DOCSLIB.ORG

A Utilitarian Assessment of the Relevance of Genetic Therapies for HIV-AIDS in Africa, with Special Reference to the Situation in Kenya

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Utilitarian Assessment of the Relevance of Genetic Therapies for HIV-AIDS in Africa, with Special Reference to the Situation in Kenya A Utilitarian Assessment of the Relevance of Genetic Therapies for HIV-AIDS in Africa, with Special Reference to the Situation in Kenya by Tom Joel Obengo Dissertation presented for the fulfilment of the requirements for the degree of Doctor of Philosophy in Applied Ethics in the Department of Philosophy at the Faculty of Arts & Social Sciences University of Stellenbosch Supervisor: Prof. Anton A. van Niekerk March 2020 Stellenbosch University https://scholar.sun.ac.za DECLARATION By submitting this dissertation electronically, I declare that the entirety of the work contained therein is my own, original work, that I am the sole author thereof (save to the extent explicitly otherwise stated), that reproduction and publication thereof by the University of Stellenbosch will not infringe any third party rights, and that I have not previously in its entirety or in part submitted it for obtaining any qualification. March 2020 Copyright © 2020 University of Stellenbosch All rights reserved ii Stellenbosch University https://scholar.sun.ac.za ACKNOWLEDGEMENTS My foremost gratitude is to the Almighty God for the gift of life, good health, and faithful sustenance to this present time. I am deeply thankful to my Supervisor, Professor Anton A. van Niekerk, Distinguished Professor of Philosophy at the Department of Philosophy, Faculty of Arts and Social Sciences, University of Stellenbosch, for his strong supervision, intellectual guidance, support, advice and encouragement which directly contributed to the successful completion of this study. Although this study was funded primarily from family income, together with scholarships and bursaries from the Department of Philosophy at Stellenbosch, I am also thankful to two individuals for gifts that supported aspects of it: Prof. John F. Kilner of Trinity International University, Deerfield, Illinois, and Dr. Theodore H. Palmatier of Yakima Worker Care Clinic, Washington DC. The Principal of Moffat Bible College, Dr. Paul Kamunge, graciously granted me leave of absence from my teaching and administrative duties in order to pursue this study programme to its conclusion. My wife Dorothy and our two daughters Rebekka Mich and Hannah Gweth gave me unwavering support and constant encouragement; they joyfully allowed time for me to study and write. My parents Michael (deceased) and Paskalia Oria-Ongadi taught me in childhood the human virtues that caused my interest in ethics; my parents-in-law Daniel and Mary Ndetei constantly prayed for me. My friends encouraged me throughout the duration of this study: Dr. Chris Jones who had been my Master’s degree thesis Supervisor, Daudi & Truphie Sumba, Prof. Philip Mbithi, Dr. Tim Teusink of SIM France, Nathan & Jane Chiroma, as well as professors and fellow post-graduate students in the Department of Philosophy at Stellenbosch. I sincerely acknowledge their kindness and support to me. iii Stellenbosch University https://scholar.sun.ac.za ABSTRACT As African countries continue to bear the largest global burden of HIV-AIDS, the use of Highly Active Antiviral Treatment (HAART) for suppression of viral multiplication is the best available treatment option in which one is advised to take a dose at least once a day for the rest of his or her life. Of the HIV-infected number people globally, some are well into their second decade of treatment with these antiretroviral drugs. Although the survival rates and the quality of life for HIV-AIDS patients have been significantly improved by the intervention, missing the pills for a number of days unleashes a rapid viral replication. Additionally, some patients experience adverse effects which may interfere with their usual daily activities or lifestyles, leading to poor adherence for some, thereby posing risks of treatment failure of the drugs in use. In other words, with continued treatment interruptions, resistance to these drugs may occur. This means there is still no cure for HIV-AIDS, hence the need to consider alternatives that may become available through emerging technologies such as genetic therapies. This research titled “A Utilitarian Assessment of the Relevance of Genetic Therapies for HIV-AIDS in Africa, with Special Reference to the Situation in Kenya,” seeks to establish if genetic therapies would be suitable for treating HIV-AIDS which affects millions of patients in the world, 70% of whom are in Africa. Kenya is among the ten leading countries in Africa in the prevalence of HIV-AIDS, hence a review of the country’s healthcare system, especially in relation to the problem of HIV-AIDS, including some on-going research. A comprehensive review of genetic therapies shows a distinction between somatic and germline genetic therapies as different but potentially effective cures for the illness. Special attention has been given to CRISPR Cas9 because, so far, it is the only technology close to providing real treatment for HIV-AIDS although there is need for caution and further development. Based on the ethics theory of utilitarianism, the dissertation concludes that genetic therapies are the most appropriate solution to the HIV-AIDS scourge that will have justifiable benefit-sharing for the people, with minimum negative consequences. The therapies are most likely to turn misery into good health, pain into happiness, and shame into dignity. From a utilitarian perspective, when genetic therapies will be made available for the treatment of HIV- AIDS, the patient will be cured, the descendants of the patient will be prevented from inheriting the disease, and future societies will be saved from a deadly disease. Therefore, there is sufficient utilitarian justification in investing both technologically and scientifically in the on- going research into genetic therapies. The dissertation recommends that there be iv Stellenbosch University https://scholar.sun.ac.za collaborative effort in supporting on-going research into genetic therapies, propagating a positive understanding of genetic therapies, commitment to using the therapies once fully developed, and governments agreeing to take final responsibility with regard to results, whether negative or positive. In view of the discussions, findings and recommendations of this research, genetic therapies are viewed as the most viable solution to the effects of HIV-AIDS. v Stellenbosch University https://scholar.sun.ac.za OPSOMMING Aangesien Afrika steeds die grootste wêreldwye las van MIV-vigs dra, is die gebruik van Hoogs Aktiewe Antiretrovirale Terapie (HAART) vir die onderdrukking van virale vermenigvuldiging die beste beskikbare behandelingsopsie, waarin ‘n mens aanbeveel word om minstens een maal per dag ‘n dosis te neem vir die res van sy of haar lewe. Van die mense wat wêreldwyd met MIV geïnfekteer is, is sommige reeds in hul tweede dekade van die behandeling met hierdie antiretrovirale medisyne. Alhoewel die oorlewingsyfers en die lewensgehalte van MIV-vigs-pasiënte aansienlik verbeter is deur die ingryping, word ‘n vinnige virusreplikasie veroorsaak wanneer die pasiënt die pille vir ‘n aantal dae nie gebruik nie. Boonop ervaar sommige pasiënte nadelige gevolge wat hul gewone daaglikse aktiwiteite of lewenstyl kan beïnvloed, wat vir sommige tot ‘n slegte nakoming daarvan kan lei, wat die risiko vir behandelingsmislukking van die medisyne in gebruik, kan inhou. Met ander woorde, met voortgesette behandelingsonderbrekings kan weerstand teen hierdie middels opgebou word. Dit beteken dat daar nog steeds geen geneesmiddel vir MIV-vigs is nie, en dus moet daar gekyk word na alternatiewe wat beskikbaar mag word deur opkomende tegnologieë soos genetiese terapieë. Hierdie navorsing, met die titel “’n Utilitêre Beoordeling van die Toepaslikheid van Genetiese Terapieë vir MIV-vigs in Afrika, met Spesiale Verwysing na die Situasie in Kenia,” wil vasstel of genetiese terapieë geskik is vir die behandeling van MIV-vigs wat miljoene pasiënte regoor die wêreld affekteer, waarvan 70% in Afrika is. Kenia is een van die tien voorste lande in Afrika in die voorkoming van MIV-vigs. ‘n Oorsig word gebied van die land se gesondheidsorgstelsel, veral met betrekking tot die probleem van MIV-vigs, insluitend deurlopende navorsing. ‘n Uitgebreide oorsig van genetiese terapieë toon ‘n onderskeid tussen somatiese en kiemsel genetiese terapieë as verskillende, maar potensieel effektiewe geneesmiddels vir die siekte. Spesiale aandag word gevestig op CRISPR Cas9 omdat dit tot dusver die enigste tegnologie is wat naby kom aan die behandeling van MIV-vigs, hoewel versigtigheid en verdere ontwikkeling nodig is. Deur middel van die aanwending van die etiek-teorie van utilitarisme, kom die proefskrif tot die gevolgtrekking dat die genetiese terapieë die mees geskikte oplossing vir die MIV-vigs-plaag is wat regverdige bevoordeeldeling vir die mense sal inhou, met die minimum negatiewe gevolge. Dit is waarskynlik dat die terapieë ellende in goeie gesondheid, pyn in geluk en skande in waardigheid kan verander. Vanuit ‘n utilitaristiese perspektief, wanneer genetiese terapieë beskikbaar gestel sal word vir die behandeling van MIV-vigs, sal die pasiënt genees word, dit sal voorkom dat die nasate van die pasiënt geïnfekteer is en toekomstige vi Stellenbosch University https://scholar.sun.ac.za samelewings sal gered word van ‘n dodelike siekte. Daar is dus voldoende utilitaristiese regverdiging om te belê in die deurlopende navorsing, beide tegnologies en wetenskaplik, van genetiese terapieë. Die proefskrif beveel aan dat daar gesamentlike pogings aangewend word om deurlopende navorsing oor genetiese
Load more

Recommended publications
  • Better Together TNVR and Public Health APHA 11-13-18.Pdf
    Better Together: TNVR and Public Health 11/13/2018 Presenter Disclosures Introduction Better Together TNVR and public health Peter J. Wolf and G. Robert Weedon • TNVR: trap-neuter-vaccinate-return G. Robert Weedon, DVM, MPH Clinical Assistant Professor and Service Head (Retired) Shelter Medicine, College of Veterinary Medicine University of Illinois • Emphasis on the “V” Peter J. Wolf, MS Research/Policy Analyst – Vaccination Best Friends Animal Society Have no relationships to disclose • Emphasizes the public health aspect of TNVR programs • Vaccinating against rabies as a means of protecting the health of the public Introduction TNVR TNVR • Why TNVR? • Why TNVR? – The only humane way to – More than half of impounded cats are euthanized deal with the problem of due to shelter crowding, shelter-acquired disease free-roaming (feral, or feral behavior animal welfareTNVR public health community) cats – TNVR, an alternative to shelter impoundment, – When properly applied, improves cat welfare and reduces the size of cat TNVR has been shown to colonies control/reduce populations rabies prevention of free-roaming cats Levy, J. K., Isaza, N. M., & Scott, K. C. (2014). Effect of high-impact targeted trap-neuter-return and adoption Levy, J. K., Isaza, N. M., & Scott, K. C. (2014). Effect of high-impact targeted trap-neuter-return and adoption of community cats on cat intake to a shelter. The Veterinary Journal, 201(3), 269–274. of community cats on cat intake to a shelter. The Veterinary Journal, 201(3), 269–274. TNVR TNVR TNVR • Why TNVR? • Why
    [Show full text]
  • Burden of Disease: What Is It and Why Is It Important for Safer Food?
    Burden of disease: what is it and why is it important for safer food? What is ‘burden of disease’? Burden of disease is concept that was developed in the 1990s by the Harvard School of Public Health, the World Bank and the World Health Organization (WHO) to describe death and loss of health due to diseases, injuries and risk factors for all regions of the world.1 The burden of a particular disease or condition is estimated by adding together: • the number of years of life a person loses as a consequence of dying early because of the disease (called YLL, or Years of Life Lost); and • the number of years of life a person lives with disability caused by the disease (called YLD, or Years of Life lived with Disability). Adding together the Years of Life Lost and Years of Life lived with Disability gives a single-figure estimate of disease burden, called the Disability Adjusted Life Year (or DALY). One DALY represents the loss of one year of life lived in full health (see text box for more explanation and examples). Looking at burden of disease using DALYs can reveal surprises about a population’s health. For example, the Global Burden of Disease 2004 Update suggests that neuropsychiatric conditions are the most important causes of disability in all regions of the world, accounting for around 33% of all years lived with disability among adults aged 15 years and over, but only 2.2% of deaths.2 Therefore while psychiatric disorders are not traditionally regarded as having a major impact on the health of populations, this picture is completely altered when the burden of disease is estimated using DALYs.
    [Show full text]
  • Defining Malaria Burden from Morbidity and Mortality Records, Self Treatment Practices and Serological Data in Magugu, Babati District, Northern Tanzania
    Tanzania Journal of Health Research Volume 13, Number 2, April 2011 Defining malaria burden from morbidity and mortality records, self treatment practices and serological data in Magugu, Babati District, northern Tanzania CHARLES MWANZIVA1*, ALPHAXARD MANJURANO2, ERASTO MBUGI3, CLEMENT MWEYA4, HUMPHREY MKALI5, MAGGIE P. KIVUYO6, ALEX SANGA7, ARNOLD NDARO1, WILLIAM CHAMBO8, ABAS MKWIZU9, JOVIN KITAU1, REGINALD KAVISHE11, WIL DOLMANS10, JAFFU CHILONGOLA1 and FRANKLIN W. MOSHA1 1Kilimanjaro Clinical Research Institute, P. O. Box 2236, Moshi, Tanzania 2Joint Malaria Programme, Moshi, Tanzania 3Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania 4Tukuyu Medical Research Centre, Tukuyu, Tanzania 5Tabora Medical Research Centre, Tabora, Tanzania 6Ngongongare Medical Research Station, Usa River, Tanzania 7St. John University of Tanzania, Dodoma, Tanzania 8Amani Medical Research Centre, Muheza, Tanzania 9Magugu Health Centre, Babati, Manyara, Tanzania 10 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Abstract: Malaria morbidity and mortality data from clinical records provide essential information towards defining disease burden in the area and for planning control strategies, but should be augmented with data on transmission intensity and serological data as measures for exposure to malaria. The objective of this study was to estimate the malaria burden based on serological data and prevalence of malaria, and compare it with existing self-treatment practices in Magugu in Babati District of northern Tanzania. Prospectively, 470 individuals were selected for the study. Both microscopy and Rapid Diagnostic Test (RDT) were used for malaria diagnosis. Seroprevalence of antibodies to merozoite surface proteins (MSP- 119) and apical membrane antigen (AMA-1) was performed and the entomological inoculation rate (EIR) was estimated. To complement this information, retrospective data on treatment history, prescriptions by physicians and use of bed nets were collected.
    [Show full text]
  • Risk, Overdiagnosis and Ethical Justifications
    Health Care Analysis (2019) 27:231–248 https://doi.org/10.1007/s10728-019-00369-7 ORIGINAL ARTICLE Risk, Overdiagnosis and Ethical Justifcations Wendy A. Rogers1 · Vikki A. Entwistle2 · Stacy M. Carter3 Published online: 4 May 2019 © The Author(s) 2019 Abstract Many healthcare practices expose people to risks of harmful outcomes. However, the major theories of moral philosophy struggle to assess whether, when and why it is ethically justifable to expose individuals to risks, as opposed to actually harming them. Sven Ove Hansson has proposed an approach to the ethical assessment of risk imposition that encourages attention to factors including questions of justice in the distribution of advantage and risk, people’s acceptance or otherwise of risks, and the scope individuals have to infuence the practices that generate risk. This paper investigates the ethical justifability of preventive healthcare practices that expose people to risks including overdiagnosis. We applied Hansson’s framework to three such practices: an ‘ideal’ breast screening service, a commercial personal genome testing service, and a guideline that lowers the diagnostic threshold for hypertension. The framework was challenging to apply, not least because healthcare has unclear boundaries and involves highly complex practices. Nonetheless, the framework encouraged attention to issues that would be widely recognised as morally pertinent. Our assessment supports the view that at least some preventive healthcare practices that impose risks including that of overdiagnosis are not ethically justifable. Further work is however needed to develop and/or test refned assessment criteria and guid‑ ance for applying them. Keywords Overdiagnosis · Risk · Uncertainty · Harm · Ethics · Risk evaluation * Wendy A.
    [Show full text]
  • Diseases of Poverty and the 10/90 Gap Diseases of Poverty and the 10/90 Gap Diseases of Poverty and the 10/90 Gap
    Diseases of poverty and the 10/90 gap Diseases of poverty and the 10/90 Gap Diseases of poverty and the 10/90 Gap Written by Philip Stevens, Director of Health Projects, International Policy Network November 2004 International Policy Network Third Floor, Bedford Chambers The Piazza London WC2E 8HA UK t : +4420 7836 0750 f: +4420 7836 0756 e: [email protected] w : www.policynetwork.net © International Policy Network 2004 Designed and typeset in Latin 725 by MacGuru Ltd [email protected] Cover design by Sarah Hyndman Printed in Great Britain by Hanway Print Centre 102–106 Essex Road Islington N1 8LU All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise) without the prior written permission of both the copyright owner and the publisher of this book. Diseases of poverty and the 10/90 Gap Introduction: What is the 10/90 Gap? Figure 1 Number of daily deaths from diseases7 Activists claim that only 10 per cent of global health research is devoted to conditions that account for 90 Respiratory 10,814 per cent of the global disease burden – the so-called infections 1 ‘10/90 Gap’. They argue that virtually all diseases HIV/ 7,852 AIDS prevalent in low income countries are ‘neglected’ Diarrhoeal 5,482 and that the pharmaceutical industry has invested diseases almost nothing in research and development (R&D) Tuberculosis 4,504 for these diseases.
    [Show full text]
  • Human Resource for Health Migration: an Analysis from the Perspective of Utilitarianism Rupesh Gautam University of Southern Denmark, [email protected]
    Online Journal of Health Ethics Volume 12 | Issue 1 Article 5 Human Resource for Health Migration: An Analysis from the Perspective of Utilitarianism Rupesh Gautam University of Southern Denmark, [email protected] Pawan Acharya University of Southern Denmark, [email protected] Follow this and additional works at: http://aquila.usm.edu/ojhe Recommended Citation Gautam, R., & Acharya, P. (2016). Human Resource for Health Migration: An Analysis from the Perspective of Utilitarianism. Online Journal of Health Ethics, 12(1). http://dx.doi.org/10.18785/ ojhe.1201.05 This Article is brought to you for free and open access by The Aquila Digital Community. It has been accepted for inclusion in Online Journal of Health Ethics by an authorized administrator of The Aquila Digital Community. For more information, please contact [email protected]. Human Resource for Health Migration: An Analysis from the Perspective of Utilitarianism Introduction Medical brain drain or health-worker migration is a part of what has been labeled a global health workforce crisis and is characterized by the migration of trained and skilled health workers (doctors, nurses, and midwives) from low-income countries to high-income countries. It leads to loss in human capital for the developing countries, uneven distribution of those professionals between the affluent and poor countries and more severe suffering for the latter, due to the heavy disease burden (Kollar & Buyx, 2013; WHO, 2006). According to an estimate by WHO, a healthcare system is considered unable to deliver essential health services if it operates with fewer than 23 health workers (doctors, nurses, or midwives) for every 10,000 members of its population (WHO, 2006).
    [Show full text]
  • Why Neglected Tropical Diseases Matter in Reducing Poverty 1.42 MB
    July 2013 Working Paper 03 Why neglected tropical diseases matter in reducing poverty Fiona Samuels and Romina Rodríguez Pose • Neglected tropical diseases (NTDs) have a direct impact on the achievement This and other Development of the Millennium Development Goals (MDGs). Without addressing these Progress materials are available at Key diseases, the broader aim of poverty alleviation is unlikely to be achieved. developmentprogress.org messages • Straightforward and highly cost-effective strategies are available to control Development Progress is an ODI project and eventually eradicate or eliminate NTDs. that aims to measure, understand and communicate where and how progress • Success in controlling, eliminating or eradicating NTDs depends on has been made in development. partnerships between multiple constituencies that enable countries to adapt international guidelines to local contexts, integrate NTD programmes into ODI is the UK’s leading independent think tank on international development health systems and engage communities in implementation. and humanitarian issues. Further ODI materials are available at odi.org.uk Introduction indicators specific to them (Molyneux, 2008). While neglected tropical diseases (NTDs) One possible explanation for have been recognised for centuries – international disinterest is that NTDs indeed as ‘biblical plagues’ – NTDs have, almost exclusively affect the developing as the name implies, remained below the world (though this is also true for malaria) radar of most international and national and are not likely to spread far beyond; policy-makers. indeed, many NTDs have disappeared This relative neglect can be seen in completely in the developed world due examining the Millennium Development to improved hygiene and sanitation Goal (MDG) framework: while NTDs standards.
    [Show full text]
  • Deworming on Literacy and Numeracy: Evidence from Uganda
    The long run effects of early childhood deworming on literacy and numeracy: Evidence from Uganda Kevin Croke Department of Global Health and Population, Harvard School of Public Health [email protected] This version July 17, 2014 Acknowledgements: Thanks to Owen Ozier, for suggesting the Uganda deworming project as a candidate for long run follow up and for providing the list of treatment and control parishes; to Harold Alderman and Günther Fink for valuable feedback; and to seminar participants at the Harvard School of Public Health. 1 Abstract: This paper analyzes the long run impact of a cluster-randomized trial in eastern Uganda that provided mass deworming treatment to a sample of preschool aged children from 2000 to 2003. An early impact evaluation of this intervention found that the treatment group, comprised of children aged 1-7, showed increased weight gain compared to controls (Alderman et al. 2007). Since there is now a large literature linking early life health, often proxied by weight, to long run outcomes (including cognitive, educational, health, and labor market outcomes), I use data collected in these communities 7-8 years after the end of the deworming trial to see whether children in treatment communities have higher scores than children in control communities on simple numeracy and literacy tests. I find that children who lived in treatment communities during the period in question have test scores 0.2-0.4 standard deviations higher than those in control parishes. Effects are larger for math than for English literacy scores. The effect is robust to a wide range of alternate specifications and inclusion of socioeconomic control variables, and to a placebo treatment test.
    [Show full text]
  • School Deworming at a Glance
    School Deworming at a glance Worms infect more than one third of the world’s There is no need to examine each child for the population, with the most intense infections in presence of worms. Individual screening offers no children and the poor. In the poorest countries, safety benefits. And it is not cost-effective; it costs children are likely to be infected from the time they four to ten times more than the treatment itself. stop breast-feeding, and to be continually infected Regular deworming will help children avoid the worst and re-infected for the rest of their lives. Only rarely effects of infection even if there is no improvement in does infection have acute consequences for children. sanitation. Instead, the infection is long-term and chronic, and can negatively affect all aspects of a child’s develop- Why deworming in schools? ment: health, nutrition, cognitive development, learn- School-age children typically have the highest ing and educational access and achievement. intensity of worm infection of any age group. In Deworming is safe, easy and cheap addition, the most cost-effective way to deliver deworming pills regularly to children is through All the common worm infections in school-age schools because schools offer a readily available, children can be treated effectively with two single- extensive and sustained infrastructure with a skilled dose pills: one for all the common intestinal worms workforce that is in close contact with the community. (hookworms, roundworms, and whipworms) and the other for schistosomiasis (bilharzia).1 The treatment is With support from the local health system, teachers safe, even when given to uninfected children.
    [Show full text]
  • Worms, Wisdom, and Wealth: Why Deworming Can Make Economic Sense
    Review Worms, wisdom, and wealth: why deworming can make economic sense Donald A.P. Bundy1, Judd L. Walson2, and Kristie L. Watkins3 1 Human Development Network, The World Bank, Washington, DC 20433, USA 2 Departments of Global Health, Medicine, Pediatrics, University of Washington, Seattle, WA 98104, USA 3 The Partnership for Child Development, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London W2 1PG, UK For those of us who have had worms, getting rid of them contemporaneous effects of deworming on health and edu- seems a good idea, and multiple studies demonstrate cation outcomes as well as long-run effects on adult earn- the simplicity and benefit of deworming children. In the ings [by projecting geographical panels (cohorts) forward past decade or so, there has been a dramatic increase in 50 years]. These results confirm the contemporaneous efforts to provide inexpensive deworming medications, observations and show that school age children in areas but at the same time there have been calls to re-evaluate with higher hookworm infection showed greater increases the impact of deworming programs. In this review, we in school attendance and literacy measures after interven- examine the history of deworming and explore the evi- tion. No significant effects were found in adults. The dence for effects of deworming on health, on child difference-in-difference follow-up of long-run cohorts indi- development, and on economic returns. Important poli- cates both a marked increase in education quality (rather cy conclusions include that a paucity of randomized trial than quantity) and a substantial income gain in the most data suggesting benefit does not equate to a lack of heavily infected populations.
    [Show full text]
  • Projecting Climate Related Disease Burden
    Projecting Climate-Related Disease Burden: A Guide for Health Departments Climate and Health Technical Report Series Climate and Health Program, Centers for Disease Control and Prevention Jeremy J. Hess1,2,3*, Shubhayu Saha1*, Paul J. Schramm1, Kathryn C. Conlon1,4, Christopher K. Uejio1,5, George Luber1 1Climate and Health Program, Division of Environmental Hazards and Health Effects (DEHHE), National Center for Environmental Health (NCEH), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA 2Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA, USA 3Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA 4National Center for Atmospheric Research, Boulder, CO, USA 5Department of Geography, Florida State University, Tallahassee, FL, USA *these authors contributed equally to this work National Center for Environmental Health Division of Environmental Hazards and Health Effects CS255978-A Projecting Climate-Related Disease Burden Table of Contents Executive Summary. 1 Introduction . 3 Conceptual Overview . 6 Develop Causal Pathway . 8 Assemble Data Elements . 12 Data Element: Climate Data . 12 Data Element: Baseline Disease Burden . 15 Determine the Scale of the Effort . 15 Choose an Indicator of Disease Burden . 15 Determine Baseline Disease Burden Estimates . 16 Data Element: Exposure-Outcome Response Function . 17 Data Element: Source Population . 18 Project Disease Burden . 20 Adaptation. 24 Perform Uncertainty Analysis and Assess Sensitivity. 25 Identifying Major Sources of Uncertainty . 25 Uncertainty in Causal Pathways . 27 Uncertainty in Analysis . 27 Reporting. 30 Iterative Use of Disease Burden Projections: Adaptive Management . 31 Limitations . 32 Practical Examples. 33 Example 1: Heat-Related Illness. 33 Causal Pathway . 33 Assemble Data Elements.
    [Show full text]
  • Ethical Issues in the Use of Cost Effectiveness Analysis for the Prioritization of Health Care Resources1
    Brock page 1 Ethical Issues in the Use of Cost Effectiveness Analysis for the Prioritization of Health Care Resources1 Dan W. Brock Brown University Resources to improve health are and always have been scarce, in the sense that health must compete with other desirable social goals like education and personal security for resources.2 It is not possible to provide all the resources to health, including health care and health care research, that might provide some positive health benefits without great and unacceptable sacrifices in other important social goods. This should go without saying, and in other areas of social expenditures resource scarcity is not denied, but in health care many people mistakenly persist in denying this fact. It follows from resource scarcity that some form of health care rationing is unavoidable, where by rationing I mean some means of allocating health care resources that denies to some persons some potentially beneficial health care. That rationing may take many forms. In the United States much rationing is by ability to pay, but in both public programs like the Oregon Medicaid program and in many private managed care plans more systematic efforts to prioritize health care resources have been carried out. To many health policy analysts it is an unquestioned, and so generally undefended, assumption that in the face of limited health care resources, those resources should be allocated so as to maximize the health benefits they produce, measured by either the aggregate health status or disease burden of a population. Cost effectiveness analysis (CEA) that compares the aggregate health benefits secured from a given resource expenditure devoted to alternative health interventions is the standard analytic tool for determining how to maximize the health benefits from limited resources.
    [Show full text]