Optimistic Voices

Vital voices in the fields of global health, global child welfare reform and family separation, and those intent on conducting ethical missions in low resource communities and developing nations. Join our hosts as they engage in conversations with diverse guests from across the globe, sharing optimistic views, experiences, and suggestions for better and best practices as they discuss these difficult topics.

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Optimistic Voices

What is Global Health?

July 29, 2022 • Helping Children Worldwide; Dr. Laura Horvath, Emmanuel M. Nabieu, Yasmine Vaughan, Melody Curtiss • Season 1 • Episode 3

0:00 | 1:34:02

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Yasmine’s guest today, is Heather Hall:
Heather has a wide range of expertise in the field. She has a Graduate degree in global public health nursing, previously worked as a nurse in Kenya, did consulting public health work in Kenya and a few other African countries, is a former Program Coordinator for the Tuberculosis/Refugee/Immigration Programs at a health department in Ohio, and recently did COVID-19 policy work for a local health department in Oregon.

Yaz and Heather discuss the definition of Global Health, the Sustainable Development Goals and their relationship to Health, and dispel the three main misconceptions about global health.

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What is Global Health
Optimistic Voices
Season 1, Episode 3
Release Date: July 39, 2022

Transcript

00:00:00 Yasmine Vaughan - Yasmine Vaughan

Second, welcome to HCW Optimistic Voices podcast.

00:00:10 Yasmine Vaughan

I'm your host, Yasmin Vaughn.

00:00:12 Yasmine Vaughan

Today's episode is all about global health.

I'm here with Heather Hall, a global public health nurse.

00:00:17 Yasmine

Heather thanks for joining us.

00:00:20 Heather Hall

Yeah, thanks so much.

00:00:20 Heather Hall

For having me.

00:00:22 Yasmine

In order to talk about what is global health, we think.

00:00:25

It would be useful to.

00:00:26 Yasmine

First, define global health and when it comes to the field.

00:00:30 Yasmine

Of global health

00:00:31 Yasmine

I think most.

00:00:32 Yasmine

Of the people who don't work in this discipline, believe that global health is about transnational issues like pandemic control, emerging infectious diseases, diseases.

00:00:42 Yasmine

That had the potential to cross borders.

00:00:44 Yasmine

Those sorts of things.

00:00:45 Yasmine Vaughan

If I could.

00:00:46 Heather Hall

Kind of maybe summarize.

00:00:47 Heather Hall

I would maybe break it down, but there are three main misconceptions about global health that people tend to have.

00:00:55 Heather Hall

First of all, I think people often have an US versus them mentality.

00:01:00 Heather Hall

And with the, with the mindset that you know global health and global health issues, that's something that happens to.

00:01:06 Heather Hall

Those people over there.

00:01:08 Heather Hall

You know, I'm not really included in that.

00:01:09 Heather Hall

That doesn't happen to me, another I think thought that people tend to have is that global health issues are rich versus.

00:01:17 Heather Hall

Poor, you know it's.

00:01:18 Heather Hall

We'll discuss more about this later.

00:01:21 Heather Hall

But a lot of times eight you kind of.

00:01:23 Heather Hall

I think that.

00:01:24 Heather Hall

If you're a rich country, you know.

00:01:25 Heather Hall

You're not really going to have global health issues.

00:01:27 Heather Hall

That that's something.

00:01:28 Heather Hall

That happens in poorer countries or less developed countries.

00:01:30 Heather Hall

But it's actually not always right to think that just because the country is rich and that they have maybe one of the best health care systems in.

00:01:38 Heather Hall

The world that.

00:01:39 Heather Hall

They necessarily automatically have the healthiest people.

00:01:42 Heather Hall

That's actually not the case.

00:01:43 Heather Hall

And then one final thing is that often with global health, people tend to think of global health as something that happens or occurs during an emergency.

00:01:51 Heather Hall

Really a lot of what global health.

00:01:53 Heather Hall

Entails has to.

00:01:54 Heather Hall

Do with non emergent times.

00:01:56 Heather Hall

Obviously the pandemic that just happened is a big example of an emergency, but there is a lot in global health and global health issues.

00:02:05 Heather Hall

That involve the.

00:02:06 Yasmine

Everyday health of.

00:02:07 Heather Hall

People every day health and well-being of people.

00:02:10 Heather Hall

All around the world so.

00:02:11 Heather Hall

Yeah, these are a couple of things that I.

00:02:12 Heather Hall

Would I would add.

00:02:14 Yasmine

I I completely agree.

00:02:15 Yasmine

The stance of thinking that things are an emergency.

00:02:19 Yasmine

I'm really glad.

00:02:19 Heather Hall

You highlighted the US versus them.

00:02:21 Yasmine

And you know this.

00:02:22 Yasmine

Is something that only happens to poor?

00:02:24 Yasmine

People this mentality is really how the field of global health emerged that historically in the 19th century European powers gathered together and they would discuss epidemics across borders and quarantine requirements around diseases like cholera, big emergency.

00:02:39 Yasmine

There's a cholera epidemic.

00:02:40 Yasmine

They would come together and discuss how they were going to do quarantine.

00:02:44 Yasmine

And this 19th century like mindset is of course around the same time as imperialism.

00:02:49 Yasmine

The scramble for Africa, the colonial period, and that's what led to the emergence of this term called colonial medicine.

00:02:57 Yasmine

And over time, this term transitioned to Tropical Medicine, which was characterized by the study of diseases like yellow fever, malaria diseases that are usually found in the tropics after World War Two.

00:03:10

You know, at the.

00:03:10 Heather Hall

End of this sort of colonial period.

00:03:12 Yasmine

We see the term international health emerge and it's used to describe the prevention.

00:03:17 Yasmine

And treatment of infectious diseases.

00:03:19 Yasmine

Is around the same time.

00:03:20 Yasmine

After World War Two, The Who.

00:03:22 Yasmine

Forms in 19.

00:03:23 Yasmine

48 and they began the work of identifying ways to treat and control infectious diseases, so they began massive campaigns on the smallpox eradication. We see really big attempts in eradicating malaria. But by the 1980s, this term international.

00:03:39 Yasmine

Health kind of fell out of favor.

00:03:41 Yasmine

A lot of it has to do with this colonial history and how it was applied.

00:03:45 Yasmine

So international health was often a tool for reinforcing authority over people groups.

00:03:50 Yasmine

Even today.

00:03:51 Yasmine

A lot of people that work in the field of global health don't use the.

00:03:54 Yasmine

Term because of its association with colonialism.

00:03:58 Yasmine

And hegemony also, during this time, you know in.

00:04:00 Yasmine

The 80s we see the Dibuat show the World Health organizations.

00:04:03 Yasmine

Falling under criticism.

00:04:05 Yasmine

Because it was.

00:04:06 Yasmine

Focusing on infectious diseases, but it wasn't bringing in a focus on health care, delivery or infrastructure, or other things like that.

00:04:15 Yasmine

They contribute to the burden of disease.

00:04:18 Yasmine

Because of this negative history, this colonial history, this rich versus poor mentality.

00:04:24 Yasmine

And the limited scope of work that.

00:04:26 Yasmine

The show is.

00:04:26 Yasmine

Doing in the 1990s, the term global health.

00:04:30 Yasmine

Began to be used.

00:04:32 Yasmine

Global health is really a field of work that begins with the work of international health that work of treating and preventing infectious diseases.

00:04:40 Yasmine

Things like improving hygiene and water supply, promoting child and maternal health, but.

00:04:45 Yasmine

Global Health is a field brings in what the.

00:04:47 Yasmine

Dibuat Show was was.

00:04:49 Yasmine

Criticized for not having a focused on National Health.

00:04:52 Yasmine

Systems it puts the spotlight on health financing with.

00:04:55 Yasmine

Problems universal health coverage.

00:04:57 Yasmine

Access to health care in rural.

00:04:59 Yasmine

Areas and other local and regional.

00:05:01 Yasmine

Challenges, which we'll talk about some of them today.

00:05:04 Yasmine

Global Health also brings in the discipline of public health, public health, I know, is a term that many of you probably heard used and have some basic understanding of public health.

00:05:13 Yasmine

Is this upstream?

00:05:14 Yasmine

Approach to health care.

00:05:15 Yasmine

It focuses not just on disease.

00:05:18 Yasmine

Burden and treatment but on.

00:05:20 Yasmine

Social determinants of health and illness and health inequality.

00:05:24 Yasmine

And how these inequalities are due to unequal distribution of social, political, economic opportunities?

00:05:30 Yasmine

In summary, a lot of global health does have that focus, like we talked about before this focus on mass mobilization around new and emerging diseases.

00:05:39 Yasmine

But it also brings in these other approaches of looking at health from a social.

00:05:44 Yasmine

And from a systems.

00:05:45 Yasmine

Approach the most common definition of global health is that it is an area for study, research and practice that prioritizes on improving health and achieving HealthEquity for all people worldwide.

00:05:58 Yasmine

And that is because global health.

00:06:00 Yasmine

Is not just a focus on cross-border health problems, it's an approach that seeks to ensure the health of all people.

00:06:06 Yasmine

It's everyone, it's all hands on deck.

00:06:09 Yasmine

That's what global health?

00:06:10 Yasmine

Is you know, so we're done, we don't.

00:06:11 Yasmine

Need to talk anymore.

00:06:13 Yasmine

I'm sure most.

00:06:13 Yasmine

Of you guys know?

00:06:14 Yasmine

That the way something is defined is often very.

00:06:17 Yasmine

Different from how it's applied.

00:06:18 Yasmine

In the fields.

00:06:19 Yasmine

So that's why we brought Heather on to talk with us.

00:06:21 Yasmine

About what global?

00:06:22 Yasmine

Health looks like Heather has a graduate.

00:06:25 Yasmine

Degree in global public health nursing.

00:06:27 Yasmine

She's previously worked as a nurse in Kenya and done some consulting public health work in Kenya and a few other African countries.

00:06:34 Yasmine

She is the former program coordinator for tuberculosis refugee immigration programs at the Health Department in Ohio and recently did some COVID-19 policy work for a health department in Oregon. So Heather again. Thanks so much for joining us.

00:06:47 Heather Hall

Thanks so much for having me.

00:06:48 Heather Hall

I'm glad to be here.

00:06:49 Heather Hall

I love talking about global.

00:06:51 Yasmine

Public health, so how that?

00:06:52 Yasmine

Before we really get into.

00:06:54 Yasmine

A deep discussion of this topic I.

00:06:56

Think it would.

00:06:56 Yasmine

Be really useful for those who are listening to go through.

00:06:58 Yasmine

A few of the key.

00:07:00 Yasmine

Terms in the field of.

00:07:01 Yasmine

Global health for people you know who have been.

00:07:03 Yasmine

Working in the.

00:07:03 Yasmine

Field, it's really easy to start throwing around vocabulary.

00:07:06 Yasmine

And I want to make sure that our.

00:07:07 Yasmine

Listeners have a clear.

00:07:07 Yasmine

Understanding of what we mean when we say certain.

00:07:10 Yasmine

Terms I think I'll begin with a term that is really important in this field, which is chronic versus infectious diseases chronic.

00:07:17 Yasmine

Uses also are called non communicable diseases, which means that you can't spread them between people, and they're usually defined as conditions that last for one year or more.

00:07:27 Yasmine

They require ongoing.

00:07:28 Yasmine

Medical attention and they can limit the activities of.

00:07:31 Yasmine

Daily living when we think chronic.

00:07:33 Yasmine

Diseases we think of diseases like.

00:07:34 Yasmine

Diabetes heart disease, cancer those are the.

00:07:37 Yasmine

Top three most common diseases that are noncommunicable or chronic infectious diseases.

00:07:43 Yasmine

These are diseases that spread from person to person.

00:07:46 Yasmine

Things like the flu or malaria or measles or chicken.

00:07:49 Yasmine

Box those are infectious diseases.

00:07:52 Heather Hall

And it's also important to note that while you do have things that are chronic diseases versus infectious diseases, it's important to note that there are occasions where you know the line between infectious diseases and chronic.

00:08:04 Heather Hall

Diseases can actually blur.

00:08:05 Heather Hall

You know, just because something is considered an infectious disease doesn't mean that.

00:08:10 Heather Hall

It can't then lead to a chronic condition or chronic disease state, so so take COVID-19 for example.

00:08:16 Heather Hall

We've all probably.

00:08:17 Heather Hall

Heard about what's called long haulers or it's also termed by the CDC Centers for Disease Control and Prevention based in the United States.

00:08:25 Heather Hall

Long hose is also called long COVID or post COVID.

00:08:29 Heather Hall

Options this is when someone who has been infected with COVID experiences long term effects from their infection.

00:08:36 Heather Hall

They can go until last weeks, months or even years, and some of us maybe even know.

00:08:41 Heather Hall

Some of these people.

00:08:42 Heather Hall

And in other words, you may no longer have an active COVID infection, but you're still experiencing the lasting effects.

00:08:50 Heather Hall

From that initial infect.

00:08:51 Heather Hall

Action wrong COVID includes a wide range of effects such as the T cough, difficulty, breathing, even things like depression or autoimmune conditions, heart issues or other multi organ effects.

00:09:04 Heather Hall

We're still learning a lot about COVID, and even now researchers are still learning about all of the different types and severity.

00:09:11 Heather Hall

Of the different long term COVID effects.

00:09:14 Heather Hall

Another example, where kind of that?

00:09:16 Heather Hall

That line between infectious disease and chronic disease can.

00:09:19 Heather Hall

Be blurred is HIV.

00:09:21 Heather Hall

HIV actually turns from an acute or initial infection into a chronic infection.

00:09:26 Heather Hall

So once you get it, you have it for life and then with HIV it also then has the potential to transition from HIV into AIDS if it's left untreated with treatment.

00:09:37 Heather Hall

Many people are able to remain in watts.

00:09:40 Heather Hall

Photo chronic state of HIV infection.

00:09:43 Heather Hall

Where they have.

00:09:44 Heather Hall

The HIV infection and they're still able to transmit it to others, but they they may not really even be having any symptoms so they can remain in this chronic state to where the virus never actually then developed into AIDS.

00:09:56 Heather Hall

AIDS of the kind of final stage or the third stage of HI.

00:10:00 Heather Hall

B and if if that person with HIV is able to have treatment, has access to treatment or resources, most people are able to live a long and healthy life.

00:10:08 Heather Hall

However, if that person does not have access to treatment once HIV turns into AIDS, the individuals immune system becomes severely weakened and that person can then become very susceptible.

00:10:20 Heather Hall

To what we?

00:10:20 Heather Hall

Call opportunistic infections, or which are essentially infections that are waiting for an opportunity to kind of wreak havoc.

00:10:28 Heather Hall

Some examples of these type of opportunistic infections are pneumonia, tuberculosis, various types of cancers.

00:10:34 Heather Hall

Once a person develops aids and then has one of these opportunistic infections, the the prognosis is usually very poor, so the outcome unfortunately is not is not a desirable outcome.

00:10:45 Yasmine

Thank you mother.

00:10:46 Yasmine

I'm glad you brought that up.

00:10:47 Yasmine

A lot of people either have a focus on chronic diseases and no focus on infectious diseases or vice versa, but the two fields really are aligned.

00:10:57 Yasmine

Well, together you see that people who.

00:10:59 Yasmine

Of infectious diseases can lead to chronic conditions and even having a chronic condition can make you susceptible to an infectious disease.

00:11:07 Yasmine

They do work in.

00:11:08 Yasmine

Tandem together and I'm glad that we discussed that a.

00:11:10 Yasmine

Little bit.

00:11:11 Yasmine

Terms of how chronic disease and infectious diseases have changed over the course of the global health timeline.

00:11:19 Yasmine

We see that chronic diseases are on.

00:11:21 Yasmine

The rise and infectious diseases are trending down, which I'm sure many of you listening.

00:11:25 Yasmine

Are aware of that.

00:11:27 Yasmine

Worldwide few people are dying from infectious diseases and.

00:11:30

People are living.

00:11:31 Yasmine

To be older and then dying of chronic diseases, diseases like diabetes, cancer or heart disease.

00:11:37 Yasmine

Are collectively responsible.

00:11:38 Yasmine

For over 70% of deaths worldwide, which amounts to about 41 million people, so most people are dying from chronic diseases now. But the battle against infectious diseases has not really been won yet. Still 17 million people die from infectious diseases worldwide, and the reason that.

00:11:56 Yasmine

I bring this out.

00:11:57 Yasmine

The epidemiological transition.

00:11:59 Yasmine

Try saying that five times fast.

00:12:01 Yasmine

The reason that I bring up this trend.

00:12:03 Yasmine

Is that there are many countries that are in the.

00:12:05 Yasmine

Middle of this.

00:12:06 Yasmine

They have really high rates of chronic diseases rising, but they also still have really high rates of infectious diseases.

00:12:14 Yasmine

This is what we call the.

00:12:15 Yasmine

Double burden of disease and this.

00:12:17 Yasmine

Is important to talk about because when we hear.

00:12:20 Heather Hall

On the news.

00:12:21 Yasmine

About other countries in the majority world.

00:12:23 Yasmine

The focus tends to be on infectious diseases talking.

00:12:27 Yasmine

About malaria children.

00:12:29 Yasmine

Dying of diarrheal disease.

00:12:31 Yasmine

Things like that.

00:12:32 Yasmine

But the truth is, is that many of these places have really high rates of.

00:12:36 Yasmine

Both and in fact there's other.

00:12:38 Yasmine

In many countries there's what's called the.

00:12:40 Yasmine

Triple burden of.

00:12:40 Yasmine

Disease, which is where a country has really high rates of chronic diseases.

00:12:45 Yasmine

They have high rates of infectious.

00:12:46 Yasmine

Diseases and then the triple is.

00:12:49 Yasmine

Accidents, so things like Rd traffic, accidents, burns.

00:12:53 Yasmine

Things like that.

00:12:53 Yasmine

Yeah, people are dying at every life stage.

00:12:55 Yasmine

Of both chronic infectious and accidents, which makes tackling these issues and this.

00:13:01 Yasmine

This approach of taking all three together so important.

00:13:05 Heather Hall

You bring up really great point.

00:13:06 Heather Hall

Yes, mean that you can't necessarily isolate infectious diseases, chronic diseases, and things like accidents.

00:13:14 Heather Hall

You know they are all very intertwined and a lot of times they all have to be addressed simultaneously.

00:13:19 Heather Hall

People might be thinking wow, OK, you guys just covered a lot of different types of issues.

00:13:24 Heather Hall

Where do we even begin?

00:13:25 Heather Hall

You know everything is seems so complex and interconnected.

00:13:29 Heather Hall

And there are different things going on in all.

00:13:31 Heather Hall

Parts of the world so.

00:13:32 Heather Hall

How do we even begin to?

00:13:33 Heather Hall

Have any type of like strategic way to.

00:13:36 Heather Hall

Address all of these things.

00:13:37 Heather Hall

Well, you know, as some people might be aware there is an organization called the United Nations and the United Nations has actually been tasked with this this very thing.

00:13:49 Heather Hall

Addressing all of these global health issues and the United Nations specifically created essentially like a task force called the United Nations Development Program, and their purpose is to strategically help countries eliminate poverty and achieve sustainable economic growth and human development.

00:14:08 Heather Hall

Because, again, as we've you know said before, and we'll touch on quite a bit, all of these things are interconnected.

00:14:13 Heather Hall

You know somebody's health and well-being directly affect their their finances, their the economic health of their family. And so, again, you can't just address 1 issue.

00:14:23 Heather Hall

You know you have to kind of look at the whole picture and the sustainable development Goals, which we'll talk about.

00:14:28 Heather Hall

Here in a minute are designed to help do that, so a little bit of back story in the year 2000, the United Nation created something called the Millennium Development Goals, or MDG's.

00:14:40 Heather Hall

So if you're in the world of public health or global health or anything like that, you probably heard of that before.

00:14:45 Heather Hall

I mean, at the time in the year 2000.

00:14:47 Heather Hall

There were just eight goals.

00:14:49 Heather Hall

So, and these eight goals covered combating poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women.

00:14:59 Heather Hall

And there was.

00:15:00 Heather Hall

Actually, a timeline that was put on this, so there was a timeline of 15 years and so it was thought that we would work on all of these things collectively and that they would hopefully be accomplished by the year 2015. Well, as we all know.

00:15:13 Heather Hall

2015 world around and there's still a lot.

00:15:16 Heather Hall

Of these issues.

00:15:17 Heather Hall

At play, and so then in 2015, the UN development programme. They took those Millennium Development Goals and actually broadened them and then adopted them into what are now known as the Sustainable Development Goals. So which are essentially.

00:15:34 Heather Hall

It's a universal. They are a universal call to action to end poverty, protect the planet, and ensure that by 2030.

00:15:40 Heather Hall

30 All people will enjoy peace and prosperity now instead of eight like there were in the Millennium Development Goals, the Sustainable Development Goals or SDG's. There are now actually 17 goals in total.

00:15:54 Heather Hall

And they're all viewed from the understanding.

00:15:56 Heather Hall

Again, like I said that each goal is interconnected and so action.

00:16:01 Heather Hall

And one goal.

00:16:02 Heather Hall

Can affect the outcome in another goal.

00:16:06 Heather Hall

So like I said, there's 17.

00:16:07 Heather Hall

Of these goals, and.

00:16:08 Heather Hall

I'm actually going to.

00:16:08 Heather Hall

Read reading each one of them because I think it's really good to get a comprehensive picture of everything that global health entails and how all of these things.

00:16:20 Heather Hall

Again, how they all affect one another.

00:16:22 Heather Hall

So the first is the first sustainable development goal is no poverty.

00:16:26 Heather Hall

Number 20 hunger #3 good health and well-being #4 quality education #5 gender equality #6 clean water and sanitation.

00:16:39 Heather Hall

#7 affordable and clean energy #8, decent work and economic growth. #9 industry innovation and infrastructure. Number 10. Reduced inequality #11. Sustainable cities and communities number.

00:16:54 Heather Hall

Responsible consumption and production number 13 climate action.

00:17:00 Heather Hall

#14 life below water #15 life on land #16, peace, justice and strong institutions and finally #17 partnership.

00:17:11 Yasmine

For the goals.

00:17:12 Heather Hall

So hopefully all of our listeners are still here.

00:17:15 Heather Hall

With us 'cause I know that was a.

00:17:16 Heather Hall

Really long list, but again I think.

00:17:18 Heather Hall

It's important to read out each one of those.

00:17:20 Heather Hall

Things because peers, again, they're all interconnected and there.

00:17:23 Heather Hall

Might be things in there.

00:17:24 Heather Hall

There well that we maybe maybe don't necessarily think of as being associated with global health and with just, you know, the overall health and well-being of people all throughout the world.

00:17:35 Heather Hall

But it's really important that what we can.

00:17:38 Heather Hall

Name those things.

00:17:39 Yasmine Vaughan

A little bit more.

00:17:40 Heather Hall

About the dogs.

00:17:41 Heather Hall

The dogs were set to be accomplished.

00:17:43 Heather Hall

Again, by the year 2030.

00:17:45 Heather Hall

Which we're not.

00:17:46 Heather Hall

There yet, but as you can imagine, you know.

00:17:48 Heather Hall

We have just.

00:17:49 Heather Hall

Experienced a very long pandemic, the COVID-19 pandemic and again as you can imagine that pandemic has set back a lot of progress on these goals.

00:18:00 Heather Hall

More specifically, new research by the United Nations Development Programme shows that the long term social and economic impact of the pandemic will actually is actually set to widen the gap between people living in rich and poor countries.

00:18:15 Heather Hall

So you know.

00:18:15 Heather Hall

We all know that.

00:18:16 Heather Hall

There's this gap between kind of your rich levels of society.

00:18:19 Heather Hall

And in your poor levels of society.

00:18:21 Heather Hall

And because of the pandemic, it's just going to increase that gap, and unfortunately it's the poor countries that are increasingly bearing.

00:18:29 Heather Hall

The brunt of COVID-19 cases and the.

00:18:32 Heather Hall

Related mortality with that.

00:18:34 Heather Hall

Now for a few more specific examples of how the pandemic has affected the SDGS, let's go ahead and just take a quick look at the first SDG, which is no poverty.

00:18:43 Heather Hall

So before the pandemic, about 1 billion children, which is about the population of China.

00:18:49 Heather Hall

Lacked basic necessities such.

00:18:51 Heather Hall

As clean water and nutrition, however now due to Co.

00:18:55 Heather Hall

David, there are now 150 million more children experiencing this level of poverty. You know? So 100.

00:19:02 Heather Hall

And 15 million more.

00:19:03 Heather Hall

That is, that is significant.

00:19:04 Heather Hall

That is huge.

00:19:05 Heather Hall

So again, you can kind of see how that increase in.

00:19:08 Heather Hall

Number has really has really shifted.

00:19:11 Heather Hall

The progress towards.

00:19:12 Heather Hall

The goal of no poverty and then another one.

00:19:15 Heather Hall

Is again also related to the first SDG of no poverty.

00:19:19 Heather Hall

The pandemic has also increased the number of orphans involved.

00:19:22 Heather Hall

Well, children in the United States alone, more than 140,000 children lost a caregiver due to the pandemic per the CDC, and as you can probably imagine, losing a caregiver significantly increases a child vulnerability, especially to poverty, and especially if the country does not have an established child welfare system. So again, you know I don't need.

00:19:41 Heather Hall

To say anymore.

00:19:43 Heather Hall

The pandemic has definitely put us back with some of these with some progress towards these.

00:19:47 Heather Hall

Goals thank you, Heather.

00:19:48 Yasmine

I'm glad you've highlighted this interconnectedness of these issues.

00:19:52 Yasmine

You know, we said Goal 3 is good.

00:19:54 Yasmine

Health and well-being but.

00:19:55 Yasmine

I'm glad we mentioned all the others.

00:19:57 Yasmine

It is all connected. Issues like poverty,

climate change, access to water and sanitation.

Clean energy.

00:20:03 Yasmine

These things all have an impact on health.
For people who don't have the ability to afford healthcare, sanitation and water obviously have a big impact on health.

00:20:11

Things like that, as you're saying before, global health brings in this interdisciplinary perspective of not just looking at how.

00:20:18

To how to treat an illness.

00:20:20

But looking upstream, what are the other things that are influencing

And playing into health?

00:20:30 Announcer

We'll be back in a Minute with more on this topic.

You're listening to optimistic voices Podcast with host Yasmine Bon and guest Heather Hall For more information on today's topic. Global health go to helpingchildrenworldwide.org Optimistic Voices Podcast season one, Episode three,

We rejoin the conversation on strategic development goals.

00:21:02 Yasmine Vaughan

SDG Three has specific targets in the field and many of these dominate a lot of the work that is being done in global health.

00:21:09

So Heather, let's let's talk a little bit.

00:21:11

About some of

The big targets in global health.

Some of the the big topics that are SDG, three is looking to tackle.

00:21:19 Heather Hall

I oftentimes we'll talk about the dogs as they relate to global health. You know, even though there are certain SVG's that may be a little more obvious than.

00:21:28 Heather Hall

Others, but again to me.

00:21:29 Heather Hall

As a global.

00:21:30 Heather Hall

Public health person.

00:21:31 Heather Hall

They're all again, like I said, interconnected.

00:21:33 Heather Hall

But more specifically, there are some dogs specifically.

00:21:37 Heather Hall

Rate relate to the topic of global health.

00:21:40 Heather Hall

The first one, which is pretty obvious is SDG. #3 and #3 is good health and well-being, and as you can imagine that can cover.

00:21:50 Heather Hall

A whole host of.

00:21:51 Heather Hall

Topics now we'll just cover a few of the major topics, but especially the ones that you often find in global health.

00:21:59 Heather Hall

So the first one is maternal child health, maternal and child health are two of the leading health indicators of a country.

00:22:06 Heather Hall

And as you can imagine, are very closely linked, so maternal health specifically refers to the health of women during pregnancy.

00:22:14 Heather Hall

Childbirth in the post Natal period.

00:22:17 Heather Hall

Now, the reason maternal health is an important indicator is because most maternal deaths are preventable as long as there's timely management by a skilled health professional, you know in in a supportive environment.

00:22:30 Heather Hall

Again, not having those things or having those things can really tell the story of the health of the infrastructure.

00:22:38 Heather Hall

Of a country.

00:22:40 Heather Hall

Now, maternal deaths are measured using the maternal mortality rate, and so a lot of times if you're talking about maternal health, this will be the most common statistic that you'll hear.

00:22:49 Heather Hall

So maternal mortality rate and per the WHL, which stands for World Health Organization, maternal mortality is unacceptably high, about 200.

00:23:00 Heather Hall

And 95,000 women died during and following pregnancy and birth in 2007.

00:23:05 Heather Hall

Team and I first just want to say.

00:23:07 Heather Hall

You know?

00:23:08 Heather Hall

Like OK, That's 2017, that's almost.

00:23:10 Heather Hall

Five years ago.

00:23:10 Heather Hall

But as you can imagine, it takes a lot of time to collect a lot of this information, so so some more recent statistics you know are probably still in development.

00:23:20 Heather Hall

Now again that out of those 295,000 women, the vast majority.

00:23:25 Heather Hall

Of these deaths.

00:23:26 Heather Hall

Which 94?

00:23:27 Heather Hall

Percent actually occurred in low resource settings, and again could have been prevented with sub-Saharan Africa and Southern Asia, accounting for approximately 86 of that 94% of deaths. So again, that's you know by far the majority. So again, keep it. Keep that in mind.

00:23:48 Heather Hall

And you know, just kind of as a real world example.

00:23:51 Heather Hall

Countries countries know how important maternal health is, and they've specifically put measures in place to try to improve maternal health.

00:24:02 Heather Hall

For a personal example, or something that I have seen first here.

00:24:05 Heather Hall

And when I was in Kenya working as a nurse there and again, Kenya is a sub-saharan African country.

00:24:13 Heather Hall

So if you're not quite sure where that is, if you look at Africa, it's it's on the eastern side on the eastern coast, and Kenya actually requires all of their nurses to be midwives and one time.

00:24:25 Heather Hall

When I was out with the immunization clinic and the antenatal clinic in Ken.

00:24:31 Heather Hall

Yeah, a woman actually came to the clinic in active labor again, you know, that wasn't the purpose of the clinic, but she knew that we were having a clinic there and and came to try to get some help.

00:24:43 Heather Hall

And because Kenyan nurses are already trained for this, thankfully, the nurse midwife who was already at the clinic, you know she already had.

00:24:51 Heather Hall

The supplies and skills to provide this woman with the access to health care that she needed at this crucial moment.

00:24:58 Heather Hall

So again, you know.

00:24:59 Heather Hall

The you know we weren't expecting to have anybody you know an active delivery but but they were prepared already again prepared with those skills and supplies and thankfully the woman had a successful delivery in birth and both mom and baby left the left the clinic healthy and well.

00:25:17 Heather Hall

So was we're very thankful that that.

00:25:19 Heather Hall

Was a positive story.

00:25:21 Heather Hall

And then moving on to child.

00:25:23 Heather Hall

Health and child health.

00:25:25 Heather Hall

Again, like I said, they're very interconnected, but maternal health and child health are very interconnected and you know.

00:25:31 Heather Hall

Child health is.

00:25:31 Heather Hall

Fundamentally important, and covers the span of a child's life. You know from from birth even before birth, up until they reach adulthood. But one of the most important global.

00:25:43 Heather Hall

Health focus is related to child health is the health of children under the age of five, and I'll go ahead and let you Yasmine talk a bit more about that.

00:25:53 Yasmine

Yeah yeah, under under 5 mortality is one of my I don't want to say one of my favorite topics because that sounds terrible, but it's a it's a topic is very close to my heart.

00:26:03 Yasmine

So under 5 mortality is the the measure of the likelihood a child will die before they reach their 5th birthday.

00:26:10 Yasmine

And like Heather said, with maternal mortality, it's an important measure of the health of the population and of the development level of a nation.

00:26:18 Yasmine

And this is because you know pregnant women and children are among the most vulnerable members of a population.

00:26:26 Yasmine

So with the Under 5 mortality and maternal mortality rifl.

00:26:30 Yasmine

Next is the strength of a health system to support its most vulnerable, and it's used as a measure of the social economic and, you know, environmental conditions in which communities live.

00:26:42 Yasmine

So you know, that's why, like these two measures in particular is so often used so worldwide.

00:26:49 Yasmine

You know we're seeing a lot of trends.

00:26:51 Yasmine

Down and and.

00:26:53 Yasmine

Under 5 mortality, so the total number of under 5 deaths has declined from 12.6 million in 1990 to 5,000,000 in 2020, so 7.6 million decline in the last 30 years, which is really wonderful.

00:27:08 Yasmine

But you know, still children in you know regions like sub-Saharan Africa tend to have the highest rates of under 5 mortality in the world, in fact.

00:27:18 Yasmine

Sub-Saharan Africa has 14 times higher the risk of children than Europe and North America and this is important because.

00:27:29 Yasmine

While sub-Saharan Africa and Southern Asia account for more than 80% of the Under 5 deaths, they only account for 53% of the global live birth rage.

00:27:41 Yasmine

So we see this tension.

00:27:42 Yasmine

There's more children dying than there are being born and.

00:27:45 Yasmine

Really, illnesses that cause deaths.

00:27:48 Yasmine

Of children under 5.

00:27:49 Yasmine

Are largely preventable.

00:27:51 Yasmine

Treffle treatable, and for the most part, relatively inexpensive and easy to do, and we'll do a whole other episode on Under 5 mortality and bring in some other speakers to talk about this, but it's a.

00:28:05 Yasmine

It's an important measure and it's.

00:28:07 Yasmine

Uhm, it's actually one of my favorite parts about the work that we do at Mercy Hospital.

00:28:14 Yasmine

So we have an Under 5 clinic every Thursday at Mercy Hospital.

00:28:17 Yasmine

Mothers and bring their children and they receive checkups.

00:28:21 Yasmine

Treatment for diseases?

00:28:23 Yasmine

There's a representative from the World Health Organization.

00:28:26 Yasmine

Who comes specifically On that day.

To give immunizations.

00:28:30

And it's.

00:28:31 Yasmine

It's really wonderful to.

00:28:32 Yasmine

Sit in on that, uhm.

00:28:34 Yasmine

I mean of course.

00:28:35 Yasmine

The children hate the immunizations part.

00:28:37 Yasmine

You know they get like 6 sticks.

00:28:39 Yasmine

In the arm when they're.

00:28:40 Yasmine

There, but it's so.

00:28:43 Yasmine

Impactful because you see that you.

00:28:46 Yasmine

Know after being at the clinic for maybe an hour and an hour and a half.

00:28:50 Yasmine

You know these kids get couple of vaccines if they have, you know, a diarrheal disease.

00:28:55 Yasmine

They get some antibiotics and then these kids are one step closer to seeing their 5th birthday, so building that infrastructure like we said is such an important an important part of global health and that's why these two measures are so important.

00:29:12 Heather Hall

Yeah yeah.

00:29:13 Heather Hall

And and and something that that really connects closely with child health is also malnutrition.

00:29:21 Heather Hall

Malnutrition more specifically includes undernutrition such as wasting stunting and under being underweight.

00:29:30 Heather Hall

It also includes inadequate vitamins or minerals, but malnutrition also includes overweight and obesity.

00:29:37 Heather Hall

And and non communicable diseases that are diet related.

00:29:43 Heather Hall

So I think a lot of times when people think about nutrition, they think of children who are underweight.

00:29:47 Heather Hall

But it actually also includes children and adults that are that are overweight.

00:29:53 Heather Hall

Now as you can, as you can guess, malnutrition has always been an important part of global health, and it's also a really great example, again, of how the SDG's overlap.

00:30:04 Heather Hall

So SDG #2, which is ending hunger, is then also linked to SDG #3 good health and well-being.

00:30:12 Heather Hall

Now you know this is a move that we all know. We all know that nutrition is important and foundational to good health and well-being and malnutrition you know can really for some people mean life or death.

00:30:24 Heather Hall

You know, especially for a child, and if you have a child that's malnourished and therefore you know they get sick.

00:30:32 Heather Hall

Because they are malnourished their their body is less prepared to fight.

00:30:37 Heather Hall

Or even easily bounce back from a major illness and sometimes even some. You know minor illnesses. So again that non nutrition or I'm sorry nutrition is foundational to just overall health and well-being in your ability to to handle other diseases or illnesses that might come your way.

00:30:55 Heather Hall

For a few statistics, the global the excuse me. The WHL reports that globally in 2020, a 149 million children under five were estimated to be stunted and stunted. Specifically, means.

00:31:09 Heather Hall

That they're too short for their age.

00:31:11 Heather Hall

And then there were 45 million children who were estimated to be wasted, which means that they're too thin for their height.

00:31:19 Heather Hall

And then there were 38.9 million who were overweight or obese. So again, just looking at those three statistics, the majority of of malnutrition in children has to do with stunting.

00:31:32 Heather Hall

Or wasting.

00:31:33 Heather Hall

Excuse me and then the the lower end has to do with children that are.

00:31:37 Heather Hall

Overweight or obese?

00:31:39 Heather Hall

Now also, around 45% of deaths among children under 5.

00:31:44 Heather Hall

Years of age.

00:31:45 Heather Hall

Are actually linked to undernutrition and these occur in low and middle income countries.

00:31:52 Heather Hall

However, at the same time in these countries, rates of childhood overweight children being overweight and.

00:31:59 Heather Hall

Obese are actually rising, so this touches again what Yasmine was talking about earlier that you know you kind of have this intersection of of issues so you have issues of children that are malnourished, but then at the same time you know that maybe are experiencing.

00:32:17 Heather Hall

Hey undernutrition, but then at the same time you may have an increasing rate of children who are overweight and obese, so especially as you have that, that widening gap between maybe the rich parts of society and the poorer parts of the society.

00:32:31 Heather Hall

So countries really have.

00:32:32 Heather Hall

To figure out how to address both of.

00:32:34 Heather Hall

Those so so again, as we've already discussed.

00:32:38

All of these.

00:32:39 Heather Hall

Issues are linked and with malnutrition.

00:32:41 Heather Hall

Poverty can really amplify their risks of and the risks from malnutrition.

00:32:47 Heather Hall

So like I just was talking about.

00:32:49 Heather Hall

And people who are poor are more likely to be affected by different forms of malnutrition versus maybe people who are rich, rich and then also malnutrition increases health care costs as well as reduces productivity and slows economic growth.

00:33:04 Heather Hall

Which again, if you are somebody who's living in, you know a situation of poverty.

00:33:10 Heather Hall

You know having issues with malnutrition and then the the the ending results can really be put in a cycle of poverty that can go on for years and years and even even potentially generations.

00:33:25 Heather Hall

When I worked in Kenya, I worked with a Community health and development program and specifically got to work with their wash program and what wash stands for is an acronym for water, Sanitation and Hygiene, and one of the.

00:33:40 Heather Hall

Of their program.

00:33:42 Heather Hall

Was for both schools.

00:33:44 Heather Hall

And individual homes to start their own garden.

00:33:47 Heather Hall

And not only did this help teach the children about healthy foods and what are good things for them to eat that can easily be grown in their area, but it also taught them a valuable skill that could not only help provide food for their family, but also you know it provided them with a skill that they could potentially maybe even make.

00:34:07 Heather Hall

Into a business opportunity in the future.

00:34:09 Heather Hall

So again, it's just a really great example of how all of those things are interconnected.

00:34:17 Yasmine

Yeah, Heather, thank you so much for that summary of malnutrition.

00:34:23 Yasmine

Another big topic in global health, ironically, is what are called neglected tropical diseases and and the reason that we call these diseases neglected is because unlike you know, big names in infectious disease like HIV and malaria, there's actually not.

00:34:43 Yasmine

A lot of.

00:34:44 Yasmine

Global funding or attention paid to these diseases come.

00:34:48 Yasmine

And these include conditions like.

00:34:50 Yasmine

Onchocerciasis, also known as river blindness, schistosomiasis, lymphatic filariasis, trypanosomiasis.

00:34:58 Yasmine

These are, you know, disease conditions that I'm sure many of you have never heard of and are currently trying to figure out how to spell.

00:35:04 Yasmine

Them so you can Google them.

00:35:06 Yasmine

But they're they're neglected because more than one.

00:35:08 Yasmine

Billion people, or you know about 1/6 of the world population suffer from at least one of these neglected tropical diseases.

00:35:17 Yasmine

And you know most of these diseases are not fatal.

00:35:21 Yasmine

They rarely lead to death, but what they do is cause significant disability.

00:35:26 Yasmine

So many of them lead to blindness or disfigurement, fatigue, you know these chronic conditions, and if you are disabled because of.

00:35:37 Yasmine

One of these diseases you know, then you're unable to work.

00:35:40 Yasmine

You're unable to provide for yourself, and this goes back to what we were saying before about the cycle of poverty for disadvantaged people.

00:35:47 Yasmine

If you can't.

00:35:48 Yasmine

If your your health impacts your economic ability, and again for.

00:35:53 Yasmine

Many of these diseases and conditions they can be prevented through surveillance and simple cost effective interventions.

00:36:01 Yasmine

And again, a lot of this ties back to access to health care for resource poor communities.

00:36:07 Heather Hall

Yeah great thanks Jasmine.

00:36:09 Heather Hall

I I always find it really interesting and fascinating to hear about the, you know.

00:36:15 Heather Hall

Neglected tropical diseases because because again when you go to some of these, these international places, global places where you see things that aren't in your maybe in your home country, it just really brought into your perspective on what people in other parts of the world might be dealing.

00:36:31 Heather Hall

With so now for a few diseases that people might be a little bit more familiar with.

00:36:36 Heather Hall

There is also obviously.

00:36:38 Heather Hall

HIV, malaria, and tuberculosis, which again are very prominent topics in global health.

00:36:45 Heather Hall

And you know, much can be said about each of them, so I'll just try to keep this brief.

00:36:50 Heather Hall

But again, these are three issues that you know have been major focuses in global health, and they probably will continue.

00:36:58 Heather Hall

To be for quite.

00:36:59 Heather Hall

A while and and one of the reasons that they're important is because they can be easily spread.

00:37:05 Heather Hall

And then of course have very serious consequences if people don't have access to treatment.

00:37:11 Heather Hall

So more specifically about HIV, which I know we've already touched on a bit, but it's important to remember that you know, while there have been significant advances in the treatment of HIV, and many people are still able to live long and healthy lives, there is still no cure for the disease.

00:37:28 Heather Hall

And while there are medications

00:37:31 Heather Hall

I hope you live a long and healthy life.

00:37:33 Heather Hall

You know, those medications don't really do you any good if you don't.

00:37:36 Heather Hall

Actually have access to them.

00:37:39 Heather Hall

In addition, there are still many cultural practices and beliefs in a lot of different parts of.

00:37:44 Heather Hall

The world that increase the risk of HIV transmission.

00:37:48 Heather Hall

And you know, if you think about it, if you have an increased risk of transmission and limited access to HIV therapies, then the results of these risky behaviors.

00:37:58 Heather Hall

Can actually have really significant impacts, not just on individuals, but whole communities.

00:38:04 Heather Hall

So for example, there are many places in the world where there are large amount of orphans due to losing their parents to AIDS.

00:38:11 Heather Hall

In 2020 there were estimated there was an estimated 15.4 million children, ages 0 to 17 who have lost one or both parents due to HIV. I'm sorry due to AIDS globally, per the United Nation aids.

00:38:27 Heather Hall

Again, these issues are very interconnected and progress or regression in one can mean progress or regression in.

00:38:35 Heather Hall

Now 2 diseases you know there might be a little a bit lesser known and are are more rare in the United States for malaria and tuberculosis.

00:38:44 Heather Hall

So you've probably heard about them.

00:38:46 Heather Hall

But you know, maybe really don't know much about them.

00:38:48 Heather Hall

So malaria is a actually a life threatening disease.

00:38:52 Heather Hall

Can be life threatening and is.

00:38:55 Heather Hall

Caused by parasites that are transmitted to people through the bites of infected mosquitoes.

00:39:00 Heather Hall

But again, thankfully, this malaria is a disease that is preventable and curable.

00:39:05 Heather Hall

In 2020, there were an estimated 241 million cases of malaria worldwide and 627,000 deaths in 2021. Very important in common initiative in global health to combat malaria is the use of bed Nets, so you can actually use.

00:39:26 Heather Hall

Treated bed Nets and some of you maybe have even seen or used these before, but these bed Nets are treated and put over somebody bed or sleeping place.

00:39:36 Heather Hall

And and obviously the goal is to help prevent people from being bitten by mosquitoes while they're asleep and and when, again, when.

00:39:44 Heather Hall

I worked in Kenya with the wash program.

00:39:47 Heather Hall

This is actually one of the requirements for people who are participating in their in their water program.

00:39:53 Heather Hall

And they they had to have bed Nets, and thankfully, most people you know, we're pretty accepting of that.

00:40:00 Heather Hall

But it is also important to to educate people on the use.

00:40:04 Heather Hall

You know it, you don't just pass out something and not educate someone on how to use it.

00:40:09 Heather Hall

You know I have.

00:40:10 Heather Hall

Heard stories before.

00:40:11

Or as.

00:40:12 Heather Hall

You know people using bed Nets for for uses other than what they were designed for, such as even like a fishing Nets.

00:40:18 Heather Hall

So it's really important that when you are using some of these public health interventions that it is accompanied by appropriate education, and again, that education may need to be reinforced now, moving on.

00:40:32 Heather Hall

To tuberculosis, many people think that tuberculosis is something that only happens in developing countries.

00:40:38 Heather Hall

Again, one of those things of, well, that just happens to them over there, but it's actually important to know that yes, while it is less common in the United States, it still does actually happen here.

00:40:50 Heather Hall

In the United States, as I'm imagining, most of our listeners are probably based in the United States.

00:40:57 Heather Hall

But tuberculosis also called TB, is caused by a bacteria.

00:41:01 Heather Hall

And is it most often affects the lungs, though it can actually occur in other parts of the body and TB that affects you in your lung.

00:41:09 Heather Hall

Times is most often spread through coughing, sneezing, or even in your spit, and it's actually estimated that one quarter of the world population is actually infected with TB because TB actually has two different phases has.

00:41:24 Heather Hall

What we call.

00:41:25 Heather Hall

A latent phase.

00:41:26 Heather Hall

Kind of like the TB infection is asleep in your body.

00:41:30 Heather Hall

And then it also has an active phase where you're actively sick and you can spread it to people so that one quarter of the world population who are infected.

00:41:39 Heather Hall

Some are probably, you know, having latent TB so they're not actually spreading it at the moment, but but they still are.

00:41:45 Heather Hall

Infected with it.

00:41:46 Heather Hall

And again, thankfully with tuberculosis like malaria, tuberculosis is preventable and curable.

00:41:53 Heather Hall

However, even though it is again preventable and curable.

00:41:58 Heather Hall

There are still 1.5 million people who die each year from tuberculosis, which actually makes tuberculosis the world top infectious killer.

00:42:07 Heather Hall

In addition, it's also the leading cause of people leaving cause of death for people with HIV, so again, you kind of put those two things together.

00:42:18 Heather Hall

You take a very vulnerable population of.

00:42:20 Heather Hall

People with HIV.

00:42:21 Heather Hall

And then the fact that tuberculosis is the world top infectious killer, you know.

00:42:28 Heather Hall

That you can see why TB is a very important global health issue.

00:42:34 Heather Hall

When I was in Ohio and I was a program coordinator for our tuberculosis program, so we we would take care of people who were actively sick with tuberculosis and as part of their care.

00:42:47 Heather Hall

The patients with TB would often be surprised to find.

00:42:50 Heather Hall

Out that we actually.

00:42:51 Heather Hall

Had to watch them take their TV medication.

00:42:54 Heather Hall

You know, and not just kind of.

00:42:56 Heather Hall

You know, watch them every once in a while.

00:42:58 Heather Hall

But we had to.

00:42:58 Heather Hall

Actually watch them take their medication every single time and document that.

00:43:02 Heather Hall

But what people didn't quite know at 1st and what a lot of people.

00:43:06 Heather Hall

Don't know about tuberculosis.

00:43:07 Heather Hall

Is that not finishing your TV antibiotics or you know most antibiotics for that matter, it can lead to what we call an increase.

00:43:16 Heather Hall

In drug resistant TB.

00:43:18 Heather Hall

And and that's actually a very scary thing to think about, because again, if you think about the world's top infectious killer and then the potential that all of the medications that we have to to fight that disease are no longer effective, you know that creates a very dangerous situation and can really affect a lot of people.

00:43:39 Heather Hall

Uhm, so again, back to these patients.

00:43:42 Heather Hall

In in Ohio we would actually go to their homes for months on end.

00:43:46 Heather Hall

You know, five days a week and go for months on end and watch them take their their TV meds.

00:43:52 Heather Hall

But thankfully again now with technological advances there are even options where.

00:43:57 Heather Hall

Patients can take their tuberculosis medication.

00:44:00 Heather Hall

You know, over some kind of video platform or even record it and then send it into their health care professionals so you know, once you're able to really explain that to people and why that's so important.

00:44:14 Heather Hall

Most people are willing to willing to comply, so.

00:44:17 Heather Hall

So yeah, so that's a little bit of interesting information about TV that a lot of people might not actually know.

00:44:24 Yasmine

Yeah, thank you Heather, for that summary of, I mean, these are three really big topics in global health.

00:44:31 Yasmine

You know there's a an organization called the Global Fund which is all about tackling HIV, tuberculosis, and malaria as those three big topics.

00:44:42 Yasmine

So you know, we're trying to go a mile.

00:44:45 Yasmine

Wide and an inch deep on each of this, and perhaps in future episodes, we'll do some focus on these topics.

00:44:52 Yasmine

More specifically, I want to circle.

00:44:54 Yasmine

Back to the point you made.

00:44:55 Yasmine

About antibiotic resistance we'll.

00:44:57 Yasmine

Talk about that again.

00:44:58 Yasmine

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