Global health trends and lessons learned towards better advocacy and development in emergency...
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Global Health trends and lessons learned:
Towards better advocacy and development in Emergency Medicine
Farooq Khan MDCMPGY5 FRCP-EM
McGill UniversityJuly 24th 2013
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Objectives
• Appreciate the role of the emergency physician as an advocate for public health – (on local and global scale)
• Understand how global health trends can impact local health care
• Be introduced to potential global health activities that are compatible with the average EP’s practice
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Outline
• Part 1: Advocacy in EM– Patients, communities and the world at large
• Part 2: Global Health trends– Political, social, economic and environmental
determinants– EM as a global priority
• Part 3: Examples of EM development and activism– GECC - Uganda– International EM research at WHO– Get involved without leaving the country
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Advocacy in EM
Part 1
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Health as a human right
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Advocacy
• Emergency Medicine is an ideal specialty for advocacy– Frontline witnesses:
• Consequences of public health hazards
• Failings of the system
– Ability to act
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Agency: “Working
the system”
Activism: “Changing
the system”
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Veysman B BMJ 2005;331:1529
©2005 by British Medical Journal Publishing Group
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GLOBAL HEALTH?
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66th World Health Assembly 2013
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Global Health Trends
Part 2
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Global health trends outline
• Globalization and social inequity• Economic crisis• Universal Health Care and poverty• Changing health demographics• The role of EM in
– Non-communicable disease and injuries– Sustaining Health systems– Humanitarian action, disasters, and pandemics– Climate change
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Political, social, economic and environmental realities
• Globalization and widening social inequities– Urbanization, migration, global alliances
• Economic crisis– Reductions in public spending, unemployed youth
and impoverished elderly
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Global recession
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Complex health challenges
• Threat to sustainability of Universal Health Care (UHC)– Rising health expenditures– Rising public expectations– Increasing use of technology
• Decreased access to health services and medical products
• Exclusion of those without financial means
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Political, social, economic and environmental realities
• Changing picture of poverty– The poor in Middle Income Countries (MICs)– Global health less about geography and more
about inequity– Exchange of ideas vs delivery of aid
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Health and demographic trends
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Health and demographic trends
• MDGs– Decreases in Malnutrition, Maternal and child
mortality, HIV/TB/malaria– Increase access to water and sanitation– Caveats: resistance, resurgence, inequities in access
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• Aging• Rise in Non
Communicable Diseases (NCD)– Cardiovascular disease,
Diabetes, Cancer, Mental Health
– Injuries
The Lancet Volume 380, Issue 9859, (15 December 2012–4 January 2013)
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WHO core functions
1. Providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
2. Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge;
3. Setting norms and standards, and promoting and monitoring their implementation;
4. Articulating ethical and evidence based policy ‐ options;5. Providing technical support, catalysing change, and building
sustainable institutional capacity;6. Monitoring the health situation and assessing health trends.
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Complex health challenges
• Fragmentation– Multiple voices in health governance– New organizations, financing channels and
monitoring systems– Duplicate/parallel services– Miscommunication
“Fragmentation is literally killing people. Together we must take action to fix it, now.”
- Dr. Jim Yong Kim, President of the World BankWorld Health Assembly, Geneva May 2013
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Combating fragmentation through Integrated Acute Care
• Integrated across specialties– EM, Surgery, Anesthesia, Obstetrics (EESC)
• Integrated through the care delivery pathways– Prehospital care, In-Hospital care, Community
rehabilitation (GACI)• Integrated through policy
– Prevention, Promotion, Monitoring/Evaluation– Health system strengthening
• Research, Best practices, and Capacity building tools
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Complex health challenges
• Funding– Donor priorities vs beneficiary priorities– Tied aid
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Funding for global health aid
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Vicious cycle of neglected health programs
Lack of funding
Lack of research capacity
Lack of evidence
base
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EM Sustaining UHC
• Ensuring access to curative and preventative services
• Ensuring financial protection• Health policy and system strengthening• Allocating supplies, human resources,
geographic distribution• Linking health to sustainable political, social,
and economic development
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Emergency risk management
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Health security and humanitarian action
• Complex Humanitarian Emergencies– MSF and the Syrian conflict
• Interdependence of relief and development
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Emerging infectious disease and pandemic preparedness
• Zoonoses• Real time intelligence• Rumor verification• Early alerts• International response
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Global alert and response
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Complex Health Challenges
• Dealing with transnational threats to health – International Health Regulations– Pandemic influenza preparedness framework
• Protecting human health while minimizing disruptions to travel, trade and economic development
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Climate change
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Summary
• EM plays an fundamental part in the future of integrated health systems
• Political and economic pressures threaten the sustainability of UHC in developed countries leading to rises in ED use
• Social and environmental changes alter disease patterns presenting to our ED
• EM has a central role in response to pandemics, disasters and humanitarian crises
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Examples of EM development and activism
Part 3
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Sustainable EM development
• Task-shifting and capacity building with GECC – Training midlevel Emergency
Care Practitioners (ECPs) at Nyakibale Hospital in Rukungiri, Uganda
• Training the trainer • Hands-off supervision
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Introduction to Injury Prevention
An interactive discussion for senior and qualified ECPsNyakibale HospitalRukungiri, Uganda
Farooq Khan MDCM, PGY4 Emergency Medicine
McGill University, Montreal, Canada
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• What about task-shifting in North America?• Budget cuts and increasing complexity of
emergency care• Role of midlevel providers?
– PAs, NPs, ACPs
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WHO Global EM capacity research
• Challenges– Political and ethical considerations– Relative lack of personnel with expertise in:
• Study design• Data management and analysis
– Lack of time– Lack of funding– Publication bias
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Activism and social consciousness
• Public health/Community outreach projects and partnerships
• Municipal and Provincial programmes • Professional societies (EuSEM, AfJEM, IFEM)• Research, publishing in open access journals• Petitions/protests• Press/Open letters• Forums• Social media
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Excerpt from F. Abergel PCR-SP, ASSS-Montreal
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“Using social media to communicate academic knowledge is not a problem in itself, it actually opens up vast new possibilities, but it forces us to ask what will happen as more and more researchers use social media and other open-access outlets for their work. How will we cope with the din? And, most importantly, who will get heard?”
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Take home messages
• EM is an ideal specialty for advocacy• Complex global trends have concrete
downstream local effects on EM• EM advocacy is easily achievable through
concerted small actions:– Awareness of public and global health issues– Sharing knowledge– Engaging communities– Expressing opinions
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Acknowledgements
• Dr. Meena Cherian – WHO Emergency and Essential Surgical Care
• Dr. Mark Bisanzo and Dr. Heather Hammerstedt – Global Emergency Care Collaborative
• Dr. Kirsten Johnson – Humanitarian Training Initiative
• Dr. Robin Cardamore – Montfort Hospital
• Dr. Raghu Venugopal – University Health Network and MSF
• Dr. Meera Muruganandan and Dr. Nicolas Hawbaker for photographs of Uganda
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Primary source
All other references appear within each slide