Geneva Health Forum Archive

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GHF2014 – PL04 – Data and the Knowledge Economy: What is there for Global Health?


Dr. Carmelo Bisognano 
Head of Strategy, Inartis Foundation, Switzerland
Prof. Angela Brand 
Professor of Social Medicine & Public Health Genomics
Institute for Public Health Genomics (IPHG), Cluster of Genetics & Cell Biology
Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
Mr. Sridhar Venkapaturam 
MSc Global Health and Social Justice Program, Department of Social Science, Health & Medicine, King's College London
Prof. Christian Lovis
Professor of Clinical Informatics and leading the Division of Medical Information Sciences, Geneva University Hospitals, Switzerland
Mr. Andrew Filev
Founder and CEO, Wrike, United States
This session will gather a panel of people from various disciplines to debate the promises and challenges big data brings to global health.
As social systems move from the physical world to the virtual world, technology has served as an enabling factor that has made it possible for human capital to be developed, shared and applied in new ways and at an immense scale and pace. The potential for capturing natural data organically has accelerated profoundly as well as the potential to shed light on connections/linkages between sets of information that were until then not processed or just analyzed in silos.  This increasing abundance of data, our ability to process it and use it meaningfully is causing what people have called a drift toward data-driven discovery and decision-making in various sectors including the health sector one. If data has become a core asset that provides a huge resource for new industries, processes, services and goods leading to significant competitive advantage, concerns for privacy and individual rights remain as well as how this new trend will benefit global health.

BisognanoDr. Carmelo Bisognano
Head of Strategy, Inartis Foundation, Switzerland

Prior to serve as Head of Strategy for Inartis Foundation, Dr. Bisognano founded and managed several companies such as Easymed Services Inc. (EZM:CN), a British Columbia, Canada, company. 

Dr. Bisognano had a post-doctoral position at the University Hospital of Geneva where he conducted research on molecular regulation of bacterial resistance. He is also the author of publications in international scientific journals and has obtained several awards for his research work (GSK and MSD Awards, Swiss Society for Infectious-Diseases).

Dr. Bisognano was also a biotechnology consultant for Geneva’s government, research institutes and a Marketing Manager in a bioinformatics company. More recently, he co- directed a course on Biotech valuation for MoT MBA (federal polytechnic school) and collaborated with investment funds for their strategic portfolio allocation.


Brand_Angela_squareProf. Angela Brand 
Professor of Social Medicine & Public Health Genomics
Institute for Public Health Genomics (IPHG), Cluster of Genetics & Cell Biology
Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands

Angela Brand is Founding Director and Full Professor of the Institute for Public Health Genomics (IPHG) at the Faculty of Health, Medicine and Life Sciences at Maastricht University, the Netherlands, as well as Dr. T.M. Pai Endowed Chair on Public Health Genomics and Adjunct Professor at the School of Life Sciences at Manipal University, India. Before she worked in the clinics, at various academic institutions and in governmental bodies in the USA and Germany. She is Paediatrician and Specialist in Public Health Medicine, holds a PhD in pathology and a Master of Public Health from Johns Hopkins University, USA. She has been the pioneer of Public Health Genomics in Europe and beyond and established this field in more than 15 European Member States within the last years ( Public Health Genomics is the field within Public Health demonstrating the need for a holistic “systems thinking” and translating research from “cell to society” towards the implementation of personalised healthcare between key stakeholders and across sectors. The IPHG is unique in Europe giving policy advice on the national, European and global level. Key expertise and industrial collaborations include regulatory issues, use of big data for health systems and ownership questions, valorisation, decision supporting tools such as Health Technology Assessment and development of the innovative LAL model™.


Vankatapuram_Sridhar_squareMr. Sridhar Venkapaturam 
MSc Global Health and Social Justice Program, Department of Social Science, Health & Medicine, King's College London

Mr. Sridhar Venkapaturam's career and research interests have their origins in his interest in topics such as development, international political economy, and human rights.  While he was planning throughout his college education on becoming an international lawyer that would work in the area of international development, an internship at Human Rights Watch changed that course.  He was the first person at HRW to examine a health issue, specifically HIV/AIDS, from a human rights monitoring perspective.  The difficulty of HRW to recognize a human right to health as well as the prevailing idea in public health that individual rights must be sacrificed for the greater good put him on the path of developing a philosophical argument for a moral right to be healthy.  He trained in a number of relevant disciplines such a public health, sociology, economics and political philosophy.  And he currently runs a graduate programme at King’s College London called Global Health and Social Justice.  His research includes such topics as theories of social and global justice and health, the philosophy and ethics of health inequalities, the human right to health, the ethics and philosophy of health economics, et cetera.

PL04_Christian_LovisProf. Christian Lovis

Christian Lovis is professor of clinical informatics at the University of Geneva and leads the Division of Medical Information Sciences at the Geneva University Hospitals. Christian is a medical doctor trained in Internal Medicine. He is heavily involved in the Swiss federal projects around eHealth as co-chair of several working groups. He has developed the clinical information system at HUG and his involved in several large pan-European projects around using big data for bio-surveillance or clinical research. Christian is member of the governing council of HIMSS Europe and board member of HIMSS World Wide.

AndrewFilevCloseMr. Andrew Filev

As the founder and CEO of Wrike, Andrew Filev is the visionary behind the unique social project management mix that has become an irreplaceable collaboration solution for thousands of customers. As a successful software entrepreneur and experienced project manager, Andrew not only oversees the company’s business strategy, but passionately leads the product management.

Prior to Wrike, Andrew Filev launched his first software development venture at the age of 17. Growing it into an international business with more than 100 engineers, he faced the same collaboration challenges that millions of companies struggle with frequently. Looking for efficient solutions, he came up with his own idea of a collaboration platform for dynamic distributed teams, running several simultaneous projects, just like his team. “Traditional software didn’t work for my team, and we weren’t alone in this. We needed a better alternative — a tool that would help connect data across multiple projects, would give a crystal-clear overview of these projects to managers and would become one hub for smooth, real-time collaboration for the whole team,” Andrew says about the origins of Wrike’s vision.

The first pillar in Andrew’s “go where data is” concept, which has become Wrike’s core, was building advanced e-mail integration to bring data from the most ubiquitous communication tools into the planning process. Further, developing Wrike as a flexible and easy-to-use system that would perfectly scale to growing teams and more data, Andrew came up with an innovative work graph model that combines the ideas from project management (work breakdown structure), operating systems (hierarchical folders), semantic web (tags) and brainstorming (mindmap) into one cohesive and simple model.

Andrew has been a contributing author in influential blogs and journals (Cutter IT Journal, Web 2.0 Journal, etc.) and has given presentations at many conferences, such as the Web 2.0 Expo, Office 2.0 Conference, PMI events and more.

To learn more about Andrew’s ideas and project management practices, you can subscribe to his Project Management 2.0 blog

Inequalities in health care utilization in Mexico.

Author(s) Christine Göppel1, Linus Grabenhenrich2, Peter Tinnemann3.
Affiliation(s) 1Institute of Social Medicine, Epidemiology and Health Economics, Charité Berlin, Berlin, Germany, 2Institute of Social Medicine, Epidemiology and Health Economics, Charité Berlin, Berlin, Germany, 3Institute of Social Medicine, Epidemiology and Health Economics, Charité Berlin, Berlin, Germany.
Country - ies of focus Mexico
Relevant to the conference tracks Social Determinants and Human Rights
Summary Mexico´s way towards Universal Health Coverage: Are the Mexican poor still at a disadvantage in health care utilization?
Background The cornerstone of the Mexican health reform towards Universal Health Coverage is the 2003 introduction of a voluntary Popular Health Insurance (Seguro Popular). It aims to ensure access to health care services for vulnerable population groups and to address inequities in health care utilization for those facing financial hardship through sickness.
Objectives To quantify the Mexican health reforms success we identified the characteristics of population subgroups that contribute attributably to disparities in health care utilization of older adults and evaluated socio-economic inequities considering the distribution of needs for health services across the income groups.
Methodology Data of the WHO “Study on global AGEing and adult health” (SAGE) Wave1, conducted 2009/10 in Mexico, was examined for determinants of health care utilization. The concentration curve and index of health care utilization were used to measure socioeconomic inequalities in health care utilization and standardized for health needs to assess inequities in health care utilization.
Results Among the SAGE Wave1 participants from Mexico, less than half of the population saw a doctor in the 12 months prior to the survey. Income is by far the strongest determinant of an older person´s probability of using health care services. Other associated factors are chronic conditions, rural residence and education of the household head respectively. Achieved access of health care services is concentrated on the richer quintiles of the population. Poor population subgroups use outpatient services less frequently, despite presenting worse health conditions. Pro-rich-inequalities in health care service utilization appear as a matter of inequity and reflect, at least partly,  inequitable distribution of health care services utilization.
Conclusion The study measures specific indicators of the Mexican health system performance as it moves towards Universal Health Coverage. Ongoing socio-economic inequalities in health care utilization are confirmed. No evidence is found that insurance coverage increases health care utilization among the elderly poor. Mexican health policy makers should address prevailing financial obstacles and improve policies to further promote equitable and sustainable access to health services.

Pediatric Cancer: Integrating referral systems

Author(s) Ramesh Menon1, R.K Marwaha2, Shashidhara Jayappa3.
Affiliation(s) 1Dept of Paediatrics, Institute of Maternal and Child Health, Govt Medical College, Calicut, Kerala, India, 2Dept of Paediatric Haematology and oncology, PGIMER, Chandigarh, India, 3Dept of Paediatrics, Institute of Maternal and Child Health, Govt Medical College, Calicut, Kerala, India.
Country - ies of focus India
Relevant to the conference tracks Health Systems
Summary There is no systematized referral path for centralized care for children with cancer in India which adversely affects outcome. We undertook a questionaire based survey of patients/ health care seekers in this group (children < 18 years of age) who used a tertiary care centre unit in North India ( PGIMER, Chandigarh). This study attempted to tease out the section of maximum delay in the existent variety of paths taken by health seekers among cancer patients, patient delay (symptom- contact) and system delay (contact- diagnosis) were analysed separately. Over a period of one year data was collected the saliant findings were the symptom- contact delay was 2 to 3 days and the contact- diagnosis delay was 27 to 40 days.
Background Estimated number of new cancers diagnosed in India every year is 700,000 to 900,000. The geographic, socioeconomic, educational and health system inequalities in cancer treatment, in children, have only now begun to be addressed. This study was designed to assess referral patterns of children with haematological malignancies (HM) in Northern India.
Objectives To identify the modifiable factors causing delay in the early referral of children with Haematological malignancies and to quantify the relative significance of the factors analysed.
Methodology In the period between the months of October 2001 and November 2002, based on a predesigned performa, parents/guardians
of children with haematological malignacy were interviewed at presentation to a tertiary cancer care facility for children in North India. Details from previous prescriptions and referrals, if available, and details of diagnosis (staging and categorization) were recorded. Haematological malignancies included acute leukemia (lymphocytic (ALL), myeloid (AML), undifferentiated (AUL) and non-Hodgkin's lymphoma (NHL)). Risk stratification of disease categories at presentation, from high risk disease and standard risk disease, was completed. Patient delay (symptom - contact interval), health systems delay (contact-diagnosis interval), total delay (symptom- diagnosis interval) and number of contacts were recorded and compared between high risk and standard risk disease groups using descriptive analysis.
Results Of the 79 children (55 boys; 69.6%) with HM, the total number in the high- risk category was 40 (50.6%), and the rest were of the  standard-risk group. The mean age was 5.9 ±3.2 years. The median patient delay of care seeking for children with high - risk HM was 2 (95 % CI; 1.27, 3) days and for children with standartd risk HM was 3 (95% CI;1, 4.22) days (P=0.42). The median system delay of care provided for children with high- risk HM was 27 days and for children with standard risk HM was 40 days (P=0.19). The median symptom to diagnosis interval for children with high risk HM was 29 days and for children with standard risk HM was 45 days (P=0.09). In the standard risk group, 19 (48.7%) had more than 3 contacts whilst in the high-risk category, only 11 (27.7%) had more than 3 contacts (P=0.043). The private sector was similarly approached in both risk groups for medical care. In the study group, the risk category had a significant association with the total delay (spearman correlation coefficient= -0.262, P= 0.02)
Conclusion Sensitizing the private sector practioners and primary care physicians to the possibility of haematological malignancy in children with obvious signs may be the most effective step in a resource poor setting for an early referral.

Equity and Local Government: Sao Paulo, Brazil

Author(s) Vera Coelho1
Affiliation(s) Citizenship, Health and Development Group , Brazilian Centre of Analysis and Planning , Sao Paulo, Brazil.
Country - ies of focus Brazil
Relevant to the conference tracks Health Systems
Summary Brazil has established a nationwide health system (SUS) aimed at ensuring universal access and has made enormous progress towards this goal over the past two decades. However, a number of studies have shown that certain vulnerable groups often do not have effective access to the services they need. The study analyzes the evolution of the supply and consumption of public healthcare services within the municipality of São Paulo between 2000 and 2011. The results show that there has been equity gains that favored groups living in areas that present the worst socio-economic indices. The paper discusses how municipal health policies and politics helped to guarantee these achievements.
Background During the 1990’s a new governance structure was forged and contracts were initiated between the federal, state and municipal governments, which defined responsibilities and transparent financing rules for the implementation of the national health policy. At that time the effective institutionalization of the health conferences, a national health council, and the health councils in all twenty-six states and in nearly all of the 5,561 municipalities also took place. Today the national government has an important role in regulating and financing health services, while state and municipal governments are responsible for delivering services and allocating supplementary funding. One major challenge facing the SUS is how to increase the system’s equity as the provision of services is still skewed in favor of wealthier regions and citizens. In particular, the study focus on the difficulties posed in tackling internal equity gaps in mega cities as, despite the fact that these are highly unequal areas, the national policy only focuses on inequalities between regions, states and municipalities. The study explores how municipal politics favored the adoption of policies that helped in guaranteeing a more equitable distribution of public health services in the mega city of Sao Paulo.
Objectives The study evaluates the redistributive efficiency of the Sao Paulo municipal policies’ adopted between 2001 and 2011. The period covers three municipal terms. The study: 1) follows the distribution of public health services – equipment and service supply - in all the 31 sub-municipalities between 2001 and 2011; 2) describes the health policies implemented by each of the three administrations and explores the rationale for its adoption; 3) tests the plausibility of the assumption that relates, on one hand, the coupled presence of competitive election for local office and citizen participation and, on the other hand, the adoption of innovations that favored greater equity. The main questions we planned to answer were: Did the gap across areas with the highest and lowest Intra-Municipal Development Index narrow during the period? Can we identify how the different strategies adopted by the municipal government in each term worked to reduce or widen this gap? What was the role played by local politics in favoring the adoption of these strategies?
Methodology The analyses gauge the effect of municipal health policies on indicators of access to public health services. The study was organized in three steps. First, a geographic Information System (GIS) was organized. It contains data from the years 2000 to 2011 on per capita primary appointments of a given submunicipality, the rate of hospital admission per 10.000 residents of a given submunicipality; age, income, and educational level of the submunicipalites’ resident population and the proportion of SUS users and out-of-pocket or private insurance users. The SUS-user is a citizen without a private health insurance, who uses the public health system, which in São Paulo’s case representes 48% of the total population. For primary consultations there is no information to allow for identification of the beneficiary for a given appointment and we assumed a plausible premise that this kind of service tends to be produced in a decentralized fashion and consumed locally. For hospital admissons we worked with the Hospital Admission Authorization (AIH), the means through which healthcare service providers in Brazil are reimbursed. AIH records indicate the zip code of those who used the SUS service which allows for mapping of the consumption of hospitalizations in the sub-municipalities areas. Equity gains have been estimated as the difference between each outcome in the sub-municipalities areas, which are in the highest socioeconomic quartile compared to the lowest quartile. The sources are CENSUS (IBGE) and Data SUS (Ministry of Health).In the second step a structured questionnaire with closed and semi-open questions was applied to health councilors, service providers and municipal public officials. Moreover, we collected data provided to official media for public announcements and mass media. The analysis of these materials helped in understanding the political context and the decisions made by each of the three administrations.In the third step we analyzed the distribution of health units and basic appointments as well as hospital admissions and sought to locate turning points that favored the equity gains identified in the first step. Once we identified these turning points we investigated the relationship between them and the policy decisions made by each of the three administrations, which were identified in the second step.
Results Despite the fact that the SUS population was concentrated in the outskirts, in 2001 in the city of Sao Paulo equipment and services were concentrated in the central and oldest areas of the city of Sao Paulo. This meant that the populations who lived in areas with better socioeconomic indicators were privileged compared to populations living in the outskirts of the city. In this sense, it is important to note that the differences in distribution measured in the present work are between the poor that live in different areas of the city, rather than between poor and non-poor as such. The bias in favor of central areas was partially reversed in more recent years and this was made possible through heavy investment in infrastructure. The average number of basic health units per 20,000 SUS users increased from 0.79 to 1.42, and there was considerable progress in the distribution of these equipments to areas in the outskirts of the city. The implementation of new hospitals has privileged poorer areas, as can be noted by the fact that four out of five new hospitals built in this period were in areas among the 10 sub-municipalities with the lowest Human Development Index (MHDI) in the city. Along with this expansion there was a shift in the distribution of hospital beds: in 2001 the 9 sub-municipalities with the smallest MHDI supplied 5.75% of the public hospital beds in the municipality, while 10 years later this percentage had increased to 13.48%. It should also be noted that, in 2010, hospitalizations were 61.9% higher among SUS users residing in the first quartile (the poorest) and were only 13.8% higher among fourth quartile residents (the richest).The rate of primary appointments increased by 154.7% between 2001 and 2010, with the average rate of basic appointments per SUS user per year going from 1.28 to 3.26. From 2002 to 2006 the standard deviation in the distribution of these appointment between submunicipalities decreased from 0.93 to 0.66.The data collected and analyzed by the study clearly shows that there was significant expansion in the supply as well in the consumption of services in the regions that presented the worst socio-economic and health indicators. An analysis of the distribution of these resources also showed that we now have a more equitable distribution pattern of public health services between locations with a reduction in the geographic inequalities hindering access to the public health system.
Conclusion The results described in the preceding section may seem expected, after all, the distribution of public health services was and still is biased towards wealthier areas and the correction of this situation is the most logical step. However, this is a striking result given how difficult it is to reverse this tendency as attested by the findings of a number of studies in different parts of the world, which indicate that the richest tend to persistently benefit more than the poorest from public spending on health (World Bank 2003; Liu, Hotchkiss and Bose 2007). The guidelines and programs established by the Brazilian Ministry of Health starting in the 1990s guaranteed that new resources reached the municipality. The simple use of these resources, replicating the distributive profile of the pre-existing equipment could, however, have easily led to a deepening of existing inequalities. As seen in the previous section, this was not what happened. From 2001, municipal managers began to take on a major role in proactively coordinating municipal policy and prioritizing those areas with higher populations of SUS users, which are the poorest areas and those with worse health indicators. The analysis suggests that the equity gains reported in the study happened trough cycles of micro and macro politics that reinforced each other. The micro cycles were lead by active local health councils which used political mobilization and contacts to pressure the municipal health secretariat for more resources. The macro cycles involved political projects and efforts by both the Workers' Party (PT), that held municipal office from 2001 until 2004, and the Brazilian Social Democracy Party (PSDB), which entered office in 2005. The equity gains made possible by the macro cycles were assured by the use of technical criteria to make sure that the new resources made available for basic health were distributed in a manner that would serve the population living in the municipality in a more equitable way. As it is described in detail in the study, these two dynamics, fed by political competition between PT and PSDB, allows for an explanation of the adoption of many of the policies that forged the distributive results described in the previous section.

Poverty and the Urban Health Challenge in Nigeria.

Author(s) Geoffrey Nwaka1.
Affiliation(s) 1Humanities and Social Sciences, Abia State University, Uturu, Nigeria.
Country - ies of focus Nigeria
Relevant to the conference tracks Social Determinants and Human Rights
Summary As we consider the post-2015 development agenda, the battle for sustainability in Africa will be won or lost in the cities. The paper considers how poverty and slum conditions in Nigerian cities can best be addressed and reversed.
Background Poverty and slum conditions pose a serious public health challenge to Nigeria’s rapidly expanding urban population. Almost everywhere in these cities environmental amenities lag behind population growth. Some elite neighborhoods enjoy relatively high quality housing and residential environments, but the bulk of the urban poor live in appalling and health threatening conditions. Inadequate housing, sanitation and waste management, and the poor state of public health infrastructure have led to the spread of a wide variety of water-borne and other communicable disease. Nutritional standards are low, and food contamination is common, especially in the extensive street food industry. Indoor pollution from open fires and stoves in poorly ventilated homes is known to be responsible for many respiratory ailments among women and children who are constantly exposed to toxic fumes in the cooking areas. As environmental and health problems overlap, the poor suffer disproportionately from the adverse health effects of environmental problems. Many of the Millennium Development Goals – in health, environmental sustainability, poverty reduction and enhanced international development assistance - will not be met in Africa despite improvements in some areas.
Objectives The paper considers how best to reach the poor, decrease inequalities in access to health services, ways to forestall the growth and spread of slums, and reduce poverty which leads to slum conditions.
Methodology I have drawn from historical material and social science literature. I have also interacted over the years with the urban poor, informal sector workers, and government officials concerned with urban health and development. Many of the insights from the UN sponsored conferences of the 1990s, the Habitat Agenda, ILO's Decent Work Agenda, WHO's Healthy Cities Programme, the work of the Cities Alliance for Cities Without Slums, and some of the more recent ideas from Rio+20, and the various 'Consultations' for the Post-2015 Development Agenda will be brought to bear on the analysis.
Results .The current pattern of government spending on the health sector tends to favor the well off in society who are the main users of curative health services. The central argument is that human development ought to be at the center of the concern for sustainable urbanization in Africa. To achieve this, the paper considers how best to promote the growth of more inclusive and humane cities by reviewing discriminatory laws and codes which tend to inhibit the access of the poor to affordable land, healthcare and housing security.
Conclusion The concluding section stresses the need for appropriate and well targeted urban health and other interventions by state and local authorities, the international development community, private sector and civil society organizations, and the urban poor themselves in a collaborative effort to build safer, healthier and more equitable cities

Global Health: Interconnected Challenges, Integrated Solutions

During recent decades significant progress has been made to focus policy attention and channel new financial resources towards global health issues. Despite this, the challenges facing our global community are becoming increasingly complex and inter-connected. This was emphasised by Dr Margaret Chan, WHO Director-General, during her opening speech to the 132th Executive board members:

The challenges facing public health are big and increasingly universal. […] The climate is changing. Antibiotics are failing. The world population keeps getting bigger, and older. The rise of chronic non communicable diseases is relentless. The microbial world continues to deliver surprises. Public expectations for health care are rising. Budgets are shrinking. Costs are soaring at a time of nearly universal austerity. Social inequalities are at the worst levels seen in half a century. Conflicts are rife. The health consequences, also for civilians, are severe. The will to relieve human misery is strong but gets blunted by too few resources, too little capacity, and too much uncoordinated aid”.

The context of this uncertain global environment is the intense backdrop for current discussions on how to position health in the post-2015 development agenda. The 2014 Geneva Health Forum (GHF) will not shy away from this difficult and challenging context.

The complexity of today's global health challenges requires harnessing the skills and energies of many sectors and disciplines in order to develop innovative and effective solutions. Never has it been so urgent to further align interests and efforts in order to maintain gains and tackle the global health and development challenges ahead. As the world moves towards the edges of its planetary boundaries, achieving sustainable development and improving global health require actions on a much broader and systemic front. In this context health is a pre-condition and an outcome of all three dimensions of sustainable development – the economic, social, and environmental.

It’s time for health to incorporate the big picture of our contemporary challenges, therefore the overarching topic for the 2014 edition of the Geneva Health Forum will be ‘Integration’.

Integration has different meanings. In its basic sense, integration is the process that brings together different parts into one single component. In pedagogy integration refers to an educational approach that helps learners solve complex problems by mobilizing resources and uniting separate elements connected to the issue at hand. In economics, integration is the consolidation of activities under a common authority. Integration can achieve a given goal by aligning interests, resources and actions more comprehensively, effectively and more efficiently.

In the field of global health, the concept of integration is not new and can be traced back to the WHO’s 1978 International Conference on Primary Health Care where the famous declaration of Alma Ata proclaimed that: “the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.”  The Primary Health Care approach is an integrative approach that combines actions in order to promote the establishment of comprehensive national health systems capable of offering a wide range of promotional, preventive, curative and rehabilitative services.  At the same time it mobilizes other sectors in order to achieve health for all and reduce social disparities.

While the broad-based development and strengthening of the health systems approach advocated by the WHO’s Health for All initiative has been viewed as too idealistic and unrealistic to implement, the issue of integration is once again topical. This is largely due to the rise of several large disease-specific global health initiatives (GHIs), the increasing burden posed by non-communicable diseases and recognition that the health Millennium Development Goals (MDGs) will not be met without improving health systems.

Beyond the polarized debates of the past decade, the GHF team invites you to revisit the concept of integration in its various dimensions and framings. We would like to promote global health as a field of study and practice that offers an integrative approach which better captures the underlying causes of ill-health and recognises the commonalities that underlie people’s health around the world.

The following section further elaborates on the various meaning/dimensions of integration describing how the concept can be approached and dissected. 13 variations of the concept matching the GHF tracks will be proposed. GHF tracks are broad thematic categories intended to clarify the content generated by the GHF over the years. Each track represents an important global health subfield and taken together these tracks constitute the backbone of the GHF content. The primary purpose of these tracks is to help our constituencies find their place in the GHF.

To facilitate abstract submission, a description of each track with specific reference to the concept of integration and a set of questions that prompt critical reflection is available here. We encourage GHF participants to submit their practical experiences with integration related projects, programme and policies. We wish to revisit this concept in varied settings in order to highlight the conditions under which integration can be a feasible and appropriate way to improve global health.

Submissions for the 2014 Forum are now closed.

Gender Inequality and HIV/AIDS: Double Jeopardy of Women

Author(s): B. Joshi*1, B. Shahi1
Affiliation(s): 1Sociology and Rural Development, Tribhuwan University, Nepal, 2Community Health, All India Institute of Medical Sciences, New Delhi, India
Keywords: Gender, HIV/AIDS, women, vulnerability, rights

Current statistics indicate that 6.1 million people in South Asia are infected with Human Immunodeficiency Virus (HIV). HIV is an extraordinary kind of crisis. It requires an exceptional response that remains flexible, creative and vigilant on the one hand and on the other hand those who are affected need a multi-dimensional approach to their lives. Now HIV infection in Nepal has a female face because of it growing fastest in this subpopulation. How do gender and HIV/AIDS make women jeopardized? Gender is a crucial element in health inequalities in developing countries. Gender can be conceptualized as a powerful social determinant of health, which interacts, with other determinants such as age, family structure, income, education and social support and a variety of behavioural determinants. In a patriarchal system, men dominate women and exercise control over their lives including their sexuality and reproductive choices. Nepalese women’s vulnerability for HIV is further fragmented by a combination of factors such as biological, social- class, caste, urban/rural location, sexual orientation, culture, economic and legal factors, etc. These factors have an impact on women’s access to services, resources and information.


A study was conducted with PLWHA women during 2005-2007. To examine the complexity of HIV/AIDS and to learn more about the specific problems faced by women living with HIV - how the concept of gender & HIV/AIDS make their life vulnerable. Case studies and Informal Interviews with HIV infected women. Data was analysed with EPI info programme.


Case studies and interviews with women from the study illustrate that low status in family, sexual violence, economic and social problems such as poverty, lack of education are some of the primary reasons to get infection. Cultural orientation inhibits them to talk about sex to their partners, which results in infectious status. In the middle-aged women, after sterilization they do not practice regular use of condoms, because they think it is primarily for family planning. Among the newly-married women they know their status only at time of pregnancy, which results in psychological trauma and other related aspects. Most of them are widows and they know their sero status at a later stage of their partner’s HIV infected life. After the death of their partner, some of them are being expelled from their home and undergo various violations of human rights.

Lessons learned:

This study revealed the need to develop appropriate programme would be emphasizing the target communities. Due to illiteracy, poverty, gender inequality women and girls are facing with spousal battering, sexual abuse of female children, dowry related violence, rape including marital rape, traditional practices harmful to female, no spousal violence, sexual harassment and intimidation at work and in school, trafficking of women, forced prostitution, rape in war, female infanticide, constant belittling includes controlling behaviours such as isolation from family & friends, monitoring her movements, restrict her access to resources. Social workers can minimize these issues by giving empathy and psychosocial support, change behaviours and attitude providing medical treatment, offer counselling ,documents injuries and refer their clients to legal assistance and support services, family planning and other mental and reproductive healthcare. Peer-educators (healthcare workers and medical students) approaches for prevention of violence are cost effective, sustainable, easy access to-hard-to reach groups. Governments, NGOs, INGOs also have crucial role to work hand in hand on these issues by empowering women, law and policy, equal education and equal economic opportunities.

Inequity in Utilizing of Healthcare Services by Infertile Patients in Nigeria

Author(s): T. M. Ola1
Affiliation(s): 1Research and Documentation, Centre for Population and Health Research, Ado-Ekiti, Nigeria
Keywords: Infertility, healthcare systems, health inequity

Health inequity refers to health inequalities that are unjust according to some theories of social justice and is represented by inequalities in health status, healthcare utilization and healthcare financing. Infertility is a stigmatized health condition which has been relatively neglected as both a health problem and a subject for social science research. Few studies have been done to assess socio – economic inequities in health in Nigeria.


The purpose of the study was to assess socio-economic inequities in infertility management services in the three healthcare systems in Nigeria (that is traditional, orthodox and spiritual healthcare systems). The study employed a triangulation method of data collection. 152 infertile patients male and female were interviewed at the various healthcare systems where they were currently receiving treatment. Information was sought on their socio-economic and demographic status and use of the 3 healthcare systems in the management of their infertility. Analysis was done using the Statistical Package for Social Sciences (SPSS) version 11. Information collected through focus group discussions and in-depth interviews were transcribed verbatim.


About 90.1% and 9.9% were females and males respectively. Majority of the respondents (41.4%) were currently receiving treatment from the faith healing healthcare system followed by 22.4% currently utilizing orthodox healthcare system. However, majority of the respondents (37.5%) first chose orthodox medicine for the management of the infertility. They later opted out for reasons ranging from the quality of care, financial and physical accessibility, unfavourable outcomes, and efficacy of services provided by the different treatment providers. The Assisted Reproductive Technology comes at a cost which makes it non-affordable to majority of the respondents with irreversible form of infertility.

Lessons learned:

In Nigeria, inequity exists in the management of infertility. Equity or fairness involves a focus on the distributive impact of health policies and programmes on different individuals and families. Such evidence for health inequities in the management of infertility should inform such programmes aimed at making infertility treatment affordable and accessible so that they include strategic components aimed specifically at keeping inequality to a minimum.

Vulnerable Populations and Inequalities in Health: The Case of Marginalized Women with Substance Abuse Problems

Author(s): M. P. Romero1
Affiliation(s): 1Researcher on medical sciences E. Direction of epidemiological and psychosocial research, National Institute of Psychiatry, Mexico city, Mexico

Vulnerable population, women, substance abuse, equity

Background: Interest in health inequalities has grown in recent years. The World Health Organization (WHO) defines them as health variations that are unnecessary, avoidable and unfair (Whitehead M, Dahall G, 2007). These inequalities are also gendered. Gender is a concept that incorporates the social factors associated with men and women’s different patterns of socialization, which in turn has to do with family roles, work expectations, types of occupation and social culture which also affect the process of health and illness. In this work we use the concept of gender quoting Ettore (2002): ‘gender is a process and an institution…As a process, gender is a part of all human interactions. Gender shapes the meaning of “female” and “male” and “masculinity” and “femininity” on cultural, political and economical levels. As an institution, gender is a part of culture just like other components of culture such as symbols, language, mores, norms, values and so on. Gender is a “stable” form of structured inequality and it is embedded in culture’ (p. 329). When women experience the damaging effects of gender whether as a social process or an institution, women are at a greater disadvantage because ‘masculinist’ (male privileging) more than gender-sensitive structures and paternalistic epistemologies predominate. In addition to gender inequalities, there are also social and economic inequalities that give rise to marginalized groups. Therefore, for vulnerable populations, ensuring healthcare coverage an access to good-quality, appropriate public and private sector services is an ongoing a challenging proposition (Ferguson 2007). Type of study: A non-experimental, descriptive, ex-post facto cross sectional study was undertaken in two women’s prison in Mexico city. A non probabilistic sample of 213 women was selected, with the following inclusion criteria: current or sometime consumers of alcohol, tobacco and drugs, aged between 18 and 65 who can read and write.

The aim of this paper is to discuss from the theoretical framework of gender perspective and vulnerable population’s literature, the burden of disease of substance abuse in vulnerable women, specifically data from a research with minor delinquents and women in prison.


Among the interviewed women 14.6% have lived in a shelter or NGO before the prison and 39.5% have lived in the street. The third part (30.5%) ran away from home at least once while being children and 21.6% live with persons different from their parents. On the day they committed the offence 41.8% were under the effects of drugs and 18.8% on alcohol. Among the drugs they used while or before committing the crime, 26.85 % had used cocaine. The most commonly reported crime among the interviewees was theft (51.6%) in different forms (non-specific/simple, qualified, aggravated, non-specified, burglary) followed by drug related offences (possession, traffic) 23.5 % and the third crime was homicide (8.5%). According to their response 43.7% reported having been in a correctional facility before.

Lessons learned:

Prison is an environment with special difficulty in the promotion of health. At the individual level, prison takes away autonomy and may inhibit or damage self-esteem. Common problems include bullying, mobbing and boredom, and social exclusion on discharge may be worsened as family ties are stressed by separation. However, imprisonment is also a unique opportunity for all aspects of health promotion, health education and disease prevention. Vulnerable groups as the women in prison and minor offenders are disadvantaged groups who would normally be hard to reach. It is the prison, therefore a prime opportunity to address inequality in health by means of specific health interventions as well as measures that influence the wider determinants of health (Haton P., 2007).

Child Sufferings and Health Inequalities: An Outcome of Poverty and Financial Constraints in the Rural-Urban Perspective

Author(s): F. Naseem*1, I. Z. Qureshi2, M. N. Adnan3, A. Rashid4
Affiliation(s): 1Science and Mathematics, Govt. Degree College for Women, B-Block, Satellite Town, Rawalpindi, Rawalpindi, 2Biological Sciences, Quaid-i-Azam University, Islamabad, 3Geography Department, F.G. Postgraduate College (Men), H-8, Islamabad, 4Department of Environmental Sciences, PMAS Arid Agriculture, University, Rawalpindi, Pakistan
Keywords: Health equity, child mortality, infection control, paediatric medicine

Wide spread disparities between rural and urban areas regarding access to health facilities are common in developing countries. Expending financial resources with less focus on rural areas has caused several complications among infants and overall children health. A continuous monitoring is required to assess the arising illness problems which are not comprehended by even parents of these children. This has become particularly important in the context of poverty, literacy and health-care quality gap that exist between rural and urban population.


For this work we selected an urban centre near Mansehra District (located in Tehsil Balakot) and its adjacent rural part. Survey of clinics and paediatric units at local hospitals was conducted and 69 families were interviewed. Our focus was to compare the health services infrastructure and quality of medical care that children of rural and urban areas are getting. In particular we aimed to investigate infection control policies practised by the child healthcare units. Effort was also made to highlight child health disparities in the study area on the basis of data collected regarding commons illness among children, their diet related anomalies and infant mortality rate.


Compare to urban child environment, a high degree of pathogens and most common health-care-associated infection sites were observed rural areas. The former area revealed lower percentage of child illnesses for all indicators except dental problems (Figure). We observed a wide gap for nutrition related anomalies and access to antibiotics mainly because of poverty in rural population. Few health outlets with inadequate number of child specialists in the study area of rural part have aggravated child mortality and infection control problems which was not fully considered in paediatric medicine. In addition, rural population complained for treatment without taken into account the specificity of the needs and environment of the paediatric patient.

Lessons learned:

Comparison of rural and urban health facilities revealed widespread disparity that has strong influence on child health. Due to less purchasing power in rural population, antibiotics were not available in medical stores and neither were offered free of cost at local hospitals. Consequently in future it seems that immunological naivety of young children, especially neonates will translates into an enhanced susceptibility to many infections. In particular, respiratory illnesses and under nutrition would a challenge for rural local health authorities. We suggest urgent interventions on infection control practices in resource-limited settings and emphasize on inclusion of microbiologist in the infection control team and antibiotic policies.