The what, why and how of health and development

Guest Columnist: Paul Maginn

Originally posted on The Honest Courtesan:

Dr. Paul Maginn is an Associate Professor of Urban Planning at the University of Western Australia; he is the co-editor and co-author of several chapters in the recently published book (Sub)Urban Sexscapes:  Geographies and Regulation of the Sex Industry.  I asked him to comment on his book and explain why a planner & geographer is so interested in sex work.

Suburban SexscapesAt social events whenever we meet someone new for the first time it can be guaranteed that they will ask, “So, what do you do for a living?”  In the past, my stock response was generally:  “I’m an academic…an urban planner”!  The stock replies to this usually range from:  “Oh! What does that mean?” to “Oh, that’s nice! I have to go now because there’s my friend over there”.  You see, being an academic doesn’t seem to capture too many non-academic peoples’ attention.  So nowadays, when I’m asked what…

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The Do’s and Dont’s of substance use language, according to journal editors

Back when I was City journalism student learning about health reporting – and later a copywriter for health charities – the sensitivity of language around medical subjects was drilled into me by various experts in fields such as mental health, HIV, and TB. The choice of terminology determines the tone of an article and sometimes even the journalist can be unaware of the implications of the language they’re using – something I often see as a freelance sub-editor of tabloid news.

The biggest mistakes do tend to appear in tabloid press, although all health journalists have a responsibility to find a middle ground between rigid medical terminology and the more illustrative language of journalism. But according to a guidance paper published by a a group of journal editors last week, scientists don’t always get it right either.

Editors of the journal Substance Abuse were apparently so concerned at some of the terms found in submitted papers they published an article appealing for researchers to use language that ‘respects the worth and dignity of all people…focuses on the medical nature of substance use…and avoids perpetuating negative stereotypes and biases through the use of slang and idioms’.

Some of the ‘what not to do’ examples sound like they could have come out of a column of a judgemental newspaper editorial:

“Although it is perhaps surprising, our journal has received submissions that contain explicitly morally laden language, e.g., referring to the “depraved and degenerate lives” of individuals who use substances,” wrote the Substance Abuse editors. They also revealed that some submissions included slang words such as ‘addicts’, ‘speedball’, and ‘clean’/’dirty’ urine.

Less obvious, but equally important, was the advice on using ‘people-first’ language, and highlighting that a person’s condition is only one aspect of them and not their defining characteristic. ‘Addicts’, ‘users’, or ‘alcoholics’ are terms, according to the authors, that erase individual differences and presumes an homogeneity in experiences. They advise instead on using: ‘person with a ‘cocaine use disorder’ or ‘adolescent with an addiction’.

By the same token, they suggest that referring to a convict by their crime – murderer, drug dealer, thief – may be dehumanising. Instead they advice using the terms ‘people in prison’ or ‘people on parole’, a phrase perhaps suitable for scientific papers but not one I can ever see getting past a newspaper editor (although I did recently read an article that used the phrase ‘people with vaginas’).

They also turn the mirror on to themselves however, acknowledging that the very title of the journal they’re editing – Substance Abuse – could be deemed pejorative, referencing addiction expert William L. White’s article The Rhetoric of Recovery Advocacy: An Essay On the Power of Language.

In his essay, White writes that “of all the words that have entered the addiction/treatment vocabulary, ‘abuse’ is one of the most ill-chosen” and “to suggest that the addict mistreats the object of his or her deepest affection is a ridiculous notion”. He argues this word comes from an historic religious and moral concept of addiction and can be compared to the now – thankfully – defunct term ‘self-abuse’ that was once used to describe masturbation.

Both White and the Substance Abuse authors agree however that people recovering from these conditions are really the ones who should shape their own language and definitions.

“Most importantly, we need to know much more about the thoughts and preferences of the individuals and families who are affected by drug and alcohol use: how do they feel about
their own and others’ use of the terminology discussed above? What language would they like us to use, and what are the implications for the services and policies they need?” the journal editors ask.

To summarise, I’ll borrow a fitting quote from the introduction to White’s paper (that he borrowed himself nonetheless):

“The difference between the right word and the almost right word is the difference between lightning and the lightning bug.” – Mark Twain


Increasing rates of HIV on World AIDS Day 2014

The battle to curb HIV infections in some regions of Europe is failing after new figures released last week show an 80 percent increase in the rate of infection in 2013 when compared to 2004.

The vast majority of new cases occur in Eastern Europe and Central Asia, which has seen a two fold surge of HIV infections in the past decade, thought to be due to insufficient policies in many countries aimed at preventing the spread of infection among drug users and men who have sex with men.

The latest figures released by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organisation Regional Office for Europe show that in 2013 there were 176,000 new HIV diagnosis, a huge increase from the 79,000 new cases that were registered in 2004.

Over 100,000 of the new cases in 2013 were registered in Eastern Europe and Central Asia, one of the few regions around the world were HIV infections continue to rise.

The lack of harm reduction programmes in drug policies, particularly needle exchange programmes, is thought to be partly responsible for the surge in infections in this region. However disease prevention experts point out that some of the main people affected across all of Europe are still men who have sex with men.

“The number of HIV diagnoses among this group has increased by 33% compared to 2004 – and has been going up in all but four EU/EEA countries. This is why prevention and control of HIV among men who have sex with men has to be a cornerstone of national HIV programmes across Europe,” explains ECDC Director Marc Sprenger.

Across much of this region there aren’t many programmes designed to specifically target and support the LGBT communities, which can partly be due to societal attitudes towards homosexuality that can make it difficult for to seek treatment. For example a 2009 European Social Survey found that the level of acceptance of the statement “gay men and lesbians should be free to live their own life as they wish” was lowest in former Soviet bloc countries.

A 2012 study looking at the experience of gay HIV positive men in Hungary found that many avoided being discriminated against by keeping their HIV status secret. One interviewee said: “If the whole town knows about my HIV status, then the dentist won’t have me and people will avoid me on the street. … So, I never inform anyone about my HIV status and, even if someone would directly ask about it, I wouldn’t say anything because it is none of their business.”

And researchers found that when the men were required to disclose their status to medics and hospital staff it was then they faced the strongest discrimination, with one nurse telling a patient to wash themselves because “she didn’t know how the disease spread” and even doctors encouraging someone to keep their status a secret.

Experts say the increasing rates of HIV infection and the societal problems that often surround the epidemic can be tackled with effective education campaigns backed up by strong policies and funding for testing and treatment programmes. And what better day to think about the road ahead than today – World AIDS Day – which this year is campaigning under the slogan “Focus, Partner, Achieve: An AIDS Free Generation.”


Free online global health courses

Since leaving London and setting up as a freelancer here in Vienna, I’ll admit that I’ve found myself with much more time on my hands than I’ve been used to. But having this extra time means I can browse the internet at a much more leisurely pace, resulting in the discovery of some fantastic free online resources. This ‘Daily German’ website’s online course has given a great kickstart to my German learning. And just last week I also signed up to this free data journalism course from the European Journalism Centre, starting in January.

Online resources health blog

A keyboard and an internet connection is all you need for an online course!

On a more health related note, health sector professionals in low income countries or working with limited resources might find this online course useful:

http://e.itg.be/demo/escart2014eng/itm.html

Called eSCART, it’s a 4 month distance learning course that aims to provide people with the knowledge they need to treat HIV patients with antiretroviral therapy (ART) in resource limited settings. It’s tutor-led, and also provides access to a discussion forum where those who signed up can discuss their learning with other ‘classmates’. It has 13 modules including an introduction to HIV, HIV and TB, side effects and monitoring and evaluation of an ART programme. Not bad for a free course that just needs an internet connection and a computer with speakers (and a brain connected to it might help too!).

For other free online global health courses check out this handy resource called Global Health elearning. From family planning and childhood development to health logistics and infectious diseases, this is a gold mine for professors or students looking for global health education resources, or just health professionals wanting to bolster their knowledge or train other staff.


Tackling the trade in counterfeit medicines

Last month, I joined Public Health Perspective (PHP) Nepal as a contributing writer. PHP Nepal is a public health online newsletter that publishes articles about health information, ideas and innovation from around the world and I’ve just written my first piece for them on the global pandemic of counterfeit medicines. Pop across to PHP Nepal to find out about some of the interesting technologies being used to tackle this trade:

For countries already struggling under the burden of multiple health problems, counterfeit  and  sub-standard medicines are a dangerous and very unwelcome addition. Although many drugs that get counterfeited are lifestyle drugs, such as Viagra, it is the proliferation of fake anti-malarials and medicines for other infectious diseases in low income countries that can devastate lives… (continue reading on Public Health Perspective Nepal)


Strengthening African health systems with palliative care

Early last month, I was thrilled to hear that an article I wrote for Think Africa Press about access to medicinal opioids had won first place in the APCA Palliative Care Journalism Awards. Part of the fantastic prize was a trip to the APCA and HPCA conference on palliative care in Africa, taking place in Johannesburg. It was a fantastic opportunity to hear stories from people working around the continent and further to get palliative care on political agendas, provide access to pain treatment, and help provide essential palliative care to thousands of patients in need. The first article I’ve written following the conference was about strengthening health systems with palliative care and can be read in full on ehospice:

Often misunderstood as care only for patients at the end of their life, the diversity and breadth of what palliative care can offer African health systems can regularly be overlooked. Other myths, for instance that palliative care is just about relieving physical pain or only takes place in a hospice, mean that the broader benefits of integrating this care into health systems are usually only known by those who provide it.

In fact, from reducing hospital admissions to helping prevent illness, integrated palliative care is uniquely placed to bring many advantages to health systems…(continue reading)


Uganda: No Country for Old Men

It’s cheap, easy to administer, and incredibly effective at taking away someones pain. Morphine, the main medicinal opioid used for pain management and in palliative care, is listed as an essential medicine by the WHO. It should, therefore, be kept in stock by hospices, hospitals and health departments around the world.

But in poorer countries, people are being denied their right to a life without pain because of strict narcotic control laws that prevent the easy importation, production and distribution of opioids. Often coping with weak drug regulatory systems and stretched resources, these countries don’t have the capacity to develop systems that would allow morphine to be imported whilst adhering to the strict international regulations on the distribution of opioids. Coupled with a misunderstanding of morphine by some health professionals due to unfounded fears of patient addiction, access to these essential drugs is limited. It’s estimated that 80% of the world’s population lacks access to this medicine, many of whom live in low and middle income countries. These countries account for 70% of cancer related deaths and 99% of HIV related deaths, yet they consume just 6% of the world’s medicinal opioids.

This award-winning documentary from Declan MacErlane shows how the denial of morphine impacts on people living with cancer and their families in Uganda. Interviewing leaders in the field of palliative care and pain management, Declan also showcases some of the pioneering work being done to change the situation in the country. Watch below and please share far and wide, folks!

Uganda: No Country for Old Men


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