Environmental Health in China from a Tradtional Perspective

The history of China is wrought with wars, droughts, famines, and rising and fallings' of empires, all of which took a toll on China's environment. Behind China's environmental history lie China's main schools of thought; Confucianism, Taoism, and Legalism. Confucianism is highly structured and stresses the value of morality, propriety, and social harmony1.

Early Confucianism regarded nature as an uncontrollable force to be conquered. For instance, it supported the idea that, “Man could not stop the coming of winter.” However later Confucian followers, as early as 400 B.C., evolved to believe that by appreciating nature’s laws, man could overcome nature’s superiority and use it for his benefit , If you were to, “Plant your crops according to the changes of season, you [would] have more food than you want[ed].”

Taoists held a more free-spirited train of thought. The Taoist credo was “Let nature take its course! Be yourself! Relax and enjoy life!” Taoism’s lack of structure therefore supported simple living and protected the environment. Unfortunately, it was Taoists’ beliefs that stunted economic development and social progress.

The Legalism school of thought perceived the need for stringent controls and rules to support the growth of China’s population and to address the growing scarcity of food and resources. Legalism was incorporated under the Qin dynasty and established a system of rewards and punishments to encourage appropriate behavior1.

All in all, Confucianism, Taoism, and Legalism collectively appreciated and respected nature. However, the dominating school of thought throughout the majority of China’s history has been the Confucian belief in man’s capability to use nature to carry out his needs that has led to the environmental issues china now faces.

Ethics in Global Health

From abortion rights to environmental protection, ethical issues regarding global health are becoming increasingly more complex. A problem in ethical consideration is that it is highly subjective, there is no right or wrong answer in most cases. Please perform this exercise by answering the two questions to have a better understanding of what I mean.

Is it okay to steal?
-You probably answered "no", the issue seems essentially black and white.

However, if I rephrase the question.

Is it okay to steal food if you're family's life depends on it?
-All of a sudden an easily answerable question becomes seemingly unanswerable.

One person's response to the second question may be highly variable from another person. Some factors that influence our responses include; ethnicity,culture, religious background, upbringing, education, personality, exposure, wants and needs. Other factors may include genetics and other environmental influence.

Good ethical decisions, as described by Gurinder Shahi, are based on reason, take into account established ethical principles, based on consensus, take into account those without voice (minority, environment, unborn fetus), and are open to change in the face of new understanding and experience.

In the face of global economic development and scientific advancement the next few decades promise to hold interesting and highly controversial issues. From stem-cell research to weapon development, these issues will affect people throughout the world. For this reason more countries and international organizations should be concerned with developing a global ethics organization. A specific mechanism for weighing out ethical issues, creating global legislation, and most importantly a method to enforce ethics adherence is necessary to ensure the avoidance of moral chaos.

Global Health and Corporate Involvement

The advent of the internet along with growth in international trade has made our world increasingly dependent on "inter-economies." Inter-economies are product enterprises between any number of countries that require a specific resource or service from each. For example, a company that produces syringes in the United States may be reliant on another company who mines metal in South America. This type of inter-economy reliance illustrates the need and importance of corporate support for global health. Following the example above, if the company that mines metal for the syringe company in U.S. is devastated by a multi-drug resistant strain of tuberculosis, the U.S. company's productivity may slow or even stop until a new source for the metals could be found. For this reason corporations should more involved in global health. By helping to establish health care and/or organizations that address health issues in other countries corporations are essentially investing in their own economic security. Besides this business incentive for corporations, they may also boast their efforts to improve global health to improve their corporate image. Therefore, not only will investment in global health ensure economic security and a positive social image for the corporation but it will improve health throughout the world and promote global economic development.

Global Health Monitoring: Grassroots or International

One challenging obstacle in global health progress is that it needs more accurate monitoring and recording methods for collecting health data. International standards often don't accurately measure health statistics in different regions. Another issue to global monitoring is, some regions don't recognize certain diseases like the psychological diseases,(i.e. ADHD and chronic fatigue syndrome). Cultural and societal norms make developing global monitoring standards extremely difficult.
In 2002 an interesting approach to monitoring and assessing population health was developed in China. The goal of the study was to develop an indicator list to effectively and efficiently monitor and assess reproductive health through urban and rural China. An issue health officials had been facing was that the international standard indicator list, created by the WHO, wasn't effectively working. The study approach to make a more effective monitoring method involved two groups, nominal and delphi. The nominal group was made up of expert grassroots reproductive health officials and providers from the local and provincial. The delphi group was made up of national and international experts on reproductive health. In the first step of development the nominal groups met and created a list of what indicators were most important to their region. The first step led to a list of more than a hundred indicators to help monitor reproductive help. In the next step the delphi group was given the nominal group's long list and they were asked to rank their perceived importance of each indicator. An abridged list was created and then redistributed back to the delphi group to make an even more concise list. In the end the list came to include 21 indicators specifically relevant to assessing China's reproductive health. Field tests proved that by combining grassroots and international expertise they were able to make a more effective and efficient health monitoring method. This approach may be a guide for other developing countries so that they may make monitoring systems that are tailored toward their populations which are more effective and efficient than standards developed by international health organizations.

Emergence of and Innovations in Disease Management

The following two clips are from a compilation my colleague Lawrence Ham and I put together. Please check them out and feel free to comment. I'll give more on my personal opinions in disease management in the near future.
Part 1

Part 2

The Bigger Challenge

A large portion of global health's scope, and what I will focus on in this entry, pertains to the elimination of infectious diseases through effective vaccination of vulnerable, and in some cases, entire populations. Obviously, a large obstacle to vaccinating people is first, developing a vaccine, but it has recently come to global health and biomedical engineer officials' attention that there may be a bigger challenges.

The bigger challenge may be covert, only showing its face after the development of a vaccine, whereas another challenge may be more overt and be easily identified. An example of an easily identifiable overt challenge faces the development of an HIV vaccination for Africans in the Sub-Saharan. The challenge to biomedical engineers and scientists would be to develop a vaccine in which the immunogens won't denature in warm weather or to develop a protective method for transporting the vaccine during a hot day. This is only one example ,however, there may be numerous other challenges regarding vaccination methods when applied in massive populations. For these reasons it is becoming increasingly more apparent that scientists developing not only vaccines, but also drugs and therapies, while working in concert with biomedical engineers and global health officials so that they may coordinate effective health technologies and strategies for addressing global health issues.

The Truth

I find it disturbing that as United States citizens we can't rely on popular press for our news. As my colleague Farah Karahpeni comments in her post Public Health in Palestine (http://farahonhealth.blogspot.com/), we are typically only given one side of the story and it's usually the side most convenient for our government. The war in the middle east between the Israelis and the Palestinians is the best example of how by the time we get our news from the popular press it has been so filtered and polluted with bias that it can't be trusted. The Israeli government continues to oppress the Palestinians so much that regular people are being driven to fanaticism, the same fanaticism our news uses to associate negative thoughts with Muslims.

The middle east is just a small example in the midst of a sea of issues we are typically misinformed about. Just recently I watched the documentary, "An Inconvenient Truth," presented by Al Gore. The documentary opened my eyes to how much the government and industry skew what we're told through popular press so that we fall into a state of doubt and skepticism which leads to inaction. "An Inconvenient Truth" describes the past, present, and future of global warming. If Al Gore's information is true our country and world has a huge problem on its hands. With the polar ice caps melting and oceans warming mankind may have to face a whole new set of environmental problems. If you haven't seen, "An Inconvenient Truth," I would highly recommend it. It will open your eyes to the issue of global warming and hopefully make you a little less vulnerable to biased popular press and news media.
(For a little fun, check out my friends "Go Green" video).

Suicide, you'd be a lot cooler if you did

Suicide and depression, they seem to go hand in hand, that is, at least in our culture. However, a case study in Micronesia will give you a new perspective on why some global populations may get hit harder than others with waves of suicides. Before the 1960's suicide in Micronesia was virtually unheard of. Unfortunately, as described by Malcolm Gladwell in his book The Tipping Point, it became the cool thing to do and turned into a storm of suicides in the young male population. Was it from depression or delirium? The answer...neither. It all started with a boy named Sima who committed suicide just after getting yelled at by his father. From that point there have been hundreds of young male suicides over things so trivial as "a brother being obnoxiously loud." Much of this influx has to do with cultural norms. Some say that this trend in Micronesia follows patterns of imitation as a result of the theory of the tipping point, yet others believe it is a cultural form of rebelion and self expression (comparable to United States teens smoking underage). Gladwell states the practice of suicide in Micronesia has turned into a form of youthful experimentation, woops.

More to Malnutrition than what meets the eye

Life isn't fair, but in some underdeveloped countries you'd be surprised at how happy the people are with next to nothing. On my medical mission trip to Costa Rica and Nicaragua I witnessed first hand how malnutrition can have a drastic effect on seemingly a quarter out of all the children despite access to food. It wasn't obvious but it became apparent that many of the children in the tropics have sufficient foods but they are mentally underdeveloped, ill-looking, and constantly fatigued. As we examined more and more children we found that many of them had distended stomachs and had worms in their fecal matter. It came to be that many of these children had lived their entire lives with gastrointestinal parasites and never sought out medical attention. I then realized that malnutrition extends further than just establishing global food security. As a result of living with GI parasites during their first years of life children are unknowingly robbed of essential nutrients for proper mental and physical development. Many of these children were permanently mentally disabled. I believe that tackling the bigger problem, establishing food security, is first and formost but in tropical regions where food may be readily accesible there must be efforts to cure the population of GI parasites that will, if not resolved, continue to paralyze children over the generations from malnutrition.

The Rich get... fatter?

We've all heard the saying that "The rich get richer and the poor get poorer," and we once believed that only rich countries need worry about the troubles of chronic disease. Unfortunately, the troubles of chronic disease have spread across the board from the rich and the poor living in developed countries all the way to those living in developing countries. In my opinion this shift toward chronic disease in developing and poor countries may be just what the doctor didn't order. The rise in chronic disease, in most situations, is a result of the increasing ease of relying on unhealthy foods that are high in fat and sugar and also lack essential nutrients to maintaining a healthy lifestyle. In regards to countries like the United States we are fortunate to have the medical care and health preventive programs in place that we do. By having these resources chronic disease can be treated and even cured so that we may live alongside chronic disease without sacrificing quality of life. On the other hand, poor and developing countries haven't been so fortunate. Without the medical care and preventive programs in place that we have they live in a world sticken with chronic disease. This lack of resources leads to millions of deaths worldwide each year, without mention to the millions left mentally and physically disabled by their chronic disease for the remainder of their life. So now the question isn't "Why do only the rich suffer from chronic diseases" but rather "Why do the poor and developing country peoples suffer so much more from chronic disease and how can we stop chronic disease rates from increasing worldwide?"

Avian Flu- Round Four of the Industrial Era

Yes, that's right avian flu is back again and it's time you and I start worrying about it. In the article "Avian Flu: Preparing for a Pandemic," Tom Walsh goes on to descibe the social and economic impacts that an outbreak would have in our modern world and steps that should be taken in order to prevent lasting global demise. I myself was a skeptic on the avian flu outbreak until exposed to recent literature on the subject. South asian and other developing countries are becoming increasingly prone to producing a human-to-human strain that could essentially kills tens of millions of people. To explain the vulnerability of developing countries to harboring avian flu is quite simple. Avian flu as you probably guessed is primarily found in wild birds or poulty, however, like many of the zoonotic viruses it may transfer and mutate in vivo into a more transmissable disease. The Chinese wet-markets, which have been part of the Chinese culture for hundreds of years, are farmer's markets where people can buy live animals for cooking purposes. Unfortunately, putting humans and animals in this high contact environment increases the chances of influenza mutating into a human-to-human form. Walsh goes on to explain that in the event a highly transmissable strain surfaces a widespread pandemic would come quickly, mostly in part to effecient global travel and product exporting. As a result all countries would be effected and economies would suffer greatly. To start off it is expected that if a flu pandemic were to occur more than 100 million people may die worldwide (200,000 estimated to die in the United States). However it wouldn't end there, Walsh cites research that indicates the world would suffer almost 1 trillion dollars in economic damage. All in all, corporate businesses and more importantly governments should focus efforts on early detection and early response, (as stated in Larry Brilliant's TEDtalk), as well as preparedness for business continuity and post-pandemic repair.

Globalization vs. Capitalization?

In the documentary, "Globalization is Good," Johan Norberg gives insight into how globalization has reduced global poverty and opened new horizons to developing countries. Norberg best proves his point by visiting, describing, and comparing the economic success of Taiwain (after globalization) and Vietnam (currently accepting gloablization) to that of Kenya, a country that has refused globalization and found itself deep in poverty and economic distress. Stay tuned for a more in depth blog that will include my personal opinions on Norberg's documentary as well as other globalization concerns.