Global Health Conversations

*****If you or a friend or loved one has been affected by the issues raised in this episode, I strongly encourage you to 1. Click here to find a domestic violence hotline or helpline near you in your country please speak to someone who will understand your situation and help. 2. Delete your search history and stay safe. *****

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These are the ways in which women disproportionately die prematurely because of being women. Throughout this episode, you will hear me use this phrase as I walk through the ways that gender based violence impacts the right to long and healthy life; as well as the real life stories of survivors. Fortunate to have lived but with life long scars - physical and emotional - to carry.
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- Listen to Episode 10: The Role of Storytelling in Women's Health (ft. Loredana Marta)
- Ross Kemp Human trafficker interview (TW)

Sources of clips used:
- https://www.youtube.com/watch?v=-hI9p_PhbKQ
- https://www.youtube.com/watch?v=2Num0P3H7lU&t=415s
- https://www.youtube.com/shorts/QG4iyS0MYUw
- https://www.youtube.com/watch?v=4I_o0l5jdOg
- https://www.youtube.com/watch?v=U1XvFSoUhWI&t=191s
- https://www.youtube.com/watch?v=77vz3r7OmZA
- https://www.youtube.com/watch?v=IU1i2IlkLbU

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(Note: I was unfortunately unable to add the supplementary slides to the show notes. However, the image described in question 8 is in this week's Newsletter. Thanks for understanding and I hope you enjoyed the episode! If so, it really helps me if you leave me a kind, cheeky little five star rating ;) Thank you, Friend, for being part of the Conversation.)

This week's episode delves into the fundamentals of global health. A beginners guide to the most basic concepts.

The first part focussed on this overview: 04:00

The second part is a fun Global Health Quiz: 18:35

Each of the 8 questions is designed to illustrate an important concept in global health. The questions are below. And so are the answers.

Global Health General Knowledge Quiz Questions

 1.  What percentage of the world lives in extreme poverty today? 
2. Average Life Expectancy at birth globally is 73 (2020). Which country has a lower life expectancy than the global average?
3. How many babies are born per woman in Sri Lanka (fertility rate)? 
4. What is the global average adult literacy rate (female)? 
5. What is the immunisation coverage for measles and DPT in Zimbabwe? 
6. Maternal mortality (per 100 000 live births) ranges from 2 – 1150 globally. What is the global average?   
7. What percentage of the world’s population live in cities? 
8.The world average for out-of-pocket expenditure is 18% of total health expenditure. Which country has the highest OOP %? 

_______

 Mentioned in the episode:

1. The End of An Era: 2015 Millennium Development goals round-up (2016)

2. The Lancet Global Health (2023): A call to action: the global failure to effectively tackle maternal mortality rates

_______
 
Quiz Answers: 

1. D 
2. C  
3. A 
4. B 
5. D 
6.  B
7. D 
8. A 

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Timestamps:
Intro & Update: 01:36
Health Systems strengthening: 5:07
Local manufacturing: 19:19

Read the Newsletter here

Summary:
This week’s episode provides a high level summary of important pillars in health systems strengthening and provides background on the move to manufacture vaccines and biologics regionally in Africa and beyond.

Listen to Part 1 here:  Universal Health Coverage: No-one Left Behind & Financial Protection (Part 1)

Resources: 

• Tracking universal health coverage: 2023 global monitoring report
• Brookings Op-ed: Africa must produce its own vaccines
• The Guardian: South Africa launches ‘unprecedented’ investigation of Johnson & Johnson over TB drug prices 
• Health Systems Strengthening points: 

1. Health Service Delivery

2. Health Workforce Development - health workforce has been a cornerstone of discussions 

3. Health Infrastructure and Equipment:

4. Health Information Systems:

5. Health Financing:

• Develop sustainable and equitable financing mechanisms, such as taxation, health insurance, and social health protection schemes, to ensure that healthcare services are affordable and accessible to all, regardless of income.
•  Reduce out-of-pocket expenses for healthcare, which can lead to financial hardship.

6. Governance and Leadership:

• Strengthen the governance and leadership of health systems by improving policies, regulations, and management structures.
•  Enhance transparency and accountability to prevent corruption and mismanagement.

7. Community Engagement and Empowerment:

• Involve communities in decision-making processes and encourage them to actively participate in their own health care.
•  Promote health education and awareness to empower individuals to make informed health choices.

8. Collaboration across sectors:

• Recognize that health outcomes are influenced by factors beyond the healthcare sector, such as education, sanitation, nutrition, and economic conditions.
•  Foster collaboration with other sectors to address these social determinants of health.

9. Research and Innovation:

• Encourage research and innovation to continuously improve the effectiveness and efficiency of healthcare services.
•  Promote the adoption of evidence-based practices and technologies.

10. Emergency Preparedness and Response:

• Strengthen the health system's ability to respond to public health emergencies and disasters, ensuring that it can provide essential services even during crises.

11. Equity and Inclusivity:

• Ensure that vulnerable and marginalized populations, including those in remote or conflict-affected areas, have equitable access to healthcare services.

12. Monitoring and Evaluation:

• Establish mechanisms to regularly monitor and evaluate the performance of the health system in achieving UHC goals and make necessary adjustments.

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We discussed the role and impact of storytelling on women’s health and explored inequities that exist in this area. We also discussed health tech and the many persisting shortcomings that impact women’s health, treatment and lives. 

Loredana Marta pens a newsletter under the name Vulvarina about how sexism interferes with our lives in unseen ways, in areas ranging from medical care, to industrial design and social dynamics. Her storytelling is stats- and fact-based, letting her legal background shine through, jazzed up with approachable anecdotes of mundane London life. She spent the last two years in the startup scene, where along with her two cofounders, she built OPEN social, bringing genuine conversations back to social media by matching people based on their moods. Writer and tech gal/lady (?) is currently exploring female health and digitalisation, as well as a gender and ethnicity personalised approach to medical research and care.
Click here to read and subscribe to Vulvarina. Loredana's hard hitting newsletter.

Resources from this week's episode:
1. The leadership gap in healthcare: https://www.oliverwyman.com/our-expertise/perspectives/health/2019/jan/women-in-healthcare-make-80--of-purchasing-decisions--yet-13--of.html
2. Female founders in the US Venture Capital ecosystem: https://pitchbook.com/news/reports/2022-all-in-female-founders-in-the-us-vc-ecosystem
3. Health system tracker - health expenditures: https://www.healthsystemtracker.org/chart-collection/health-expenditures-vary-across-population/#Average%20individual%20health%20spending,%202019%C2%A0
4. Discussion of the research and funding gap in women's health:
https://medcitynews.com/2022/12/womens-health-is-suffering-due-to-lack-of-research-and-funding-experts-say/
5. Commentary piece on the profitability of women's health - Why we're betting big on women's health
6. Research Funding for Women's Health: A Modeling Study of Societal Impact: Findings for Alzheimer's Disease and Alzheimer's Disease Related Dementia Model (Free to access)
7. Medical textbooks: https://www.sciencedaily.com/releases/2008/10/081015132108.htm
8. Time: 'Women Die From Heart Attacks More Often Than Men': https://time.com/5499872/women-heart-disease/
9. Principles of Sex-based Differences in Physiology: https://www.sciencedirect.com/bookseries/advances-in-molecular-and-cell-biology/vol/34/suppl/C
10. Guardian commentary on study: 'Women 32% more likely to die after operation by male surgeon' 

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• The Basics: The Paradox of the Dual Burden – NCDs and CDs (2016)
•  Seven lessons I learned from Professor Hans Rosling: A Tribute (2017)
• Challenges Facing the South African Pharmaceutical Industry (2017)

• World Cancer Research Fund. (2020). Cancer statistics for Africa.
• International Agency for Research on Cancer (IARC). (2018). Cancer in Africa: Epidemiology and Prevention.

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Dr. Asika Miriam is the Hospital Manager at Zenith Medical and Kidney Center.  Miriam is a medical doctor and a healthcare management consultant with 7+ years of experience in clinical service delivery, healthcare operations management, health policy, planning & financing, strategic planning, and performance improvement gleaned from career endeavors in  Eastern Europe, England, and Africa. Miriam is an alumnus of the Ivano-Frankivsk National Medical University, where she earned her MD (General medicine) degree. She also holds a postgraduate degree in International Health Management from Imperial College Business School. Miriam is passionate about African development and wants to improve healthcare delivery and strengthen the region's healthcare system.

This was a great conversation with a truly insightful healthcare professional.

Miriam loves to inspire others and often works with earlier career professionals to help them figure out their path. Especially fellow clinicians going into management. Reach out to Miriam here: https://www.linkedin.com/in/miriambeth-asika-173893a8/

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This episode is a little different. Today's episode is a story looking at the case of the TGN1412 CIinical Trial. A trial that went terribly wrong. 

I thoroughly enjoyed making this episode and have a number of ideas for similar ones. If you liked this bonus episode, please leave a 5 star rating so that I know you're interested to hear more in future.

In March of 2006, a clinical trial for the drug TGN1412 gathered eight young and healthy men as volunteers. Within a mere 16 hours, all six were urgently transferred to Northwick Park Hospital's intensive care unit due to severe and life-threatening reactions.

This catastrophic event, now infamously known as the 'Elephant Man Drug Trial,' sent shockwaves rippling through the medical and pharmaceutical communities. TGN1412, a groundbreaking monoclonal antibody drug developed by TeGenero, a German biotech company, had held the promise of treating autoimmune diseases and leukemia. Paraxel, a prominent contract research organization, was responsible for conducting the Phase I trial, the critical first-in-human testing, within an independent clinical trials unit at Northwick Park.

Prior to the trial, comprehensive clinical and animal testing, including studies involving non-human primates, had been diligently carried out. These preliminary tests had seemingly indicated no signs of safety issues.

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Contact me: [email protected]

Expert group on Clinical Trials report: Duff GW, et al. (Expert Group on Phase One Clinical Trials) (7 December 2006). Expert Group on Phase One Clinical Trials: Final report (Report).

Excellent, open-access paper looking at the biochemical phenomenon behind this case. Revisiting CD28 Superagonist TGN1412 as Potential Therapeutic for Pediatric B Cell Leukemia: A Review

*Correction: The compensation that the 6 affected participants received was £2mil to be split between the 6 participants. 

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This episode is a must listen.

In this episode of Global Health Conversations, I spoke to Maria Myrto Kasimati, MHCM, a scientific expert specialized in immunology and public health currently working for Havas Just:: as a Medical Writer.

We talked about nudges, financial incentives, financial discincentives and using these health economics and policy approaches in addressing the causes affecting reduced life expectancy. It was an interesting talk - an unofficial Part 2 to Episode 3 structured as a discussion.

Connect with Mary here: https://www.linkedin.com/in/maria-myrto-kasimati-mhcm-92139314b/

Resources: 

1.     Nudges Versus Financial Incentives (abstract) (2023) 
2.      Changes in life expectancy and house prices in London from 2002 to 2019: hyper-resolution spatiotemporal analysis of death registration and real estate data (Full paper)
3.     World Bank - Life Expectancy at Birth (years) (up to 2021)
4.     Key Data on Health and Health Care by Race and Ethnicity (2023)
5.     CDC Vital Statistics Surveillance Report (2021)

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I would love your feedback. Feel free to e-mail me here: [email protected]

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Margareta Rybarikova is a current PhD candidate with a keen interest in the development of novel therapies for genetic disorders. She received her Bachelor's degree in Biomedical Sciences from Brunel University London, where she focused on gene therapy, genomic medicine, molecular pharmacology, and cellular pathologies. 

Margareta went on to complete a Master's degree in Genes, Drugs, and Stem Cells - Novel Therapies at Imperial College London, where she was elected as the Course Representative. For her MSc project, she explored AAV-mediated gene editing with small Cas9 nucleases for Huntington's disease. Her passion for genetic therapy led her to pursue a PhD at the CHUV, as part of the Lemanic Neuroscience Doctoral School in Lausanne. In her doctoral research, she is developing a CRISPR-Cas9 system for ATXN3 gene editing in Spinocerebellar ataxia type 3 (SCA3).

A friend of the podcast, Margareta discusses her research, gene therapies as a frontier in tackling rare diseases, access to biotherapeutics and balancing life and science and scientific career paths.

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