um so we are joined by Dr Sarah Marshall uh this evening to provide our talk on global Health um there will be some time for Q a um after the lecture so if you do have any questions as we're going along you can just pop them into the Q a function on Zoom um and we'll try and get through as many of those as possible um this evening um it's often not possible to get through everybody's questions but we'll try to to get through as many of those as we can lovely in which case um I will introduce our speaker this evening uh so Dr Sarah Marshall is an honorary lecturer uh in global Health having recently retired from the global health and infection department at bsms um Sarah is a qualified pharmacist and her PhD looked to find new medicines to treat malaria based on plant remedies uh being used in West Africa and Sarah's worked in Oman and the Netherlands as well as the UK and various Pharmacy settings including community and Hospital Pharmacy as well as at universities and in clinical Trends uh trials even so at that point I will hand over uh to Sarah for tonight's lecture over to you Sarah good evening everybody it's great to be here thank you very much for inviting inviting me to be part of this and I'm looking forward to talking to you a little bit about global health and which is not um an area that I've actually fallen into but I'm absolutely very passionate about and as as Zach said I started off my journey um because I started off doing a PhD having done a pharmacy degree looking at whether we could get access get medicines to treat malaria from traditional remedies plant remedies that were being used in West Africa so um Zach I wondered if you'd start off with a mentimeter because I I can't see anybody so I'm speaking blind today but I just wondered whether you could actually give me an indication of where you're joining us from today I know that in the past we've had people from Trinidad and Tobago and from Nigeria and from Hong Kong as well as from the UK so we would love to know where you where you're joining us from so what I'd like you to do is go to the mentimeter link that's at the top and you can see there's a code here and we'll use this for a couple of questions thank you very much indeed it looks like Zach we've um that's the number of responses that we've got we've not got any more so yes thank you the other thing I'd be really interested to know is what subject would you like to study at University that's really helpful for me to know so we've particularly got an emphasis on Healthcare professionals and Healthcare sciences and things like that so as Zach said I'm Dr Sarah Marshall I've got my undergraduate degree in Pharmacy I've just finished I've just retired as a lecturer in global Health which is why they've given me the title honorary lecturer because I'm going to still carry on doing some bits and pieces and I'm based at the Brighton and Sussex Center for Global health research which is part of the medical school so what I'm going to be talking to you about today I'm going to do a little bit of myth busting okay and you'll we'll understand a little bit more about that later we're going to talk about measuring Global health we're going to talk a little bit about social determinants of Health which for those of you if you've any of you are doing um an a level in sociology or I've done a GCSE in sociology they all know a little bit about that but for some of us that's new territory and then finally we're going to have a look at a case study in the Democratic Republic of Congo and then I'll talk a little bit about medicines as part of that right okay time for some myth busting I'm going to explain some Global Health terms what I'd like you to do is to put some answers into the chat what do we mean by Health oh this is looking good thank you very much most of you have opted for physical and mental well-being um physical and mental well-being free from disease Asia thank you very much oh this is interesting provocative Muhammad the holistic welfare of society zainab said well-being state of physical and well state from open social mental physical state of well-being Soul thank you very much for that physical and mental well-being physical social and mental well-being great okay physical social in emotional well-being okay so there's some really interesting messages coming up here so that most of you are opting for physical mental and social well-being great thank you and some of you are opted for not being mentally or physically ill or without illness or injury state of being free from disease yep there's all sorts of aspects okay right if you'd like to stop we'll stop with that now because I'm going to run out of time otherwise because you're getting the right the right idea because yes you're right it is in one part it's about the absence of disease or injury or infirmity but it's also what some of you have picked up which is brilliant is that it's much broader than that health is a state of complete physical mental and social well-being and some of you pick that out which is excellent and not merely the absence of disease or infirmity the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race religion political belief economic or social condition and that's how the World Health Organization defines health so I'm going to talk to you about global Health what do we mean by global health I'm not going to get you to put anything in the chat this time round a lot of people think that it's actually about health worldwide health all around the globe but actually with global Health there's a a particular Focus as an emphasis on what we call Health inequities and by inequities I mean the avoidable and unfair differences in health globally and that can happen there could be differences between countries there can be differences within countries there can also be differences within age groups within a country there can also be differences within cities so I'm based in Brighton and some of us are actually based in right some of the people on the call are based in Brighton and there are huge differences in health outcomes just within our city okay this is the first one of the first myths I want to bust quite often You're Going to Hear I get very cross about it the term developing country and you'll hear it on the television you'll hear it on the radio you'll see it written in papers and I want you to next time you say next time you hear that I want you to query it and say why are you using that phrase so that's your job okay so these are some of the reasons developing countries hugely contentious in global Health terms but these are some of the reasons why it's not appropriate because it's actually judgmental it's quite often been used from somebody from a high income setting a developed setting about another setting and about developing and it's suggested of inferiority it also suggests that developed countries have finished developing so you know we've actually achieved everything we don't need to get any further but for those of us that are based in the UK for example we know of the difficulties that the NHS for example faces at the moment there's no way that we have finished developing we have got so many more improvements in people's Health that we can make also our countries with a space program developing can your classmates developing so this photograph is a picture from India's space program and India is often referred to as a developing country but they have a space program with 74 million dollars but spent was spent on sending a probe to the Moon that's not developing to me and lastly I'm going to give you these are these are some of the reasons why we shouldn't use the phrase developing country lastly I'm going to give a statistical reason so if you have a look at this graph with me what it shows is the vertical axis life expectancy in years and on the horizontal axis it's income per person and each one of those little bubbles represents a country and the bigger the country the bigger the population of the country the bigger the bubble and this is from data from 2018 and you can see that the colors correspond to different parts of the world so the green bubbles are for North America and South America the blue ones are for um the African continents and the yellow ones are for um Europe and the red ones are for the Middle East and Asia okay so what we can see is if we plot for those countries the income per person for each country versus the average life expectancy for men and women what we can see is we get a range of values okay so um and this is a logarithmic scale so the phrase developing country actually came about in the 1950s and 60s when there was a really clear distinction between countries that had low income and low life expectancy so they were all down in the bottom right hand bottom well it's a left-hand corner compared with high income countries with high income per person so they were all in the top right hand corner there was a really clear divide between developing and developed that's no longer the case so because actually there are countries on a scale a spectrum of development if you like okay so it's no longer the case as a clear separation what we tend to use instead is the term resource poor settings or low middle and high income countries or emerging economies particularly low middle and high income countries particularly useful phrase because it's much less um judgmental and much more objective so the next time you hear that phrase developing country pick somebody up on it so I'm going to talk to you about global Health well let's think about how we can measure health first of all how can we measure how healthy the population of a country is oh this is good and good an idea of how healthy the population um somebody suggests looking at life expectancy yes oh this is brilliant obesity rates okay GDP oh good stuff um people per doctor life expectancy health records HDI okay Health developments okay quality of life survey um cause of death yep quality of life life expectancy mortality rates good and life expectancy qualities prevalence and instances oh right you've been reading my notes by seeing a person's calorie intake that's a really interesting one um quality of life and so on we've got some really okay infant mortality rates to know look good well done looking at the age democracy or employment good right you're obviously thinking broadly some of you that's really super okay maternity rates so maternity maternal mortality okay birth rates Health Care Services looking at diseases that are common in the country or potential illnesses and their health care practices and medical equipment right you've really you're doing really well here this is fabulous um I'd love it when you talk to me thank you very much different disease rates thank you looking at mental health thank you Jasmine okay right malnutrition and extensive immunization there's some fabulous ideas in there I'm just going to talk about some of the metrics that some of you have mentioned thank you life expectancy brilliant most of you got that one many of you mentioned that life expectancy at Birth incidents some of you mentioned with an incidence being the number of new cases of a disease or condition and prevalence being the total number of existing cases so okay the incidence of covid um the number of new cases today compared with the prevalence which is the number of total people who've got covered at the nice at the time whether that's in the last three weeks or two weeks or so on and have still got it um mortality and some of you can pick picked out that can be cause related so related to a particular type of illness or or caused injury for example it can also be age related so looking for it for example at children or it can be related to sex so it could be could be um for example sex specific so maternal looking at maternal mortality so some of the things that we would use to measure that are neonatal mortality rates so that's children under the age of 28 days infant mortality rates so that's children under the age of one year or child mortality being under five years and then you've got the maternal mortality ratio which is the number of women that die as the result of pregnancy or childbirth compared to the total number of women giving birth and then we've also got because he's a condition that we're interested in will cause deaths then um we've actually want to get a measure for diseases that cause suffering but don't cause death so for example um something like rheumatoid arthritis causes a great deal of suffering and pain but it doesn't kill people instantly that's the thing so we need a measure for for that um and that's years lived with an impairment or years lived with disability and that can be it's not just for example a lost limb but actually any condition that causes an impairment whether that's Parkinson's or Alzheimer's or um or as to say um a number of different conditions rheumatoid arthritis let's have a look at life expectancy and I'm going to look at life expectancy at Birth here because it can vary hugely between regions and by life expectancy the definition above that of that is the average number of additional years a newborn baby can be expected to live if current mortality Trends were to continue for the rest of that person's life okay so a baby is born today and their life expectancy is estimated based on assuming that nothing changes in the circumstances around in their society and so on um in the in the foreseeable future if we look at this data life expectancy from 2019 the different colors relate to the different life expectancy in the different countries so the darkest areas are life expectancy are between 86 and 90 years so we can see Canada parts of Europe and Australia and gradually as they get paler life expectancy is going down so you can see at the bottom end we've got life expectancy of 54 years for some parts of sub-Saharan Africa so we can see there's a big difference in life expectancy in different regions and we can see that in general countries in sub-Saharan Africa have the lowest life expectancy so some of us may be familiar with that what might be less familiar to us is that actually if we look at high income countries life expectancy can also vary let's have a look at these 7 G7 countries this shows life expectancy at Birth for the years 2021 or the latest available mostly that's 2021 so on the right hand side we've got this vertical column and that gives us the number of years that people are expected to live and on the bottom we've got the United States the United Kingdom Germany Canada France Italy Japan all rich High income countries but what we can see is that actually life expectancy varies hugely Within These all of these very rich countries so for example we tend to think of us as being ourselves as being quite similar to the US but actually the U.S life expectancy for 2021 was 77 years whereas in the UK 80.4 years three year difference for quite similar societies but actually if we start to drill down and I know some of you are in the UK and some of you are in England um even within countries life expectancy can vary so on the left hand side of your slides we've got life expectancy for always or males at Birth 2016 to 2018.
and here you can see in the center you can see the scale so the Payless green is below 76 years and the darkest blue is 88 up between 85 and 88 years so we can see that depending on where you live in England life expectancy for males at Birth is different foreign and then we start to drill down further this map that you see on the right hand side is actually the area where I am now which is Brighton and Sussex and there's actually a huge difference even within this region of of two three years three years yeah between the city and some of them the the less urban areas so there's a huge amount of variation between in life expectancy just within a city within a country and within a region so the question is why is this happening is it because people are different I'm going to talk to you a little bit about what we call social determinants of Health what determines whether people are healthy or not I wonder if you can quit me some quick answers in the chat okay we've got poverty lifestyle income access to property nutrition diet Environmental Quality upbringing access to healthcare brilliant disease okay you're really on upbringing interesting symptoms um illness um great ideas here folks thank you safe housing diet diet okay what else have we got I think is that education yes education is always a good answer um lifestyle mental stability depending on income thank you Mara and where people live genetics yeah absolutely financial situation okay income Access to Health Care parents genetics epigenetics happiness that's a good one to pick on thank you Joe um well-being past medical history crime crime rates genetics genetics sometimes yeah nutrition income Air Quality Healthcare culture environmental changes diet BMI right it's a super physical activity less levels weight great okay access to certain things well that's interesting um um could being content with life okay um sports or active lights diet and social life access to charity services practically everything right that's a good one so thank you um Quality of Life compared to the rest of society social setting living standards Council funding Health luxuries for example gyms oh this is really good discussion stuff okay thank you very much indeed for that there are you've picked out some really good examples and I think you've probably picked out most of the things I'm going to talk about as we said genetics also age can determine it determines the sorts of conditions that we will get at particular ages so children will get Chickenpox whereas older people might get Parkinson's or degenerative conditions so 6 will determine which sort of con which sort of conditions that we get some some cancers for example are linked to either a male or female sex genetics as you've all picked out individual lifestyle factors some of you are talking about diet and nutrition anybody mention smoking or alcohol not sure do people you talked about exercise certainly but yes drug use for example as in illegal drug use these can affect us our People's Health social and Community networks we didn't actually we talked about perhaps or didn't really pick that out so much in the chat but what we've seen through covid for example when people were in lockdown and people were in isolation is that actually we are designed to be part of a network as human beings um so we are social and Community networks are actually vital for both mental health but also our physical health water and sanitation is really important if we've got poor water and sanitation you're much more likely to get diarrheal diseases socioeconomic status you picked up on air pollution I think somebody did mention air pollution if you're burning for example and we're talking globally here because we're talking about global Health if you're if you're burning things like peat or animal dung to provide heat to cook with for example or to heat your home then you're going to get particulates in the air and that means that you're much more likely to get chest infections and things like that a work environment so if you're doing a job which is quite risky and is isn't very well protected by safety standards then your that's going to affect your health for example if you're mining or you're logging or you're mining gold for example in poor quality conditions yeah or or mining coal for example education you picked out thank you for that education is one of the most important things we can do to improve help People's Health Agriculture and food production linking to some of you mentioned about diet and nutrition if in a country all of your land is being used to grow tobacco for example or much of your land is being used to grow tobacco then when a drought hits then you have much less capacity to provide food for your for your country we call that food security gender norms and Equity now I don't think we picked up on this um so the idea of the roles gender roles and how fair they are and whether people are one gender is is more disadvantaged than another for example and we'll look at the little bit of an example of that later on that can really affect people's Health housing we talked about if you're living in a in a house with a damp and that's cold and there are lots of you all all in one room that can really be very detrimental to health for example for tuberculosis or for infectious diseases Healthcare Services whether they're there and if you can get to them good you picked up on that some of you employment versus unemployment mostly it's it's thought that employment is better than unemployment for Health it depends what it is it depends on how stressful it is and whether you have any what we call agency to actually to be allowed to to make decisions about your within your employment and then overarching all of that we've got National Regional and international politics so who and those are the what we call social determinants and the World Health Organization defines social determinants as social determinants of Health are the conditions in which people are born grow live work and age and these circumstances are shaped by the distribution of money power and resources at global national and local levels social determinants of Health are mostly responsible for health inequities the unfair and avoidable differences in health status seen within and between countries and quite often you'll see this depicted as a a rainbow sort of onion type model with lots of layers to it this is Dahlgren and Whitehead's model and you've got the things that we talked about you'll see them in in successive layers so age sex and genetics individual lifestyle factors social and Community networks and then beyond that living and working conditions and then beyond that General socio-economic cultural and environmental conditions and I'll show you a little bit more about how that works when we look at our case study later but what this doesn't show what this diagram doesn't capture capture is the interactions between all of these and the fact that actually it's a very Dynamic process this suggests that it's static but actually it's extremely dynamic and we can see that social determinants affect Health when we look at the example of TB in the UK when we think about What's led to successful TB control in the UK let's have a look at this graph and on the bottom this shows the notification rates and the death rates from TB per 100 000 people from the years 1913 to 2009 so almost a century so we've got two thousand it starts with 1913 on the horizontal axis and finishes at 2009.
and then on the the vertical axis on the left hand side we've got the notification rate per 100 000 people so this is the number of cases of tuberculosis that have been notified to the to the authorities and that's the red line the green line is the death rate per hundred thousand people so this one is the one that starts here so that's the number of deaths per typical for tuberculosis and what we can see is that actually the number of cases and the number of deaths from tuberculosis was decreasing substantially before we introduced what we call chemotherapy which is basically using medicines to treat TB and before we had a vaccine BCG against TB and before we started to pasteurize milk to prevent TB being contracted from cattle and before the in the Advent of short course therapy so what was happening before all these medicines and these vaccines and the interventions came along TB was always already decreasing what was actually happening was that housing was improving and there was less poverty so when I said about about housing and being very tightly lots of people living in one house that's um a huge Factor on in TB rates and so housing improved and poverty improved people people didn't live in poverty so much or people were moving out of poverty and those social determinants were improving TB in practice and I'm going to compare two countries I'm going to compare Afghanistan and the United Kingdom and I'm going to look at some of the metrics that we've talked about that we can use to measure health so if we look at life expectancy at Birth in years for Afghanistan about 60 and about 81 years this is these days this data is from about 2015 but hasn't changed a great deal since if we look at the under five mortality rate for the two countries and the by that we mean the number of deaths of children under five years per thousand lifebirds in the UK it's about five when Afghanistan it's 20-fold higher so that's almost one in ten children not reaching their fifth birthday if we look at the maternal mortality ratio which is as I've said before the number of women who die as a result of pregnancy and childbirth complications per 100 000 live births in a given year so 100 000 babies being born in the UK it's estimated to be about Elders eight women who die as a result of pregnancy and childbirth whereas in Afghanistan it's um 400 which is huge it's one of the worst in the world let's think about some of the social determinants that we see um with Afghanistan's been in the news a great deal recently um we have conflict we have extreme poverty we have a lack of education and you will have seen um girls who have not been allowed to go to secondary school being hugely Brave and protesting about that and then that's been in the about the lack of of Education that that is um that they are allowed to have um malnutrition is quite severe so people just not getting enough nutrients weak Health Care Systems so a health system that's not working very well and then gender inequity so an unfair difference in how the genders are treated um whereas the UK for example lifestyle and aging population and a strong Health System um have actually caused or actually a responsible for some for some of those differences in metrics okay so is everybody with me so far yeah okay now we talked a little bit about um child mortality so under five mortality and that is it's good to know what children are it's a good metric to have to know how many children dying but actually it can tell us so much more than that let's have a look at the global distribution of deaths um for children in the ages 26 20 figures from 2017 so we look what we're looking at is this sort of ring which shows what children are dying from children under five globally so if we look on the left hand so you can see there's a blue line that's almost almost half most almost half of the deaths so we're looking about 45 are actually in neonates so in children under 28 days and the rest are in children between the ages of 28 days and five years and what we can start to see are the things that are causing children to die there's lots of different things which I won't go into any detail but have a look with me at the top right hand side you can see that big blue chunk that dark blue chunk that's acute respiratory infections so that's things like pneumonia and then there's another chunk next to it a dark pink chunk of diarrheal diseases so when we've got lots of children dying from pneumonia and from diarrheal diseases that actually shows us something about the country it shows us that actually there's a high rate of air pollution that shows us that the causes of these things are actually are causing a lot of problems diarrheal diseases we've talked about water and sanitation if it's poor then that can really contribute to diarrheal diseases being high and um if you for example if there's a high instance of meningitis or measles then that suggests that there's a problem with the healthcare service because children can be vaccinated against meningitis and measles and Melinda Gates has put it like this um child mortality is a proxy for overall well-being but it's also a leading indicator of progress or a lack of it so these metrics these measurements that we can use can show us not just the number of children or people who've got a particular condition or children that are dying but actually can actually reveal a great deal more about a country so let's actually have a look at the top 10 causes of death comparing High income countries HIC and low and middle income countries and that's between 1990 and 2013.
if we look at the high income countries which is the two charts at the top we can see the blue ones are what we call non-communicable diseases the red pinkish lines are communicable so infections but also maternal causes neonatal and nutritional diseases and then the green ones are injuries so things like Road injuries and self-harm so if we look at high income countries and compare 1990 to 2013 they've actually the cause of death haven't changed a great deal they're very similar they're predominantly these non-communicable these blue ones these non-communicable diseases whereas in low and middle income countries what we've seen is an epidemiological transition but you don't need to worry about that an epidemiological transition we've seen a change in the pattern of disease things that are causing people to die um so in 1990 in low and middle income countries we had predominantly these red conditions and communicable maternal neonatal and nutritional and now in 2013 we're moving to actually the top three courses of death on non-communicable diseases but there are still communicable diseases so pneumonia HIV and tuberculosis are still causing a significant number of deaths if we just compare High income countries in 2013 with low income or low and middle income countries we can see that there's actually a significant difference and why is that it's back to our social determinants of Health and this this model that I showed you dalgan and Whitehead's model thank you so although many of us are interested in health care and Health Professions and biomedical and Neuroscience and things like this actually the if we're going to improve health globally it's going to need a much broader approach it's going to need a multi-disciplinary approach because if we're saying that these are the things that affect health then have a look at those and think what sort of people need to be involved to actually improve these things these factors here we'll come back to that I'm going to finish off by talking a little bit about the Democratic Republic of Congo which if you look at the map on the right hand side and get my mouse to go there yes DRC right in the heart of sub-Saharan Africa the capital is kinshaza the population is about 87.7 million people and it's a low income country the fertility rate is about 4.7 births per woman so that means that women are having an average of four or five children during their lifetime the life expectancy male to female for men was about 60.4 years and for women was 64.3 years the under five mortality rate was 57 is 57 per thousand live births so not as high as in Afghanistan but still very high and the things that cause people to die let's see this chart in the middle here number one malaria two tuberculosis three pneumonia lower respiratory infections four neonatal disorders so things are killing babies and five diarrheal disease yep malaria's might as I say is my research project it's my research area um nobody needs to die of malaria not anymore we've had a cure for 400 years um civil registration of birds is 28 and what I mean by that is that actually only 28 of of babies born their birds are reported to the authorities and registered so that means you can get a birth certificate and you can enrolled for school and all of this sort of thing only about 28 of children are being registered DRC is a country that's recovering from conflict um from in 19 between 1994 and 2003 but there are still Rebel groups operating and it's rich in diamonds gold copper zinc and Colton which is a a component of mobile phones so is very much sought after and when we try and think about the social determinants of Health that are operating in the Democratic Republic of Congo okay we have poverty as I said it's a low income setting we have conflict and the aftermath of conflict because you don't if a con if you've had a conflict a war you don't just suddenly everything improve it it wrecks Health infrastructure and societies and cohesiveness but as a conflict as a result of the conflict we have people who are displaced and that can mean that they are displaced within their country because there's conflict in the one area so they've had to move to another area and leave everything behind them or it could be that they've actually had to move to a different country and have become refugees got poor quality roads and transport we've also got um Ebola outbreaks that occur regularly for those of you will be familiar with Ebola with a viral condition that's passed on by touch and is fatal in many many instances the health services really struggling um as a result of the conflict but also the lack of investment and the lack of and the lack of money available for a low-income country 53 of girls aged 5 to 17 don't go to school at all we're talking about education here as a social determinant it also attacks on health workers I talked about Rebel groups still operating so for example the charity msf medicine Frontier um they've had they've had to pull out of DRC at times because of a tax on their workers but also attacks on on um DRC health workers 42 of the population lives in urban areas now why is that significant it means that 58 is living in rural areas and there there tends to be that urban areas are where facilities are and Health Services are predominantly so that means that 58 are going to have a reduced Access to Health Care and then lastly as I've referred to this is gender inequity this uneven um balance in what one the address compared to is able to do particularly amongst for girls versus boys so look at this diagram and look at these social determinants and I wondered if you'd like to give me some ideas about jobs that are needed to improve health in DRC I'll pop them in the chat social workers thank you Lowry okay midwives policy makers Educators brilliant love it construction workers Charlotte thank you teachers yes thank you doctors Builders yes Joe thank you teachers and professors I like that one thank you very much do they see investors Ahmed that's superb well done thank you yeah people who are actually better politicians are thank you social workers occupational therapists Community workers mental health workers yes absolutely police well done that's superb shantita um Community nurses teachers doctors yes key workers nurses doctors nurses thank you sanchita for the pharmacist mentioned charity workers yeah Construction activists love it Grace thank you researchers non-corrupt politicians human rights activists teachers a leader a politician to unite unite the country and make efficient policies Farmers needy thank you that's brilliant um stable government lawyers awareness spreaders if that's a job yes active they could call it a activism thank you humanitarian Aid workers journalists to raise Global awareness um Technologies yes technologists businessmen and women musicians Soul love it musicians to cheer people up yes absolutely these are super thank you practically everything once again yes human rights lawyers yes lawyers food scientists farmers superb well done okay you've got the hang of this you understand it's not just because as as Healthcare professionals like myself as a pharmacist and some of us are thinking of going into Healthcare and nursing and Midwifery and docs and medicine and so on the good news is the bad news is that it's not just up to us but the good news is it's not just up to us because this is a multi-disciplinary effort yeah have a look at this diagram with me this is msf medicine Soul Frontier but it's there what they call their chain of life so um they are a charity trying to get vaccines to the Democratic Republic of Congo to children in remote parts of Democratic Republic Congo and you as you saw with all of those things that we highlighted there are lots of difficulties that have to be overcome to do that really well so the vaccines start off you look at the very top they start off in Belgium or in or in France and then they have to be transported by truck and then they have to be transported by plane to Kinshasa and then once they get to Kinshasa to the capital of DSA they have to be um they have the plane lands and they go through customs okay and then they will have to be transported perhaps 4 000 miles um through along along the roads which may be quite um put in Port quite poor condition and So eventually if the roads get very poor condition then actually they'll be transported by motorbike in specially adopted adapted cool boxes to keep vaccines cold because as you know vaccines have to be kept many vaccines have to be kept between two and eight degrees So eventually though coming by motorbike but in the meantime a health promoters have been out busy telling people in the communities of these Villages about the importance of vaccination this is for measles for example so that everybody is sensitized before um and actually wants to come get get a vaccine before it actually arrives so this is to say msf's chain of life is zigzag to make sure that people get the medicines that they need and children get the vaccinations that they need so we've thought about generally what sort of jobs are needed for people to improve Global Health but let's think specifically about this one about trying to get vaccines to people safely are securely and and properly what sort of jobs do you think might be needed for that one I'm going to have a look at the chip Pilots Engineers yes yes absolutely Community nurses drivers Logistics experts thank you Holly yes people who know how to organize the supply chain so that actually things are end up being in the right place at the right temperature at the right term drivers truck drivers yeah absolutely truck drivers managers yes Ahmed thank you very much translators thank you Elena non-government organization workers pharmacist thank you Rebecca um and drivers nurses yep truck drivers midwives yep Public Health campaigners yes fundraisers absolutely local coordinators drivers Community workers Logistics logisticians pharmacists Health promoters in the community and local people getting involved yes absolutely to make sure that this is um something that's not top down driven but does actually comes up from the Grassroots as well um Armed Forces right okay um employing local people people who inform yes people who are going to give a raise awareness um manufacturers yeah absolutely health care workers to administer the vectors public speakers that's a really good idea Girling because you want people who can actually um yeah and sometimes picking up by Soul as well you want people who can talk about this who can raise awareness of what's needed so people can get funding volunteers to promote vaccines in the community people from from other countries with helping with funding High income volunteers to inject vaccines doctors to train the local people's reporters possibly to erase awareness this is Fab thank you very much indeed okay great you've got some fabulous ideas I came up with some doctors nurses pharmacist logistians interpreters we had mechanics make sure that the trucks still work drivers Pilots inventors Engineers filmmakers because to actually as we'd say raise awareness social scientists to understand why people think particular ways and psychologists help influence behavior marketing people um graphic designers to produce all these nice infographics that can communicate a message really well design technologists are looking at design of cold boxes for example or lawyers managers and administrators Human Resources staff and Warehouse staff so there are lots of different ways that lots of different professions and lots of different jobs and people that are needed to actually make this work really well so that's my last slide um so to conclude there are many different measurements used to measure Global Health we talked about life expectancy and mortality of various age groups and things but these in measurements can actually give insights into social determinants of Health and we can't improve Global Health with medicines and with with just with with Healthcare professionals unless we improve the social determinants and improving Global Health it's going to need a multi-disciplinary approach so everybody needs to get involved now Zach I've run over time a little bit but I was going to say does anybody does anybody have any questions have you got lots of questions in the Q a we haven't had that many come through we can try okay that's fine just we are we are close on time today yeah so that's great we've had no no it's been an excellent excellent level of interaction as well from you've been superb thank you everybody who's been here so this has been fabulous um so we'll try and answer a couple of questions here um that have come in if you get a couple of questions in now that we might be able to answer some of those and so the first one that we've got here that came in fairly early um I think this was when you were talking about um the terms developing and developed countries I can read it actually yeah uh yes so it's quite a tricky one this um but I'll read it out in case anybody else can uh can see it uh can't see it thank you for your insightful criticisms on the use of the terms developing and developed and what are your thoughts about referring to countries as previous Colonial powers or previously colonized Nations I find that it is helpful to analyze how colonialism has led to Global Health disparities but I'm interested to hear the criticisms of the use of these terms too any thoughts about that it's a very loaded questions in a nutshell Elena thank you very much um I I can see both sides to this because because there is a huge impact that colonialism has had on people's history but you do you want to Define countries by their past all the time so um yes I'm going to leave that one for you to think about because I would I think I think there are it's hugely loaded and I'm going to back away from that one and actually say that there are probably advantages and disadvantages um somebody who is anonymous how the new malaria vaccine networks okay a little bit about about that malaria is quite a difficult disease to um develop a vaccine too because I don't know if you know much about it but the parasite when somebody is bitten by the mosquito and the parasite enters the blood um it actually goes and hides in the liver and then in red blood cells so it's actually quite hard to for the immune system in the body to actually find it so um what the malaria the new malaria vaccine does and has has been targeted at is um antigens on the the very the first the form of the parasite that is first injected so as soon as it gets into the body it's the proteins on the outside of the of the um the sporozoite the swimming version of the parasite before it goes and hides in the liver or in the blood blood cells so that's the way that it converts it um actually triggers an immune reaction oh this is a potentially a really good one to to make sure that we include here um how can we start a career in global health right um well as you've seen everybody can actually be involved in improving Global Health we need a multi-disciplinary effect um an effort it depends on what you're interested in doing um because all there's loads of questions I'm not going to have a big a a lot of time to answer all of these um sorry let's just think about where we're going yeah starting a career in global health I would say get your qualifications first but also look at um operations are examples of um or organizations that you can get involved in if as a student if I'm if I'm presuming that you're thinking about University then um there's organizations such as um students for Global Health you can get involved with that one that's um you'll find branches at most universities um that's for Medics but a pharmacists but actually anybody that's interested in global Health they organize conferences if you are interested if you are doing medicine for example there are organizations that you can join as a medic there are organizations that you can join as a pharmacist for example as a pharmacy student when we have the international Pharmacy students Federation which is part of our Global professional body the FIP if so you can join them and they do conferences all around the world and get Pharmacy students to actually go out and do health promotion campaigns wherever they are whether that's Indonesia or Ghana and so on and so on what I will do is just share very briefly some information about some other bits and pieces that you might be interested in um our next monthly lecture like I said we run this every month is on Wednesday the 7th of December um this is uh led by Dr Simon Mitchell who is a systems biologist so looking at sort of virtual patients and using virtual patients to choose um sort of the right medication and so that's that looks to be a really interesting one as well um we also have a number of other talks um and online activities that you can join if you want to find out more about medicine in general like I said if you do have any questions that come out of today's talk um we unfortunately we aren't able to answer um all of those um please do um send us an email to outreach bsms.ac.uk um you can also find us on social media at bsms Outreach if you do want to ask us any more questions find out any more about what um we have coming up in terms of other activities um excellent anything that you would like to close with um Sarah I'd just like to say a huge thank you to everybody and um because thank you very much indeed for your involvement with a chat and for being willing to answer questions and I would like to just wish you all the best with your careers and with your University and everything um and it's lovely to see just how enthusiastic you are and how engaged and how um and how interested and thank you for the very kind comments that are put in put in the chat as well I'm glad it's been helpful excellent I'd like to yeah Echo those remarks in the in the in the comments thank you very much for your lecture this evening um Sarah it's been really really really interesting so and thank you very much and thank you for attending folks um you can now head off enjoy the rest of your evenings um and hopefully we'll see you at another lecture in the very near future
