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Trinity College Dublin Centre for Global Health

GLOBAL DETERMINANTS OF HEALTH AND DEVELOPMENT

Course Book February 2010

Course Coordinators Dr Edward Lahiff, Centre for Global Health, Trinity College Dublin

Dr Raúl Pardíñaz-Solís, Skillshare International Ireland

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INTRODUCTION Trinity College School of Medicine, the Centre for Global Health in partnership with Skillshare International Ireland created this course called “Global Determinants of Health and Development”. This is an opportunity for undergraduate medical students at TCD to develop their understanding of emerging health issues in Ireland and their relationship to global health and international development. The module responds to the need to raise awareness of development issues within higher education institutions, and to international benchmarking standards for medical education. Trinity Medical students have a long history of providing service and care in developing countries, over 70% of our 3rd year students are involved either in fundraising activities or in providing direct care in resource-poor settings. We wish to see this energy harnessed to create a life-long commitment to the ethos of Development. In that context this course aims to broaden your perspectives on the factors that contribute to health and disease in a global context, and to equip you with skills to advocate for the effective delivery of health care to disadvantaged communities across the world. The Irish Government has endorsed this work through the program of cooperation between Irish aid and the HEA. It has been designed in partnership between the School of Medicine, The Centre for Global Health at Trinity College Dublin and Skillshare International Ireland; it is interdisciplinary, with contributions from the Schools of Medicine, Psychology, Microbiology, Environmental Engineering, The Centre for Global Health and Skillshare International partners in Africa and Asia. The course is organised as a series of five plenary sessions and four workshops available to each student. Together the sessions combine a model of plenary teaching with small group workshops to facilitate group interaction, problem based learning, and student-directed learning. The course encourages students to be actively involved throughout the module. This course book is designed to provide some guidance on the topics that will be covered, teaching and learning outcomes and assessment processes for all participants in the module – faculty and students. PARTNERS

The School of Medicine TCD

The Mission of the School of medicine at TCD is to facilitate, foster and provide to the highest international standards in

Education and professional training of medical undergraduates and postgraduates. Research, scholarship and publication in peer-reviewed journals in collaboration with

our teaching hospitals and primary care practices. Creation of an infrastructure for development of economic gain in society. Development of the skill of critical appraisal.

The School of Medicine seeks to set international benchmarks in fulfilling this mission whilst emphasising ethical values, responsibility, accountability and deep understanding of deprivation, inequity and bio-psycho-social influences on health and disease at local, national and global levels. The Centre for Global Health is a part of the School of Medicine.

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The Centre for Global Health TCD In analysing Global Health we address health problems and issues that transcend national boundaries, and informed by the circumstances and experiences of countries in differing contexts. Our underlying assumption is that the world's health problems are shared and are best tackled by cooperative action and the sharing of innovative solutions. Based on our existing strengths and experience we have identified the theme of Strengthening Health Systems as a point of synergy. The philosophy of addressing problems shared by high, middle and low resource countries by sharing solutions emphasizes the collaborative nature of the Centre. Our strategy is to build strong collaborative links with universities in high-income countries who have already well-established reputations in international health, as well as universities in the South and East who have developed significant expertise in global health research and are well-respected within their own countries. We also endeavour to provide a focal point for global health activity in Ireland by collaborating with third-level institutions on an all-Ireland basis through the Irish Forum for Global Health. Skillshare International Ireland Skillshare International Ireland is an international development NGO1 based in Dublin, which works to reduce poverty, injustice and inequality and to further economic and social development in partnership with people, local organisations and communities throughout the world. A major part of Skillshare’s work is to support development projects and the recruitment of development workers with transferable skills. Skillshare International Ireland and its sister organisations in the UK, East Africa, Southern Africa and Asia are committed to building understanding of international development issues in the countries where we work, and to that end works in partnership with a variety of education providers and NGOs in this country. Skillshare International staff, returned development workers, Skillshare supporters and medical academic staff will deliver some of the sessions and provide on-going tutorial support.

CONTRIBUTORS

The School of Genetics and Microbiology TCD

The Department of Microbiology, a part of the School of Genetics & Microbiology, is housed in the Moyne Institute of Preventive Medicine on the main TCD campus. Its mission is to progress knowledge related to human and animal health and to the prevention of infectious disease. On a global basis infectious diseases are responsible for the deaths of more people and animals than any other causes. The Department is committed to exploration of the interactions between microbial pathogens and their animal hosts and to advancement of knowledge likely to positively impact on the development of vaccines, diagnostic tools and novel preventive and therapeutic treatments to combat and control infectious and communicable diseases affecting mankind and domestic animals worldwide. The Trinity International Development Initiative TCD The Trinity International Development Initiative (TIDI) is a college-wide initiative, involving all three faculties and multiple disciplines, to coordinate and promote TCD’s expanded engagement with research and education on international development. TIDI achieves this by initiating and supporting research, teaching and outreach activities. TIDI is supported by Irish Aid and the Higher Education Authority through the Programme of Strategic Cooperation between Irish Aid and Higher Education and Research Institutes 2007-2011.

1 NGO – Non Governmental Organisation working in development cooperation

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AIMS AND OBJECTIVES Aim This course ‘Global Determinants of Health and Development’ aims to develop students’ understanding of emerging health issues in Ireland and their relationship with global health issues and international development. Objectives By the end of the course students should be able to:

Discuss the social, economic, cultural and political factors that differentially determine access to health services, and health outcomes, between and within different parts of the world.

Describe the principal factors that result in premature death and excess mortality in disadvantaged communities around the world

Discuss the role of governments, international agencies, NGOs and community based organisations in health provision in developed and developing countries

Explain concepts of access and control in relation to health care in developing countries and for minority groups in Ireland.

Explore concepts of participation and empowerment in relation to community level health provision

Debate the impact of exchange of health workers between Europe, Ireland and developing countries

Reflect on your own attitudes toward development in Ireland, International Development and the role of International Organisations

LEARNING OUTCOMES Knowledge To understand the current health challenges in Ireland in the context of global health inequalities, the approach of different governments to implementation of health systems, and recognition of inter-dependence of global health systems. You will learn about the social, economic and political factors that contribute to global health inequalities. You will study different systems for health care delivery offered by governments including national and international aid packages and secular and religious aid provision. You will learn about the impact of diseases that represent the main causes of morbidity in global terms but may now be encountered in Ireland and Western Europe. By considering the role of people who live in very different societies in shaping the health services they experience, you will enhance your understanding of essential concepts such as patient empowerment, mutuality in the “doctor-patient” relationship and community participation in health care planning.

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In learning about the reasons for insufficient provision of trained health workers to deprived rural and urban communities in developed and developing countries, you will improve your understanding of factors that result in unequal provision of care (the “Inverse Care Law”). Many of these concepts can be applied equally to developing and developed health care systems. You will also learn about the role of governmental and non-governmental services that exist to support health care delivery Skills Within the workshops students will develop communication skills appropriate to diverse cultural settings, and for working alongside people with different lifestyles and approaches to health care provision. You will be encouraged to practice cross-cultural teamwork and strategies, to apply skills in resource poor settings, thus enhancing your ability to identify new ways to provide treatment within disadvantaged communities. Health care is mainly delivered by small teams of individuals. The course programme and evaluation is dependent on working within small groups. We will monitor the operation of the small groups during the course and provide appropriate support and guidance. The assessment of the course involves formal self reflective evaluation and poster design and presentation; this will enhance your experience and skills in using these methods of communication. Attitudes and Values The course challenges you to consider your attitudes towards patients as individuals, communities and health care delivery systems. We are explicit about our personal commitment to health care provision, and the importance of valuing the contribution of individual patients and communities in improving access to health benefits However, you will be encouraged to challenge these attitudes and to examine the evidence that such values do produce better health outcomes. You will be expected to consider your own values at the start of the course and to consider whether these have changed as a result of studying it. Institutional Credits: This module is awarded ECTS credits as part of the 15 credit assignment to Medicine, Medical Gerontology and Global Determinants of Health and Development

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GLOBAL DETERMINANTS OF HEALTH AND DEVELOPMENT Course Timetable: February 2010

Day 1: Introduction and Keynote. Thursday 4 February. Venue: Trinity Centre RSLT, St James’s Hospital 2.00pm – 2.15pm

Introduction Dr Martina Hennessy

RSLT 2.15pm – 3.00pm

Overview of Global Health / Understanding Development Dr Edward Lahiff and Dr Raúl Pardíñaz-Solís

RSLT Break (15 min)

3.15pm – 4.15pm

Keynote speech: Geoff Loane, ICRC Challenges to humanitarian assistance provision in armed conflict

RSLT Presentation course mechanics, Pre-Attitude Questionnaire and allocation to workshops

RSLT 4.15pm – 5.00pm Group A Group B Group C Group D

Day 2: Monday 8 February. Venue: Trinity Centre, St James’s Hospital 2.00pm – 3.00pm

Plenary Session 1 Malaria Control: From the Parasites to the Politics

Dr Andrew Collins (UCC) RSLT

Break and split into workshops (15 min) Workshop 1

Health Workers Migration – role of

NGOs Leader:

Dr Raúl Pardíñaz-Solís Tutor:

Dr Laura Madrigal

Workshop 2 Climate Change

Impact on Health and Indigenous

Communities

Leader: Julie George

Tutor: Dr Margaret Dunne

Workshop 3 Immunisation: The Politics of Health

Leaders:

Dr John Jackson Dr Derek Doherty

Workshop 4 Malaria: A Case Study of Drug Development,

Deployment and Delivery for a Global

Disease

Leader: Dr Angus Bell

Tutors: Dr Uzma Siddiqui Ms Ola Owojori

3.15pm –5.15pm

Group A RSLT

Group B WMLT

Group C WHSR

Group D 1.53

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GLOBAL DETERMINANTS HEALTH AND DEVELOPMENT Course Timetable 2010

Day 3: Tuesday 9 February (afternoon), Venue: Trinity Centre, St James’s Hospital, WMLT

1.00pm – 2.15pm

Plenary Session 2 Climate Change and Global Health

Julie George (Skillshare)

Climate change potential impacts in the tropics Dr Alison Donnelly (TCD)



NGOs Leader:


Dr Laura Madrigal



Communities




Leaders:




Disease



2.30pm – 4.30pm

Group B 3.51 (Radiation

Therapy)

Group C WMLT

Group D 1.53

Group A DSPSR

Day 4: Wednesday 10 February. Venue: Trinity Centre, AMNCH (Tallaght)

1.00pm –2.30pm

Plenary Session 3

Stefanie Meredith: Global Partnerships for Health - Access to Medicines Prof Sam McConkey (RCSI): Health Systems in Developing countries

TRINITY LT Break and split into workshops (15 min)

Workshop 1 Health Workers

Migration – role of NGOs

Leader: Dr Raúl Pardíñaz-

Solís Tutor:

Dr Laura Madrigal



Communities




Leaders:




Disease



2.45pm – 4.45pm

Group C ED LT

Group D SEM ROOM 3

Group A TRINITY LT

Group B SEM ROOM 4

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Day 5: Thursday 11 February. Venue: Trinity Centre, St James’s Hospital, RSLT

1.30pm – 2.45pm

Plenary Session 4 Eilish McAuliffe (CGH),

"Is Globalisation good for your health?"

Dr Raúl Pardíñaz-Solís, Health Workers Migration: A Pervasive Subsidy



NGOs Leader:


Dr Laura Madrigal



Communities




Leaders:




Disease



3.00pm – 5.00pm

Group D WMLT

Group A 1.53

Group B RSLT

Group C DSPSR

Day 6: Friday 12 February (afternoon), Venue: Trinity Centre, AMNCH (Tallaght)

Pre-selected Workshops SEMINAR ROOMS 1, 2, 3 AND 4

Workshop 1

Discussion of projects with tutors

Leader:


Dr Laura Madrigal

Workshop 2

Climate Change Impact on Health and

Indigenous Communities

Leader:

Julie George Dr Margaret Dunne

Workshop 3


Leaders:


Workshop 4


Leader:

Dr Angus Bell Tutors:

Dr Uzma Siddiqui Ms Ola Owojori

1.00pm – 1.45pm

Group 1 SEM ROOM 1

Group 2 SEM ROOM 2

Group 3 SEM ROOM 3

Group 4 SEM ROOM 4

Coffee Break (10 min) 2.00pm – 3.00pm

Global Health Video Conference One Health for All

Dr Tito Fernandes, Mozambique TRINITY LT

3.15pm – 4.30pm

Plenary Session 5 NGOs in Global Health

Panel from: Skillshare, MSF, Concern TRINITY LT

4.30pm – 5.00pm

Closing Plenary Session, Evaluation and Post-Attitude Questionnaire Dr Raúl Pardíñaz-Solís and Dr Edward Lahiff

TRINITY LT

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PLENARY - SPECIFIC LEARNING OBJECTIVES Introduction Overview of Global Health / Understanding Development Dr Edward Lahiff Dr Raúl Pardíñaz-Solís

To identify the difference between global health, international health and the global determinants of health To identify different notions of development – livelihood approaches and human development capabilities.

Plenary 1 Combating Malaria Dr. Andrew Collins Dr. Angus Bell

To familiarise with the current problems to eradicate some tropical diseases such as Malaria To identify the economic, political and environmental factors that influence Malaria control To identify the socio economic factors that limited the eradication of Malaria

Plenary 2 Climate Change and Global Health Ms Julie George Dr Alison Donnelly

To understand links between climate change and health To identify the impact of climate change in different

communities particularly for people living in poverty & socially excluded

To understand the difficulties in international consensus on climate change measures – non-inclusive mitigation strategies;

Plenary 3 Global Partnerships for Health – Access to Medicines Dr Stefanie Meredith Prof Sam McConkey

To identify the multifaceted challenges to quality health and medicines in developing countries To familiarise with the public private partnerships as a mechanism to address diseases of the poor in developing countries The different categories of public private partnerships, Global Health Partnerships and financing mechanisms

Plenary 4 Health Workers Migration: a Pervasive Subsidy. Dr. Eilish McAuliffe Dr R Pardíñaz-Solís

To identify the problem: causes & consequences of migration in the health sector

To recognise the power relation and un fair subsidy from poor to rich countries with human capital

Plenary 5 NGOs in Global Health Panel: Representatives from Skillshare, MSF, Concern

To identify different development intervention; emergency relief, mid and long term development

To familiarize with the positive and negative role and impact of NGOs in developing countries

To explore different career paths for health workers in international development

Videoconference One Health for All Professor Tito Fernandes, Universidade Lúrio, FCS, Nampula, Mozambique

To familiarize with the concept of “one health” To understand the interaction between human, environment and animals to achieve good health for all To identify the challenges and opportunities for human rights enforcement in Mozambique

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WORKSHOPS SPECIFIC LEARNING OBJECTIVES

Workshop 1 Health Workers Migration – the role of NGOs Dr Raúl Pardíñaz-Solís Dr Laura Madrigal

Identify the problem: causes & consequences Recognise some facts about HW migration in

NGOs Introduce you to some solutions that demand a

global partnership

Workshop 2 Climate Change Impact upon Tribal communities health in India Julie George

Understand links between climate change and health for tribal communities

Understand that people living in poverty & socially excluded are most vulnerable to the effects of climate change

Understand the difficulties in international consensus on climate change measures – non-inclusive mitigation strategies;

Develop a commitment to future action;

Workshop 3 Immunization: The Politics of Health Dr John Jackson Dr Derek Doherty

To understand the role of immunisation in global health provision To understand the political, cultural, financial and biological barriers to disease eradication using polio as an example To identify potential solutions to ineffective vaccine uptake

Workshop 4 Malaria: A Case Study of Drug Development, Deployment and Delivery for a Global Disease Dr Angus Bell Dr Uzma Siddiqui Ms Ola Owojori

Explain the major issues in antimalarial treatment and the properties of ACTs. Draw up a list of minimum requirements for a new antimalarial drug and explain how meeting these requirements can be integrated into the process of new drug development. To differentiate between antimalarial drug policy (at the national and international levels) and the practices in place (at the community and local levels). Analyse and describe policies and practices and suggest ways to combine them (and even participate in decision making) while keeping in mind the realities 'on the ground'. Describe different ways in which antimalarial drugs can be delivered to the people who need them.

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WORKSHOPS DESCRIPTIONS

Workshop 1 Health Workers Migration, the role of NGOs Human migration is part of humanity; however, while applying this to the current context of international development, the increasing inequality among communities and countries and the fact that developing countries are financing developed countries through the current trade agreements, capital flow and skill global workforce, then these are some points for reflection considers: Highly internationalised workforce in health Highly demanded skills – globally value Increasing crisis in poor countries especially in Sub Sahara African Poorly researched & documented; polarised views; human rights vs. shortage of highly

qualify workforce and equality debate Strong tensions thrown up by most policy solutions Migration itself is not a problem, it brings benefit for individuals and communities with capital gain among communities that are part of the migration patterns. It only becomes a problem when it leads to gaps in human capital or to over saturated human capital in particular area and field. Migration is not the ‘problem’, but a self-perpetuating result of problems. These are commonly framed as ‘push’ and ‘pull’ factors, but this is too normative. Instead consider them as inequality driving by huge differentials in working and living conditions that exist between communities at local, national and international level. Workshop 2 Climate Change Impact on Health and Indigenous Communities In this workshop students are expected to become more aware of the status of socially excluded tribal communities, understand the impact of climate change on their livelihoods and the resulting vulnerability to poor health. The workshop also aims to facilitate proactive thinking by the students by analysing the current situation and for making personal commitments for future actions aimed at enhancing the quality of health & life of some of the poorest communities in the world. The 78 million strong tribal community in India is the most dependent on natural resources especially land, water & forests. Livelihoods are disappearing, migration has increased manifold and poverty has worsened. The result is a vicious cycle of poverty, ill health, malnutrition and more poverty. Severe variations in weather patterns, temperatures and crop behaviour are leading to an increase in water-borne diseases, malnutrition and other chronic illnesses and not strangely worsening poverty & maladjustments are increasing levels of mental illnesses and suicides. Vector-borne diseases will stay longer and will more negatively impact resource–poor communities already lacking access to health care services, worsening the morbidity and mortality rates especially among under fives and pregnant & lactating women. Workshop 3 Immunisation: The Politics of Health Immunisation is arguably the greatest advance in medicine and we now have effective vaccines against many infectious agents and have succeeded in eradicating them from the Western World. However, many of these preventable diseases remain endemic in less

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developed countries. In this workshop, we will explore the political, cultural, financial and biological barriers to disease eradication in less developed countries, using polio as an example. Two types of polio vaccine have been developed and in 1988 the World Health Assembly passed a resolution to eradicate polio by the year 2000. At this time, 350,000 cases of polio were known worldwide and through a series of immunisation programs, this number was reduced to less than 500 in 2001, however, it has risen steadily since and today, polio remains endemic in four countries (India, Pakistan, Afghanistan and Nigeria) with cases reported in many other countries including Europe and North America. The aim of this workshop is to understand the barriers to polio vaccine uptake and to identify potential solutions to the problems. Workshop 4 Malaria: A Case Study of Drug Development, Deployment and Delivery for a Global Disease The impact of malaria worldwide exceeds that of any other communicable disease with the possible except of tuberculosis and AIDS. The malaria burden falls disproportionately on developing countries, especially in sub-Saharan Africa. Drugs are a mainstay of both prevention and treatment of this disease and in this workshop we shall review the antimalarial drugs in use and the emergence of artemisinin combination therapies (ACTs) as the drugs of choice. We shall also explore the development of new drugs using an approach that takes more account of the requirements of the end-user at an early stage. The recommended treatment options and the way in which ACTs and other drugs are deployed is however crucial if patients are to benefit from the drugs available, and we shall also explore different deployment paradigms. Finally, there are serious problems of access to drugs by those who need them most and we shall contrast the abilities of public and private models of drug distribution and delivery to achieve this goal.

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COURSE MANAGEMENT, SUPPORT AND FACULTY Course Coordinators Dr Edward Lahiff Coordinator International Doctorate in Global Health

Centre for Global Health, Trinity College Dublin Tel: +353-1-896-4177 Email: [email protected]

Dr Raúl Pardíñaz-Solís

Skillshare International Ireland Dominick Court, Dublin 1, Ireland Tel: + 353 (1) 874 8188 and Fax: + 353 (1) 874 8960 Skype - rpardinazsolis Email: [email protected]

Course Tutors Dr Laura Madrigal School of Medicine TCD (Education Division)

Email: [email protected]

Dr Uzma Abid Siddiqui School of Medicine TCD (Education Division) Email: [email protected]

Ms Ola Owojori School of Medicine TCD (Education Division) Email: [email protected]

Course Administrator Ms Brighde Gallagher

Administrative Officer, School of Medicine TCD, Curriculum Administration, phone: +353 1 896 3069, email: [email protected]

School of Medicine, TCD Dr Martina Hennessy Senior Lecturer Consultant Medical Education Dr Matthew Phillips Clinical Lecturer in Medical Education, SpR in Genitourinary

& HIV Medicine

SPEAKER PROFILES

Geoff Loane. Geoff Loane is a graduate of the University of Dublin, Trinity College, Mr Loane is Head of Mission for the International Committee of the Red Cross (ICRC) in London where he manages relations with the UK government and other stakeholders involved in humanitarian work in armed conflict. He was Head of the ICRC Regional Delegation for United States and Canada for five years. In this capacity, he oversaw ICRC visits to the detention facility in Guantanamo Bay, Cuba and was responsible for working relationships with the Governments of the United States and Canada. Mr. Loane has also worked in the Balkans and the Middle East, and spent more than a decade in the Horn of Africa during the major conflicts there. These included Ethiopia, Sudan, Somalia, and Rwanda. He has served as the Head of the Emergency Unit at ICRC headquarters in Geneva. Mr. Loane has published books on the unintended consequences of humanitarian assistance and has conducted extensive field research in assistance operations. He was a senior scholar for the Conflict Prevention Network in Berlin where he

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prepared a number of research papers for the European Commission. He has organized and managed an emergency roster of personnel on behalf of the Irish government. Contact details: Head of Mission for the International Committee of the Red Cross (ICRC) in London Professor Tito Fernandes. Is a renown academic, professor Mozambican Higher Education expert, has degrees from Lisbon, Newcastle-upon-Tyne (MSc, PhD), 6 Honoris causa, President of EAEVE (93 Universities of 35 European Countries), evaluated over 100 Universities in Europe, South America, Middle East and Africa. Founder member of European Programmes which originated the Bologna Process, the ENQA Agency for Quality Assurance in HE in Europe, EC Advisor for 2 decades, EFSA member of the Scientific Committee. As Nutritionist, field of R&D involves the knowledge of nutrients as immunomodulators. Contact details:Universidade Lúrio, Nampula, Mozambique Dr John Jackson. Dr Jackson is a Senior Lecturer in Clinical Immunology and Chief Medical Scientist in Immunology at St James hospital Dublin. He has lectured widely on many aspects of clinical immunology at undergraduate and postgraduate level. His research interests include regulation of inflammatory processes and autoimmune disorders. Contact Details: Senior Lecturer and Immunologist, Department of Immunology, Trinity Centre for Health Sciences, St James’s Hospital. Email: [email protected] Dr Derek Doherty. Dr Doherty is a Lecturer in Clinical Immunology in Trinity College Dublin at St. James’s Hospital. A founder partner of the Combat Diseases of Poverty Consortium, he has a long-standing interest in global health and development. His research interests focus on the mechanisms by which the immune system can selectively respond to different types of infectious agents and tumours and how it sometimes fails or responds inappropriately, causing autoimmune and allergic disease. Central to immune regulation are populations of “innate lymphocytes” that provide early signals for the activation of diverse immune effector mechanisms. Derek’s group is currently investigating how these cells can be manipulated for the design of improved vaccines and therapies, focussing on infectious and autoimmune diseases of the liver and liver cancer. Contact details: Senior Lecturer and Immunologist, Department of Immunology, Trinity Centre for Health Sciences St James’s Hospital. Email: [email protected] Dr Angus Bell Dr Bell trained at the Universities of Edinburgh, British Columbia and Basle and is currently a Senior lecturer in Microbiology and Fellow at Trinity College. His research interests focus on malaria, especially the biochemistry and molecular cell biology of erythrocytic stages of the most virulent human malarial parasite, Plasmodium falciparum, mechanisms of action of and resistance to antimalarial agents, and new antimalarial drug design. His laboratory is the largest malaria research group in Ireland. His major collaborators outside Ireland are in the U.K., U.S.A., France and Kenya. Contact details: Senior Lecturer Microbiologist, School of Microbiology and Genetics, Moyne Institute, Trinity College. Email: [email protected]

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Stefanie Meredith Dr. Stefanie Meredith is a consultant in global health, currently working on issues of access to medicines, quality control of medicines and pharmaco-vigilance. She was formally director of public heath partnerships at IFPMA (International Federation of Pharmaceutical Manufactures and Associations). She has a strong academic and technical background with more than 15 years of experience in program design, implementation and management focusing on tropical public health interventions in Africa as well as field and laboratory research experience in endemic research institutes and national health programs and her research focused on filariasis, leishmaniasis and malaria. Formally the director of the Mectizan Donation program, she also worked as a consultant in a variety of different areas as diverse as immunization, injection safety, monitoring and evaluation of HIV/AIDS treatment programmes and public private partnerships Dr. Andrew Collins. Andrew Collins is a General Practitioner and part time lecturer at the department of Epidemiology and Public Health of University College Cork. He has over a decade of experience working in communicable disease control in Africa holding clinical and public health positions. He has worked at various levels of the health system in Uganda from front line to working closely with the Ministry of Health. From 2003 t0 2007, he was Deputy Director and Case Management specialist of the Malaria Consortium Africa, an International NGO specialising in malaria, tuberculosis and other communicable disease control. Here, he was responsible for coordinating a large multicountry health systems strengthening programme for malaria and communicable disease control. This programme involved working closely with national and local governments as well as UNICEF and WHO in five countries in East and Southern Africa. He holds a Masters Degree in Tropical Medicine and International Health from the London School of Hygiene and Tropical Medicine. Prof Sam McConkey. Samuel J. McConkey is Associate Professor and Head of Department at the Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland and Consultant in Infectious Disease and Tropical Medicine, Beaumont Hospital, Dublin, and Consultant in Tropical Medicine, Our Lady of Lourdes Hospital, Drogheda. From 2005 to 2007he was Head of Viral Disease Research Programme, MRC Laboratories The Gambia, seconded from Nuffield Department of Clinical Medicine, University of Oxford. His research is largely in the areas of HIV and Aids, and malaria, particularly in Africa. Prof McConkey many qualifications include Doctor of Medicine, Trinity College, Dublin, Ireland, Master of Arts (Mathematics, Statistics), Washington University, St. Louis, Missouri, USA, and Diploma in Tropical Medicine and Hygiene, Liverpool. He is a member of numerous professional societies and associations, including Fellow of Royal College of Physicians in London, Fellow of Royal College of Physicians of Ireland, Fellow of the Royal Society of Tropical Medicine and Hygiene, Member of American Society of Tropical Medicine and Member of American Association for the Advancement of Science. Eilish McAuliffe. Eilish McAuliffe is Director of the Centre for Global Health and Senior Lecturer in Health Policy and Management, Trinity College Dublin. Her research is on strengthening health systems in middle and low-income countries, with a particular focus on the human resource crisis and maternal health. She has also made a substantial contribution to issues such as public ownership of health, public and user involvement in health planning, organisational change and organisational strategy. She has contributed to books and published in high impact peer reviewed journals on these issues. Previously, Eilish worked at the Centre for Social Research, University of Malawi where she specialised in research on HIV/AIDS focusing particularly on vulnerable and at risk women and youth. She has also provided a wide range of consultancy

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support to governments, NGOs and professional healthcare bodies and has contributed to numerous strategy and policy documents in healthcare in both high and low-income countries. Contact details: Director of the Centre for Global Health at School of Medicine, Trinity College Dublin. Julie George Julie, an Indian by birth, is the Programme Director of Skillshare International, for India and Nepal. A social activist for nearly 30 years, her experience in the social development sector ranges from working and living with some of the most disadvantaged and socially excluded communities, to building and managing several NGOs, advising the UN on gender & development, working with UNIFEM’s South Asia Office for socio economically & politically empowering women in the SAARC region, and working with INGOS like OXFAM and Skillshare International. Julie has a basic degree in nursing, an MBA with specialization in rural management, finance and marketing; besides she had also been trained to be a Development Worker (volunteer) through a specialized one-year course on social development work. She focuses on making systemic changes through policy advocacy at varying levels, by building community skills to demand constitutional guarantees & human rights and by sensitizing those who can make a difference to the lives of the excluded communities especially women and children. Contact details: Programme Director of Skillshare International in India and Nepal, New Delhi, India. [email protected] Dr Raúl Pardíñaz-Solís Raul is a Mexican educationalist, with a wide international experience from Mexico, USA and Europe, working in different capacities as teacher, researcher, lecturer, and development worker. His professional interests focus in particular on citizenship, global education, development education and management. Before working in Europe Raúl had a senior post in Mexico City Government. Over the last seven years he has contributed to development education and global health education in the UK and in the last 5 years to similar debates in development education in Ireland, Portugal, Sweden and Austria. His research interest focuses on management and leadership for transformational education and teaching and learning in global health education and development education at higher education level. Dr Edward Lahiff Edward Lahiff is the Coordinator of the International Doctoral School in Global Health at the Centre for Global Health, Trinity College, Dublin. He received his PhD in Development Studies from the School of Oriental and African Studies at the University of London in 1997. He spent ten years in southern Africa working with rural NGOs and, latterly, as Senior Lecturer in Land and Agrarian Studies at the University of the Western Cape. In February 2009 he was appointed Doctoral Programme Officer with the Trinity International Development Initiative (TID) and Coordinator of the International Doctoral School in Global Health at the Centre for Global Health, Trinity College Dublin. Dr Lahiff has published widely on rural development in southern Africa. He is currently engaged in capacity building partnerships with a number of universities in Africa. Sarah Lee Sarah Lee is an Australian occupational therapist currently living in Waterford. She graduated from The University of Newcastle, Australia in 1999. Since then she has worked in a clinical capacity with adults and children with physical disabilities to assist them to achieve and maintain independence in activities of daily life and optimise quality of life. In 2004-2005 Sarah worked in Moshi, Tanzania as a health trainer for Skillshare International. Her role involved training occupational therapy students at Tumaini University and working clinically with clients in Kilimanjaro Christian Medical Centre.

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Sarah currently works as the CPD officer for AOTI (The Association of Occupational Therapists of Ireland). Alison Donnelly Alison Donnelly is a research lecturer at the Centre for the Environment in the School of Natural Sciences which is located on Trinity College’s main campus. She leads the Phenology Research Group, which is investigating the impact of climate change, in particular rising spring temperatures, on life-cycle events in plants and animals through a large-scale EPA-funded project. She also collaborates on the EU FP7 BRIDGE (Sustainable urban planning decision support accounting for urban metabolism) project. She is currently a member of the Royal Irish Academy's Climate Change Sciences Committee. Prior to this she was a research fellow and was involved in developing environmental indicators for use in (a) Strategic Environmental Assessment and (b) climate change. Alison taught the Botany Broad Curriculum course ‘Global Environmental Change’ in 2007/8.

Dr. Rosalyn Tamming Rosalyn Tamming began her career in international health as a nurse-midwife with Concern Worldwide. She spent three years in health and nutrition programmes in emergency and development contexts in many countries in Sub-Saharan Africa. This was followed by a Masters in Community Health and a PhD in Health Services Research in Trinity. She then worked for almost four years as an epidemiologist at the Centers for Disease Control and Prevention spending the first two years on the Epidemic Intelligence Service programme and then specializing in research and promotion of Hib and Pneumococcal Vaccines for children in developing countries. She then spent a year at the London School of Hygiene and Tropical Medicine working in the same area before taking up a joint position in late 2008 as Head of the Health Support Unit in Concern Worldwide and as Adjunct Lecturer in Global Health in the Centre for Global Health in Trinity.

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ASSESSMENT PORTFOLIO

There are three components to the assessment portfolio in the course: Anonymous attitude survey (pre – and post-course), Reflective Self Evaluation, and Poster Presentation. Anonymous Attitude – Knowledge Survey The survey is completely anonymous, it will be used only for research purposes to assess the course effectiveness and its impact upon students knowledge and attitudes. It will not be used to assess individual students in the course. The survey will be administered at the beginning and at the end of the course in a paper format (pre-post questionnaire). It is essential that all students complete the pre and post questionnaire and clearly indicate their student ID number and consent to use the result for research purposes. Your ID number will be used by Skillshare International only to match the pre and post questionnaires, and will not be shared with the School of Medicine TCD. The individual responses thus cannot be tracked back by the School of Medicine to your student number. The overall anonymous result will be forwarded to the School of Medicine as part of the assessment portfolio for this course. The Reflective Self Evaluation Every student undertaking the course is required to write a personal reflective evaluation of 600-700 words maximum. This should be handed to the School of Medicine office for evaluation within 2 weeks of completing the module – i.e. by 5pm on Friday 26th February 2010. This is accessible via on-line facility at Skillshare website www.skillshare.ie When planning your reflective piece you should consider the learning objectives of the course. In writing this reflection you should reflect upon what you feel you have achieved in this course, show any particular knowledge or view/perspectives you have acquired as a result of the course activities, and explain if this has a meaning and value to you as medical student and for your future career. You must also tell us if this course has improved your understanding of global health issues and how they relate to individuals and communities both in Ireland and abroad. Finally you will need to explain if your attitudes towards development have changed, or remained the same after taking the course. Poster Presentations The poster presentation must be related to a research topic chosen by a group of students. A list of possible topics is provided below. Topics are grouped loosely around workshop and plenary themes. Immunization: The Politics of Health

1. HIV awareness work with young people is ineffective without tackling gender inequalities.

2. Immunology solutions (vaccines) are a political not a health problem. 3. Immunisation against common preventable diseases should be compulsory for all

children. 4. All remaining laboratory stocks of smallpox virus should be destroyed. 5. Money spent on developing a vaccine against HIV would be better spent on educational

programmes. 6. The majority of research developments in medicine are irrelevant to developing nations 7. BCG immunisation for the prevention of human tuberculosis should be abandoned. 8. Payments to living donors in the developing world for transplantable organs is an

acceptable solution to the chronic organ shortage existing in organ transplant programmes.

19

A Case Study of Drug Development, Deployment and Delivery for a Global Disease 9. Supplying free anti-retroviral drugs to all HIV positive people in Africa would be a cost

effective solution to the AIDS crisis. 10. Western pharmaceutical companies support health care provision by devising drugs for

common diseases of developing countries 11. Physicians should be prevented from accepting any material benefits from the

pharmaceutical industry. 12. Money for malaria control spent on deployment and delivery of existing drugs,

insecticides and bed-nets is useless without a vaccine. 13. Where resources are scarce, men should be given priority over women (pregnant or

not) and children in receiving anti-malarial preventive treatment. 14. Policies for malaria should be focussing on parasite/vector control. 15. The public sector can distribute cheaper and more anti malarial drugs to the people

than the private sector. Health Workers Migration – The poor financing the rich

16. Health workers from overseas are exposed to cultural misunderstanding when working with patients from disadvantage communities in Ireland.

17. HIV-AIDS is a disease of poverty as much as an infection. 18. Changing demographic patterns in Ireland in recent years have created great

challenges for the Irish health system and health workers. 19. The Irish health system employs small numbers of health workers from developing

countries and therefore does not contribute to “brain-drain”. 20. Health workers migration benefits both sending and receiving countries and should be

encouraged rather than discouraged. 21. Without addressing the pull factors from rich countries migration of health workers will

always be negative for the poorer communities. 22. Ireland experiences ‘brain drain’ of health workers and in the current financial situation

this is likely to increase. Climate Change and Health

23. High patterns of consumption in high-income countries play a major role in worsening the poverty of people in low-income countries.

24. Deforestation, destruction of biodiversity and indiscriminate industrialisation is the result of modernity in developing countries.

25. Global warming and its impact on the lives of the rural poor has consequences for both developed and developing countries.

26. Climate change is directly or indirectly contributing to the increase of poverty, food insecurity and morbidity/mortality among resource-poor communities.

27. Leaders in most communities worldwide, such as teachers, lawyers and medical professionals can play a major role in influencing public thinking towards the impact of climate change on disadvantaged communities.

28. Climate change may not be entirely a human made phenomenon; however we do have responsibility to counteract its adverse effects.

Conflict and Health

29. At the end of a violent conflict, trauma healing should come before social reconstruction 30. Without successfully addressing wounds of trauma, today’s aggressors become

tomorrow’s perpetrators. 31. Conflict prone societies report higher levels of nutrition-related illnesses than those that

are peaceful NGOs in Global Health

32. NGOs represent “colonialism with a human face” 33. Most deaths from disease in developing countries could be prevented by the provision

of clean drinking water 34. Improvements in global health will require a radical re-distribution of the world’s wealth

20

The topics offered are in the form of a statement, which takes a clear stance on an issue. In the research you are free to support, oppose or to present a balanced view. Students do not have to agree with the opinions of the course leaders or the speakers. What we are looking for is a poster that presents a well reasoned argument, supported by facts, that presents its result in a poster suitable to a professional audience. Posters will be presented at on the same day as the evidence based medicine presentations. Student groups will need to be available to discuss and defend their posters to the assessors on April 8th 2010. Developing your Poster – Guidelines for Students Regardless of the topic the research for your poster it must address common aims. Explicit criteria are provided for evaluating the poster, which will be double marked by the Course Co-ordinators. This poster will contribute 60% of your mark towards the Faculty code grades of “Excellent, Good, Satisfactory, Borderline or Fail”. Your poster should demonstrate that you have addressed the aim and objectives of the Global Determinants of Health and Development course. Your poster should be based on your own research of the selected topic and this should be developed in small groups (typically of 5-7 people). The groups you are in will be allocated at the beginning of the course by the course organisers. A list of topics is provided (above), and topics will be allocated to groups on a first-come first-served basis, so you should make your choice of topic within your group and inform the course organiser no later than 10pm on Wednesday 11 February 2010. Alternative topics (not on the list) can be proposed but must be agreed in advance with the course organisers. Your poster will be presented on poster boards on the morning of the evidence based medicine presentations (April 8 2010), the venue for which will be confirmed shortly. The posters may not be removed until the end of the day. Full attendance is mandatory at this session and an attendance list will be taken. Plagiarism Students should take care to acknowledge their sources and avoid plagiarism in their work. Plagiarism is interpreted by the University as the act of presenting the work of others as one's own work without acknowledgement, and as such, is considered to be academically fraudulent. The University considers plagiarism to be a major offence, and it is subject to the disciplinary procedures of the University. The University's full statement on plagiarism is set out in the University Calendar, Part I, 'General Regulations and Information', II, Academic progress, §63 - §71. College has a university wide subscription to a software service called "Turnitin". Turnitin automatically compares the submitted documents with a databank of web accessible resources.

21

RESOURCES AND INFORMATION SERVICES

Skillshare International Ireland Website: www.skillshare.ie and www.skillshare.org Please contact Dr Raúl Pardíñaz-Solis for any information resources Trinity College Dublin Medical Libraries and Libraries on the main University Campus and at the two main teaching hospitals

St James's Hospital (John Stearne Medical Library) Adelaide and Meath Hospital, Dublin incorporating the National Children's Hospital

(AMNCH) at Tallaght (for Trinity College Centre for Health Sciences) Irish Government and United Nations Irish Aid: Irish Aid is the Government of Ireland’s programme of assistance to developing countries. The website includes information about the goals of the organisation, events and initiatives run by Irish Aid and links to other health and development organisations. Also known as the Development Corporation Ireland (DCI). www.irishaid.ie The World Health Organisation: The World Health Organisation website includes references to key global health challenges and country-by-country information on health issues and health systems. www.who.int UNAIDS: The joint United Nations programme on HIV/AIDS website holds information on international level initiatives to counter AIDS. www.unaids.org UNDP: United Nations Development Programme website includes information on the Millennium Development Goals (MDGs), the annual Human Development Report and areas and programmes of development work done by the UN. www.undp.org Irish Non-Governmental Organisations Concern Worldwide: Concern Worldwide is an international humanitarian organisation dedicated to reducing suffering and ending extreme poverty. http://www.concern.net/ Dochas: Dóchas is the association of Irish Non-Governmental Development Organisations- A network of Irish Development NGOs. Dochas website has links to Irish NGOs and information on development issues for Ireland. www.dochas.ie Comhlámh (pronounced ‘co-law-ve', Irish for ‘solidarity') is a member and supporter organisation open to anyone interested in social justice, human rights and global development issues. Marking its 34th year in 2009, it connects, informs, educates and campaigns on these matters. Comhlámh (which means "Link Hands" or "Solidarity") has activist groups and initiatives made up of volunteers from the public in the areas of Trade Justice, Anti-Racism, Focus magazine and Options and Issues in Development and we run regular courses and training workshops for the public and development workers alike. www.comhlamh.org

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Trócaire. Trócaire is the official overseas development agency of the Catholic Church in Ireland. http://www.trocaire.org/ The Africa Centre, Dublin: Dublin-based organisation that runs a number of schemes and programmes promoting links between communities in Ireland and Africa and aims to improve the welfare of African immigrants living in Ireland. www.africacentre.ie Goal (Ireland): Irish overseas development and aid organisation working to alleviate poverty, respond to international crises, improve health and promote social change in developing countries. Goal website has links to partner agencies and information on development projects. www.goal.ie IDEA : Irish Development Education Association (IDEA) is an association of organisations and individuals involved in the provision, promotion or advancement of development education throughout the island of Ireland. We have a vision of development education which is strong, credible and vibrant and impacts on all sectors of Irish society. www.ideaonline.ie

Oxfam Ireland: Oxfam Ireland works with people around the world to end the injustice of poverty. It is an independent and secular not-for-profit organisation. Oxfam Ireland is a member of Oxfam International, a confederation of thirteen independent members. The members work together to achieve greater impact by their collective efforts. www.oxfamireland.org

Campaigning Organisations International Society for Equity in Health: ISEqH was formed to promote equality in health and health services internationally through education, research, publication, communication and charitable support. www.iseqh.org Whirled Bank: A site established to criticise and parody the World Bank, and to offer alternative strategies to promoting development. www.whirledbank.org LifeOnline: Provides information to audiences around the world about the impact of globalisation on the poverty and social development agenda of the World Summit on Sustainable Development in Johannesburg. www.lifeonline.org The Bretton Woods Project: The Bretton Woods Project is a resource for independent and critical information on the activities of the World Bank and International Monetary Fund. www.brettonwoodsproject.org Baby Milk Action: Baby Milk Action is a non-profit organisation which aims to save lives and to end the avoidable suffering caused by inappropriate infant feeding. Baby Milk Action works within a global network to strengthen independent, transparent and effective controls on the marketing of the baby feeding industry. www.babymilkaction.org Other International Non-Governmental Organisations OneWorld: OneWorld is an online community of over 1250 organisations working for social justice. The searchable website includes information on key development issues. www.oneworld.net Médecins Sans Frontières: is an independent humanitarian medical aid agency committed to two objectives: providing medical aid, wherever needed regardless of race, religion, politics or sex and raising awareness of the plight of the people it helps. www.msf.org

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The International Committee of the Red Cross (ICRC): this was founded nearly a century and a half ago. It seeks to preserve a measure of humanity in the midst of war. Its guiding principle is that even in war there are limits: limits on how warfare is conducted and limits on how combatants behave. The set of rules that were established with this in mind and endorsed by Geneva Conventions are the bedrock of the organisation. www.icrs.org The Aga Khan Development Network: is a group of development agencies working in health, education, culture and rural and economic development, primarily in Asia and Africa. www.akdn.org Healthlink Worldwide: Works to improve the health of poor and vulnerable communities by strengthening the provision, use and impact of information. http://www.healthlink.org.uk/ International HIV Alliance: A global partnership of nationally-based organisations working to support community action on AIDS in developing countries. Website has good information on global HIV/AIDS issues and links to other international health organisations. www.aidsalliance.org International Health Medical Education Consortium: American website includes directory of internet based resources for international health. http://www.ihmec.org/ Journals and Publications International Journal for Equity in health: www.equityhealthj.com Perspectives in Health – online magazine. Pan-American Health organisation: http://165.158.1.110/english/DPImag/dpi01m27.htm South African Health Review: http:/www.hst.org.za/sahr Executive Summary SAHR: http://www.hst.org.za/uploads/files/chap1 03 Bulletin of the World Health Organisation: www.who.int/bulletin/en/ WHO Regional Periodicals:

Africa: http://afro.who.int/press/periodicals/index.html Americas Region: http://publications.paho.org/home.php Southeast Asia :

www.searo.who.int/EN/Section7/Section39/Section2180/Section2185.htm Europe: www.euro.who.int/publications East Mediterranean: www.emro.who.int/publications/ Western Pacific Region: http://www.wpro.who.int/publications/publications.htm

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READING LIST Updating the list Inevitably a list of this nature is incomplete, and some of the links will no longer operate. We would appreciate feedback when this is the case, so that we can add useful links for the future, and relocate missing resources.

Topic Recommended reading General Development

British Library for Development Studies- E Journals: Extensive catalogue of electronic journals on development issues, mostly free to download or accessible via an Athens account at the University. (hardback copies are available from the institute at Sussex University) http://blds.ids.ac.uk/elibrary/ej-list.html

HIV/Aids in Africa / Control

Debunking the myths in the U.S. Global AIDS strategy: An Evidence-based analysis. Center for Health and Gender Equity, USA, March 2004.

No Man is an Island – HIV/AIDS and the G8. Action Aid International, UK 2004. [pdf file]

Taking Action – Summary of the UK’s strategy for tackling HIV/AIDS in the developing world. Department for International Development (DfID) UK 2004. [pdf file]

Infectious Diseases

Getting the Community to Own its Health. India Case Studies, Skillshare International 2004. [pdf file]

Fighting Starvation, Battling Disease. India Case Studies, Skillshare International 2004. [pdf file]

Health Care Provision in Mozambique. Skillshare International 2004. [pdf file]

Immunology, Politics of Health

Minor PD. Polio eradication, cessation of vaccination and re-emergence of disease. Nat Rev Microbiol 2: 473-482, 2004.

Conyn-Van Spaendonck MA, de Melker HE, Abbink F, Elzinga-Gholizadea N, Kimman TG, van Loon T. Immunity to poliomyelitis in The Netherlands. Am J Epidemiol 153: 207-214, 2001.

Oostvogel PM, van Wijngaarden JK, van der Avoort HG, Mulders MN, Conyn-van Spaendonck MA, Rümke HC, van Steenis G, van Loon AM. Poliomyelitis outbreak in an unvaccinated community in The Netherlands, 1992-93. Lancet 344: 665-670, 1994.

Odusanya OO, Alufohai EF, Meurice FP, Ahonkhai VI. Determinants of vaccination coverage in rural Nigeria. BMC Public Health 8: 381, 2008.

Smith PJ, Chu SY, Barker LE. Children who have received no vaccines: who are they and where do they live? Pediatrics 114: 187-195, 2004.

Jegede AS. What led to the Nigerian boycott of the polio vaccination campaign? PLoS Med 4: e73, 2007.

Clements CJ, Greenough P, Shull D. How vaccine safety can become political--the example of polio in Nigeria. Curr Drug Saf 1: 117-119, 2006.

Senessie C, Gage GN, von Elm E. Delays in childhood immunization in a conflict area: a study from Sierra Leone during civil war. Confl Health 9: 14, 2007.

Ulmer JB, Liu MA. Ethical issues for vaccines and immunization. Nat Rev Immunol 2: 291-296. 2002.

Reynolds T. Polio: an end in sight? BMJ 335: 852-854, 2007. Dowdle WR, De Gourville E, Kew OM, Pallansch MA, Wood DJ. Polio

eradication: the OPV paradox. Rev Med Virol 13: 277-291, 2003.

25

Bonnie A. Maybury Okonek and Linda Morganstein, eds. Development of polio vaccines. Access Excellence Classic Collection. http://www.accessexcellence.org/AE/AEC/CC/polio.php

Paul Y, Dawson A. Some ethical issues arising from polio eradication programmes in India. Bioethics 19: 393-406, 2005.

Roberts L. Polio endgame. Fighting polio block by block, house by shack. Science 303: 1964-1965, 2004.

Arita I, Nakane M. Road map for polio eradication--establishing the link with Millennium Development Goal no. 4 for child survival. Jpn J Infect Dis 61: 169-174, 2008.

The disease and the virus. Global Polio Eradication Initiative News. http://www.polioeradication.org/disease.asp Polio vaccinations on Peace Day. Global Polio Eradication Initiative News. http://www.polioeradication.org/content/general/LatestNews200809.asp

Access to Medicines

Street Price, a global approach to drug pricing for developing countries. VSO, UK. [pdf file]

Drug Deals,medicines, development and HIV/AIDs, VSO, UK. [pdf file]

Health and Conflict

Health and Human Rights, Edited by Jonathan M. Mann, Sofia Gruskin, Michael A. Grodin & George J. Annas, Routledge, London 1999, p. 6-19, 396-403.

Women and Development in the Third World. Janet Henshall Momsen, Routledge, London 2000, p.93-105.

Much beyond their calling. India Case Studies, Skillshare International 2004. [pdf file]

“Conflict and Health Journal” – Contains numerous articles and examples of contemporary issues affecting the subject. http://www.conflictandhealth.com -all articles are freely available, published in the US by Pub Med. (Public Medicine Organisation)

Peace through Health: How Health Professionals can Work for a Less Violent World, Edited by Neil Arya and Joanna Santa Barbara, Kumarian Press, Sterling, VA, USA 2008

Online resources: * www.conflictandhealth.com -> initiated by the open access

publisher BioMed Central, online journal encompassing many aspects of the intertwined relationship between health and conflict

* www.who.int/en/ -> website of World Health Organization

Education and Empowerment

Inform, Inspire, Encourage: A guide to produce effective HIV/AIDs materials. Tina Wallance, ActionAid International, May 2004

“An endogenous empowerment strategy: a case-study of Nigerian women” Kassey Garba, Development in Practice, v9, n1 & 2, February 1999

Battling an Epidemic. India Case Studies, Skillshare International 2004. [pdf file]

In the Land of the Blue Mountains. India Case Studies, Skillshare International 2004. [pdf file]

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An assessment of the needs and gaps of PLWHA2 networks, organisations and support groups in Botswana, Namibia, Lesotho and Swaziland. SADC Health Sector Coordinating Unit, Skillshare International, December 2003 [pdf file]

Participatory Approaches

Communication, Education and Development. Exploring and African Cultural Setting. Kwasi Ansu-Kyeremeh, Ghana Universities Press, ACCRA, 1995, p.32-109

“Publications on Participation”- further examples of literature on participatory approaches Institute for Development Studies, UK (Nov 2008) https://cms.ids.ac.uk/UserFiles/file/Publications%20on%20Participation%20November%202008.doc [pdf file]

Methods for Development Work and Research. Britha Mikkelsen, Chapter 7, p.166-195.

The Road to Health and Wealth. India Case Studies, Skillshare International 2004. [pdf file]

The Development Research Centre on Citizenship, Participation and Accountability: International network of researchers and activists exploring new forms of citizenship and participation in development: Website contains information on processes and innovations in improving participation in development work and a number of working papers on participation issues. www.drc-citizenship.org

Health Workers Migration

The Art of Crossing Cultures. Précis and adaptation by Alison White from the book by Craig Storti, The Art of Crossing Cultures, Intercultural Press Inc. USA

“Viewpoint. On the pros and cons of volunteering abroad”. Michael Palmer, Development in Practice, v12, n5, November 2002

“Renewed Beginnings for Occupational Therapy in Bangladesh”. World Federation of Occupational Therapists - WFOT Bulletin, v38, November 1998

Example of Impact of Migration on the UK, see section on Migration of physicians and nurses to UK and impacts: Developing evidence-based ethical policies on the migration of health workers: conceptual and practical challenges, Stillwell et al. 2003, Bio Med. http://www.human-resources-health.com/content/1/1/8

Physicians' migration in Europe: an overview of the current Situation Miguel A García-Pérez et al, 2007, BMC Health Services Research, 7:201 http://www.biomedcentral.com/1472-6963/7/201

Jacobson KH. Introduction to Global Health. 2008. Jones and Barlett Publishers Chapters 2 and 3 are particularly relevant

2 PLWHA is an acronym for People Living with HIV and AIDS.

27

Hardey M. The Social Context of Health. Health Psychology Series-Sheila Payne, Sandra Horn (eds.). 1998. Open University Press. Chapters 5 and 6 are particularly relevant Barry AM. Yuill C. Understanding The Sociology of Health-An Introduction (2nd ed). 2003. Sage Publishers Haralambos M. Holborn M. Sociology-Themes and Perspectives (6th ed). 2004. Harper Collings Publishers More general reading that is useful both as a background to the session and building on the knowledge gained from class discussion

Workshop 3 Minor PD. Polio eradication, cessation of vaccination and re-emergence of disease. Nat Rev Microbiol 2: 473-482, 2004. Ulmer JB, Liu MA. Ethical issues for vaccines and immunization. Nat Rev Immunol 2: 291-296. 2002. Reynolds T. Polio: an end in sight? BMJ 335: 852-854, 2007. Dowdle WR, De Gourville E, Kew OM, Pallansch MA, Wood DJ. Polio eradication: the OPV paradox. Rev Med Virol 13: 277-291, 2003. Bonnie A. Maybury Okonek and Linda Morganstein, eds. Development of polio vaccines. Access Excellence Classic Collection. http://www.accessexcellence.org/AE/AEC/CC/polio.php Paul Y, Dawson A. Some ethical issues arising from polio eradication programmes in India. Bioethics 19: 393-406, 2005. Roberts L. Polio endgame. Fighting polio block by block, house by shack. Science 303: 1964-1965, 2004. Arita I, Nakane M. Road map for polio eradication--establishing the link with Millennium Development Goal no. 4 for child survival. Jpn J Infect Dis 61: 169-174, 2008. The disease and the virus. Global Polio Eradication Initiative News. http://www.polioeradication.org/disease.asp Polio vaccinations on Peace Day. Global Polio Eradication Initiative News. http://www.polioeradication.org/content/general/LatestNews200809.asp Senessie C, Gage GN, von Elm E. Delays in childhood immunization in a conflict area: a study from Sierra Leone during civil war. Confl Health 9: 14, 2007. Clements CJ, Greenough P, Shull D. How vaccine safety can become political--the example of polio in Nigeria. Curr Drug Saf 1: 117-119, 2006. Jegede AS. What led to the Nigerian boycott of the polio vaccination campaign? PLoS Med 4: e73, 2007. Smith PJ, Chu SY, Barker LE. Children who have received no vaccines: who are they and where do they live? Pediatrics 114: 187-195, 2004.

28

Odusanya OO, Alufohai EF, Meurice FP, Ahonkhai VI. Determinants of vaccination coverage in rural Nigeria. BMC Public Health 8: 381, 2008. Oostvogel PM, van Wijngaarden JK, van der Avoort HG, Mulders MN, Conyn-van Spaendonck MA, Rümke HC, van Steenis G, van Loon AM. Poliomyelitis outbreak in an unvaccinated community in The Netherlands, 1992-93. Lancet 344: 665-670, 1994. Conyn-Van Spaendonck MA, de Melker HE, Abbink F, Elzinga-Gholizadea N, Kimman TG, van Loon T. Immunity to poliomyelitis in The Netherlands. Am J Epidemiol 153: 207-214, 2001.

Workshop 4 White NJ (2008). Qinghaosu (artemisinin): the price of success. Science 320: 330-334. Greenwood (2004). The use of antimalarial drugs to prevent malaria in the population of malaria-endemic areas. Amer. J. Trop. Med. Hyg. 70: 1-7.

Young MW (2007). Effective management of childhood malaria at the community level: programme experience to guide the research agenda. http://www.tropika.net/svc/review/030324-Malaria_8

4. Arrow KJ et al (2005). Making antimalarial agents available in Africa. N. Engl. J. Med. 353: 333-335.

Vennerstrom JL et al. (2004). Identification of an antimalarial synthetic trioxolane drug development candidate. Nature 430: 900-904. [Except detailed chemistry aspects]

Bloland PB et al (2003). Trends in antimalarial drug deployment in sub-Saharan Africa. J. Exp. Biol. 206: 3761-3769. [First 4 pages]

Enserink M (2008). Malaria drugs, the Coca-Cola way. Science 322: 1174.

Whitty CJM et al (2008). Deployment of ACT antimalarials for treatment of malaria: challenges and opportunities. Malar. J. 7: S7.

APPENDIX I

GLOBAL DETERMINANTS OF HEALTH AND DEVELOPMENT

POSTER MARKING SCHEDULE

Group No. and Students Names: …………………………………………………………………………………………………………………………………… Students ID: ……………………………………………………………………………………………………..…………………………….

Poster Title: …………………………………………………………………………………………………..

Please place tick in ONE column only for each criterion

Fail

Borderline Satisfactory Good Excellent

CONTENT OF ESSAY (a) Understanding of the learning outcomes

(b) Awareness of key concepts addressed within the course

(c) Critical appraisal of factors that affect central issues

(d) Quality of reflection on changes in own attitudes

(e) Presentation (readability, Referencing, length)

Learning Outcomes for the Global Determinants of Health and Development Course In the essay you should: Describe the principle factors which result in premature death and excess mortality in disadvantage communities around the world Discuss the role of governments, international agencies, NGOs and community based organisations in health provision in developed and developing countries Explain concepts of access and control in relation to healthcare in developing countries and for minority groups in Ireland Explore concepts of participation and empowerment in relation to community level health provision Debate the impact of exchange of health workers between Ireland, Europe and developing countries Reflect on how your own attitudes towards development in Ireland, international development and the role of the international organisations

EXAMINER’S COMMENTS (Please continue overleaf if you require more space) OVERALL GRADE: …………………. SIGNED: ………………………………….. DATE:………………………….

b

APPENDIX II

GLOBAL DETERMINANTS OF HEALTH AND DEVELOPMENT COURSE EVALUATION FORM

Name of Student (optional):______________________________________________ Please help us to plan future courses by completing this feedback form as the module progresses and tearing it out and handing it to the tutor at the final session or, alternatively, this can be sent to Dr Edward Lahiff, Centre for Global Health School of Medicine at the end of the module, or to the course administrator Ms Brighde Gallagher, at School of Medicine TCD. Please circle the most appropriate response number (NB: 7 = excellent, 1 = poor)

Plenary:

Introduction: Overview & Understanding

Development 7 6 5 4 3 2 1

Plenary 1: Combating Malaria 7 6 5 4 3 2 1

Plenary 2: Climate Change & Global Health 7 6 5 4 3 2 1

Plenary 3: Global Partnerships for Health 7 6 5 4 3 2 1

Plenary 4: Health workers migration 7 6 5 4 3 2 1

Plenary 5: NGOs in Global Health 7 6 5 4 3 2 1

Video Conference: One health for all 7 6 5 4 3 2 1

Workshops:

Workshop 1: Health workers migration 7 6 5 4 3 2 1 Workshop 2: Climate change impact 7 6 5 4 3 2 1 Workshop 3: Immunisation, the Politics 7 6 5 4 3 2 1 Workshop 4: Malaria: Drug Development 7 6 5 4 3 2 1 2 The course as a whole: The subjects covered were:

relevant 7 6 5 4 3 2 1 not relevant During the sessions was there opportunity to: actively participate 7 6 5 4 3 2 1 not participate The module will improve my understanding: Will improve 7 6 5 4 3 2 1 will not improve

c

APPENDIX II (second part) The module was worth the time invested in it: was worth it 7 6 5 4 3 2 1 was not worth it 3 Assessment process Do you consider the assessment process to be reasonable? YES / NO If your answer is “No”, how would you like to see this changed? 4 The most useful aspects of this course have been: 5 Any suggestions for future topics: 6 Any other comments, e.g. venues and organisation:

d

APPENDIX III

Criteria for Selecting Developing Countries

This list below has been based on the Human Development Index (UNUDR 2008) and the Irish Department for International Development (Irish Aid) priority areas of work. The term Developing Countries refers to countries with the low human development indicator index, regression in human development indicators, and/or higher discrepancy with the development living conditions for rich and poor, and rural and urban divide within one country. Africa: Angola, Burundi, Cameroon, Cote D’Ivoire, Democratic Republic of Congo, Eritrea, Ethiopia, The Gambia, Ghana, Kenya, Lesotho, Liberia, Malawi, Mali, Mozambique, Namibia, Nigeria, Rwanda, Senegal, Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe. Asia: Afghanistan, Bangladesh, Burma, Cambodia, People’s Republic of China, East Timor, India, Indonesia, Iraq, Jordan, Kazakhstan, Kyrgyz Republic, Nepal, Pakistan, Palestinian Territories, Sri Lanka, Tajikistan, Uzbekistan, Vietnam, Yemen. Latin America and Caribbean: Belize, Bolivia, Brazil, Guyana, Jamaica, Montserrat, Nicaragua, Pitcairn (UK), St Helena (UK). Europe: Albania, Armenia, Bosnia, Georgia, Kosovo, Macedonia, Moldova, Montenegro, Russia, Serbia, Ukraine.

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