Why are seventy percent of our population suffering from obesity? unfortunate current statistic, according to Qatar biobank report

As a medical student , I’ve attended many clinics, but my favorite one was always the endocrine clinic because I felt it combined my interest in medicine and public health. It was really unfortunate to be exposed to the high  number of people who suffered from obesity & obesity related complications, mainly as a result of poor dietary choices.

 

Source: http://www.nytimes.com/2010/04/27/world/middleeast/27qatar.html

A review that looked at food patterns and diet quality among Qatari nationals found that the fatty foods consumed by Qataris  had twice as high level of fat nutrition density than what is recommended by the WHO. Qatar ranks sixth globally for the prevalence of obesity and has the highest rate of obesity among adolescents boys in the middle east region. Latest report from the Qatar Biobank, released in March 2017, showed that 70% of the Qatari population are either obese or overweight. Obesity is a major risk factor for many diseases, most of them unfortunately with debilitating consequences, especially if obesity starts at a young age.

Despite Qatar’s wealthy economy and it’s advancement in the healthcare sector, Qatar focus so far has been mainly on treatment rather than implementing effective prevention programs. A couple of intervention programs have been implanted mostly in terms of providing nutrition counseling clinics which  patients can access either through primary health centers or as referrals from any subspecialty clinic.

Source:http://www.qatar-tribune.com/news-details/id/54297

The above presented facts, calls for an urgent need to develop practical programs by the Ministry of Public Health. Programs that equip people with the proper diet and exercise education, while taking into consideration the complexity of the culture and the importance of social norms. My idea of an effective intervention is a one that targets different  groups of the society simultaneously, so we can change the society as a whole .We need to work hand in hand with people from various fields to reshape our culture into a more healthier one. We need to reallocate our resources to focus more on interventions rather than on treatment options only. I believe it’s time to step up, and plan for serious actions.

 

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LGBTQ-Inclusive Sex Education for Maryland Schools

In Maryland, all youth, regardless of gender identity or sexuality, deserve the right live healthy lives and thrive in school. For lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth, this can be difficult.

Research shows that this population is disproportionality at risk of experiencing dating violence and contracting sexually transmitted infections (STIs), including HIV. The CDC furthers this by stating that in 2015, 81% of the youth ages 13-24 who were diagnosed with HIV were gay or bisexual men.

Additionally, a survey on school climate conducted in 2015 found that Maryland public schools are not safe for most LGBTQ students, with 61% of LGBTQ students reporting that they were verbally harassed because of their sexual identity and 45% because of their gender expression. Furthermore, only 1 in 4 students reported being taught positive information about LGBTQ people in school. A hostile school environment can lead to mental health issues for LBGTQ youth, higher absentee and drop-out rates, and even suicide.

Providing LGBTQ-inclusive sex education to middle and high school students is a vital component in empowering this population to thrive.

With an inclusive curriculum, students obtain medically accurate and age-appropriate information on sexual health that integrates LGBTQ needs. LGBTQ youth learn about health risk behaviors that impact them and how to protect themselves against STIs. Equally important, all students are given the opportunity to explore topics related to sexuality and gender identity in a setting that positively depicts LBGTQ individuals. This helps dispel stigmas and negative stereotypes frequently tied to the LGBTQ community and builds a more welcoming and inclusive school environment.

Four states and Washington D.C. have passed legislation that mandates public schools provide sex education that respects and addresses the needs of all genders and sexual orientations.

It’s time for Maryland to follow suit and create similar legislation mandating inclusive sex education. In addition, funds should be allocated for the development of supporting materials, resources, and training for educators and school administrators. Research should be conducted alongside these changes to evaluate the impact LGBTQ inclusive-sex education has onSTI/HIV infection rates and bullying in Maryland schools. With these actions, we can help bridge the gap to providing LGBTQ youth with an equal opportunity to live healthy and successful lives.

 

Housing, Not Handcuffs: The Criminalization of Homelessness in Colorado

From Durango to the Front Range, many Coloradans in 2018 are struggling to find affordable housing in a state experiencing one of the greatest housing crises in the US. In 2014, a Denver resident needed to make $35/hour to afford median rent, more than triple the state’s minimum wage. The reality is much worse for families with very low income, who could affordably access just 7.5% of housing units across Colorado in 2016, a staggering drop from 32% in 2010.

In such a context, it is no surprise that our population experiencing homelessness has risen, and housing solutions have not kept pace. In 2017, Denver had a homeless population of over 5100, but only 1800 shelter beds. Yet even with such obvious barriers to housing, Colorado continues with aggressive criminalization efforts, with over 350 laws across the state that penalize acts associated with homelessness.

 

One category of such laws is urban camping bans, which punish basic survival acts such as sleeping in a car or covering with a blanket while resting in public. Just six months after Denver enacted an urban camping ban in 2012, 83% of survey respondents reported having been “asked by police to “move along,” without being offered alternative services”, and 66% reported sleeping in less safe locations. Boulder’s even stricter enforcement resulted in over 1700 citations for unauthorized camping from 2010-2014.

 

http://peoplestribune.org/pt-news/wp-content/uploads/2017/01/pt.2017.01.05_denver.jpg

Camping bans are expensive to enforce and can have multiple negative effects on health, well-being, and opportunities for those experiencing homelessness. Police “sweeps” of homeless encampments displace people to unsafe areas away from service providers and may deprive people of their personal property, including medications. Citations, arrests, failure to pay fines and jail time may disqualify residents from future housing and employment opportunities, perpetuating the cycle of poverty.

Colorado needs to stop spending tax dollars on ineffective policies that punish the poor and unhoused,  and focus on workable solutions. Denver Homeless Out Loud and a large coalition of supporters have fought since 2015 to pass the Right to Rest Act, HB18-1067, which would prohibit legislation that criminalizes resting, sleeping, covering oneself, or sharing food in public spaces.  Call your representative in the local government committee. Tell him/her that Coloradans need housing, not handcuffs.

A Pharmacist’s ViewPoint: Why Nigeria’s Medicines Anticounterfeiting laws should be Repealed

 

Whilst the Nigerian Government and relevant international organizations present in country are working hard to ensure adequate supplies of essential medicines are available to the reach of the people; some individuals have identified gaps in the distribution chain and affordability by the population and have therefore established a chain of production, sales and distribution of fake and counterfeit medicines and other healthcare commodities. For so long in Nigeria, there has been no major consequence for committing the criminal offence of selling, distributing or producing fake or counterfeit medicines.

Infact, the law states that anyone convicted, should only pay the equivalent of about $150. Meanwhile counterfeiting of medicines is a multimillion dollar business in Africa’s largest market.

The current law (THE COUNTERFEIT AND FAKE DRUGS AND UNWHOLESOME PROCESSED FOODS (MISCELLANEOUS PROVISIONS) ACT, CAP, C34, LAWS OF NIGERIA) therefore needs to be repealed , updated and reenacted for better health outcomes.

A stringent law will serve as a deterrent to perpetrators of this criminal offence.

This is because when counterfeiting of medicines occur, it’s the patients that suffers. Consequences of this include adverse drug reactions, drug resistance, prolonged morbidity and even death in some cases. This is aside the financial burden it places on the patients. Counterfeit medicines could include medicines with no active ingredients, inadequate active ingredients, wrong excipients, wrong packaging, wrong labelling etc. The FDA has introduced the Mobile Phone Authentication of Medicines(MAS) but adoption has been very low.

Nigerian Pharmacist are therefore pushing for a bill for an act to amend the law and make it more stringent. Convictions and Life term jail sentences are been proposed. The Proposed bill should incentivize citizens who act as whistle blowers, while severely punishing those who engage in counterfeiting activities. Although, there might be resistance from certain groups of people like the importers of medicines, who might be affected by the new law, the Nigerian Agency for Food and Drug Administration and control(NAFDAC) and the Nigerian Parliament, in collaboration with major stakeholders must ensure the concurrent passage of the new bill as well as the Presidential Assent of it.

 

Affordable Food Access

According to the United States Department of Agriculture (USDA), an estimated 40 million people live in neighborhoods without easy access to fresh, affordable, and nutritious food options. Accessing healthy food can mean having to ride multiple buses while carting groceries and children, or scrambling to find someone with a car who is willing to drive to the nearest market. This problem of food inaccessibility affects residents in both urban and rural parts of the US. These areas are greatly in need of reliable transportation, in addition to the jobs and economic activity that grocery stores and healthy food retail can provide.

The Reinvestment Fund (TRF) addresses this issue of poverty and food access by using analytical and financial tools, to bring high-quality grocery stores, affordable housing, schools and health centers to the communities that need better access and other programs such as The Office of Community Services (OCS) Healthy Food Financing Initiative partners with states, communities and agencies to eliminate causes of poverty, increase self-sufficiency of individuals and families and revitalize communities.

As a future Public Health Practitioner, I strongly support the development of a policy that addresses the issue of food access with regards to poverty constraining buying fresh food across the United States. This policy would help to improve the state of obesity in the United States and encourage healthy food choices amongst many in the country that currently have issues affording healthy food options. Stakeholders such as the U.S. Department of Health & Human Services, and The National Supermarket Association need to have collaborative efforts with the USDA to help create a change in the lives of those living with Having access to healthy food is a vital part of a healthy, thriving community. In addition to this, improving healthy food access can help to improve healthy eating habits and lower the risk for diet-related diseases, such as diabetes and obesity.

Do as the French do, ban food waste.

Currently, 30 to 40 percent of food produced is wasted in the United States and of this food wasted, 31 percent is lost at the retail and consumer level. This equates to over 133 billion pounds of food being wasted a year (over $161 billion worth of food). This is a completely unnecessary problem of excess in a time period where one in every eight Americans reports being food insecure. This means that at the same time that 133 billion pounds of food is being wasted, 42 million Americans are going hungry.

Thus, in September of 2015, the USDA launched the first national food loss and waste goal in the United States with the goal to achieve a 50 percent reduction in food waste by 2030. However, despite the USDA’s various initiatives to reduce food loss and waste, very little reductions have occurred. As such, it is time to address this issue with a strong policy change that promotes the reduction of food waste.

There is an urgent need to evaluate our current food system and question why Americas lead the world in food waste. Given that, food waste and food loss refer to a total decrease in food throughout the various stages of the food supply chain it is well documented that this leads to less food being available for all, however, this is also a problem of labor, water, energy and land use. 

As such, the United States should adopt legislation similar to the recently implemented French Food Waste Law, which fines supermarkets that throw away food that is edible or usable for animal feed. This type of legislation would make food donations mandatory, something that is only encouraged by current legislation, thus, improving food security in the United States. Similarly, it would establish the need for accountability at every stage of the food supply chain and the need for improvement of our current food system which is currently failing to feed all Americans. 

Continuing to Improve Antibiotic Stewardship Programs in the U.S., Beginning with Delaware (DE), The First State

When modern antibiotics were discovered over a century ago, little did those early researchers know that not only would their discoveries pave the way for significant advancements in the fields of medicine and pharmacology and save millions of lives, but there would come a time when these drugs would become less and less effective as they were being used more and more. Additionally, patients would face an even greater health risk because of potential exposures to antibiotic-resistant organisms, now on the rise.

CDC

U.S. Centers for Disease Control (CDC), through investigative studies, have subsequently set forth guidelines and recommendations for implementing Antibiotic Stewardship programs (ASPs) in various health care settings. According to a recent, 2017 report by the CDC, data regarding the antibiotic use specifically in U.S. hospital settings was highlighted as needing improvement. In fact, they detail a trend in more powerful antibiotics being used up to 40% more frequently in the years 2006-2012.

Additionally, the Joint Commission now requires all hospitals, regardless of size, to have ASPs. The CDC guidelines include seven core elements for Hospital Antibiotic Stewardship Programs: Leadership Commitment, Accountability, Drug Expertise, Action, Tracking, Reporting, and Education. And, recent studies have shown that all seven elements need to be implemented in order to be most effective.

Hospitals networks in the State of Delaware (DE) have taken the mandate to implement Antibiotic Stewardship programs within their hospitals very seriously. They have created a successful partnership, EbrightHealth, to implement ASPs in all 5 major DE hospital systems.

According to the latest data, 75% of all hospitals in DE meet all seven core elements of an Antibiotic Stewardship Program.

DE is undoubtedly doing a great job. However, 25% of hospitals still either have not implemented ASPs or do not meet the 7 Core Elements. EbrightHealth allows each hospital and hospital system to implement an ASP in accordance with their needs and resources, which is understandable considering these are often limiting factor for smaller hospitals. Their allowance is not, however, reasonable, considering they do not mention the necessity of incorporating all 7 Core Elements within an implemented ASP. We propose further collaborations between EbrightHealth, Delaware Division of Public Health, and the DE Healthcare-Associated Infections Advisory Committee (HAIAC), to create a policy ensuring these 7 core elements are incorporated within all DE ASPs.

Alcohol Consumption should be of Public Health concern in Nigeria

Alcohol consumption in Nigeria has a minimum legal drinking age of 18 years, but in reality, children are exposed to consumption at a younger age in both rural and suburban parts of the country, though in parts of Northern Nigeria, Alcohol is not authorized for sale, but they are usually available. The major trend now is huge public approval for consumption of Alcohol, without consideration of its Health risks.
Nigeria has different locally produced alcoholic beverages distinguished by regions and ethnic groups. In the North, pito and burukutu are commonly consumed. In the South and parts of the North, palm wine tapped from the palm tree is popular and gotten from the sap of the palm tree while the native gin locally called ogogoro, kai-kai, akpuru-achia, or Sapele water distilled from the fermented palm wine consumed in the Niger-delta area.

Many Nigerians believe that palm wine aids with eye sight and improves lactation in women. Alcohol consumption has generally been part of the cultural fabric of the Nigerian people.

Mother teaching baby how to drink beer Source: Nigerian Times Newspaper

Majority of the packaged beers are made by the two major Breweries Guinness and Nigerian Breweries, who are responsible for most of the advertisements of Alcohol. Generally, abuse Alcohol can be attributed to the fact that it is a part of daily lives of these communities and for many of them, the greater influence comes from the social and environmental influences that includes cultural history, messages received from advertisements, community practices, adults, and friends about alcohol.

Federal Road Safety Commission at an Event sponsored by a Major Brewer Source: Guiness Nigeria PLC

Holistic interventions targeting underage drinking and binge drinking among the whole population is needed. Policy makers need to fight against the rising trends linking alcohol consumption and healthy living, Campaigns initiatives focus more on rural areas rather than big cities, because majority of Nigerians live in the rural communities and are the ones involved in brewing or tapping local alcohol. There should be total ban on advertising that makes alcohol consumption look good, by extension ban on social marketing that offers free alcoholic drinks and events organized by Brewers co-sponsored by the stakeholders against alcohol consumption.

Bridging the Gap – Immediate Action Required to Provide Adequate Mental Health Services to Canada’s Indigenous Youth

There are countless examples of health care disparities among Canada’s First Nation populations – tuberculosis rates up to 38 times higher, diabetes rates 4 times higher and poor housing conditions 3 times higher than non-Aboriginal communities.  One of the most significant deficiencies is provision of mental health services, particularly to Canada’s Indigenous youth.  Alarmingly, the suicide rates of First Nations youth is 5-6 times higher than the non-aboriginal population.

Delivery of health services to Canada’s Indigenous populations is complex, as funding is divided between provincial/territorial and federal governments.  The lack of clarity in legislation around this division has led to significant delays in patient care.  In 2005, Jordan River Anderson, a 5-year-old Cree boy with a neuromuscular disorder died in hospital.  It had been determined several years before that he could have been cared for at home, however the dispute over funding for this care extended longer than Jordan survived.  This lead to the development of Jordan’s Principle with the intent to prevent First Nations children from being denied services or experiencing delays receiving them.

Despite Jordan’s Principle being passed in 2007, the Canadian Human Rights Tribunal recently ruled that the federal government is discriminating against First Nation children by failing to provide equivalent health services compared to non-Aboriginal communities.  When a suicide pact was uncovered among youth in Wapekeka, an urgent request for support was issued to Health Canada – it was not provided until after the deaths of two local teenagers.  The Canadian Paediatric Society has found significant discrepancies in how Jordan’s principle is implemented in each province/territory.

Supported by several First Nations and advocacy groups (Chiefs of Ontario, Assembly of First Nations, Nishnawbe Aski Nation, Amnesty International), the tribunal has called for immediate action to address the gaps in mental health services.  The steps required include:

 

• Analysis of the current programs for mental health services for First Nation youth to identify gaps.  The tribunal has given this a deadline of April 2, 2018.
• Reallocation of funding specifically to support First Nation youth mental health services.
• Communities identifying specific resources needed to bridge the gap and how to provide them in a culturally appropriate manner.

Photo by Assembly of First Nations

Never Again

On February 14, 2018, Marjory Stoneman Douglas High School, in Parkland, Florida, experienced a mass shooting in which 17 students and teachers died. It was the 18th US school shooting, just in 2018. However, the aftermath of this shooting was different because of a passionate and determined advocacy group that emerged — Never Again MSD, founded by approximately twenty students who survived the Stoneman Douglas shooting.

The group started on social media as a movement using the hashtag #NeverAgain. They staged protests demanding legislative action to be taken to prevent similar shootings in the future, vocally condemned U.S. lawmakers who have received political contributions from the National Rifle Association (NRA), and played a part in corporations’ revocation of NRA sponsorships and discounts for NRA members.

Due to the high level of activism and mounting pressure on lawmakers to enact change, on March 9, Florida signed into law an array of gun limits that included raising the minimum age to purchase a firearm to 21 and extending the waiting period to three days. The law also imposes restrictions on the possession of “bump stocks,” funds more school police officers and mental health services, broadens law enforcement’s power to seize weapons, and allows certain staff members to carry guns in schools.

Within hours of signing the legislation, the NRA filed a lawsuit in Federal District Court, arguing that Florida’s age restriction was “a blanket ban” that violated the Second Amendment, as well as the 14th Amendment’s guarantee of equal protection. The NRA is considered one of the most influential lobbying groups in Washington.

The result of the NRA’s lawsuit remains to be seen. However, it seems the country has woken up. The NRA now has its hands full having to contend with several other states also considering action since the Parkland shooting. Although the Florida legislation is a victory for Never Again MSD, it needs to continue its advocacy if it wishes to enact change at the national level. Its main focus should be to make its nationwide demonstration, planned for March 24, 2018, as powerful as it can be.

Gun rights have deep roots in this country, its founding, and its history — however, without infringing on gun rights, we can and should as a country pass effective, evidence-based gun laws to prevent senseless acts of violence.