1. Reporting public health and medicine Thomas Abraham

2. Today’s class Introduction to health and medical reporting Course objectives and course outline Organizing our course work

6. "The observed number of two GBS cases among vaccinated persons so far lies within normal expectation of baseline incidence that would occur in a population of 170,000 (regardless of vaccination history), adjusted for age and seasonal effects," the spokesman said.

10. This is about life and death Experts are often divided There are often commercial, political and personal interests at play The public depend on you for information on which they can act

16. Life and death at a global level: global health issues “AIDS is not just another public health threat, but now belongs in the league of make-or break issues of our times-together with mass poverty, climate change and terrorism.” Peter Piot, former head of UNAIDS Today, 12,000 people are likely to be infected with HIV/AIDS and 6,000 are likely to die http://www.globalhealthfacts.org/topic.jsp?i=1#table

17. Other diseases 2,500 children, mostly under the age of five, are likely to die today in sub Saharan Africa of malaria. Diarrhoeal disease kills 1.5 million children every year. Tuberculosis kills 1.8 million people a year By reporting on these issues, intelligently journalism can persuade governments to take action

18. Why study health and medical reporting? If you are good at it, you can make a difference!

19. Three areas of health and medical reporting Health policy Medicine Public health

20. 1. Health policy How should health care be provided? By the government, or by private businesses and foundations? Should the cost of health care be borne by individuals, or by society as a whole? Should all members of a society have a right to health care regardless of their ability to pay? How much should a society spend on health care?

21. 2. Medical reporting Largely about new treatments for diseases Three main sources -articles in scientific journalsarticles in scientific journals -scientific conferencesscientific conferences -press conferences by scientistspress conferences by scientists

22. The challenges of medical reporting 1. Understanding and interpreting medical trials, and the principles of evidence based medicine http://www.cbsnews.com/video/watch/?id =7123744n&tag=cbsnewsSectionsArea.3

23. Understanding the power of money 2. Understanding the power of money: the global pharmaceutical industry is a US $500 billion dollar a year industry, facing severe competitive, regulatory and economic pressures http://www.youtube.com/watch?v=lNFuEcy5e kg

25. Understanding the power of money “Some of the expensive drugs available today have only modest therapeutic benefits, while many inexpensive medicines are highly effective and safe.” “Manufacturers provide a stream of new products for the medicines market place, usually at higher prices than existing products.” WHO Report “The World’s Medicines Situation

26. Understanding the power of money Medical research is fuelled by money: -from industry -from foundations -from governments and public money Even scientific journals are commercial enterprises

27. 3. Public health Public health is concerned with the health of communities and societies Clinical medicine on the other hand focuses on disease in individual patients Public health studies ways to improve community health through disease prevention Public health interventions to improve community health include improving sanitation, promoting healthier lifestyles, vaccinations etc.

28. Some definitions of public health “The science and art of preventing disease, prolonging life and promoting health through the organised efforts of society” Sir Donald Acheson “What we as a society do collectively to assure the conditions in which people can be healthy” Institute of Medicine. USA

29. Which of these headlines is about public health, and which is not? “Government unveils new measures to reduce road side pollution” “New surgical treatment increases success rate of liver transplants” “Vietnam announces fresh outbreak of bird flu” “Outbreak of diarrhoea forces kindergarten closure” “New drug dramatically reduces high blood pressure”

30. John Snow (1813-1858) and public health

31. Cholera From around 1830, Britain and Europe were struck by several waves of cholera, causing hundreds of thousands of deaths In those days, doctors believed that cholera was caused by “miasma” or poisonous gases from sewers and swamps. Snow was not convinced- why did coal miners who worked far from sewers get cholera? Also, the first symptoms were always digestive- so he thought it must be to do with food or water

32. Snow became convinced the water supply was responsible During an outbreak in 1853, he studied the water supply to 44 households with cholera cases. He knew that all residences in London were supplied by one of two water companies. Company A drew its water from a section of the Thames river polluted with sewage Company B drew its water from a section of the river that was farther away from the city and less polluted

33. Snow went to each house and where there had been a death and asked which company they got their water from He found that 38 of 44 cases were in houses that got their water from Company A He expanded his study to 334 cases, and found that 286 had their water from company A Snow thought he had “very strong evidence of the influence that which drinking water containing sewage has on the spread of cholera”

34. Snow’s critics were not impressed-there was no evidence of any kind of infectious agent in the water Snow’s technique- collecting data on the incidence and distribution of a disease to determine probable cause, is a basis of modern epidemiology

35. Snow’s vindication In August 1853, Cholera broke out on Broad Street, close to Snow’s home in London. He noticed that most of the fatalities were close to a public water pump on the street. He got a list of all the victims, and calculated the distance from their houses to the pump 73 of 83 deaths were in homes closer to the Broad Street pump than any other pump. Of the 10 remaining, 8 had drunk at the pump- some were children who used to drink at the pump on the way to school

36. Snow persuaded health authorities to remove the handle from the pump so it could not be used- cases of cholera decreased. Importantly- also established that those living close by who had a separate source of water did not fall ill.

37. Logical principles behind epidemiology that Snow demonstrated Cause of a disease will lead to higher rates of illness among those exposed to the cause, then those not exposed Cause can be found by analysing patterns of occurrence of the disease in a population

38. http://www.ph.ucla.edu/epi/snow/snowbook.htm

39. The Broad Street pump

40. Reading For more on Snow http://www.ph.ucla.edu/epi/snow.html http://www.ph.ucla.edu/epi/snow.html Read Wikipedia entry on public health http://en.wikipedia.org/wiki/Public_health Visit the website of the Centre for Health Protection in Hong Kong (www.chp.gov.hk) and get an idea of what the major communicable diseases are in Hong Kong, average life expectancy, major causes of death etc.www.chp.gov.hk

41. The demand for health and medical journalism http://www.reuters.com/news/health http://www.bbc.co.uk/news/health/ http://www.nytimes.com/pages/health/index.html http://www.cbsnews.com/2718-500202_162-489.html?tag=related www.bmj.com www.thelancet.com http://www.kaiserhealthnews.org/ http://www.cidrap.umn.edu/

42. Course objectives To get a broad understanding of public health, the scope of public health reporting, possible careers in public health reporting. To understand the principles of good public health and medical reporting To understand the sources of scientific and health information and how to use them To learn to understand and interpret scientific and health information and turn them into clear, intelligent news reports.

43. Home work Sign up for news alerts with Pro- Med(www.promed.org), the Lancet (www.thelancet.com), the New England Journal of Medicine, Science and Nature Follow the Eurekalert web site http://www.eurekalert.org http://www.eurekalert.org

44. Course work You will chose a topic in medicine or public health you are interested in ( ie cancer, HIV/AIDS, influenza, mental illnesses etc) and write 3 stories of around 400-500 words each based on a paper in a scientific journal (40% of grade) You will complete on line courses in HIV/AIDS, tuberculosis and malaria at http://www.globalhealthlearning.org/login.cf m ( 40% of grade) http://www.globalhealthlearning.org/login.cf m

45. You will read and review one book written for a general audience on a medical or health topic (list of books will be distributed in class) Deadlines and details in the next class..