Get to Zero

Today is World AIDS Day! On this date last year this blog had its first post commemorating the global day of solidarity in the fight against HIV/AIDS and in the last year – when the world marked 30 years of AIDS – I’d like to hope that I’ve contributed, in very small ways, to our communal effort of getting to zero.

With the Trust for America’s Health and amfAR I collaborated on research and policy development for structural and environmental prevention innovations for gay and bisexual and other men who have sex with men in the U.S. – changing the risk environment and the national structures that are inhibiting prevention for that population.

With the Organic Health Response(OHR) and the Ekialo Kiona Center(EK) I’ve continued my connection with the communities of Mfangano East, Lake Victoria, Kenya – primarily through assisting community grant writers to improve the well-being of those living with HIV – to turn the tide of HIV in this corner of the World. Through social solidarity, biomedical and agriculture innovations, and community driven vision, OHR and EK are changing the standards and definition of a “community-based organization”. And transforming the way people live with HIV.

So it wasn’t much, but something…

Now it is time to get to zero. Zero new infections; zero discrimination; and zero AIDS-related deaths. Getting to zero takes prevention and treatment and policy and community. It takes Health in All Policies and nutrition and the built environment and linkages to NCDs and sexual health and biomedical innovations and cultural competency. It takes many small contributions, from just about all of us.

*Want to make your own small contributions? Check-out the Whitman Walker Clinic and OHR for volunteer opportunities!

Image: Author’s own. Ekialo Kiona Center, Mfangano East, Lake Victoria, Kenya.

In the News: February Blur

This super short month has gone by in a blur. While several substantive ideas have come out of this period, they need more time to marinate. Here are some tidbits from the last few weeks:

*The announcement that London would be hosting the 2012 summer Olympics spurred hope in Britain that there would be a marked increase in the number of normal citizens taking on regular exercise.  A NYTimes article last week reports that this has sadly not been the case, with new parks and other facilities going unused. (I’m sure I wrote about all of this in relation to obesity back when it was announced!)

*A very interesting article in Inside Higher Ed discusses the growth and impact of anthropologists without doctorates.

*OHR has a newly revamped website – check it out!

*The National HIV/AIDS Prevention Strategy (which came out last year) has gotten the full backing of the White House. In a blog post up yesterday, the Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services, Dr. Ron Valdiserri makes the science-backed case for this strategy.

*Finally, yesterday I attended a roundtable workshop at IOM. The goal of the day was to examine how disparities and inequity impact overall life expectancy of certain populations within the United States and what policy shifts are needed to change these trends. It was a dynamic discussion and a reminder that all of us need to be thinking about ALL populations in our work towards better health.

Being Part of the Change

This past week, ABC News launched its Be the Change: Save a Life initiative – “stories and solutions for a global health initiative”. The idea, the way I understand it, is to highlight and share real world solutions to the array of global health challenges. One of the components I find fascinating is how these solutions are coming from every sector, not just medicine and public health. There are portable and re-heatable (without electricity) baby incubators from a group of Stanford students; pumps to clean water from a former nightclub owner; and local solutions too, like horses to get HIV tests to labs in time in Lesotho.

Being local, which won’t be a surprise to my regular readers, is key. Nifty tech devises and creative fund-raising are important, we need both for innovative and sustainable solutions. However, to make innovations work a) the local needs, environment, and lives must not just be acknowledged, but understood and b) solutions need to be fostered from within communities and not just presented to them.

This year-long initiative will undoubtedly share with all of us some truly remarkable solutions…for determinants and disease. And hopefully, as with the piece on child nutrition in Guatemala (I know someone involved with this initiative!), medical anthropologists and other community thinkers will be engaged and highlighted. For when all of us are part of the change, practical, simple and human solutions become a reality and lives are saved.

Preventing as a Community

This week I am attending a meeting in Oakland, California focused on community prevention (and some grant opportunities for community prevention programs that are mandated in the new health care law). The aim of the meeting is not simply to acknowledge that community focused prevention programs and initiatives can work (which most of us know to be the case), but how we in health define “community”; what prevention means; and how our cultures (American) can move towards creating healthier communities rather than just focusing on specific diseases?

These are all interesting and dynamic questions which need to be explored in full, and the focus of the meeting will be what structural and social changes can be made. However, simply making “structural” changes – adding sidewalks, taxing tobacco, or making neighborhoods safer – will not necessarily engage communities. Community prevention has to come from within. Not just communities having the will or desire to make their communities healthier (in their eyes or ours), but they have to embody prevention. Healthier lives and “communities” are a lived experience. There are day-to-day realities that penetrate deeper than whether or not you have access to fresh produce or quality, affordable health care services.

Evidence-based methods and tactics are what get funding for communities to implement prevention programs. Hopefully this gathering will acknowledge that the internal experience is evidence and should be part of any comprehensive community prevention campaign.

As an interesting counter to this meeting, beginning next week I will be spending several weeks on Mfangano Island, Kenya. The Organic Health Response (OHR) is attempting to revolutionize disease prevention by fostering community from within – as an organization which has taken a truly diverse group of volunteers and has them supporting community members on Mfangano, rather than make changes for them. OHR has a sustainable ethos (which started with an organic farm), has harnessed IT, and thrives off of and builds social solidarity, not external structural changes. With one of the highest concentrated rates of HIV infection in Africa (and the World) – over 30% of adults are HIV + – the Lake Victoria region must make community prevention work. AIDS is a cornerstone of OHR, but holistic, community drive, community prevention is the aim.

Two very different perspectives on making communities healthier – a world apart? Or maybe not. It could be wishful thinking on my part to imagine that there is tangible give and take between the two, but I think not.

*Image is author’s own: Protests (which later turned violent) in Oakland, CA. Unsafe neighborhoods – violent environments – are unhealthy communities.

Stay tuned for notes from the island upon my return from Kenya!

Know Your Neighbor

There has been a tremendous amount of talk as of late regarding priorities and funding in the global health arena with the recent G20 and G8 summits, and rightfully so, there are any number of seemingly impossible health challenges the global community faces. Luckily, there has been some discussion about the need for global health initiatives to be “culturally competent” (which many already strive to be!). I was originally planning to have a post on these calls to action, but several recent reports have spurred me to think more about “cultural competency” as a concept, since everyone seems to be using it. And besides, there are far smarter people to be talking about the details of global health funding and finance besides me..!

Tuesday, Trust for America’s Health released its annual report on obesity in the United States, F as in Fat. Not surprisingly, the report highlighted growing waistlines in both adults and children. With disparities in the South and among economically and ethnically marginalized populations. The report received a lot of press, as it should, but while reading many of the comments made on blogs and articles regarding these findings I found myself getting quite mad.  The seeming lack of empathy among my fellow Americans was astounding.

I’ve written about “non-judgement” when it comes to personal responsibility and health before, and don’t mean to beat this topic into the ground. Additionally, as an anthropologist, I will be the first to defend the fact that each of us come from our own perspective and experience. However, if we are going to strive to be non-judgmental of those around us and their choices, we have to learn to be culturally competent too, right?  But what does this mean?!

A recent piece from Diversity Inc. attempted to tackle this issue and whether culturally competent health care can close health disparity gaps – including obesity. A physician with the US Navy argues that yes, in fact, culturally competent care can work to close gaps – or should. She addresses stereotypes and language barriers directed towards minority and immigrant populations. Luckily, she also acknowledges that it is nearly impossible for any given individual to enter a situation completely unbiased by their own experience and cultural values.

This basic definition of “cultural competency” seems well and good, but far easier to apply to the “other” and not those right next to us. It is simple for most of us to point out the differences between ourselves and someone from a different religious, ethnic, or racial demographic both in our big cities and in communities half-way around the World. What about those right next to us, that on the surface seem to be the same?

For example, accusing the South of having poor eating habits and “cultural” connections to food is easy and naïve (I wrote on this a couple of years ago), and being culturally competent doesn’t just mean being able to speak the same language or know what you think someone else is eating. I applaud the global (and when I say global, I mean all of us!) health community’s continued efforts for both evidence-based AND culturally competent practices, but I hope that from time to time, we take a step-back and look at our neighbors…maybe we can’t become completely culturally competent, but hopefully culturally present..?