Reinventing Global Health

Global Health from an African Perspective - with Joachim Kapalanga, MD

Main points * Definition of global health in the context of Africa  * Primary problems in quantity and quality in human resources confounded by the multiplicity of stakeholders * Lack of harmonization of partnership and funding channels and modalities are different for stakeholders * Lack of tracking of resources by governments * Weak point: no direct government oversight of the project: no political will and/or no mechanism to harmonize the projects * International programs often lack sustainability. Example: H3Africa Program (Human Heredity and Health in Africa)  * Competition for the same skilled workers to carry out international programs who are thus diverted from provided healthcare to local populations. It also participates in the brain drain (example: H3Africa) * No prioritization of the programs in the interest of home countries (medications, tests, equipment). Example in South Africa: patient genetic difference between California and Africa * Accountability: No separation between politics and judicial systems. As a result, there is no prosecution when waste or corruption occurs in many cases. Example: SASA conference * Successes: H3Africa with sickle cell and genetic diseases / Training of workers skilled in global health / Help in rural areas * To counter the brain drain, two examples: (1) Brain Circulation, (2) Carnegie Foundation (cross appointments)    * Rural areas. The situation has improved in the last decades but they are still underserved particularly regarding access and distribution. Moreover, facilities are underdeveloped, understaffed, and lack diagnostic tools. Example in Tanzania for the training of healthcare workers but it has plateaued. Priority: mother and children healthcare    * Collaboration between African countries: despite African Union’s efforts there is little collaboration. No continent-wide standards for healthcare * Current Ebola outbreak in Uganda (date: 10/3/2020) * Disproportion between funding and priorities: HIV/AIDS, TB, malaria are well funded at the expense of other diseases like neglected tropical diseases and chronic diseases * Deciders for best ROI: African governments but external players like the Bill Gates foundation have their own projects.  * Political consequences if programs fail: no mechanism holding anybody accountable * Influence of academia on decision-makers. Difficulty in developing policies to advise governments. They have problems on their own: insufficient funding, low salaries, lack of academic freedom, nepotism and lack of competent leaders and staff, lack of equal access to academic institutions * High cost of tuition deprives African countries of bright students * Advice for people wanting to get involved in global health in Africa:       - Despite of challenges, follow your heart      - Work in rural settings. Personal examples (1) in Tanzania, (2)        McMaster University, (3) Distributed medical education * Advice to fix what is not working in global health in Africa: (1) Training level: Expand distributed medical education nationally or internationally in Africa, (2) More collaboration between academic institutions promoting global health creating guidelines * Good example of a successful program that can be scaled: In Tanzania a training program initiated by a foundation in the Netherlands and taken by the Fogarty foundation  * Good example of program successful for sustainability: Nutritional program started by Oxfam against kwashiorkor and marasmus * Example of good collaboration between anglophone and francophone countries: Rwanda and Uganda and DRC (Democratic Republic of Congo) regarding Ebola BIO Dr. Kapalanga is a physician-scientist and educator who received his medical education from Yale University, the state university of New York, queen’s university and the university of Guelph.  He is currently professor of paediatrics at the Schulich school of medicine and dentistry and the South Western Ontario academic health network - knowledge translation group, Canada.  His scholarly and research pursuits are in the epigenetics of neurodevelopmental disorders and exploration of shared endophenotypes in neurobehavioral disorders.  https://www.linkedin.com/in/joachim-kapalanga-62a64551/?originalSubdomain=ca [https://www.linkedin.com/in/joachim-kapalanga-62a64551/?originalSubdomain=ca]

The Future of Global Health. The Main Healthcare Systemic Challenge: Prioritization with Yann Meunier, MD

Main points * Speaker introduction (international experience and expertise / pharmaceutical industry and corporate background)  * Presentation goals (road map for reaching maximum efficiency and efficacy in providing healthcare across the globe / providing food for thought to frame issues) * Global and healthcare challenges: The African example * The Clinton foundation as an example of unreliable funding * One requirement to face multiple challenges: Prioritization * Analogy: Medical emergency department * Triage process * Criterion #1 for global health: ROI with several dimensions (medical, financial, societal, political, moral, and personal) * First concrete example: Acute vs chronic disease (tetanus vs HIV/AIDS) * HIV/AIDS situation description * HIV/AIDS age distribution * HIV/AIDS treatment yearly cost (for life) * Maternal and neonatal tetanus situation description * 2022 study: Vaccination coverage of mothers in East Africa  * The financial calculus  * The question: Why is the choice not made in favor of the tetanus vaccination? * Conclusion * Fear: Resurgence of historical diseases with COVID-19 is in the news (TB, cholera, polio, HIV/AIDS, malaria)   * Second concrete example: Prevention vs cure (the tetanus example) * Conditions for success (avoiding bureaucracy and making the hard choices) * Solutions * * Priority #1: Good health * Three values (equity / solidarity / liberty) * One need: One accepted and respected leadership * One urgency: A general political consensus * Two sub-priorities: Nutrition and education * One must: Erasing the African debt * Three strategies: A new and serial approach / Thinking locally and acting globally / Consolidating global health  * Six suggestions: Mergers, coordinating superstructure, drastic limitation of face to face international conferences and congresses, the right to interfere in countries for healthcare reasons (particularly transmissible diseases) and the creation of global health blue helmet brigades, having poverty as the #1 risk factor for many diseases) * The past and the future * Food for thought * Vision * Conclusion BIO Dr. Yann Meunier is an international and multifaceted healthcare professional and a pioneer in academia, healthcare provision (in clinical settings and public health programs), research, and business.  During his education, He studied medicine at Paris V University (France), the Federal University of Rio de Janeiro (Brazil) and The George Washington University (USA). He holds specialty degrees in emergency medicine (Paris XII University), and tropical diseases (Paris VI University), a certificate from the ECFMG, a certificate from Harvard University in internal medicine and two certificates from Stanford University in communication.  During his career, In Academia He was Assistant Professor in Tropical Diseases and Public Health (Paris VI University), Adjunct Assistant Professor of Medicine (The George Washington University); Lecturer (The George Washington University Center for International Health), Director (Stanford Health Promotion Network), Manager in Health Promotion (Stanford Health Improvement Program), Mentor (Stanford Medscholars Research Fellowship Program), and Instructor (Stanford Health Improvement Program) He is widely published in the international medical literature and is the author or co-author of nine books on global health and tropical diseases (Oxford University Press and Springer published two). As Healthcare Provider Clinically He was (1) Private General Practitioner in France, Singapore (only European Private General Practitioner in the country), New Caledonia (first and only Private General Practitioner on the island of Lifou), and Nigeria (only European Private General Practitioner in Lagos), (2) Tropical Diseases Consultant (at the Pitie-Salpetriere hospital in Paris, France), (3) Chief Medical Officer for Chevron Oil Co. in Papua New Guinea (PNG), (4) Corporate Physician in Cameroon (for Cellucam), Nigeria (for Spie-Batignolles and Schlumberger), and China (for EDF), (5) he was the team Physician during corporate trips in Gambia and Egypt (for Bosch), and Congo-Brazzaville (for a timber consortium), and (6) he worked as Emergency Medicine Specialist for SAMU 94 (at the Henri Mondor hospital in Creteil, France). In Public Health He (1) created a public health program for about 10,000 Kutubu-area villagers in the Southern Highlands province of PNG, (2) wrote a report on public health priorities in Lifou, (3) conducted public health programs and epidemiological surveys in Senegal (for USAID), China, Papua New Guinea, Haiti, and New Caledonia, and (4) created and delivered health promotion and preventive medicine tools at Stanford University for the Stanford University staff and the San Francisco Bay area population and corporations, in particular several located in Silicon Valley. As Researcher He led or participated in clinical trials providing new treatments for HIV/AIDS, tropical (malaria, intestinal nematodoses, amebiasis, giardiasis), cardiovascular, hematological and respiratory diseases. As Business Executive He was the Director of International Corporate Affairs and Business Development for Stanford Hospital and Clinics in Palo Alto, CA, Research Manager for Hoffmann LaRoche drug Co. (in charge of antibiotics and anti-parasitic drugs) and Export Medical Director for Delagrange drug Co. (in charge of Eastern Europe, Africa, the Middle-East, and Asia) in Paris, France. He was Co-founder and Business Manager of International Business Proactivity Pte Ltd in Singapore. He created his own healthcare consulting company HealthConnect International LLC, in Silicon Valley, CA, and is now its CEO and a Global Health Expert.  Dr. Yann Meunier is an Honorary Member of the Brazilian National Academy of Medicine, Associate Member of the Academy of Medicine, Singapore, and Fellow of the Australasian College of Tropical Medicine. He is listed by the Institute of Medicine, U.S., Division of Health Promotion and Disease Prevention (celebrities, public figures). He is fluent in English, French, and Portuguese, including medical terminology.

What is Wrong with Global Health in 2022? What are the Solutions? - with Alain L. Fymat, PhD, PhD

COVID-19 has underlined the current poor state of global health. In this podcast, I have tried to identify the underlying problems that were evidenced, at least in part, by the root causes of the pandemic. My remarks were largely based on my published book “Pandemics: Prescription for Prediction and Prevention”*, especially its Chapter 18.  To summarize: We live in an unruly, not easily managed world of ~ 8 billion people that is constantly growing. Notwithstanding the plethora of international, regional, national, and other organizations, there are glaring inequities among nations, principally between developed and poor ones. In particular, within the context of COVID-19, the prime organization among them, the World Health Organization (WHO), has been dilatory, at times issuing contradictory recommendations, and deferring to those powerful nations that fund it most (in this instance, China).  In this context, humanity has again proven to have a short memory of past epidemics/pandemics, not having even clearly identified what are their root causes. It is therefore no wonder that these events will continue to haunt us till the end of times ... unless we are able to devise appropriate strategies for predicting/preventing them such as the one I have proposed. For this purpose, I have identified ten important measures: * Highlight global health security; * Create and strengthen necessary mechanisms;  * Promote multidisciplinary engagement; * Strengthen multisectoral coordination; * Emphasize the importance of financial preparedness; * Improve early warning and detection; * Collect and share data in a timely manner; * Conduct laboratory testing; * Develop joint outbreak response capacities; and * Take appropriate science-based actions. I have also identified ten intertwined cardinal factors that are the root causes of pandemics that need to be simultaneously tackled and remedied: * Rapid growth of global human population; * Increased globalization; * Environmental degradation and destabilization of ecosystems; * Creation of new urban or agricultural ecosystems; * Economies of scale and monocultures in agriculture and dysfunctional agrifood systems; * Loss of land and ocean biodiversity; * Water scarcity; * Human-induced climate change; * Societal inequities; and * Irrational mass denialism of hard-won facts of science (vaccinations, antimicrobial overuse).  Some of the above factors could be correlated with the United Nations (U.N.) Sustainable Development Goals (SDG).  In the same book, I have offered a blueprint for a 6-level strategic pandemic prediction and prevention program that should herald the beginning of the end of pandemics:  1. Creating of a new “World Environment Organization”; 2. Shifting the current health paradigm to a “One-World/One-ecoHealth paradigm” that will be grounded by a new “International Pandemic Treaty” and other international laws; 3. Involving international, intergovernmental, regional, and national health organizations; 4. Incorporating the “Global Human Virome Project”; 5. Actively developing models (epidemiological, climate-type) with their enabling technologies and databases: and 6. Folding-in the development of vaccines & therapeutics and the corresponding research.  The value and success of the proposed approach will be gauged by four measures:  * Reducing causes of new infectious diseases; * Preventing outbreaks and epidemics from becoming pandemics; * Preparing for potential future pandemics that could not be prevented; and * Ensuring that the causing virus does not re-emerge thereafter (e.g., by sustaining itself in domestic animals). Within that blueprint, I truly believe we can reach a stage where pandemics could at long last be predicted and prevented. *Book (hard cover and paperback): Pandemics: Prescription for Prediction and Prevention: https://www.amazon.com/Pandemics-Prescription-Prediction-Alain-Fymat/dp/0228867215 [https://www.amazon.com/Pandemics-Prescription-Prediction-Alain-Fymat/dp/0228867215] BIO Dr. Fymat is a medical-physical scientist and an educator. He is the current President/CEO and Professor at the International Institute of Medicine and Science with a previous appointment as Executive Vice President, Chief Operating Officer and Professor at the Weil Institute of Critical Care Medicine. He was educated at the University of Paris-Sorbonne and the University of California at Los Angeles. He was formerly Professor of Radiology, Radiological Sciences, Radiation Medicine (Oncology), Critical Care Medicine, and Physics at several U.S. and European Universities. Previously, he was Deputy Director (Western Region) of the U.S. Department of Veterans Affairs, Veterans Health Administration (Office of Research Oversight), and Director of the Magnetic Resonance Imaging Center and for a time Acting Chair of Radiology at its Loma Linda, California Medical Center. He has extensively published (~ 425 publications including patents, books & monographs, book chapters, refereed articles). As invited/keynote speaker and member of organizing committees of international congresses and symposia, he has lectured extensively across the USA, Canada, Europe, Africa and Asia. He has been the recipient of numerous research grants from government, academia and private industry, and has consulted extensively with these entities. He is a Board member of several institutions and Health Advisor of the American Heart & Stroke Association (Coachella Valley Division, California). He is Editor-in-Chief, Honorable Editor or Editor of 35 medical-scientific Journals. He published more than 167 articles in different journals. https://www.linkedin.com/in/dr-alain-l-fymat-bb555012/ [https://www.linkedin.com/in/dr-alain-l-fymat-bb555012/]

Healthcare Systems and Global Health: The U.S. Example - with Michael J. Zema, MD

The US Healthcare system has slowly evolved over the past century through a combination of legislative efforts, need assessment by the private sector and pioneering efforts by a few dedicated and resourceful patient care givers. As such, morphing over the decades and at times having been shackled by political compromise, it is not surprising that with its evolution there would be some unintended consequences. At this stage, to help create a future healthcare delivery system which can facilitate the timely, efficient and appropriate access to healthcare for those most in need at a cost that is sustainable, one must proceed carefully lest we continue to apply layer upon layer of more ineffectual “band-aids” as has been previously done. Healthcare is complicated and so therefore is its delivery. As HL Mencken once warned, “For every complex problem there is a solution which is simple direct and wrong.” In this digital world in which we now live, do not surrender to the vicarious technological varlets: fax, voice mail, email, text, electronic health records and artificial intelligence, the very effective and personable interactions with your colleagues and your patients, including a carefully performed physical examination. The latter represents an important transactional moment between doctor and patient, “a laying on of healing hands” which helps foster the trust needed for relational continuity and effective cure. To those who would have you believe that technology will totally replace this interaction, I would have them remember the old girl scouting adage…. “Make new friends but keep the old, the one is silver, the other gold”… Further, please never forget, “No one cares how much you know until they know how much you care.” Remember, even an intellectual argument, including detailed statistical analyses can at first appear quite cogent, but upon more careful examination may be found to be fraught with erroneous assumptions and even faulty methodology. Be critical in your review of the literature. As Benjamin Desraeli, 19th century Prime Minister of England twice over quite perspicaciously once stated, “There are three kinds of lies; lies, damned lies and statistics.” When reviewing the literature, remember to fix your sights on the proper target. Albert Einstein once stated, “Not everything that can be counted counts and not everything worth counting can be counted,” words of wisdom when applied to healthcare. * OECD (Organization of Economic Cooperation & Development) https://www.oecd.org/health/health-statistics.htm World Index of Healthcare Innovation www.freopp.org/wihi/home [http://www.freopp.org/wihi/home] * Kaiser Family Foundation Schaeffer Center for Health Policy  * Brookings Institute Center for Medicare & Medicaid Services Commonwealth Fund https://www.commonwealthfund.org/international-health-policy-center/system-stats [https://www.commonwealthfund.org/international-health-policy-center/system-stats] * IMS Institute for Healthcare Information Global Medication Use in 2020 US Census Bureau https://www.census.gov/quickfacts/fact/table/US/PST045221 [https://www.census.gov/quickfacts/fact/table/US/PST045221]  * American Hospital Association https://www.aha.org/statistics/fast-facts-us-hospitals [https://www.aha.org/statistics/fast-facts-us-hospitals] * US Dept Health & Human Services Office of the Inspector General https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf / [https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf%20/] https://oig.hhs.gov/oei/reports/OEI-06-18-00400.pdf [https://oig.hhs.gov/oei/reports/OEI-06-18-00400.pdf]  * Association of America Medical Colleges https://www.aamc.org/data-reports/reporting-tools/report/tuition-and-studentfees-reports [https://www.aamc.org/data-reports/reporting-tools/report/tuition-and-studentfees-reports]  * 3M Clinical and Economic Research https://multimedia.3m.com/mws/media/2117913O/his-pm-cer-socioeconomicstatus-health-care-deliverysystem-performance-report-en-us.pdf [https://multimedia.3m.com/mws/media/2117913O/his-pm-cer-socioeconomicstatus-health-care-deliverysystem-performance-report-en-us.pdf]  * American Association of Nurse Practitioners (AANP) https://www.aanp.org [https://www.aanp.org]  BIO Dr. Zema has enjoyed a tenure of forty plus years in the healthcare arena on the “inside” as physician trainee; private practitioner; member of a hospital medical board; vice president of a physician independent practice association; board member of a physician holding company; pharmaceutical industry and malpractice legal consultant; chief of cardiology at both community hospital and academic medical centers; professor of medicine at two state university colleges of medicine; and physician clinical reviewer for a large national radiology benefits manager. Having operated in all of the above "silos," at one time or another, unlike so many of today's so-called "pundits,"  Dr. Zema has indeed walked the walk and not merely talked the talk and as such is uniquely qualified to debate healthcare delivery providing a glimpse from the inside out. https://www.linkedin.com/in/michaeljzema-md/ [https://www.linkedin.com/in/michaeljzema-md/]

Global Health: Universal Preventive Medical Checkups in Three Modules (in French) - with Jean-Michel Lichtenberger, MD

Plus on détecte précocement un problème de santé en devenir, plus son traitement sera facile, voire seulement possible. C’est une évidence. La médecine de plus en plus s’attache à chercher des « signaux faibles » qui permettent des diagnostics de plus en plus précoces. C’est le cas par exemple dans l’imagerie en utilisant de savants algorithmes. Mais c’est aussi le cas pour des choses aussi simples que de mesurer le taux d’hémoglobine glyquée à la recherche d’un diabète, de TSH à la recherche d’un dysfonctionnement de la thyroïde ou de PSA pour la prostate, voire une simple mesure de la tension artérielle. Bien d’autres examens sont possibles. Proposer de faire un « bilan de santé » est une fausse promesse car nul ne peut prétendre dresser l’état de la santé d’une personne dans son entièreté. Ce que l’on peut faire est d’explorer le plus probable pour une personne en fonction de ses antécédents personnels et familiaux, et des signes cliniques qu’il présente. Également, on va chercher ce qui est le plus fréquent épidémiologiquement pour sa tranche d’âge ou son genre. Ainsi pourra-t-on approcher un « bilan médical » ciblé qui a le plus de chances d’être pertinent pour une personne donnée. C’est pourquoi notre Centre Médical International propose des « bilans médicaux modulaires » attachés à une fonction (sommeil par exemple), ou à un organe (cœur par exemple), plusieurs modules pouvant être assemblés pour réaliser ce que d’autres appelleront un « bilan de santé ». Mais ce n’est pas le tout de dépister, encore faut-il savoir que faire de ce que l’on a trouvé. Après un bilan, on ne se précipite pas toujours sur un traitement médical ou une opération. Surtout lorsque l’on a détecté des signaux faibles ; il suffit parfois juste de mettre en œuvre des mesures de prévention de l’aggravation. Ou alors au moins de mesures accompagnant des traitements qui peuvent en être plus légers. Car c’est bien joli de faire un bilan pour détecter un sujet à considérer, mais qu’en fait-on ? L’important pour nous, ce sont les suites qu’on donne à un bilan. Certaines conduiront à un spécialiste pour approfondir une recherche parce qu’un résultat questionne. On entre dans la sphère médicale classique. D’autres conclusions ne conduiront qu’à des recommandations d’hygiène de vie. Elles sont fondamentales. Les déterminants de la santé sont loin d’être entre les mains des seuls médecins. Ils sont avant tout entre les mains de chacun ou de sa destinée. Pour le patrimoine génétique ou les traces laissées de l’enfance, on ne peut que les subir. Pour les facteurs importants conditionnant la santé de tout un chacun comme les facteurs sociaux, économiques ou familiaux, tout comme l’environnement, on ne peut pas faire grand-chose. Il reste toutefois de nombreux domaines sur lesquels on peut agir pour influencer considérablement l’avenir de sa santé. Il s’agit pour l’essentiel de l’activité physique, de l’alimentation, du sommeil, du stress et des addictions à commencer par le tabac. Notre objet dans le podcast était d’en souligner l’importance et leur place dans la médecine moderne. En effet celle-ci s’efforcera de plus en plus de ne pas être réactive – à savoir attendre la maladie pour agir, mais prospective – à savoir anticiper et prévenir les risques pour ne pas avoir à en traiter les conséquences plus tard. En ce sens, la prévention ne peut être utile que si elle rencontre le projet de santé d’une personne. Si un fumeur ne veut pas arrêter, un obèse ne pas arrêter de mal manger ou un sédentaire de rester devant sa télévision, une action préventive sur l’addiction, la nourriture ou l’activité physique sera inutile. Par contre, discuter avec son médecin de ses points faibles que l’on veut renforcer, et des moyens que l’on veut se donner pour améliorer sa santé, c’est ce qui permettra de travailler une prévention en santé vraiment utile pour éviter l’apparition de maladies, ou l’aggravation de pathologies existantes. BIO Parcours du Dr. Lichtenberger après avoir pratiqué la médecine en contexte tropical, essentiellement en Afrique:  1983-1990  * Creation de la la société SMI « Service Médical International », qui a pour vocation de répondre à la problématique médicale et financière des entreprises operant dans les regions insuffisamment médicalisées du globe. Elle œuvrera principalement en Afrique mais également au Moyen Orient et en Asie du Sud Est. * Gestion de projets (secteur privé) : montage et supervision de dispensaires et de petits hôpitaux, gestion du personnel medical et administratifs, systemes d’information, approvisionnement en materiel medical et medicaments (Cameroun, Chine, Congo, Guinée, Nigeria, RDC (ex-Zaïre), Sultanat d’Oman). * Direction de programmes de lutte contre le paludisme, puis plus tard contre le SIDA (Angola, Cameroun, Guinée Équatoriale, Mali). * Développement de projets de maîtrise médicalisée des dépenses de santé, en Côte d’Ivoire, puis au Gabon. Développement de mutuelles de santé d’entreprises. * Études medico-sanitaires dans de nombreux pays (en plus de ceux déjà notes : Arabie Saoudite, Indonésie, Hong Kong, Kazakhstan, Maroc, Pakistan, Russie, Sénégal, Sultanat d’Oman, Soudan, Tunisie). Depuis 1990 * Vice-président de la Société de Médecine des Voyages (deux mandatures). Membre actif depuis la naissance de la société. Toujours en cours. Depuis 1992 * Création de SMI Équipements, fournisseur de produits de santé aux côtés de SMI, fournisseur de services médicaux. En 1999 * Co-création du Collège International du Voyage, association de réflexion transversale pluridisciplinaire sur le voyage (colloques «Au seul souci de voyager», cafés du voyage, voyages littéraires…). Entre 2001 et 2011 * Création de Health cy, Agence de développement et de gestion de la santé. * Développement de SMI Équipements et SMI Pharma. * Enseigne dans le DIU de médecine des voyages Paris Sorbonne (toujours actuellement). * 2011: Vente des sociétés au groupe International SOS et retrait de toute activité dans leurs domains. * 2012: Création de l’Association Voyage et Santé (AVS) et redémarrage du Centre de Vaccinations Internationales Air France, par AVS. * 2016: Développement et déménagement du Centre au 38, quai de Jemmapes, Paris 10eme. 2018 🡪 ce jour * Création du Centre Médical International integrant le Centre de Vaccinations Internationales, accueillant quelque 90 000 patients et réalisant plus de 100 000 vaccinations internationales par an.   https://www.linkedin.com/in/jean-michel-lichtenberger-0128869/?originalSubdomain=fr [https://www.linkedin.com/in/jean-michel-lichtenberger-0128869/?originalSubdomain=fr]