Health Inequalities in the Americas

In the past decade, most economies in Latin America and the Caribbean have undergone rapid growth, allowing approximately 70 million people to rise out of poverty. Sadly, this growth has not benefited everyone equally. In turn, it has resulted in major variations in health indicator data, both between and within countries in the Americas region.

About inequality:
The Gini coefficient is a measure of the inequality of a distribution, a Gini coefficient of 0 represents exact equality—that is, every person in the society has the same amount of income and a Gini coefficient of 1 represents total inequality—that is, one person has all the income and the rest of the society has none. The average Gini coefficient of Latin America is 0.52 although this average hides a deep variation between countries, for example Bolivia, Haiti and Jamaica have Gini coefficients around 0.60 and Uruguay close to 0.45; but taking a look in the Americas’ region the gap becomes bigger and bigger with two developed countries like US and Canada, that have Gini coefficients of 0.45 and 0.32 respectively.

On the 22nd of June, 2015, the World Health Organization (WHO) State of Inequality Report was presented to the Americas’ Region at the Pan American Health Organization (PAHO) Headquarters in Washington, DC, USA.

With the knowledge that the Latin American region faces the greatest socioeconomic and health inequalities in the world, national Health Ministers, department heads of the PAHO, non-governmental organizations (among these, the International Federation of Medical Students Associations’) and many others, were anxiously awaiting the release of this report.

The objective of this report was to showcase best practices in inequality reporting in low- and middle-income countries (LMICs) using high-quality data, robust analysis methods, and user-friendly reporting methodologies.

The publication focuses on inequalities pertaining to reproductive, maternal, newborn, and child health (RMNCH), and has been compiled using public data from 86 LMICs. Using 23 RMNCH indicators, inequality status and its evolution over the last few decades has been assessed.  All data has been disaggregated according to four dimensions of inequality: education, economic status, education, sex, and place of residence.

A simultaneously promising and disappointing message permeated the report. Within-country inequalities have narrowed, with improvements in the poor subgroups driving the national decreases in disparities. However, significant inequalities in the RMNCH indicators continue to be present worldwide. Women, infants, and children who are the most socioeconomically disadvantaged, least educated and living in rural regions are the most vulnerable to health inequalities.

Maternal health intervention indicators were found to be the most disparate across inequality dimensions. The percentage of births attended by skilled birth health personnel, for instance, was 80 percentage points higher in the richer subgroups compared to the poor subgroups. A similar trend was discerned in antenatal care coverage (at least 4 visits), wherein the poor and less educated experienced at least a 25 percentage point difference in coverage.

On a positive note, coverage gaps in immunization (specifically BCG, measles, polio, and DTP3) were noted to be very minimal to virtually non-existent across inequality dimensions. Additionally, the under-five mortality rate has significantly decreased in poorer subgroups within the last decade, indicative of narrowing inequalities in child mortality.

On the whole, in many nations reported improvements in health coverage have been driven by select subgroups, failing to capture the true status of all citizens. Health inequality monitoring is thereby integral to the promotion and attainment of health equity, and without a designated regard for and analysis of disadvantaged subgroups, nations risk blinding themselves to the true state of health coverage in the face of improving national averages.  As Dr. Carissa Etienne, Director of the Pan American Health Organization remarked on June 22nd, “We need to go beyond the averages. Because beyond the averages is human suffering of immense proportions.”

As we enter the post-2015 era, we must continue to strive for access to essential health interventions for all who need them, without financial hardship. And in the words of Dr. Etienne, it must be ensured that “we leave no one behind.”

The full report can be accessed at: http://apps.who.int/iris/bitstream/10665/164590/1/9789241564908_eng.pdf?ua=1&ua=1

Entry written by Claudia Frankfurter (IFMSA-CFMS) and Maria Jose Cisneros Caceres (IFMSA Regional Coordinator for the Americas)

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Research Integrity Day

Everyone has a role and responsibility to play in promoting a healthy and positive research culture that is conducive to the training of young scientists and the realization of scientific innovations for the benefits of humankind. – National Institute of Health

The IFMSA Research Integrity Day is a chance to keep learning about Research, with a special regard on integrity.

What is Research Integrity?

Why is it so important to have research skills and to have research methodologies integrated in the undergraduate education?The scientific research enterprise is built on a deep foundation of trust: “this trust will endure only if the scientific community devotes itself to exemplifying and transmitting the values associated with ethical scientific conduct”. The concept of Research integrity includes: the use of honest and verifiable methods in proposing, performing, and evaluating research; reporting research results with particular attention to adherence to rules, regulations, guidelines and following commonly accepted professional codes or norms.

In 1974 Dr. William Summerlin at the New York City’s Sloan-Kettering Institute for Cancer Research startled the scientific world by reporting that he had discovered a way to avoid the reaction that has resulted in the failure of so many transplant operations: the tendency of the body’s immune system to destroy foreign tissue. But other scientists were unable to repeat Summerlin’s experiments, and skepticism about his results grew steadily. Since when Summerlin was accused by colleagues of painting the skin of some laboratory mice. “Painting the mice” has become a synonym for research fraud, after his deceptive behavior that might have been due to a combination of mental and physical exhaustion, a heavy clinical and experimental workload, and pressure to publicize positive results. This is just a old story but there are many similar ones till nowadays.

In many scientific fields, results are often difficult to reproduce accurately, being obscured by noise, artifacts, and other extraneous data. That means that even if a scientist does falsify data, they can expect to get away with it – or at least claim innocence if their results conflict with others in the same field. There are no “scientific police” who are trained to fight scientific crimes; all investigations are made by experts in science but amateurs in dealing with criminals. It is relatively easy to cheat although difficult to know exactly how many scientists fabricate data.

Ghostwriting is another example of cheating, the phenomenon where someone other than the named author(s) makes a major contribution. This is somethign to hide the drug companies. It incorporates plagiarism and has an additional element of financial fraud.

Career pressure: watch out! Science is still a very strongly career-driven discipline. Scientists depend on a good reputation to receive ongoing support and funding, and a good reputation relies largely on the publication of high-profile scientific papers. Hence, there is a strong imperative to “publish or perish”. Clearly, this may motivate desperate (or fame-hungry) scientists to fabricate results.

Would you like to know more? And share your experiences? Join us! You can find here our Research Integrity Package to participate to the online campaign: http://tinyurl.com/ifmsaresearchintegrityday

You will also find details about what you could do at national level and give your contribution by filling the survey about your personal experience. The IFMSA Working Group on Research Integrity is currently conducting a survey to study the status of medical education worldwide, with a focus on the implementation of research related programmes. It would be great if you could involve as many Universities as you can in your countries, to spread the Research values at local level and to inspire the students to organize initiatives.

Join us also on our Facebook event and please use our official hashtags #IFMSAResearchIntegrity and #ifmsaRI2015 to promote your initiatives on social media!

Entry written by Ivana Di Salvo, IFMSA Liaison Officer for Research and Medical Association (lorma@ifmsa.org)

Professionalisation of Medical Humanitarian Actors

The humanitarian landscape is changing. The number of actors is increasing along with the willingness to assist and help the ones in need. But do we have the capacity to really help in an efficient way? Are the medical guidelines, the kind of diseases our patients have the same in disaster settings as in the hospital back home?

Today emergency medicine is a specialised medical degree and the world is starting to recognise  the need for special training for humanitarian medical professionals.

The IFMSA have, during the year 2014 – 2015, hosted a series of extracurricular trainings on Disaster Medicine & Emergency Risk Management for our members. Computer-based simulations of medical humanitarian response have been facilitated by CRIMEDIM, a research and training institute in Italy delivering the European Master for Disaster Medicine. Discussions on medical ethical dilemmas have been facilitated by IFMSA members with support from the International Committee of Red Cross and Crescent (ICRC).

European Master for Disaster Medicine

IFMSA is taking part and contributing to the professionalisation of medical humanitarian actors. During May this year we were invited to the European Master in Disaster Medicine to share best practice of engaging students in Disaster Risk Management. The participating doctors from around the world were fascinated and inspired by our actions, they wanted to help us grow and they wanted to mentor our members in disaster medicine.

Photo: Picture taken in the European Master in Disaster Medicine Full-Scale Simulation, hosted by CRIMEDIM together with Italian Army.

During my two days in the European Master in Disaster Medicine, I also attended the Real Size Disaster simulations. The Italian Army had set up a field hospital. A plane crash in a low-resource setting was simulated and medical students from the IFMSA NMO SISM-Italy were playing the role of casualties. The students of the European Master were the response personnel. Witnessing this was an experience beyond my expectations. It was not just not a confirmation of the importance of preparing medical personnel before working in the humanitarian field, but also a source of inspiration and insight in how the medical humanitarian response is coordinated in reality.

Photo: The 1st International Summer Course for Trainers in Disaster Medicine. Apply before July 10th to be able to take in this unique experience.

Training for Medical Students – 1st International Training of Disaster Medicine Trainers

Do you also want to experience this? Do you as an IFMSA member want to enhance your knowledge and skills of Disaster Medicine and Disaster Risk Management? There is currently a call for participants to attend an International Residential Course for the Training of Disaster Medicine Trainers. For more information about this IFMSA Activity, read this brochure. Remember to apply before the 10th of July by filling out this form. selected participants will be informed by the mid of July.

Entry written by IFMSA Liaison Officer for Human Rights, Moa M Herrgård
With support from Training for Disaster Medicine Trainers team;  Patrick Achkar from IFMSA-Québec, Monika Bednarek from IFMSA Poland, Giancarlo Bruno from SISM-Italy, Eleonora Leopardi from SISM-Italy, IFMSA Project Support Director Ljiljana Lukic