Vector Volume 11 Issue 1 - 2017

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Editor’s Note: The Sky’s No Limit Of the many things that come to mind when one thinks about global health, an astronaut is probably not high on the list. The front cover of this first issue of Vector for 2017 is not what we would conventionally expect of a global health journal. And yet, that is precisely the message that this issue conveys – the limitless diversity that global health has come to represent. We are living in an increasingly globalised world, with greater wealth and inequality we have ever encountered. We have made remarkable progress over the past few decades on the frontier of global health, including increased vaccination and access to treatment for diseases such as HIV. However, the agenda is now shifting to focus on new and emerging challenges. Undoubtedly, healthcare in a global context is intrinsically connected to the political, social and cultural phenomena that define today’s world. The rise to power of the United States President Donald Trump raises serious questions and concerns about the future of global health, with his controversial approaches and perspectives towards climate change, refugees and migrants, as well as sexual and reproductive health. Owen Burton (p 2) provides a thoughtprovoking commentary on these issues, and urges Australia to consider our future potential role in leading an alternative direction rather than following the direction set by the US. War and conflict, political stability and human rights also intersect with global health issues, as we see with the distressing increase in targeted attacks on health care facilities, Michael Wu (p 18) offers an insightful perspective into the situation of medical neutrality in conflict zones. In addition to man-made crises, natural disasters also pose a threat to human health and health care systems, with mental health implications a particular concern deserving attention, as discussed by Rose Brazilek (p 32). Climate change is the greatest challenge we are facing in the global health arena. Personal experiences and commentary are provided by Erica Longhurst (p 8). Noncommunicable diseases (NCDs) account for a substantial proportion of the global burden of disease. We are reminded by Charlotte O’Leary (p 14) that we need to question and redefine the approach we take towards this issue, to ensure that women’s health is not limited to reproductive health concerns, but a holistic approach over the entire life course, including addressing the risk factors and burden of NCDs specific to women and girls. Yet whilst our focus often turns to issues “abroad”, there is much to be addressed in global health on a local level. Health promotion amongst key populations in Australia is a particular topic of interest. A comprehensive review article by Alec Hope (p 29) describes issues regarding the promotion of HIV pre-exposure prophylaxis amongst Aboriginal gay and bisexual men in Australia. Migrant women in Australia also have lower rates of cervical cancer screening; the factors and interventions to address this issue are explored in a review article by Archana Nargendiram (p 36). The recent health policy “No Jab No Play / No Jab No Pay” also raises the issue of vaccination scepticism and conscientious objection, a concerning phenomenon in Australia as well as worldwide. A commentary by Elissa Zhang (p 5) provides an interesting overview of historical events like the Cutter Incident (involving the polio vaccine) and common concerns held by ‘anti-vaxxers’. With so much happening in global health, it is understandable for the general public, and particularly young people, to feel disenfranchised or disempowered. We even become desensitised and apathetic to the problems; such as conflict, mass displacement and natural disasters; that we are constantly exposed to in the media. Patrick Walker calls on us to remember the human side to the tragedies that we see, but also to promote tolerance and understanding with people who hold different views to our own (p 11). An interview by Ashley Wilson-Smith with NASA astronaut, paediatrician and internist Professor David Hilmers (p 26) provides a window into his vast experiences in resourcepoor settings, including recently in the Ebola crisis, and the interview reinforces that global health is not always what we expect it to be. Professor Hilmers is also one of our Advisory Board members, a new initiative aimed at strengthening the academic standard and longevity of Vector Journal. There is a growing community of medical students who share a passion for global health. (Indeed, they are attending conferences around the world, including at Doctors for the Environment Australia (Belle Woody, p47) and with the IFMSA in Montenegro (p44)!) Unlike other medical specialities that have a clear career pathway, global health is a blank canvass. It is hard to define, and that lends a huge amount of potential – global health can be anything that you want it to be. There is “no limit” in that sense! I believe that the contents of this issue speak to the diversity of global health. Not only does it bring attention to some of the greatest challenges, it also celebrates the developments in research, collaboration and policies that pave the way towards new and creative solutions. We hope this issue engages you, inspires you, and challenges your ideas and assumptions about global health. I am incredibly grateful to the Vector Committee, to all of our authors and contributors, to the Advisory Board, AMSA Global Health and many other supporters. Dear Reader, let Vector be a platform for you to launch beyond the horizon into global health. Carrie Lee, Vector Editor-in-Chief 2017 Correspondance: carie.lee@amsa.org.au 1
Rise of Trump/Fall of Health [Commentary] Owen Burton Owen Burton holds degrees of Bachelor of Biomedical Science (Griffith University) and Masters of Orthoptics (University of Technology, Sydney) As Donald Trump took the stage declaring victory as the 45th President of the United States and the Leader of the Free World, I had a sudden chilling realisation. This man, who has spent his entire life ignoring or actively working against the dangers of climate change, progressive social policy and a centralised state control healthcare system, now sits at the head of the American government, which sets the trends in policy and action in the Western world. His often-repeated goal during campaigning was to “repeal and replace” Obamacare by relaxing legislation which prevents exploitation of the injured by private insurance interests, and removing funding for vital infrastructure in hospitals and speciality clinics, as well as sexual health and Planned Parenthood programmes. Although he has, so far, been unsuccessful in repealing Obamacare, he has not given up his crusade against basic healthcare provisions. Under Trump’s direct guidance, Tom Price, head of the Department of Health and Human Resources, continues to reduce requirements for insurance companies to provide essential benefits, and works towards completely dismantling systems related to women’s or sexual health. Such a removal of support and shift away from women is concerning, as it appears to indicate the return of deep-seated sexism within governmental institutions which sets an example for the wider society. These cuts will jeopardise the health of the world’s most at-risk individuals by removing access to education and preventative measures against sexually transmitted diseases, as well as all facets of maternal healthcare. While Trump has proven time and time again that he has little regard for females, this blatant attack seems like an extreme first step. People have been protesting the numerous unconstitutional and unethical executive orders streaming from the desk of the White House through large organised protests, rallies at offices of local governmental officials and online petitions. It is vital, however, that this momentum does not weaken: accepting this situation as the new ‘normal’ cannot be allowed to happen. Having to fight constantly is exhausting but essential. Without significant resistance, it is likely that Trump will be able push many of these bills through a Republicandominated congress and into law. Trump’s executive order to freeze funding and support for global aid serves to reinstate and expand Reagan’s 1984 ban on United States (US) foreign aid. All $9.5 billion USD of American global health funding will be restricted from being available to any nongovernment organisations providing or even discussing abortion with patients.[1, 2] These cuts will jeopardise the health of the world’s most at-risk individuals by removing access to education and preventative measures against sexually transmitted diseases, as well as all facets of maternal healthcare. The World Health Organization estimated that a total of 225 million women in developing countries were not using contraception, mainly due to lack of access and education.[3] With the implementation of this gag, it is expected that these numbers will rise significantly. 2
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Page 3: Contents Editor’s Note: The Sky
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Page 9 and 10: may perceive the risks from vaccina
Page 11 and 12: Climate Change and Vector-Borne Dis
Page 13 and 14: REFUGEE AND ASYLUM SEEKER UPDATE MA
Page 15 and 16: Just two weeks after Dukhan’s let
Page 17 and 18: Redefining Women’s Health: A Nonc
Page 19 and 20: posit in Women’s Health: A New Gl
Page 21 and 22: Healthcare in Conflict Zones [Featu
Page 23 and 24: to bring governments and warring fa
Page 25 and 26: Surgery: Luxury or Necessity? [Feat
Page 27 and 28: providing surgery are high, investi
Page 29 and 30: Beyond the horizon and back again I
Page 31 and 32: soft-drinks in day-to-day practice.
Page 33 and 34: prevention method.[15] At-risk indi
Page 35 and 36: Mental illness following disasters
Page 37 and 38: increase the incidence of disasters
Page 39 and 40: Factors that contribute to the redu
Page 41 and 42: does not allow for the provision of
Page 43 and 44: Medical electives in resource-poor
Page 45 and 46: the tensions which exist between se
Page 47 and 48: IFMSA - 5 letters with one big miss
Page 49 and 50: Health, was involved in presenting
Page 51 and 52: million more people into extreme po
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Vector Volume 11 Issue 1 - 2017

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