ELLA Course in Global Health

Draft 12, 2016 ELLA course in Global Health

May 2-20, 2016

Education North Room N2-115

Coordinator Anne Fanning,

Topics and presenters

Overview Global Health is defined, for the purposes of this course, as health of the poor wherever they reside. For the most part the highest burden of disease is in low income countries, where there are limited health care resources. The factors which contribute to this disparate circumstance are complex, mainly financial, but as well historical, related to geography, conflict, trade. Attempted solutions to the disparity, dating back over 50 years, have been at the level of international governance, national, and individual public and private acts of benevolence. The impact has been limited, disappointing.

There will be three general areas of discussion. The current status of health globally, regional variation, and trends, causes of the variation in health status, and impact of historical interventions will examine underlying factors of climate, food security, trade and international organizational impact. The second set of topics will deal with infectious diseases, non-communicable diseases, childhood and maternal burden and mental health and the health delivery systems through which health services are delivered. The third section will look ahead at the Sustainable Development Goals and strategies for reaching them by 2030, the Human Rights, ethics and social justice of the current situation and policies to make change. We will consider the role of national governments in delivering health care in their own countries, and their obligation to join the global effort local to create a level playing field by reducing disparity for all.

We are extremely fortunate that a large number of presenters have agreed to contribute. They are busy people and some out of town, hence we have had a challenge to schedule the talks so that the flow is appropriate. All are dynamic, thoughtful with a vast and varied array of experience from which to draw. They are all aware of the intense interest and broad range of experience of the audience and are willing to accommodate questions at the conclusion of each presentation. They have provided for you an outline of their presentation and some references for additional reading. The schedule:

Week I

• May 2-Global burden of disease, measures and trends- Anne Fanning.

• May 3 Health and the Geography of Food security--- Brent Swallow

• May 4 Social determinants of health: income, education, housing, access, ie beyond the genes and body parts- Ricardo Acuna

• May 5 Health systems in OPEC countries ---Tom Noseworthy

• May 6- health systems in low income countries Tom Noseworthy and Anne Fanning

Week II

• May 9 Communicable diseases: due to pathogens, and managed with vaccines and antimicrobials- Stan Houston

• May 10 Non communicable diseases: CVD, Cancer, Diabetes- Nazneem Wahab

• May 11 Maternal health: Slowest to improve- Zubia Mumtaz

• May 12 Child health – Michael Hawkes

• May 13 Human Rights, A human rights based approach: does it make a difference.- Lisa Oldring

Week III

• May 16 Mental health- Kim Williams,

• May 17 Canada role in SDGs; government and NGO sectors- Heather McPherson

• May 18 GRANT ASSENHEIMER – DISPELLING MISCONCEPTIONS ABOUT HUMANITARIAN AID: PERSPECTIVES FROM INSIDE DOCTORS WITHOUT BORDERS

• May 19 –Climate change and its impact on Health, How to create public engagement- Gwendolyn Blue

May 20 Third world health in Canada First nations and Inuit health Kue Young

And Wrap Fanning & Young Form D Description of the course

The Global Health course 2016 will review the Burden of disease by region, and the trends, examining the factors in disparity of health outcomes, poverty, education, history, climate, politics. With experts in the field we will consider the role of communicable and non communicable diseases, maternal and child health challenges and the importance of mental health, in a country's health status. The new Sustainable development goals (SDG) approved by the UN in September 2015 will challenge all countries to leave no one out in eliminating poverty, hunger and improving health for all sustainably. We will consider the role of Canada in reaching these objectives at home and globally .

Anne Fanning will coordinate the course with the following presenters Ricardo Acuna, Grant Swallow, Tom Noseworthy, Stan Houston, Nazneem Wahab, Zubia Mumtaz, Michael Hawkes, Kim Williams, Lisa Oldring, Heather McPherson, Grant Assenheimer , Gwendolyn Blue and Kue Young

Schedule

Week I

May 2,2016

1. Disease burden globally ……………………………….…Anne Fanning The first lecture will give an overview of the course, provide reference texts and sites, and attend to adjusted schedule and other housekeeping details.

To personalize the issues discussed throughout the course, it is suggested that the participants select one or two countries to follow on data sites to illustrate the issues being discussed.

The body of lecture will discuss the global burden of disease (Factors and interventions):

The world and its international agencies has committed to the human right to health. Yet there is a wide disparity in disease burden, by country and region, and there are large intra country differences in life expectancy.

Disease burden is measured by mortality due to all or selected diseases, or by DALYs (disability adjust years of life saved (ie years of life lost plus years lived with disability). Measurement is critical to planning interventions, and evaluating its impact. Life expectancy is a measure of the effect of health and wealth. As health improves birthrates decline. As health programs address communicable diseases effectively people live long enough to be at risk of non communicable diseases, cardiovascular, cancer. Always present are the challenges of mental health.

References

1. Global health watch (an alternative world health report) 1, 2, 3 and 4. The third, 2011, examines the political and economic architecture which impacts health because these factors determine wealth( the big 3 food fuel and finance). It draws attention to the renewed interest in primary health care, social determinants and the heavy burden on women’s health. It considers effects of social economic, environment, governance, migration, aging population, the food crisis, conflict situations, impact of global trade, biotech promise( is diagnostics and therapeutics and gap.It also looks at the international players in health. 3. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990—2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet 2012 < http://www.thelancet.com/global-burden-of-disease>

4. UNHDR http://hdr.undp.org/en/countries

5. Realizing the Right to health, Clapham and Robinson, Ruffer and Rub Switzerland, 2009, on health and human rights

6. Global Population Health and Well- Being in the 21st Century, George Luddeke, 2016. On order.

7. The great divide; unequal societies and what we can do about them, by Joseph e Stiglitz, 2015. Inequality and the failure to manage the economy aggravated the disparity between the top 1% who hold close the same amount of wealth as the other 99%. A collection of articles of the past decade, showing that unfettered markets, monopoly of power, unbalanced trade aggravate the divide and are unhealthy for all.

8. Schrecker, T. and Labonté R. “Globalization: The Global Marketplace and Social Determinants of Health”, in J. Lee and R. Sadana. (eds.). Improving Equity in Health by Addressing Social Determinants of Health, Geneva: World Health Organization. pp.23-58. 2012.

9. Labonté R., “Health activism in a globalising era: lessons past for efforts future,” Lancet, 381:2158-9 (essay), June 2013. Tuesday May 3, 2016

2. Health and the Geography of Food security ………………Brent Swallow

Over 850 million of the world’s people continue to suffer from hunger and malnutrition. Despite the shocking size of this number, many of the world’s low and middle-income countries are now forced to deal with so-called double-burden malnutrition, significant numbers of people suffer from either under-consumption or over- consumption. Simple solutions, such as the production of more cereal crops, have limited benefit for dealing with these challenges. There is a growing need to understand how the food environment affects food consumption and chronic disease incidence. This presentation will consider the geographic nature of this challenge from different perspectives, from global to local, with a case study of Edmonton. Possible solutions that are being studied by UofA researchers will also be reviewed.

Selected references:

Abbade, E.B., Dewes, H., 2015. Food Insecurity Worldwide Derived from Food Supply Patterns. Food Security 7: 109-120.

Wang, H., Qiu, F. and Swallow, B., 2014. Can Community Gardens and Farmers’ Markets Relieve Food Desert Problems? A Study of Edmonton, Canada. Applied Geography 55: 127-137.

Wednesday May 4, 2016

3. Health determinants; Factors influencing disease burden: Ricardo

Acuna

Income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.  Education – low education levels are linked with poor health, more stress and lower self-confidence.  Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions  Social support networks – greater support from families, friends and communities is linked to better health. Culture - customs and traditions, and the beliefs of the family and community all affect health.  Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.  Health services - access and use of services that prevent and treat disease influences health  Gender - Men and women suffer from different types of diseases at different ages.  References:

1. WHO website: < http://www.who.int/hia/evidence/doh/en/ > 2. Macroeconomics and health, 2003 < http://www.who.int/macrohealth/en/ > 3. Globalizations impact and need for redistribution < https://www.dropbox.com/sh/2cdc14ikzhs7b06/AACgxmoP7uxMxWX8o1WYSKQya/Globalizati on%20and%20Social %20Determinants/Improving_Equity_in_Health_by_Addressing_Social_Determinants.pdf > Richard Wilkinson

De Savigny

Compared to poorest quintile, the top quintile in Tanzania are:

 2.8 times more likely to have skilled attendance at delivery  3.4 times more likely to use modern contraception  7.0 times less likely to give birth at home AND have no post-natal  care  8.7 times more likely to have a C-Section  14 times more likely to have slept under an ITN the previous night  40% more likely to have measles vaccination  40% more likely to receive treatment for fever at a health facility  20% more likely to receive any ORS for diarrhoea Smithson, P. from Tanzania DHS 2004

Constraints preventing the poor from benefiting must be understood… Thursday May 5, 2016

4. Health Systems in Developed (or OECD) Countries; ………….Tom Noseworthy ( Tom Noseworthy is an expert in OECD health care systems and will describe their complexities and the 3 major models, public tax base funding eg England and Canada, social services model , health care provided through employment, Germany, and market driven private system , US. He has no experience in L&MIC except to know that without funding they depend on delivery of public health with availability of disease management to those with private funding.)

Elements of a health care system:

1. Service delivery which is safe, good quality, staffed, measured 2. Personnel are the health workers of the system, trained, paid, cared for, supported 3. Health information is the data on which to measure outcome and need 4. Medical technologies 5. Financing 6. Leadership and Governance

Balabanova , Department of Global Health and Development, Faculty of Public

Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK

April 8, 2013

• Good governance and political commitment

 Eff ective leadership and long-term vision  Clear priorities and realistic policy goals  Responsiveness to diverse population needs  Continuity of reform  Careful sequencing of reforms  Seizing windows of opportunity  Enhanced accountability • Effective bureaucracies and institutions

 Strong regulatory and managerial capacity  Provision of intelligence and evidence  Stability of bureaucracy  Sufficient autonomy and flexibility to manage health systems effectively  Engagement with many stakeholders, including  non-state actors and local communities  Synergy between governments and donors acting together to formulate and implement policy  Use of the media as a catalyst for change • Innovation

 Novel health workforce strategies  New approaches to health system financing and financial protection  Pragmatism in service delivery • Resilience in the health system

References

May 6, 2015

5 .Health care systems in Developing countries: the challenges of providing health for all…..Tom Noseworthy with Anne Fanning Dr Noseworthy will extend his discussion of health care systems to examine how systems can work where financial and human resources are scarce.

In LIC the basic population needs of clean water, sanitation, food, shelter, maternal/ child health services, Communicable disease, NCD programs, Emergency care, mental health must be delivered , but often on a budget of less than $5/person per year for health expenditures. Planning has to cross sectors: education, finance, social services, information systems. There has to be political will to execute. The delivery of services in an affordable way, to make a difference, must be based on needs assessment, proven strategies, performance indicators to regularly assess outcomes. This all requires partnerships of policy makers, professions, academics, communities, the NGO sector.

Anne Fanning will use country examples to illustrate the challenges. 4. Peoples health movement is a source of information on global health. This URL deals with GH Governance http://www.phmovement.org/en/node/9211 5. DeSavigny and Adam, Health system thinking

Monday May 9, 2016

6. Communicable diseases: Still with us………….Stan Houston  Historically, communicable diseases have accounted for the largest share of human illness and premature death. Correspondingly, control of communicable accounts for most of the dramatic improvements in life expectancy and other health indicators over the past century or so. Poverty reduction and improvements in the determinants of health including water and sanitation (for many, but by no means all), vaccination, and advances in health care including antimicrobial drugs, contributed to this success. But communicable diseases continue as an important and evolving human health problem, from the opportunistic infections to which hospital inpatients, or organ transplant recipients are vulnerable, to brand new diseases, of which HIV is the most important, Zika virus perhaps the most recent. At the same time, some of our most important tools for treatment and control, antimicrobial agents, are rapidly becoming less effective.  Current contribution of communicable diseases to the global burden of illness and death  •Examples  –TB & malaria: old diseases, cautious optimism  –HIV: 100 years old, dramatic advances in treatment, but much left to do  –Hospital acquired infection; an increasingly recognized priority  –New infectious diseases: what happened with ebola virus?  –Disease eradication: small pox, polio, guinea worm, others?, and control  --Antimicrobial resistance

Readable but accurate book about emerging infections: Spillover: Animal infections and the next human pandemic. David Quammen

Tuesday May 10, 2016

5. Non- communicable diseases: ………………Nazneem Wahab  Defining selected NCD’s—CVD, DM, HTN, respiratory illness, cancer

 Global impact of these conditions

 WHO NCD 2013-2025 goals for addressing NCD’s

 Proposed interventions

 Determinants of success of interventions

Learning Objectives:  Develop a general understanding of the impact of non-communicable diseases on a global scale— particularly in relation to low and middle income countries

 Appreciate the multiple interacting variables which inform the strategies for intervention

 Understand the role of primary care in the management of non-communicable diseases in low and middle income countries.

Selected references:

HOGERZEIL, H. V., LIBERMAN J FAU - WIRTZ, V. J., WIRTZ VJ FAU - KISHORE, S. P., KISHORE SP FAU - SELVARAJ, S., SELVARAJ S FAU - KIDDELL-MONROE, R., KIDDELL-MONROE R FAU - MWANGI-POWELL, F. N., MWANGI-POWELL FN FAU - VON SCHOEN-ANGERER, T. & VON SCHOEN-ANGERER, T. Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN political declaration.

MAHER, D., HARRIES, A. D., ZACHARIAH, R. & ENARSON, D. 2009. A global framework for action to improve the primary care response to chronic non-communicable diseases: a solution to a neglected problem. BMC Public Health, 9, 355-355.

WHO 2013. 2013-2025 NCD action plan.

Wednesday May 11, 2016

6. Maternal health-…………………… ………... Zubia Mumtaz

The health of mothers is critical to the health of families, their right to control family size their right of access to safe motherhood, to birth attendance, to safe delivery, and to assured care for their neonate is the slowest area of global health to respond. Women don’t trust the health care system which is distant and arrogant and whose reputation is full of disasters. Even when attended delivery is available with access to CS and transfusion, if not trusted it will not be used. Hence the challenge to reduce maternal mortality requires community buy in to the services offered. Zubia Mumtaz will address the global trends in maternal mortality, the recommended services, for mothers and their neonates, and the impediments as evid3enced by her field research in Pakistan .

 Almost 300,000 women died globally in 2013 from causes related to pregnancy and childbirth.  The proportion of deliveries in developing regions attended by skilled health personnel rose from 56 to 68 per cent between 1990 and 2012.

 In 2012, 40 million births in developing regions were not attended by skilled health personnel, and over 32 million of those births occurred in rural areas.  52 per cent of pregnant women had four or more antenatal care visits during pregnancy in 2012,  an increase from 37 per cent in 1990.

Goal 5: Improve maternal health 29. Globally, the maternal mortality ratio dropped by 45% between 1990 and 2013, from 380 to 210.

May 12, 2016

9.. Childhood illness …………………………………………….Michael Hawkes

GLOBAL CHILD HEALTH (Michael Hawkes, 12 May 2016)

Outline and key messages:

Where and why are 5.9 million children dying each year?

 The number of under-five deaths was cut in half between 1990 and 2015, from 12.7 million to 5.9 million.

 Infectious diseases (68%) are the main cause, including pneumonia, diarrhea, and malaria.

 Evidence-based interventions are available: estimated 63% of child deaths could be prevented

The newborn period: a time of special vulnerability

 For too many babies, their day of birth is also their day of death. 1 million neonatal deaths occur on day one of life, 2 million in the first week of life, 2.8 million before 28 days of age.

 Main causes: infections, intrapartum conditions, and preterm birth complications  Small size at birth--due to preterm birth or small-for-gestational-age (SGA), or both--is the biggest risk factor for more than 80% of neonatal deaths

 Half of the world's newborn babies do not get a birth certificate, and most neonatal deaths and almost all stillbirths have no death certificate. To count deaths is crucial to change them.

Vaccines

 With the exception of safe water, no other modality, not even antibiotics, has prevented more deaths.

Malnutrition

 Malnutrition is estimated to contribute to more than one third of all child deaths, but is not usually listed as a direct cause.

 Protein-energy malnutrition: marasmus and Kwashiorkor

 Micronutrient deficiencies

Malaria

 The numbers: 198 million cases, 1.24 million deaths. 90% of all malaria deaths occur in sub-Saharan Africa, children <5 years account for 78% of all deaths

 Good news: the global burden of malaria is decreasing! (cases and deaths reduced 47% worldwide from 2000 to 2013)

 Rapid diagnostic tests (RDTs) can be used in remote areas for rational diagnosis.

 Treatment is with ACT (uncomplicated malaria) and artesunate (severe malaria).

 P. falciparum resistance to artemisinin has been detected in the Greater Mekong subregion.

 Prevention strategies: long-lasting insecticidal nets (LLIN), indoor residual spraying, intermittent preventive therapy, and others.

Pneumonia

 Pneumonia remains the leading cause of childhood mortality, causing 900,000 deaths each year, most of which are preventable.

HIV  Mother-to-child transmission of HIV: a golden opportunity to intervene and save a lifelong chronic disease

References/Suggested Reading:

1. Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, Lalli M, Bhutta Z, Barros AJ, Christian P, Mathers C, Cousens SN; Every Newborn: progress, priorities, and potential beyond survival. Lancet Every Newborn Study Group. Lancet. 2014 Jul 12;384(9938):189-205.

2. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012 Jun 9;379(9832):2151-61.

3. Zar HJ, Ferkol TW. The global burden of respiratory disease-impact on child health. Pediatr Pulmonol. 2014 May;49(5):430-4.

4. Yeboah-Antwi K, Pilingana P, Macleod WB, Semrau K, Siazeele K, Kalesha P, Hamainza B, Seidenberg P, Mazimba A, Sabin L, Kamholz K, Thea DM, Hamer DH. Community case management of fever due to malaria and pneumonia in children under five in Zambia: a cluster randomized controlled trial. PLoS Med. 2010 Sep 21;7(9)

5. World Health Organization. State of the world’s vaccines and immunization. Third edition. Available at: http://whqlibdoc.who.int/publications/2009/9789241563864_eng.pdf?ua=1

6. World Health Organization. World Malaria Report 2014. Available at: http://www.who.int/malaria/publications/world_malaria_report_2014/en/

Friday May 13, 2016

9. What is a rights-based approach to health, and does it matter?.- Lisa Oldring.

Lisa is currently on leave from her position with the United Nations Office of the High Commissioner for Human Rights in Geneva, Switzerland, where she serves as advisor on human rights and security policies. Previously she served as a legal advisor to international commissions of inquiry on Darfur, and on Lebanon; Special Advisor to Mary Robinson, Chair, GAVI Board; assistant to the first UN Special Rapporteur on the right to health; advisor on human rights and HIV/AIDS with the UN Office of the High Commissioner for Human Rights; attaché to the International Committee of the Red Cross; and human rights officer with the UN human rights field mission in Rwanda.

The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. Preamble, WHO Constitution

 What is the right to health?  The link between the right to health and other human rights  Does a human rights-based approach to health matter?  Key challenges  Right to health and the Sustainable Development Goals

Week III

Monday May 16, 2016

11. Mental health ...... Kim Williams psychiatry resident

Mental Health Lecture By Kimberly Williams

Bio: Dr. Kimberly Williams is a second year Psychiatry Resident Physician at the University of Calgary. She completed a MSc in Global Health (with Dr. Stan Houston as her supervisor) prior to attending medical school. She has worked as an intern at the World Health Organization in their department of essential medicines and was the Vice-President Global Health for the Canadian Federation of Medical Students. She is currently the Resident Doctors of Canada Representative to the Junior Doctors Network (JDN) of the World Medical Association and the JDN Social Medical Affairs Officer. She is a big proponent of education being a tool for improving Global Mental Health discrepancies and is working as a part of a team in Tanzania to create an undergraduate medical education curriculum in psychiatry.

Objectives:

1. To contrast mental health and mental illness 2. To describe the global gaps in access to treatment which exist for those with a mental illness 3. To recognize the diversity of ways in which mental illness can present 4. To identify key global mental health resources Summary:

What is global mental health? Global mental health is an ideology rooted in global health. With the rise of globalization in recent decades, the development of a unique concept to understand, frame and address health on both a local and global scale has emerged. This is the concept of global health. Global mental health is applying the principles of global health within the domain of mental health. Global mental health is interdisciplinary in nature and action-oriented. It seeks to improve the lives of people and their families affected by mental health problems.

Mental illness has an enormous impact on health globally. The Global Burden of Disease study (Patel & Prince, 2010) indicated that five of the top 10 contributors to years in a persons life lived with disability were from mental illness. Mental illness accounts for 13 percent of the burden of disease and 4.3 percent accounted by depression alone. The additional burden is accounted for by bipolar disorder, schizophrenia, anxiety disorders, dementia, substance abuse, and intellectual disability. Therefore there is great need to expand services that prevent, recognize, support, treat and promote human rights.

The burden of mental illness is massive and it is only in recent years that there has begun to be increased recognition of the need to address this burden. In 2013 the World Health Assembly approved a Comprehensive Mental Health Action Plan for 2013-2020 that was a step in recognizing the large impact that mental illness has on not only health, but by society at large.

Like with many other diseases, there is a very prominent human rights component to mental illness. As with other diseases like HIV and AIDS the most vulnerable are those from lower socio-economic backgrounds as well as already marginalized citizens. There is a massive disparity in resources allocated to treat mental illness between low-and-middle-income countries (LMIC) and high-income countries. Greater than 75 per cent of persons identified with serious anxiety, mood, impulse control or substance use disorders in world mental health surveys in LMICs receive no care at all (Patel & Prince, 2010). In certain areas such as sub-Saharan Africa, over 90 percent of those with schizophrenia and other forms of psychosis are untreated. Those with mental illness often lack basic necessities such as nourishment, clothing, shelter and security. In order to reduce health disparities we must address both access to care but also social determinants. We must acknowledge that current social, economic and political factors impact health. These factors could likely be reframed or fine-tuned in the interest of improving global mental health.

It is hard to imagine a world that continues to ignore the mental health issues of a large portion of the worlds’ population. We saw people dying of AIDS and said this is wrong. So now it is time to change not only the way we perceive mental health, but what we as a global community do about it. Mental health has increasingly been recognized as an important contributor to physical health. Lack of access to treatment and stigma are global health challenges that must be addressed. It is important that trainees, health professionals and society advocate to improve the lives of those suffering from mental illness and ensure access to treatment. After all, there is no health without mental health.

References: 1. World Health Organization. (2014). Mental Health: A State of Well-Being. Retrieved from http://www.who.int/features/factfiles/mental_health/en/ . Geneva: WHO.

2. World Health Organization. (2014). Suicide Data. Retrieved from http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ . Geneva: WHO.

3. Patel, V., Gregory, S., Chowdhary, N., Kaaya, S., & Araya, R. (2009). Packages for Care for Depression in Low-and Middle-Income Countries. PLoS Medicine, 6(10), e10000159

4. Corrigan, P & Watson, A. (2002). Understanding the impact of stigma on people with mental illness. Stigma and Mental Illness, 1, 1-20.

5. Jiang, W., Krishnan, R., & O’Connor, C. (2012). Depression and Heart Disease. CNS Drugs, 16 (2), 111-127

6. Patel, V. & Prince, M. (2010). Global mental health, a new global health field comes of age. Journal of the American Medical Association, 303(19), 1976-1977.

7. Kastrup, M. & Ramos, A. (2007). Global Mental Health. Danish Medical Bulletin, 54(1), 42-43.

8. Collins, P., Insel, T., Chockalingam, A., Darr, A. & Maddox, Y. (2013). Grand challenges in global mental health: integration in research, policy, and practice. PLOS Medicine, 10(4), e1001434

Tuesday May 17, 2016

10. 12. Canada’s record in ODA and the importance of the NGO sector Heather Mcpherson Alberta’s Council for Global cooperation was the first provincial council developed under Peter Lougheed’s government and enabling Alberta NGOs to do development work since. In many ways the NGO sector is extremely well equipped to do this work. They do so with volunteer time and resources, they often have practical experience on the ground in country and in speciality areas and are able to more efficient in their delivery than a bureaucracy. And Finally they sho the face of Canada in thie delivery I a way that a bureaucracy cannot..

Lester Pearson set the goal of 0.7% of GDP for overseas Aid. Canada has never reached the target, though the Scandinavian countries are regularly close to 1%. The US is about .11% , and Canada, although Steven Harper has declared commitment, we are at .26% and falling.

13. MAY 18, 2016

GRANT ASSENHEIMER – DISPELLING MISCONCEPTIONS ABOUT HUMANITARIAN AID: PERSPECTIVES FROM INSIDE DOCTORS WITHOUT BORDERS Doctors Without Borders / Médecins Sans Frontières (MSF) was established in 1971 by a small group of French doctors who had worked together during the Nigerian Civil War. Upon their return, they were determined to find a way to respond rapidly and effectively to public health emergencies, with complete independence from political, economic and religious influences.

Today, MSF is one of the world's leading independent international medical relief organizations, working in close to 70 countries worldwide and with operational centres and national offices in 19 countries.

Personally, I’ve been involved with MSF since 2008 and completed 6 overseas contracts with the organization. As a non-medic, I started off in logistics and then as project coordinator, working in Bangladesh, the Philippines, Democratic Republic of Congo and Chad. I currently sit as a board member for MSF-Canada.

What you see and hear doesn’t always reflect the reality on the ground. In this talk, I hope to use my stories from the field to challenge some common misperceptions about Humanitarian Aid in general and MSF in particular. Questions to be answered include:

- Who is the real humanitarian worker? - What about the non-medical aspects of providing medical humanitarian relief? - How sustainability is humanitarian aid? - Why don’t we take advantage of targeting fundraising campaigns?

References / Addition Reading

1. www.msf.ca 2. “An Imperfect Offering”- Dr James Orbinski 3. “Humanitarian Negotiations Revealed” – Claire Magone 4. “Condemned to Repeat: The Paradox of Humanitarian Action” - Fiona Terry Thursday May 19

14. Global health and climate change

The goal of this lecture is to critically examine the links between global health and climate change. We will begin with an overview of the ways in which climate change has been linked with global health. Measures to frame climate change in terms of health in order to make publics and policy makers more aware of the risks will be examined. Research from geography will round out the discussion, particularly work that cautions against deterministic readings of climate change and its impacts. The lecture will conclude with an examination of representation and uncertainty in the politics of climate change and the implications for articulating pressing global issues with one another.