Pass it On

Last night, I witnessed the infectious way good news can spread within a network of friends – improving everyone’s well-being. The theory that social networks and connections affect individuals and populations is not necessarily new, but has begun to make it big in discussions of health. It is being used to examine many aspects of health from eating habits to infectious disease. As social beings, humans are easily influenced and transformed by those around them. Our networks literally allow ideas, actions, habits, and beliefs to spread, in the same way a pathogen moves from one organism to another. Two areas where this “networking” theory could provide amazing breakthroughs are obesity and AIDS.

In their book Connected, Nicholas Christakis and James Fowler explore how social networks shape our lives. One of their arguments is that these social connections can literally shape our lives by affecting what we eat, when we eat, how we eat, how we exercise, and our views on body size and image. These types of influences can have both positive and negative impacts on our bodies. Christakis gave a TED Talk earlier this month on the spread of obesity through networks, and Fowler has made an appearance on the Colbert Report explaining how even our connections through social networking sites affect our health. Most simply, if those you are connected to are obese, you are more likely to be obese. If those around you exercise regularly, you are more likely to exercise. And if your friends have body image ideals that are unhealthy, you are more apt to as well. We all know obesity is a hot topic in the United States, Mrs. Obama’s determined goal to put an end to childhood obesity has been in the news as of late. Changing the way we eat and approach food will have to come as a cultural shift, and shifts of this magnitude come from infecting a network with a new “habitus” of food.

The infectious character of HIV/AIDS does not come only in the form of bodily fluids passed from one individual to another, but in the social environments in which it spreads. Yes, effective prevention programs and stronger health infrastructures on the continent of Africa and in countries like Haiti will help to stop the disease. The environments in which AIDS spreads, however, are complex social networks with deep cultural and ecologic roots. In a post earlier this week, I discussed the strong stigmas in many African societies surrounding AIDS, stigmas which in many cases are perpetuating its spread. By effectively shifting the thought process of several individuals – in a way that blends with the local fabric of life and understanding – whole social networks can begin to change their beliefs and behaviors, as well as the structural barriers which force individuals to choose certain actions over others. Organizations such as the Organic Health Response (in Kenya) and The Global Micro-Clinic Project (in several developing countries) are working to improve health outcomes through social solidarity – stopping the spread of infection at the social level.

The strength of social networks is evident even at the Olympics. As these games come to an end, we have witnessed the communal admiration, triumph, and pride one person and one event can create. This theory, the impact social networks have on our health, can and should be applied to everything from maternal mortality (birthing practices, nutrition, and cultural capital) to health care reform (how we pay for it and who gets coverage). Good news can spread among friends in the blink of an eye and the strength of our very human, and very powerful, social networks can affect our individual and collective well-being without us even noticing…an idea we should spread!

*Image is author’s own.

Another Perspective: How Easily We Forget

A colleague pointed out over the weekend, in her blog haba na haba, hujaza kibaba, that less than 40 days after the earthquake that rocked Haiti to the core, the public and media have already moved on. While its not surprising that the media and much of our attention is now focused on the Olympics and our own political messiness (remember the health care negotiations this coming Thursday!), this does not mean that the people of Haiti aren’t still suffering and facing daunting challenges. Not being an expert in disaster relief, transition, and development, I am overwhelmed by the thought of the sheer amount of coordination and continued dedication that will be needed. If you are interested in learning more, or being part of the solution, you should look at her blog and a post I had in January about health challenges Haitians are facing post-earthquake.

Ending AIDS Forever?

AIDS could effectively be eradicated within the next decade according to a number of public health professionals. Dr. Brian Williams of the South African Centre for Epidemiological Modeling and Analysis (Sacema), giving a talk at the American Association of the Advancement of Science (AAAS) annual meeting over the weekend, stated his belief that universal testing and therapy (through ART regiments) in high-risk regions, could end the disease within five years.

A Sunday Times article nicely summed-up the plan: that universal testing and therapy, while initially quite costly, would cut transmission from person to person as well as slowing the spread of other diseases which are co-infection concerns, such as TB. By starting individuals on ART early, within the first year of infection, their chances of infecting others would be significantly lessened, and the disease would die out. Currently, only about 12% of HIV-positive individuals worldwide take ART drugs.

The most effective ways for this type of program to work would be to ensure annual testing, access to drugs, and taking ARTs correctly. This is where “compliance” comes into play. Being compliant means to be excessively obedient. Compliance is often cited as a reason for why certain treatment programs are unsuccessful – patients being non compliant. Quoting Dr. Williams: “Compliance in Africa is actually much better than in developed countries, because in the latter HIV tends to affect intravenous drug users and other marginalised groups, whereas the victims in Africa are just poor.” Is Dr. Williams implying that “the poor” are, for whatever reason, more easily compliant? Either way, trials in several African countries on this type of detection and treatment protocol are set to begin this year.

Seen as one of the high-risk regions for AIDS, Africa has without a doubt felt the burden of HIV/AIDS heavier than anywhere else on earth. Despite their exposure and burden, there remain strong stigmas towards the disease and those infected – keeping people from getting tested, learning about the disease, and seeking out what treatments may be available to them. These stigmas will not disappear overnight if universal treatment is presented. Additionally, there are many local and international organizations working very hard on innovative and socially tangible means for combating AIDS and stigmas. How would these existing structures fit with a plan for universal therapy? Would they too find themselves needing to be “compliant”?

The financial and policy needs behind such a plan are mind-boggling, and would require an extreme degree of coordination. Eradicating AIDS within the next decade is a goal we should all strive for, but through collaboration and not compliance alone. As Sir Mark Walport of the Wellcome Trust simply stated, we have “no way of knowing how acceptable or effective such a program would be.”

Interestingly, the Sunday Times also ran an article on the growing evidence that long-term ART regiments, or the extended life they provide, may be causing dementia and pre-mature aging. If this is the case, universal therapy could bring an entirely new set of health concerns to already strained communities, health systems, and regions.

Reform Quickie

This blog has not addressed United States health care reform – yet. An op-ed in today’s NYTimes by Nicholas Kristof makes the point, once again, that keeping with the status quo is not our best solution. No doubt there will be future discussions on this blog regarding U.S. health care – after all, our health care systems do affect our health and well-being.

Tut tut tut

credit: bikyamasr.com

A study in the  current issue of the Journal of the American Medical Association (JAMA) concluded King Tutankhamun died of complications from a broken leg made worse by malaria, not murder (which has been the leading theory for the last 40 years or so). This conclusion was made by extracting DNA from the skeleton. Broken bones and an infectious disease may be far less mysterious and romantic than murder, but they serve as a striking example of the power of parasites and the stark contrast that is contemporary malaria.

Today, nearly 250 million malaria cases and one million malaria deaths are reported every year. The World Health Organization (WHO) believes about half of the world’s population is at risk of malaria. In Africa, one in five childhood deaths are caused by malaria. In King Tut’s day, malaria did not discriminate. Not even the powerful and sacred were spared – the Plasmodium parasite weakening his red blood cells and making it difficult for his body to heal itself. Today, the powerful (and those of us fortunate enough to live in developed countries) live far away, geographically and mentally, from malaria. Out of sight, out of mind…and anti-malarials at hand.

Admittedly, I know little about the ins-and-outs of malaria. This parasite which has adapted and survived for thousands of years, continues to leave its mark on human populations. It is a clear marker of the extreme disparities in health equity between the global north and the global south. As archeologists and doctors have evolved their theory on the demise of the infamous King Tut, perhaps it is time we too evolve our perspective and actions on fighting malaria and closing the equity gap.

*There are a number of organizations which focus on malaria exclusively: Malaria Foundation International and Malaria No More.

*WHO fact sheet of malaria.

*Image originally from this website.