Global Health

In this paper, we revisit the revolutionary principles-equity, social justice, and health for all; community participation; health promotion; appropriate use of resources; and intersectoral action-raised by the 1978 Alma-Ata Declaration, a historic event for health and primary health care. Old health challenges remain and new priorities have emerged (eg, HIV/AIDS, chronic diseases, and mental health), ensuring that the tenets of Alma-Ata remain relevant. We examine 30 years of changes in global policy to identify the lessons learned that are of relevance today, particularly for accelerated scale-up of primary health-care services necessary to achieve the Millennium Development Goals, the modern iteration of the "health for all" goals. Health has moved from under-investment, to single disease focus, and now to increased funding and multiple new initiatives. For primary health care, the debate of the past two decades focused on selective (or vertical) versus comprehensive (horizontal) delivery, but is now shifting towards combining the strengths of both approaches in health systems. Debates of community versus facility-based health care are starting to shift towards building integrated health systems. Achievement of high and equitable coverage of integrated primary health-care services requires consistent political and fi nancial commitment, incremental implementation based on local epidemiology, use of data to direct priorities and assess progress, especially at district level, and eff ective linkages with communities and non-health sectors. Community participation and intersectoral engagement seem to be the weakest strands in primary health care. Burgeoning task lists for primary health-care workers require long-term human resource planning and better training and supportive supervision. Essential drugs policies have made an important contribution to primary health care, but other appropriate technology lags behind. Revitalisng Alma-Ata and learning from three decades of experience is crucial to reach the ambitious goal of health for all in all countries, both rich and poor.

Chronic obstructive pulmonary disease (COPD) is a global health problem. Being a progressive disease characterized by inflammation, it deteriorates pulmonary functioning. Research has focused on airway inflammation, oxidative stress, and remodelling of the airways. Macrophages, neutrophils and T cells are thought to be important key players. A number of new research topics received special attention in the last years. The combined use of inhaled corticosteroids and long-acting β 2 -adrenoceptor agonists produces better control of symptoms and lung function than that of the use of either compound alone. Furthermore, collagen breakdown products might be involved in the recruitment and activation of inflammatory cells by which the process of airway remodelling becomes self-sustaining. Also, TLR (Toll-like receptor)-based signalling pathways seem to be involved in the pathogenesis of COPD. These new findings may lead to new therapeutic strategies to stop the process of inflammation and self-destruction in the airways of COPD patients.

The paper addresses four key themes: the impact of the earthquake and the subsequent cholera epidemic on Haiti's health system; security community participation in health system recovery and reconstruction; coordination mechanisms that facilitated or directed the security community's involvement; and the information generating and sharing mechanisms that allowed the security community to best participate in health system strengthening . Investigations into these four themes were focussed through the use of the three narratives given in the Annexes to this paper.

It is sometimes argued that the non-therapeutic, non-consensual alteration of children’s genitals should be discussed in two separate ethical discourses: one for girls (in which such alterations should be termed ‘female genital mutilation’ or FGM), and one for boys (in which such alterations should be termed ‘male circumcision’). In this article, I call into question the moral and empirical basis for such a distinction, and argue that all children—whether female, male, or intersex—should be free from having parts of their genitals removed unless there is a pressing medical indication.

What is 10x more lethal than COVID-19? Viral covidiocy. 9 out of 10 COVID deaths were vaccinated in the K, Israel, Chile and Argentina, where case fatality rate was 1300% higher for the vaccinated than for the unvaccinated, plus a higher 40% contagion rate (5% if unvaccinated): the opposite of the narrative. The USA, also showed worse outcomes for the vaccinated than the unvaxxed. COVID waves seem to have receded due to the increase of herd immunity of the recovered, both vaccinated and unvaccinated.

In the USA and Europe, 5 million adverse reactions and 70 thousand deaths were reported linked to COVID vaccines. Informed consent forms can’t protect COVID-19 vaccine manufacturers against legal actions, even under immunity by law, not only because they are not really “vaccines” but gene hacks to produce the S1 spike protein (or parts), nor because some or all the elements are secret, un-disclosed or hidden, but especially, because the cure had been found, voiding Emergency Use Authorization (EUA): if you get COVID, especially if vaccinated, follow this successful evidence-based treatment: https://covid19criticalcare.com/covid-19-protocols/ ( translations: https://covid19criticalcare.com/covid-19-protocols/translations/ ). Yet, there are many other options in this document.

This research is not “anti-vaccine”, but pro-sane-vaccines. Unlike insane vaccines, it stands for evidence based medicine, i.e. scientifically proven safe and effective treatments. 500 scientific citations prove a systemic bias against cheap effective cures and towards unethical, ineffective and/or unsafe vaccines.

Among dozens of effective treatments here reviewed, ivermectin is the best mass cure for COVID-19 variants. It had been scientifically proven beyond any reasonable doubt by May 2020, yet, instead of informing the public about the amazing results and going back to normal, there was a global scheme to block lifesaving information and promote lock downs, masks, restrictions, experimental vaccines and passports.

1 million dollars of ivermectin would end the pandemic compared to 160 thousand million dollars PER YEAR to keep a perpetual endemic disease, with vaccines always chasing new variants in a never ending lucrative arms race. It is not a matter of unsettled science: there are more RCT studies than for any other standard-of-care treatment. An insane “war on bugs” by legal drug cartels? It was an un-treatment pandemic designed to push vaccines and expensive monoclonal antibodies as the only option.

The pandemic proved that there is neither quality control nor pharmacovigilance in any country of the world, especially the USA. In spite of more deaths linked to COVID vaccines than all deaths reported since 1990 from all vaccines, there was no real follow up of cases, no studies about subclinical side effects like myocarditis and thrombosis, no interest in public health:

Deaths after vaccination (USA, openVAERS.com)


With COVID vaccines, Governments have turned a medical act into an administrative mandate. Yet, practically no medical association protested against this violation of the right of the physician to practice medicine, i.e. a customized treatment according to the best knowledge/possibilities.

Human rights continue to be systematically violated: to life, to informed consent, to fertility, to ethical treatments (where benefits are higher than harms), to healthcare (instead of sickening-care), to treatments for vaccine injuries, to compensation for injuries and death, to privacy (passes), to freedom (to work, move, assemble, worship), etc.

This research presents strong scientific evidence for a planned global genocide:

MAY A PERSON : WITH
COVID
VACCINATION WITH
EFFECTIVE
TREATMENT
AVOID GETTING SICK FROM COVID? 🗴 No ✓ Yes
AVOID INFECTING OTHERS? 🗴 No ✓ Yes
AVOID HOSPITALIZATION? 🗴 No ✓ Yes
AVOID DYING FROM COVID? 🗴 No ✓ Yes
AVOID SIDE-EFFECTS LIKE INFERTILITY, MISCARRIAGE, DISABILITY OR DEATH? 🗴 No ✓ Yes
GET HEALTHCARE OR MANUFACTURER LIABILITY FOR INJURIES, DEATH OR NEGLIGENCE? 🗴 No ✓ Yes
HELP PROTECT OTHERS? 🗴 No ✓ Yes
HELP REDUCE THE SATURATION OF THE HEALTH SYSTEM? 🗴 No ✓ Yes
GENERATE HERD IMMUNITY? 🗴 No ✓ Yes
HELP TO END THE PANDEMIC? 🗴 No ✓ Yes
REDUCE THE GENERATION AND SPREAD OF VARIANTS? 🗴 No ✓ Yes
AVOID COOPERATION WITH VACCINES PRODUCED WITH ABORTION CELL LINES? 🗴 No ✓ Yes
GIVE INFORMED CONSENT WITH A PACKAGE INSERT LISTING ALL THE INGREDIENTS? 🗴 No ✓ Yes
AVOID UNDISCLOSED GENE-HACKING, NANO-TAMPERING AND BLUETOOTH CHIP? 🗴 No ✓ Yes

From the systematic genocide of abortion, they moved on to the 7 COVID genocides:
1. Engineering and releasing of the infertilizing, handicapping and lethal virus.
2. Maximizing spread (delaying alerts with open borders, forbidding open air activities, cloth masks, lock downs, vaccination).
3. Lethal recommendations (the above plus banning autopsies, pre-term delivery/c-sections, mother-baby separation).
4. Censoring, defunding and persecuting effective treatments.
5. Unneeded deadly treatments (ventilation, Remdesivir).
6. Infertilizing, handicapping and lethal vaccines and haccines (especially during pregnancy, breastfeeding and childhood).
7. Magnetoxic attacks: graphenation of haccines, food and beverages, EMF blasts from satellites, towers and phones, etc.

The genocidal trend didn’t change, only the target population. Same serial killers, different weapons.

Hosea 4:6 “My people are dying for lack of knowledge...”

Health has long been intertwined with the foreign policies of states. In recent years, however, global health issues have risen to the highest levels of international politics and have become accepted as legitimate issues in foreign policy. This elevated political priority is in many ways a welcome development for proponents of global health, and it has resulted in increased funding for and attention to select global health issues. However, there has been less examination of the tensions that characterize the relationship between global health and foreign policy and of the potential effects of linking global health efforts with the foreign-policy interests of states. In this paper, the authors review the relationship between global health and foreign policy by examining the roles of health across 4 major components of foreign policy: aid, trade, diplomacy, and national security. For each of these aspects of foreign policy, the authors review current and historical issues and discuss how foreign-policy interests have aided or impeded global health efforts. The increasing relevance of global health to foreign policy holds both opportunities and dangers for global efforts to improve health.

We aimed to summarize and map the existing global population-based data on active trachoma and trichiasis. Detailed distribution maps of various infectious diseases have proved a valuable tool in their control. Such maps play an important role in assessing the magnitude of the problem, defining priority areas for control, monitoring changes, and advocacy. Until now, information on trachoma prevalence at within country levels has not been systematically collated, analysed and reported. We gathered the last 18 years' worth of reported data on active trachoma in children aged less than 10 years, and the last 25 years of reported trichiasis in adults aged 15 years and over from 139 population-based surveys in 33 countries. We collated these data into one database using the "district" (second administrative level) as the standard unit of reporting. We used Geographical Information Systems as a database and cartographic tool to generate a global map of the prevalence of trac...

This editorial describes the contents of this special issue of Sexual Health devoted to anal cancer. The aim of the issue is to provide readers with information to assist them in making decisions about what to do about detecting anal cancer early in men who have sex with men with HIV. Should they be advocating screening? It discusses the epidemiology of HPV infection, anal intraepithelial neoplasia, and anal cancer in MSM, heterosexual men and women; anal cancer screening and treatment of anal cancer. And most importantly, what should be done about vaccinating boys with the HPV vaccine.

Although vaccination has almost eliminated measles in parts of the world, the disease remains a major killer in some high birth rate countries of the Sahel. On the basis of measles dynamics for industrialized countries, high birth rate regions should experience regular annual epidemics. Here, however, we show that measles epidemics in Niger are highly episodic, particularly in the capital Niamey. Models demonstrate that this variability arises from powerful seasonality in transmission-generating high amplitude epidemics-within the chaotic domain of deterministic dynamics. In practice, this leads to frequent stochastic fadeouts, interspersed with irregular, large epidemics. A metapopulation model illustrates how increased vaccine coverage, but still below the local elimination threshold, could lead to increasingly variable major outbreaks in highly seasonally forced contexts. Such erratic dynamics emphasize the importance both of control strategies that address build-up of susceptible individuals and efforts to mitigate the impact of large outbreaks when they occur.

This response document will briefly address concerns about the ethical, legal and methodological flaws with past research informing aspects of present PEPFAR program areas; concerns about adverse consequences of PEPFAR program areas; and concerns about the absence of oversight of the activities of PEPFAR funding recipients.

disease or aged ,18 yrs or other reasons. The 311 study patients were interviewed 3.7¡1.88 yrs (maximum range 1.1-6.3 yrs) after the diagnosis. In total, 190 (61%, 95% confidence interval (CI) 55-67) patients confirmed a smoking history (active or former) at the time of pulmonary embolism, of whom 94 (30%, 95% CI 25-36) patients were actively smoking. Out of these 94 patients, 32 (35%, 95% CI 25-45) had successfully quit smoking in the first year following the diagnosis. Overall, only two (0.64%, 95% CI 0.08-2.3) patients started smoking after the diagnosis of pulmonary embolism. The percentage of quitters was not associated with age in the pulmonary embolism cohort.

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at-risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother-to-child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other preventive measures. In this sense, it represents a new biotechnology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries' struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource-poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections.

BACKGROUND: Global health research is essential for development. A major issue is the inequitable distribution of research efforts and funds directed towards populations suffering the world's greatest health problems. This imbalance is fostering major attempts at redirecting research to the health problems of low and middle income countries. Following the creation of the Coalition for Global Health Research - Canada (CGHRC) in 2001, the Canadian Society for International Health (CSIH) decided to review the role of non-governmental organizations (NGOs) in global health research. This paper highlights some of the prevalent thinking and is intended to encourage new thinking on how NGOs can further this role. APPROACH: This paper was prepared by members of the Research Committee of the CSIH, with input from other members of the Society. Persons working in various international NGOs participated in individual interviews or group discussions on their involvement in different types of ...

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1•14 billion (95% uncertainty interval 1•13-1•16) individuals were current smokers, who consumed 7•41 trillion (7•11-7•74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27•5% [26•5-28•5] reduction) and females (37•7% [35•4-39•9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0•99 billion (0•98-1•00) in 1990. Globally in 2019, smoking tobacco use accounted for 7•69 million (7•16-8•20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20•2% [19•3-21•1] of male deaths). 6•68 million [86•9%] of 7•69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7•69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a clear and urgent opportunity to pass strong, evidencebased policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Funding Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

Based on the Health Promotion approach, the Making Pregnancy Safer initiative has proposed a strategic framework for working with individuals, families and communities to improve maternal and newborn health. The aims are to contribute to the empowerment of women, families ...

Background The COVID-19 pandemic has led to system-wide disruption of health services globally. We assessed the effect of the pandemic on the disruption of institutional delivery care in Nepal. Methods We conducted a prospective cohort study among 52 356 women in nine hospitals to assess the disruption of institutional delivery care during the pandemic (comparing March to August in 2019 with the same months in 2020). We also conducted a nested follow up cohort study with 2022 women during the pandemic to assess their provision and experience of respectful care. We used linear regression models to assess the association between provision and experience of care with volume of hospital births and women’s residence in a COVID-19 hotspot area. Results The mean institutional births during the pandemic across the nine hospitals was 24 563, an average decrease of 11.6% (P < 0.0001) in comparison to the same time-period in 2019. The institutional birth in high-medium volume hospitals decl...

Understanding global variation in firearm mortality rates could guide prevention policies and interventions. To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths. Firearm ownership and access. Cause-specific deaths by age, sex, location, and year. Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of...

Background: Underage alcohol use is a pervasive problem with serious health, social and safety consequences. This study was undertaken to assess alcohol use by primary school children in Trinidad and Tobago, and to identify associated risk factors. Methods: We analysed data collected from 40 primary schools in Trinidad and Tobago by the National Alcohol and Drug Abuse Prevention Programme (NADAPP). The sample comprised of children aged 8 -15 years old, in standards 3, 4 and 5. Result: Out of the 2052 children, 648 (31.6%) have consumed alcohol in their lifetime, and same proportion reported ever being drunk (31.6%). Male gender was significantly associated with lifetime alcohol use (AOR =1.60, 95% CI= 1.25 -2.05). Children not living with their father (AOR= 2.45, 95% CI=1.86-3.24) and those whose fathers have either primary or secondary education (AOR = 1.88, 95%CI=1.07 -3.31; AOR= 1.58, 95%CI=1.12 -2.23 respectively) were at higher risk for lifetime alcohol consumption. However, age group 8 -11 years was significantly inversely associated with lifetime alcohol consumption (AOR= 0.67, 95% CI=0.48 -0.94). Conclusion: Being a male student, not living with father, and father attaining either primary or secondary education level were significantly associated with increased likelihood for lifetime alcohol use. However, children between 8 -11 years were less likely to consume alcohol.

AKNOWLEDGMENT I would like to express my sincere gratitude to Professor Philip J. Jaggar for the precious support he has given throughout the year with my dissertation, as well as all the knowledge he has taught me along the years as my Hausa lecturer.

Senescence arises from age-specific deterioration of the soma as a consequence of optimization of life history, and such effects of senescence should appear when comparing species that differ in intensity of sexual selection, as well as when comparing, within a species, the two sexes that often differ in intensity of sexual selection. However, any extrinsic cause of mortality that reduces life expectancy will reduce the possibility of detecting sex-specific differences in senescence. We investigated geographical variation in human sex differences in longevity across 121 countries to test whether differences in sexual competition for limiting resources, reflecting intensity of sexual selection, affected sex differences in longevity. Men on average lived 5 years shorter than women. High rates of childhood morbidity and mortality reduced the sex difference in longevity, while increased overall longevity increased the sex difference in longevity. Increased resource availability estimated from gross domestic product per capita reduced the sex difference in longevity, accounting for 10% of the variance, while there was no additional effect of income inequality as reflected by the Gini coefficient. In a separate analysis of sex differences in longevity among the states of the US, there was a strong effect of the Gini coefficient on sex difference in longevity, with the negative effect on male longevity being stronger than that on female longevity. In contrast, there was only a marginal effect of average household income. Thus, there was evidence of increased competition for resources contributing to increased sex differences in longevity within a single nation. Am. J. Hum. Biol., 2009. © 2009 Wiley-Liss, Inc.

Molecular Pharming, the production of recombinant pharmaceuticals through plant biotechnology, has the potential to transform the biologics sector of the pharmaceutical industry. More fascinating however, is how it might be used to improve access to modern medicines, and improve health of the poor in developing countries and emerging economies. Although improving global health through molecular pharming has been discussed for at least two decades, little progress has actually been made. In this manuscript, a four point plan is described to maximise the opportunity for molecular pharming to provide solutions. These are (i) to identify and prioritise important drug targets that are relevant to the poor; (ii) to support research and development partners in low to middle income countries to develop local expertise, transfer technology and build capacity; (iii) to increase collaboration between regulatory bodies to enable national regulatory frameworks to be developed in low to middle income countries; and (iv) to promote intellectual property management approaches that include socially responsible licensing. An existing case study is described to illustrate how this might be achieved. 2013) Realising the value of plant molecular pharming to benefit the poor in developing countries and emerging economies. Plant Biotechnol. J.,

The likely health effects of climate change make it one of the most pressing global public health issues of our time. Effects range from more intense and frequent cyclones, flooding, and heat waves through to changing infectious disease patterns, food and water insecurity, sea-level rise, and economic and social disruption. The governments of almost all developed nations are now focusing their attention on national policy responses to the threat of climate change. In New Zealand, it is currently unclear what path our current government will take to contribute to the global response and fulfil our Kyoto obligations. In this paper we discuss the main carbon pricing options currently under consideration, and their implications for health and health inequities in New Zealand. We summarise the literature about the likely health and equity implications of different kinds of carbon pricing policy. A health sector voice in these significant policy decisions is vital to ensuring a policy tha...

Background: The costs of care for patients with Alzheimer's disease are correlated with key measures of disease severity. This relationship is important in the economic evaluation of new treatments and is used to translate treatment efficacy into effects on costs through economic modeling. We aimed to identify what measures of disease severity are the most important predictors of societal costs of care and whether their relationship differs across countries. Methods: Interviews were conducted with 1222 patient and caregiver pairs residing in the community or in residential care settings in Spain, Sweden, United Kingdom, and the United States. Assessments included costs of care (Resource Utilization in Dementia) and key disease severity measures: cognitive function (Mini-Mental State Examination), ability to perform Activities of Daily Living (ADL-ability, Disability Assessment for Dementia [DAD]), and behavioral symptoms (Neuropsychiatry Inventory (NPI)-severity). Results: ADL-ability was the most important predictor of societal costs of care of communitydwelling patients in all countries. A one-point decrease in DAD resulted in a 1.4% increase in costs of care in Spain, United Kingdom, and the United States on average, and a 2% increase in Sweden. This translated into a 45% increase from a standard deviation decrease in DAD on average. NPIseverity and Mini-Mental State Examination were also significant predictors but with lesser effect. Although mean costs of care differed across countries, the important predictors were the same. Conclusion: ADL-ability is the most important predictor of societal costs of care in community dwellings irrespective of country and should therefore be central in the economic evaluation of Alzheimer's disease therapies.

Shipping companies were surveyed to evaluate the effect of public health measures during the influenza A (H1N1) pandemic of 2009 on ship and port operations. Of 31 companies that operated 960 cruise, cargo, and other ships, 32% experienced health-screening measures by port health authorities. Approximately a quarter of ports (26%) performed screening at embarkation and 77% of shipping companies changed procedures during the early stage of the pandemic. Four companies reported outbreaks of pandemic influenza A (H1N1) 2009 on ships, which were ultimately stopped through infection control practices. Public health measures did not interfere substantially with port and ship operations with the exception of some port authorities that delayed embarking and disembarking procedures in a few ships. However, in the shipping companies' experience, measures were inconsistent between port health authorities. Access to antiviral drugs and pandemic vaccine was not provided in all ports. Current...

Background Alcohol, tobacco, and illegal drug use cause considerable morbidity and mortality, but good cross-national epidemiological data are limited. This paper describes such data from the first 17 countries participating in the World Health Organization's (WHO's) World Mental Health (WMH) Survey Initiative.

Healthcare-associated infection is a major safety issue affecting the quality of care of hundreds of millions of patients every year in both developed and developing countries. To meet the goal of ensuring patient safety across healthcare settings around the globe, the World Health Organization launched the World Alliance for Patient Safety in October 2004. Healthcare-associated infections were identified as a fundamental work priority and selected as the topic of the First Global Patient Safety Challenge launched by the Alliance. Under the banner "Clean Care is Safer Care", the Challenge aims at implementing several actions to reduce healthcareassociated infections worldwide, regardless of the level of development of healthcare systems and the availability of resources. Implementation strategies include the integration of multiple interventions in the areas of blood safety, injection safety, clinical procedure safety, and water, sanitation and waste management, with the promotion of hand hygiene in healthcare as the cornerstone. Several initiatives have been undertaken to raise global awareness and to obtain country commitment to support action on this issue. The new Guidelines on Hand Hygiene in Health Care, including the most consistent scientific evidence available, have been issued in an advanced draft form. An implementation strategy is proposed therein to provide solutions to overcome obstacles to improvement in compliance with hand hygiene practices, together with a range of practical tools for use in

The United Methodist Church has a theological statement in the Book of Resolutions 2012 on ministries in mental health that opens: We believe that faithful Christians are called to be in ministry to individuals and their families challenged by disorders causing disturbances of thinking, feeling and acting categorized as "mental illness." We acknowledge that throughout history and today, our ministries in this area have been hampered by lack of knowledge, fear and misunderstanding. Even so, we believe that those so challenged, their families and their communities are to be embraced by the church in its ministry of compassion and love.[1] According to a World Health Organization report in 2012 entitled " Depression: a Global Public Health Concern, " one in four persons suffers from a mental disorder, and among mental disorders, depression is the most prevalent. Depression is the leading cause of disability worldwide in terms of total years lost due to disability.[2] Depression, as well as other mental disorders, adversely impacts the ability of affected persons to perform at work, school, and in the family. The World Health Organization (hereafter referred to as WHO) estimates 350 million people of all ages around the world suffer from depression, contributing significantly to the overall global burden of disease. [3] Lack of treatment compounds the problem. Less than half of the persons afflicted with depression, and in some countries less than 10%, receive any kind of treatment.[4] Lack of treatment is due to a lack of resources, including education, diagnostic tools, psychiatrists, psychologists, therapists, medication and support systems. Lack of resources is directly connected to the poverty and underdevelopment of such countries. Misdiagnosis is also another contributor to improper treatment. Untreated or improper treatment of depression can lead to other more dangerous mental disorders and often to suicide. The WHO cites that over 800,000 persons commit suicide every year, and it is the second leading cause of death globally in 15-29 year olds.[5] Depression is not the only mental disorder that afflicts persons globally. Anxiety, bipolar disorder, schizophrenia, dementia, autism spectrum disorder and other mental and developmental disorders are on the rise as well, and countries face the similar challenges in treating these disorders. There are many individual and social factors that determine risk: genetics, perinatal infections, nutrition, stress, environment and environmental hazards, individual cognitive-behavioral coping skills, trauma, life crises, national policies, social protection, standards of living, work conditions and community support among others.[6]

Hepatitis B virus (HBV) is causally linked to acute and chronic form of hepatitis, which due to continuous immune mediated inflammation and scarring may lead to cirrhosis and/or hepatocellular carcinoma. HBV spread via exchange of infected bodily fluids underlie unique public health considerations due to similarities with other community related issues such as sexually transmitted diseases (eg HIV) blood borne pathogens (Hepatitis-C) and perinatal transmissions (TORCH complex).

This article reviews the principles and skills involved with psychosomatic medicine and their potential ability to improve global health care. New awareness of the escalating global public health impact of noncommunicable diseases, including chronic medical conditions and mental disorders, has stimulated interest in determining how best to organize health services. Home to the biopsychosocial model, the field of psychosomatic medicine is well-suited to inform such efforts by virtue of its emphasis on crossdisciplinary collaboration and specialized knowledge at the interface of medicine and psychiatry that takes into account individual and contextual influences on health. Consistent with the principles of psychosomatic medicine, promising strategies to improve global health care include integrating mental health care into primary care, applying the chronic care model in programs aimed at enhancing disease selfmanagement, and using innovative models such as Internetbased therapy and telemedicine to increase access to quality care.