Section Connection An insider's view of the APHA international health section

"To deny people their human rights is to challenge their very humanity."

Nelson Mandela

Issue 3 - April 2017

In This Issue:

  • Letter from the IH Section Chair and Section Happenings
  • Meet Your Leadership
  • Student Spotlight
  • Getting to Know APHA
  • IH Conversations
  • Connecting to Global Health Trends
  • Call to Action: Global Health Photo Submissions and National Public Health Week

Editors:

  • Theresa Majeski - Editor-in-Chief
  • Erick Amick - Associate Editor
  • William Rosa - Associate Editor
  • Meghan Huff - Meet Your Leadership Section Editor

Letter from the IH Section Chair and Section Happenings

With contributions by Adelia DeMarsico

Dear International Health Section members,

Greetings to you all with this mid-year update (between Annual Meetings) on Section activities. This year has been more challenging for public health than ever before. The IH Section is rising to the challenge in a number of ways.

In response to rising concern over harmful domestic and international public health policies coming out of Washington, DC, in February 2017 APHA’s International Health section lifted its voice in writing an open letter to Dr. Georges Benjamin, Executive Director of APHA, to speak out for public health on behalf of the public health community. In this letter, Dr. Benjamin is applauded for his work with Al Gore to revive the cancelled CDC conference on Climate Change, and later is urged to lead APHA in continuing to fulfill its role of “taking strong positions against Executive Orders and laws that would jeopardize the health, safety, and lives of women, children, and men in the U.S. and around the world.” The letter received signatures from 34 APHA Components and further expresses the two greatest concerns of APHA Sections, Caucuses, Committees and Student Assembly— the executive order which reinstates and expands the scope of the Mexico City Policy and the threat of extreme cuts in foreign assistance for health. The letter commits unwavering support from the APHA Components to assist with external communication for this “urgent and ongoing endeavor.” Dr. Benjamin positively acknowledged the letter, embraced its message and showed support for the efforts of APHA Components. In his response, Dr. Benjamin stated, “We have been working to highlight critical issues related to public health with the new Congress and administration, and we have no intention of stopping now.” Moreover, in response to the current administration’s fiscal year 2018 budget request, released in March 2017, Dr. Benjamin took a stand for public health voicing strong opposition to the request, stating, “To become a healthier and more secure nation, we must invest in the health and safety of everyone, not just in our military.” The IH section will continue to be at the forefront during this difficult time for public health as it encourages APHA to continue to promote public health during this unprecedented time. Please keep up your calls and emails to Congress, which are valuable and have an impact on policy in Washington.

As to the day-to-day work of the IH Section committees, working groups, and members, here is a sample of what they have been accomplishing:

Our IH Nominations Committee has identified some strong nominees for a number of IH Section leadership positions that will become vacant in November 2017. Nominations for IH Section leadership positions are open until April 21st. We ask all Section members to exercise your rights by voting online May 25 to June 15.

The IH Program Committee received hundreds of abstracts to compete for slots at the Nov. 2017 APHA Annual Meeting in Atlanta. Up to 135 IH members volunteered to serve as abstract reviewers.

The IH Policy and Advocacy Committee submitted three Policy Statement Proposals developed by IH members, for review by the APHA Joint Policy Committee (JPC), on the subjects of "Promoting Palestinian health and justice", "Reducing diarrhea mortality for children under age 5", and on "Law enforcement violence as a public health issue".

Our IH Communications Committee has been actively producing the IH Blog with regular global health news updates, and managing our Facebook and Twitter accounts.

The IH Membership Committee has been analyzing IH Section membership trends, sending welcome letters to new members, and seeking ways to encourage new and continued membership by students and young professionals.

The IH Student Committee completed an expectations survey of our student members. One result was to link students with IH working groups in their field of interest.

Our IH Mentoring Committee is in the midst of their second round pilot for the mentoring of students and young professionals by more experienced IH members.

Other committees and working groups such as Climate Change, Community-Based Primary Health Care, Global MCH Network, Palestine Health Justice, Systems Sciences for Health Systems have been busy with knowledge sharing and coordinating plans for the Atlanta meeting.

We thank Section members for their hard work, including the Global Health Connections Working Group for their great efforts to create the e-newsletter you are now reading!

Best,

Laura C Altobelli, DrPH, MPH

Chair, International Health Section

Professor

Peru Country Director

Future Generations University

www.future.edu

Meet Your Leadership

Amy Hagopian - Nominations Committee Chair

By Shazie Senen

Amy Hagopian, MHA, PhD

Aside from being Chair, Amy is an Associate Professor at the University of Washington School of Public Health, where she directs an MPH degree program. Community Oriented Public Health Practice is centered around problem-based learning and focuses on social justice determinants of public health. She also teaches health policy, program evaluation, public health skills, and a course on war and health. Currently, her research interests lie within the effects of war on health. In 2011, she led a team to estimate the mortality associated with the 2003 invasion of Iraq, which involved surveying 2000 households across Iraq. Additionally, she has researched the migration of health workers from poor countries to rich ones, while also working on homelessness and incarceration as health issues. The unifying theme of her work is to identify how the inequitable distribution of power and privilege undermines health.

What does the Nominations Committee do?

The Nominations Committees, amongst the various committees, identifies talented and enthusiastic individuals to run for the Section’s elected positions. Amy Hagopian has been leading the International Health Section’s Nominating Committee for several years. Her role as Chair is to scout for “good looking people” for section leadership. To her, good looking entails those who show promise and potential. She gathers names of people who come to the Annual Meeting, those who vocalize their stance in membership meetings, and those who give interesting talks in the scientific sessions. Furthermore, she observes enthusiasm in the people who show up at the committee meetings and those who volunteer to do something; because they are often the ones eager to get involved and the ones who produce astounding results.

One of Amy’s favorite things about being Nominating Chair is her ability to stack the deck in favor of activists. Scouting for people who show up, are willing to engage tasks, and are not simply looking for a resume position, is refreshing. She also finds it rewarding to work with people located in other countries. Despite how inconvenient it is for them, witnessing their willingness to attend the Annual Meeting and dial into the leadership calls speaks volumes of their character and work ethic. Amy has also proudly mobilized more women and people of color into leadership positions.

What kind of commitment is required for members on this committee?

The Nominations Committee spends time each year recruiting folks to run for the various positions by reaching out to invite them to run, helping them craft their applications, and generally guiding them through the nomination process. Elections occur annually in the Spring, however the specific position vacancies change each year.

The time required for the elected positions vary. For instance, the secretarial position requires at least an hour a week. The Section Council position depends on what tasks the person agrees to take on in relation to a committee, whereas the Governing Council duties are episodic - time required increases when policies are being discussed and at the time of the Annual Meeting.

Before running for office in the IH Section, Amy highly suggests being involved in ways that nominating committee members can notice. For example, writing an article for the newsletter/blog or being involved in working groups demonstrates potential. By volunteering some time to contribute your skills and talent to the IH Section, it not only showcases your talent, but also outlines your dedication and desire to help.

How can members be more involved with the committee?

They can contact Amy at hagopian.amy@gmail.com to learn more about current opportunities.

Gopal Sankaran - Awards Committee Chair

By Giancarlo Atassi

I recently spoke with Dr. Gopal Sankaran, Professor of Public Health at West Chester University and head of the IH Awards Committee, about himself and his committee. Below are his answers to several questions, edited for length and clarity.

How did you become interested in global health?

After completing medical school, my first job was to work as a junior epidemiologist with the World Health Organization in the National Smallpox Eradication Programme in India. There, I was responsible for surveillance for the entire Jalpaiguri district. Every day, I used to travel 10-15 kilometers on foot and an additional 100+ kilometers by motor vehicle. I met hundreds of people, often in remote villages. That experience crystallized my interest in public health practice. The fact that a single disease was having a devastating impact in multiple nations and the possibility that it could be eradicated piqued my interest in global health.

What advice would you give to young public health professionals about starting a career in international health? What trends are you seeing that entry-level public health researchers should know about?

When I entered a residency program in public health/community medicine, my mentor used to say that public health professionals should have “the heart of a lion, the eyes of an eagle, the soul of a saint and the skin of a rhinoceros.” One must be prepared for the unexpected, be courageous and compassionate, and not feel hurt when things don’t go one’s way. My advice: Know yourself first. Identify your areas of interest and strength, develop your knowledge and skills intentionally, and network. Get your feet wet (through volunteering or short-term work). Be ready to shift gears (i.e., change places or programs).

What does the Awards Committee do, and how can IH section members get involved?

The Awards Committee creates and disseminates the criteria for the various awards, reviews nominations/applications, selects the best IH professionals for the specific awards, organizes the Awards Social and Reception in coordination with Section leadership, and recognizes the awardees for their contributions to improving global health. IH Section members can join the committee when a vacancy arises. IH Section student members and others can help with organizing the Awards Social and Reception, which is held in conjunction with the Annual Meeting, and the post-awards networking event.

What benefits do members of your committee receive?

Members have the unique opportunity to learn about fellow international health professionals, their work, and accomplishments. They also have the chance to work with a fine group of individuals, who bring a high degree of professionalism and commitment to our work.

How can members learn more about the Awards Committee?

They can contact Gopal Sankaran at gsankaran@wcupa.edu to learn more about opportunities and vacancies on the Committee.

"2017 not only brings a new president to the White House, but also a new Director-General to the World Health Organization and a new United Nations Secretary General... As a result, there is tremendous uncertainty about the future practice and policies of global and domestic public health."

Dr. Michael Osterholm

Student Spotlight

Featuring: Dhruvi Chauhan

By Chelsea Alexandra Schafer

Dhruvi Chauhan is studying to obtain her degree in Global Public Health at the University of California. As a child of immigrant parents, she became exposed to many different cultures growing up. This changed her perspective at an early age, providing her with an early awareness of the various ways in which people view the world. Eventually, she became more interested in global issues, realizing that so many of the injustices in our world translate into serious health disparities. During her undergraduate studies in Public Health Policy, she learned how public health deeply impacts every aspect of society, reaffirming her passion to advocate for and bring awareness to global public health issues.

Dhruvi has gained experience in the field by volunteering twice in her campus’ Global Public Health Brigades program. She has gone to both Honduras and Nicaragua, taking on the role of Education Chair. This experience truly solidified the importance of working with communities across the globe to address their critical needs. Working directly and face-to-face with communities in these countries reaffirmed the importance of global health justice and raising awareness about the communities who have been undermined and ignored. Dhruvi realized that simply starting these conversations about global health can make a massive impact on others.

With her career, she hopes to work in the global health field, bringing awareness to the stories of people in dire need of justice and better health. She seeks to create a space for conversations regarding why global health disparities exist, specifically working at the intersection of gender and global health. Examining the connection between how climate change, natural disasters, and the global economy impact the health of women and girls across the world would be a pivotal role. She imagines working with nonprofits conducting policy advocacy and research. After completing her degree, Dhruvi hopes to continue on to her PhD, furthering her ability to work with various communities.

Her advice to students pursuing global health is to become involved in their campus and community regarding global health concerns, join campus organizations, and attend talks or events that raise awareness about specific issues that are important to you. Additionally, she feels that another great way to get involved is to find a reputable volunteer abroad club or organization. Sometimes the best way to understand how health, poverty, and injustice exist in other countries is to simply embed yourself in another country, even for a short while.

Getting to Know APHA

This section focuses on introducing you to APHA as a broader organization, how the IH Section works with other APHA Sections, and how to make the most out of your APHA membership.

By Jeanie Holt

As I mentioned in my January article, I want IH Sections folks to know more about what affiliates are doing, especially in the field of global health. This month I report on an interview with John Oswald, Co-Chair of the Global Health Committee of the Minnesota Public Health Association. John has been especially active in creating a sister-affiliate partnership with the public health association in the province of Villa Clara, Cuba.

Please describe the global health activities and programs of Minnesota Public Health Association.

There are two major components of the Global Health Committee of the Minnesota Public Health Association.

Our overarching activity is our collaboration with MN International NGO Network (MINN). MINN primarily has roots in non-health work (refugees, human rights, agricultural development) so MPHA brings health focus to their work. In 2016 we held 2 joint workshops; we hope for 3-4 in 2017.

Tell us more about your connections with Villa Clara.

The other major activity has been with professional exchange among public health professionals in Cuba. We have arranged visits to Villa Clara and from the province to Minnesota. We are working with a group in Minnesota that recycles medical equipment. Much of the equipment in Cuba is more than 30 years old. Medical personnel in Villa Clara want both more up-to-date equipment and training for using it. Beyond that, we are working to learn from the Cubans so that we have a comprehensive exchange of information. We’d like to do more but money remains an obstacle so fundraising is a primary focus of our efforts.

Describe the structure that supports global health work in your affiliate.

We have a Global Health Committee which I co-chair with PaHoua Vang. We have a small committee budget, though we are seeking grants specifically for our global health work. We report to the Board of MPHA.

How can the Council of Affiliates and/or APHA help/be involved?

Possibly you could provide a clearing house of activities going on in other affiliates with contact information. You can help affiliates connect with each other on country-specific projects.

"When the whole world is silent, even one voice becomes powerful."

Malala Yousafzai

IH Conversations

This section profiles various members of the IH Section to highlight their global health careers and learn about how they got into global health.

Featuring: Caroline Kingori

By Katrina McCandless

What originally drew you to the general field of public health?

I was drawn to the field of public health after witnessing the devastating impact of HIV infection globally about 3 decades ago, particularly in Africa. Open discussions about the infection were not common at the interpersonal or the national platform, given its attachment to sex. It was a taboo topic. There were many misconceptions and misperceptions surrounding HIV transmission, which fueled stigma and discrimination against those infected. This culture of silence and shame motivated my participation in prevention efforts, particularly working in affected communities while engaging in research to find ways to enhance HIV prevention.

Have you worked in any other fields that have informed your approach to life and/or work?

Before my interest in public health, I pursued banking and finance after high school but shifted focus to psychology for my undergraduate studies. Psychology was my gateway to public health after exposure to prevention science through a competitive honors program at Morgan State University. I was selected to participate in the program during my junior year and that experience solidified my interest in public health. I pursued psychology because I wanted to understand individual behavior. That desire to understand behavior motivated me to want to focus on not only the individual but also different influences of behavior at other levels e.g. interpersonal, and societal levels. That led to my pursuing an MPH and PhD in Health Behavior.

What spurred you to pursue global health in addition to your domestic work?

I was interested in global health primarily to give back to my community in Kenya after gaining the necessary skills in the US. I realized that I could continue gaining further education and skills in the US and go back and forth to Kenya to conduct community based participatory research to improve health outcomes. My domestic work in the US was motivated by the need participate in the elimination of health disparities in communities of color, including immigrants and refugees.

Do you have any recommendations to other researchers or students on finding the health issues or populations they wish to focus on in their career?

There are so many health issues that need attention. The secret is passion. Find something that excites you and that will ultimately make a difference in another person’s life, including society in general.

Could you share a triumphant moment in your career? What factors do you feel led to this moment?

There are many of them. But, one that is poignant is when I conducted HIV stigma research in the rural central province of Kenya. My late grandfather and other ancestors hail from one of the towns where I collected data. When people asked me where I was from and I told them about my family, it was great to hear people talk about the great things that my grandfather, a former Senior Chief, had accomplished that benefited the whole community. I realized that my innate desire to enhance the well being of communities, was akin to what my grandfather had done as a community leader.

What do you see as being the greatest challenge for international health during the next four years?

Relevant to Africa, funding for HIV/AIDS prevention and treatment continues to decline in favor of other communicable diseases, e.g. malaria and tuberculosis in Africa. Regarding HIV treatment for people who are HIV positive, there are only about 40% in Africa and 32% in Asia who have access to antiretroviral therapy. Such information is disconcerting. Also, the co-morbidity of HIV and other chronic diseases (e.g. diabetes, tuberculosis, malaria) is alarming in Africa and other resource limited regions. Such issues present great challenges in the effective treatment of HIV/AIDS. Decline in HIV funding will have a greater impact on the already broken health systems in countries disproportionately affected by HIV infection.

Do you have any talents or hobbies you would like to share-perhaps one that has intersected with your work?

I enjoy traveling, dancing, listening to music, singing, cooking, etc. Pursuing global health and conducting research across different countries has complemented my traveling hobby. I have enjoyed interacting with people from different cultures, tasting different types of foods, and listening to varying perspectives about health issues affecting communities.

Featuring: Laura Chanchien Parajón

Putting the Community First

By Laura Chanchien Parajón, MD, MPH, Intro by Temitayo Ifafore-Calfee, MPH

Programs that support and train community health workers (CHW) started in China in the 1930s. The model quickly spread to other countries. By the 1960s and 1970s, CHW programs were widespread throughout Latin America.

Community health programs provide curative and preventive services in areas that are not easily served by the existing health system. Perhaps equally, if not more important, community health programs, serve a transformational role. These programs empower and engage community members to serve as change agents for the well-being of their communities.

What’s a good model for a U.S-registered organization to support community health programs? How can cultural humility be used to put the community first?

I asked Dr. Laura Chanchien Parajón to share her experience because she and her husband co-founded AMOS Health and Hope to serve 25 remote, rural and urban communities across Nicaragua. Below are her reflections on why she and her team do the work they do.

Dr. Laura Parajón: Many of my physician friends say they are inspired that my husband and I took a 75% pay cut to live and work in Nicaragua for the past 15 years. However, we both acutely recognize that our "choice" to go to Nicaragua is one of privilege. At any moment we can leave and return to suburbia and a well-paid medical job in the U.S. This is why for me, living and working in a low resource setting towards the dream of "health for all" is not any kind of sacrifice -- it is my calling.

I have a passion for community empowerment and taking action for social justice, and ultimately choose to live in Nicaragua as a medical missionary because I am also a mom, medical doctor, and public health practioner fighting for a world where everyone has the opportunity to make a choice.

In the remote mountain community of San Onofre, Nicaragua, women like Timothea --my inspiration, friend and co-worker-- make much more difficult choices everyday than I have ever made in my life. She is a community health worker (CHW) with only a fourth grade education. When she decided to follow her dream of becoming a CHW to help prevent infant deaths in her community, her husband, a product of Nicaragua's highly machisto society, left her because "a woman should stay home to take care of her family." As a CHW she has saved countless lives of children and mothers in her community at a high personal cost.

I found this photo of myself, and Timothea with a member of her youth committee. The other members of the health committee are gathered around the rest of the picture. I love this photo because I am alongside Timothea, listening to her as she shares the results of the nutrition and anemia data with members of her health committee. This is data that she and her health committee used to take action to improve childhood malnutrition in her community.

My husband and I co-founded the non-profit organization AMOS Health and Hope. We lead our community-based health work with a public health team that implements health programs; an inspiration team that fundraises for donations and provides service opportunities for mission teams, an operations team that runs a guesthouse to finance community-led projects, and an innovation team that provides global health education opportunities for students and volunteers, writes and implements foundation grants, and uses community based participatory research (CBPR) methods to innovate for improved health in low resource settings.

AMOS uses the strategy of Community Based Primary Health Care (CBPHC). It is a comprehensive approach which promotes community empowerment, equity, evidence-based methods and partnership. Our AMOS team has been working for the past ten years to evaluate, reflect and improve our practice of trying to reach the most vulnerable populations. As an organization, we constantly challenge ourselves to recognize our own power and privilege in an effort to authentically and humbly contribute to the well-being of poor and marginalized populations. We have developed as a learning organization to use data to continuously improve our health interventions, and through AMOS we have helped to decrease health inequities by providing access to health care for over 23 communities, influenced health policy through research and advocacy, and contributed to over a 50% reduction in child and neonatal mortality in the communities we serve through community based participatory methodologies and evidence-based interventions.

This is what global health is all about – each of us sharing our strengths to make things better to decrease health inequities as part of our call for social justice to transform this world to be a better place.

Top to bottom, left to right: Dr. Laura Parajón in a rural community in Nicarauga with AMOS staff and community health workers; Dr. Laura Parajón with AMOS staff and community health worker in a rural community of Nicaragua, supervising distribution of donated medications; Dr. Laura Parajón is pictured here with all 22 of the current AMOS Health Promoters, as well as AMOS staff, during their annual training in Managua in 2016; Dr. Laura Parajón meets with AMOS staff in Managua during a "data party," during which data from the rural communities is reviewed and analyzed in a process of monitoring and evaluation; Dr. Laura Parajón with community health workers in a rural community in the Southern Caribbean Coast of Nicarauga

Temitayo Ifafore-Calfee, MPH is a USAID Health Workforce Technical Advisor under the GHFP-II contract. An avid traveler, she’s been to over 35 countries and speaks 4 languages.

Connecting to Global Health Trends

This section highlights current global health events. The opinions presented in this section are solely that of the author and may not represent the position of the IH Section and/or APHA.

Modern Day Slavery: Transnational Human Sex Trafficking is a Public Health Epidemic

By Cherise Charleswell, MPH

Human sex trafficking is a multifaceted human rights and public health problem that represents a “borderless” and global epidemic, and according to the International Labor Organization it is a lucrative industry which rakes in $150 billion globally; the US Department of Homeland Security states that it nets $32 billion nationally. While there has been much public health discussion about the harmful or negative effects of transnational corporations, in terms of the impacts on the environment, and the transmission of western diets and fast food, which replace more nutritious foodways, there hasn’t been nearly enough discussion, awareness, and financial resources being put forward to combat human sex trafficking, which is the second largest global criminal enterprise. Consider a 2007 study, conducted in the city of Atlanta Georgia that found that the underground sex trafficking economy was two-times larger than the Atlanta Falcons payroll.

Every minute of every day, those from the most vulnerable populations –having the common denominator or driver for this exploitation- poverty and/or economic hardship, are raped for profit without impunity; and these victims are literally “trafficked”, meaning moved across national borders, provinces, state, and county lines. In areas in the United States that are not sanctuary cities, and in other countries where there are no immigrant protections—these victims become stateless. They are further victimized by governments, who force them to live in fear of coming forward to seek help, and escape the violence of trafficking.

When it comes to the World Health Organization’s definition of health – “it is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”; victims of human sex trafficking experience negative health impacts across all of these factors.

Those who fall victim to sex trafficking experience multiple-levels of trauma before they are even trafficked, and this is due to the underlying social determinants of health as mentioned above, as well as several factors within their built environments that prove to be detrimental to their health and well-being. In this respect, climate change and environmental degradation can even serve as drivers for trafficking, because they intensify existing socioeconomic inequalities; and leave the most vulnerable populations feeling as if they are without other options.

For the victims of sex trafficking, the health impacts are life-long and include mental health issues (PTSD, anxiety, trauma-induced mental disorders), physical issues (permanent injury, traumatic brain injury, STI/AIDS infection, infertility, malnutrition, and premature death from violence), and socioeconomic issues (interruption of education and social development, lack of job readiness skills, financial illiteracy). Additionally, sex trafficking impacts community health, particularly in terms of infectious disease and increased violence, because street gangs and other types of organized crime have taken over control of the trade, and this is because it provides a better return-on-investment. Little to no investment is directed toward their victims, and they can sell them again-and-again; which is why anti-trafficking advocates point out that harsher penalties, that reduce demand, will be the only way to mitigate this epidemic.

Ultimately, more needs to be understood about victims of trafficking in order to help them rebuild their lives.

Cherise Charleswell is the Immediate Past President of the Southern California Public Health Association, the Women’s Issues Chair at The Hampton Institute, and the Development & Outreach Officer at Journey Out.

Call to Action

By Theresa Majeski

Global Health Photography Feature Opportunity

We are inviting International Health section members to submit their global health photos to share their global health experiences with other section members. Accepted submissions will be featured on the APHA IH blog or the Section Connection newsletter and may be used in APHA IH materials. This opportunity is ongoing and submissions are accepted at anytime, subject to the approval of the APHA IH Communications Committee. For more information on how to submit, please click here or contact us at ihsection.communications@gmail.com.

National Public Health Week

Healthiest Nation 2030

April 3 - 9, 2017

It is time again for National Public Health Week (NPHW), an initiative of APHA.

There are lots of ways for APHA members to get involved:

  • Participate in the NPHW Twitter chat on April 5.
  • Attend a local event in your area.
  • Host your own event if there aren't any in your area. (And then submit your photos to the IH Communications Committee.)

Get started with Connect / Check out the blog / Connect on Facebook / Find us on YouTube / Follow us on Twitter

Background photo credits, in order: Chhor Sokunthea/World Bank, Martine Perret/UNMEER, Pippa Ranger/Department for International Development, Pippa Ranger/DFID, Martine Perret/UNMEER, Lindsay Mgbor/Department for International Development, P, Chhor Sokunthea/World Bank, Chhor Sokunthea/World Bank, Martine Perret/UNMEER

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