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International Health

Health Systems Program

Date: Feb 2017

The Health Systems Program in the Department of International Health at Johns Hopkins Bloomberg School of Public Health (JHSPH) was awarded an R21 grant from the National Institutes of Health (NIH) and Fogarty International Center for a mobile health (m-Health) project in Uganda.

The award was granted recently to Assistant Scientist, Dr. Dustin Gibson, for the project Mobile Phone Surveys for NCD Risk Factors in Uganda (MoP-NCD). Dr. Gibson will be the co-Principal Investigator along with Dr. Adnan Hyder, Professor and Director of the Health Systems Program. Dr. George Pariyo, JHSPH, and Drs. Fred Wabwire and Elizeus Rutebemberwa from Makerere University School of Public Health (MakSPH) are also co-Investigators on the study. The project is designed to be a collaboration between JHSPH, MakSPH and Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda.

Deaths from non-communicable diseases (NCDs) are rising rapidly, especially in low- and middle-income countries (LMICs), which bear a disproportionate burden. About 75% of all global deaths from NCDs are in LMICs and almost half of them are premature, occurring before age 70. Dr. Gibson said “In Uganda, NCDs are responsible for four of the leading 10 causes of death, yet data on NCD risk factors remains obscure." More research is needed on the burden that NCD risk factors pose, along with an innovative method for collecting and documenting data, in order to frame the problem and shape targeted health systems responses that can save millions of lives.

The MoP-NCD program will leverage the IM-HDSS to assess the quality and reliability of data collected by a mobile phone survey as compared to traditional methods of data collection (i.e. household surveys). Telephone and mobile phone surveys have been utilized to collect population level estimates of health and demographics in high income countries, but their application has not been extensively studied in lower income countries. As the population coverage of mobile phones increases, opportunities exist to leverage m-Health technologies to improve the efficiency, timeliness, and cost-effectiveness of data collection in LMICs by interviewing respondents over their own personal mobile phone. “Given the low cost of mobile phone surveys, and if they are successfully validated, they have the potential to rapidly generate much-needed data on NCD risk factors and help define health policy and program management decisions,” stated Dr. George Pariyo, Senior Scientist at JHSPH.

The Fogarty grant “enables JHSPH to conduct intensive field training of researchers at MakSPH who will serve as a resource for the country in future use of mobile phone surveys for NCD risk factor surveys,” emphasized Dr. Adnan Hyder.  

 The Health Systems Program is focused on achieving accessible, cost-effective health care and healthy outcomes across the lifespan for families, communities and nations. In the past decade, the Program has conducted projects in over 50 countries, with particular expertise in South Asia and sub-Saharan Africa, where the greatest number of people continue to struggle with deep poverty and unmet health needs.

For more information, please contact Melissa Reed, Communications and Program Specialist, at melissar@jhu.edu

Health Systems faculty member, Dr. Connie Hoe, is also core faculty of the Johns Hopkins International Injury Research Unit (JH-IIRU). JH-IIRU hopes to help reduce road traffic injuries in low-and middle-income countries by providing monitoring and evaluation support to road safety risk factors such as helmet use, speed, drink driving and seatbelt use for projects, including the Bloomberg Initiative for Global Road Safety (BIGRS) project.

Dr. Hoe, who is interested in the politics of health policy, is now looking into the issue of drink driving by studying how the alcohol industry impacts policy for road safety, especially in low- and middle-income countries (LMICs). While consumption per capita is greater in high-income countries, the mortality burden is greater in low-income countries.

The alcohol market potential has driven the industry to LMICs where trade liberalization has increased. Citizens in LMICs are also growing more receptive to the lures of the industry due to increasing disposable income and a larger youth population. The World Health Organization (WHO) Global Status Report on Road Safety found that the percentage of drivers testing above the legal limit varies and also differs widely across the board, however high-income countries were more likely than LMICs to have drink driving legislation in line with best practices.

Today, the alcohol industry functions much like the tobacco industry of 50 years ago. By targeting consumers in LMICs, the industry hopes that their marketing efforts will have a wider reach and not as much oversight. One of the major reasons for the lack of effective drink driving policies in LMICs is the alcohol industry’s opposition to meaningful regulation around the issues of drink driving and road safety. However, it’s not just LMICs that have cause to be concerned – in June 2016, Formula One (F1), the premier form of auto-racing, signed a deal with Heineken that allowed them to become a sponsor at sporting events. This partnership means that Heineken gets to create a larger exposure to alcohol in an already more susceptible audience.

Health Systems and JH-IIRU faculty hope to influence the aggressive tactics taken by the alcohol industry by providing evidence on the negative outcomes of alcohol marketing, especially in low- and middle-income countries. Read more about BIGRS’ work here

There is often a political stigma that there might be a conflict between choosing the Islamic faith and serving in the United States military. Mansoor Shams, a Johns Hopkins Alumnus and U.S. Marine Corps Veteran, aims to interrogate the stigma that continues to perpetuate, a challenge growing slightly more tricky given the President’s recent Executive Order.

Mansoor served four years in the marines, from 2000 to 2004, an honor he wears with pride. In that time, he attained the rank of corporal and received several honors, including meritorious promotion, Marine of the Quarter, and Certificate of Commendation. Mansoor is also a small-business owner, serving as the President of Technology for Eye Deal Systems, a distributor of technology and consumer products and provider of information technology solutions.

A self-appointed ambassador as the “Muslim Marine,” Mansoor’s method of choice for combatting Islamophobia is through one-on-one dialogue with other Americans. Recently, he has been travelling around the country with the goal of reminding the American public that it was our willingness as a culture to welcome people of all religions, culture and ethnicity that makes us an example to the rest of the world.

People questioning his loyalty to the country was an attitude that Mansoor didn’t consider when he joined the U.S. military- after all, loyalty to one’s country is part of the Islamic faith. He strives to educate on common questions people have about his Muslim faith, women’s rights and terrorism, and reminds people that the Muslim world is comprised of 1.6 billion-plus people. It is important to make a conscious effort not to paint everyone with a broad brush.

At a time where anti-Muslim rhetoric from political leaders is growing increasingly common and anti-Muslim hate crimes are at their highest since 9/11, it is important to have as many conversations with people as possible. On February 15, Mansoor Shams is speaking at Johns Hopkins Bloomberg School of Public Health (JHSPH) in the first of a series of seminars on understanding American Muslims, a series that hope to highlight the many positive contributions of Muslims across the country. The seminar series is going to be part of a larger initiative exploring the life, successes and challenges of American Muslims. 

Women’s health has long been a central focus in the field of public health. It is well-known that many health disparities exist between men and women all over the world due to unequal access to basic health care and education. While certainly not specific to resource-poor settings, women tend to experience more discrimination and mistreatment in low- and middle-income countries (LMICs), where there are also higher rates of preventable deaths and disease. Because of societal structures and social pressures, women can have unequal power in sexual relationships, economic decision-making, and navigating reproductive and child health services1. One of the most effective ways we can reduce this inequity is by promoting, supporting and fostering the next generation of women leaders in low- and middle-income countries.

Equity in leadership is desired in all fields, but it is especially important in the field of health and medicine where saving lives and reducing global health burdens is a core and urgent task. Women leaders are more likely to implement policies that target women and children, and are more likely to support antenatal care, health facilities and immunizations2. When it is quite literally a matter of life and death, I believe that it is critical to address the gender gap in health leadership, especially when there is strength in working collaboratively and added value in community-building and diversity.

Lack of easily accessible female role models and difficulties balancing career and personal life contribute to the inequity in global health leadership3. Women are put under enormous pressure to maintain a balance between family life and professional life, a burden that is even heavier for women in LMICs where they are often expected to prioritize family over education. Women in resource-poor settings also face the added challenges of abiding by social-cultural norms often set my men, facing daily hurdles in mobility, and unfriendly work environments.

In order to tackle some of the most pressing health issues, we need to encourage and support women’s leadership in health, especially in the most vulnerable parts of the world. It is crucial to do this work in a meaningful way by incorporating the views and lived experiences of those in the ‘global south’ into our policies and decision-making process, and by considering local priorities in ensuring equal access to education and resources. Gender equality is not just an issue for women but an issue for everyone and if we don’t strive to achieve it, we will continue to struggle with the burden of death, disease and disability worldwide.

Dr. Adnan A. Hyder, is one of the keynote speakers at the 7th International Womens Leaders Summit presented by New World Concepts in Karachi, Pakistan. He is professor and associate chair, Department of International Health; director of the Health Systems Program; and director of the International Injury Research Unit at the Johns Hopkins Bloomberg School of Public Health in USA. He has 20 years of global health experience in low- and middle-income countries. With this background, Dr. Hyder leads a team of experts to conduct groundbreaking research on health systems strengthening and capacity building.

References:

1 Deborah Derrick. Empowering women and girls: the impact of gender equality in global health. The Lancet Global Health Blog, 2014 Aug 8

2 Jennifer A. Downs, Lindsey K. Reif, Adolfine Hokororo, Daniel W. Fitzgerald. Increasing Women in Leadership in Global Health. US National Library of Medicine, 2015 Aug 1

3 Kelli Rogers. Why do women hold less than 25 percent of global health leadership roles? Devex, 2015 Feb 3