Global Health trends and lessons learned:

Towards better advocacy and development in Emergency Medicine

Farooq Khan MDCMPGY5 FRCP-EM

McGill UniversityJuly 24th 2013

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

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

Advocacy in EM

Part 1

Health as a human right

Advocacy

• Emergency Medicine is an ideal specialty for advocacy– Frontline witnesses:

• Consequences of public health hazards

• Failings of the system

– Ability to act

Agency: “Working

the system”

Activism: “Changing

the system”

Veysman B BMJ 2005;331:1529

©2005 by British Medical Journal Publishing Group

GLOBAL HEALTH?

66th World Health Assembly 2013

Global Health Trends

Part 2

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

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

Global recession

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

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

Health and demographic trends

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

• 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)

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.

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

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

Complex health challenges

• Funding– Donor priorities vs beneficiary priorities– Tied aid

Funding for global health aid

Vicious cycle of neglected health programs

Lack of funding

Lack of research capacity

Lack of evidence

base

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

Emergency risk management

Health security and humanitarian action

• Complex Humanitarian Emergencies– MSF and the Syrian conflict

• Interdependence of relief and development

Emerging infectious disease and pandemic preparedness

• Zoonoses• Real time intelligence• Rumor verification• Early alerts• International response

Global alert and response

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

Climate change

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

Examples of EM development and activism

Part 3

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

Introduction to Injury Prevention

An interactive discussion for senior and qualified ECPsNyakibale HospitalRukungiri, Uganda

Farooq Khan MDCM, PGY4 Emergency Medicine

McGill University, Montreal, Canada

• What about task-shifting in North America?• Budget cuts and increasing complexity of

emergency care• Role of midlevel providers?

– PAs, NPs, ACPs

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

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

Excerpt from F. Abergel PCR-SP, ASSS-Montreal

“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?”

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

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

Primary source

All other references appear within each slide