we can add last year’s Hurricane Irene, the derecho of summer ‘12, a devastating drought in the middle of the country, paralyzing snowstorms in both October 2011 and last week that felled trees and branches that were still in leaf, and so on.

But the new normal – extreme weather, rising sea levels in the Northeast, higher storm surges, and, as the National Aeronautics and Space Administration (NASA) reported, ecosystem change – isn’t just a matter for transportation and land-use planners. 

It means that we need new norms for health – and new ways of protecting the gains in human capacity and longevity won in the course of the previous century.

How will we train a generation of health professionals to be capable of taking on dire problems of tomorrow whose outlines are only beginning to be perceptible today?

Here are five issues to consider in training future health professionals to confront the New Normal:

1. Ecosystem alteration will both accelerate and alter the evolution of microbes.  Microbes outnumber humans (by a lot!) and they can adapt far more readily to changed circumstances.  What will ecosystem change mean for infectious diseases of humans?  What sorts of responses will replace antibiotic therapy – already hopelessly out of date?

1. The great gains in life expectancy of the past 150 years were partly attributable to improvements in waste management and water purification.  How will our leaders protect those gains – when infrastructure is imperiled by rising sea levels, harmed by extreme weather, or out of power?  How will waterborne illness be kept at bay?  What sorts of microbial adaptions will create health concerns even outside of emergency situations?

1. Energy shortages will exacerbate food insecurity – already a serious problem in our region and a pressing one worldwide.  When poverty limits people’s access to nutritious food and failures of refrigeration or shipping curtail the availability of those foods that are (or were) accessible, we can anticipate new forms of debility.  What will our leaders to do guarantee nutritional stability – and how will they do it without amplifying the damage to ecosystems already under way as a result of industrialized agriculture?

1. Communities are challenged not only to develop new structures to prepare for dire events and respond to the unexpected, but especially to promote the solidarity necessary to respond collectively to trauma – both individual level trauma and that experienced by the community itself.  What kind of leadership will be needed?  Who will cultivate such solidarity at the same time as providing services?

1. Finally, leadership itself is at stake.  We can already see that some leaders hear cries for help while others simply preach to the victims about altering their risk-inducing ways. 

A cautionary tale on leadership: 

Two weeks after Hurricane Sandy, 55,000 NYC residents were still lacking power, many of them in buildings that also lacked running water.  The New York City Commissioner of Health and Mental Hygiene, a leader in banning large servings of sugar-sweetened beverages and promoting bicycling, has done almost nothing to mobilize aid for threatened food and water supplies or provide warmth or medical care.  Instead, the Department of Health and Mental Hygiene addresses suffering residents solely with warnings:  “Never use stove burners or ovens for heat,” “Dry ice: safety tips,” “Hypothermia after Hurricane Sandy,” and other messages populate the website. 

Effective leadership in the New Normal will mean being proficient technically, of course.  But it will also mean not wasting time and resources preaching about behavioral “improvement.”  It will mean recognizing the enormity of suffering and the depth of human needs.  And it will mean being able to plan and respond in ways that are both smart and humane.

Acknowledging, with the advent of Sandy, that the New Normal has arrived, we who train health professionals are challenged to produce the right kind of leaders for the future.

Philip Alcabes is a professor in the Adelphi University School of Nursing and director of the Public Health Program. He is an epidemiologist and has studied the history, ethics, and policy of public health.

Superstorm Sandy: An energy wake-up call

by Meghan McPherson, MPP, CEM

In the days leading up to Superstorm Sandy making a direct hit on the New York region, emergency management officials made warning after warning that this was a storm not to take be taken lightly.  This storm was destined to be an outlier from recent memory in terms of the amount of heavy damage it would cause.  Yet, Long Island Power Authority COO Michael Hervey continues to assert that LIPA had no way of knowing that the effects of the storm would be this catastrophic, with over one hundred thousand still without power 14 days after the storm.  One could contend the exact opposite.  LIPA certainly did know the likelihood of this type of paralysis, even without the dire warnings from emergency management and public officials. 

There have been a lot of comparisons between Hurricane Katrina and Superstorm Sandy in the past two weeks.  I personally saw the aftermath of both storms, and I can speak to their similarly devastating impacts on the many sectors critical infrastructure.  But from an energy perspective, there is no comparison.  The population density and critical infrastructure needed to support that population is second to none in the New York area, and especially on Long Island.  The interdependencies of energy sector critical infrastructure and the cascading consequences when the energy sector collapses could be seen coming as a menacing wave long before our homes were flooded. 

The concept of energy assurance focuses on this specific issue.  The US Department of Energy, Office of Electricity Delivery and Energy Reliability defines energy assurance as “Improving the ability of energy sector stakeholders to prevent, prepare for, and respond to threats, hazards, natural disasters, and other supply disruptions.”  With 85% of the national critical infrastructure privately owned, it is crucial for our energy sector stakeholders to develop redundant systems and protocols that will reduce the impact of a major storm and will speed the recovery of the entire region.  Long Island’s residents have suffered long enough from the inexcusable power outages and the resulting impact on health care, gasoline availability, heat for our homes, school closures, and business losses. Let this be a wake up call to our region and to energy officials all over the country.  The energy infrastructure is old and is being relied upon much beyond its original determined lifetime.  If we continue to ignore this issue in light of increasing severity and frequency of major weather events, we will continue to see our entire way of life screech to a grinding halt while power officials tell the public, “It was beyond the magnitude of what anyone expected.”

Meghan McPherson is the Coordinator of Adelphi University’s Center for Health Innovation and the Program Manager of Adelphi University’s Graduate Emergency Management Programs. Before joining Adelphi University in the fall of 2011, Ms. McPherson spent four years as both a grants manager and the Energy Assurance (energy emergency management) Program Manager in the Governor’s Office of Energy and Planning at the State of New Hampshire. Click to read more about Ms. McPherson’s experience.