Lessons from Global Public Health

Mousumi Banikya-Leaseburg

Mousumi Banikya-Leaseburg

Recently I attended a meeting of a few Baltimore City health professionals to talk about ways to enhance the youth-friendliness of Baltimore City clinics that provide sexual and reproductive health services to adolescents and young adults. During the course of our brainstorming session, we came up with a number of innovative strategies and approaches, many of which we knew to have been successfully implemented in developing countries, in low-resource settings, with positive outcomes. The realization that Baltimore as a city­—and the United States as nation—are lagging behind many countries with weaker health infrastructure and poorer economic support, in terms of finding and implementing innovative, sensible, and cost-effective solutions for a vast number of public health challenges was paramount on my mind as I made my way back home from the meeting. I began to think, “What are some lessons that the United States can learn from global public health?”

Having worked as a physician, researcher, and public health practitioner in both international and domestic low resource settings for many years, I have always viewed health as a basic human right that every man, woman, and child is entitled to—regardless of who they are, where they come from, or where they are headed—and not as a privilege. In my opinion, the politicized nature of health in the United States is the single most important factor that has prevented us from adopting more real-life, innovative, and sensible solutions that can reduce the burden of health disparities on the American population. If health could only be viewed as what it truly is, without all the baggage of politics, policies, religion, privilege, money, etc., I imagine there would not be so many obstacles in achieving it. I think other countries do a much better job of viewing health through a more objective lens, providing an excellent lesson for us to learn. I know this might sound like a simplistic approach, but sometimes the most groundbreaking solutions are the most simple.

“Reverse Innovation” is a term used to describe innovation that begins as a practical solution to meet the needs of populations in developing countries, and then “trickles up” to developed countries where the same practical solution which was born out of necessity and constraints is essentially repackaged as an innovative, low-cost solution for the populations of developed countries. There are many such reverse innovation solutions in the field of health that the United States might be able to adopt to solve contemporary health system challenges particularly those in the field of adolescent sexual and reproductive health. Here are just three examples:

  1. Modified Service Delivery Models: To combat the chronic shortage of skilled health care workers, developing countries are promoting novel approaches and introducing specialized worker education and training. Many developing countries are training mid-level workers to perform emergency procedures. This approach has improved health access through task-shifting. Such workforce substitution has most recently been implemented with great success by the Contraceptive CHOICE research project where non-clinical, lay, frontline staff were trained to provide contraceptive counseling to overcome the barrier of clinicians not having enough time to provide full contraceptive options counseling to patients. Similarly, community health workers (CHWs) and peer health workers can be mobilized following the example of countries such as India and Pakistan to increase positive health outcomes in communities across the United States.
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  2. mHealth and Telehealth: Despite the widespread availability of mobile health (or mHealth) and telehealth technology, the United States seems to be hesitant about fully embracing and taking advantage of such innovation that has the potential to drastically decrease existing health disparities in the country. Countries such as Kenya, Uganda, South Africa, Rwanda, and India have jumped to the forefront of mHealth innovation using new technology to transform healthcare through improved data collection, disease surveillance, post-discharge surveillance, health promotion, diagnostic support, disaster response, and remote patient monitoring. Both mHealth and telehealth can be used in the field of adolescent sexual and reproductive health (ASRH) to deliver health education to disadvantaged communities and to increase access to sexual health services for adolescents and young adults.
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  3. Leadership and Governance: Visionary leadership is required to successfully implement and sustain public health initiatives. Such leadership can kindle community optimism which is important for community support of any initiative. Despite leadership development being a top priority for health leaders, underdeveloped leadership and management skills coupled with a high rate of turnover in key positions plague most health systems in the United States. The State of Ceará, in Brazil, mandates that public servants receive leadership training to apply for management positions. By doing so, the state has been able to strengthen leadership and management of public sector employees. Over time, this has contributed to improved health system performances. Between 2000 and 2004, 25 (out of 37) municipalities in Ceará reduced infant mortality–some by as much as 50%. The United States can certainly learn from the success story of Ceará.

We need to be more creative in our approach to public health in the United States and embrace innovation and change with open arms. Although traditional approaches may be tried and tested, the reality is that these tried and tested approaches have not been able to eradicate the vast disparities that exist in health indices in the United States among different groups of people, particularly in the field of ASRH. Perhaps for some, a sense of urgency has still not arisen. Maybe that is why they are still content with the status quo. I, on the other hand, am not satisfied with how things are and shall continue to advocate for more integration of successful lessons from global public health.

What are some other lessons the United States can learn from global public health? What hurdles have you faced when attempting to introduce new and innovative strategies in your own work?

Mousumi Banikya-Leaseburg, MD, MPH, CPH is a Program Manager at Healthy Teen Network.

Additional reference: http://www.globalizationandhealth.com/content/8/1/17#B48

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Graphic Novels as a Tool to Improve Literacy: 5 Facts

(Photo by byronv2)

In the 1970s, the definition of literacy expanded to recognize the reality that students learn to construct meaning from a variety of text types, including visual images. Graphic novels—distinguished by their heavy use of imagery with text—are particularly useful in developing literacy skills among youth. Graphic novels have enjoyed increasing popularity in recent years and have become valuable tools for teachers in the classroom and for good reason.

Five Benefits to Using Graphic Novels as a Tool to Improve Literacy

1.   Including graphics with texts helps students encode information more readily, improving their reading comprehension.

When images are used alongside text, students can more easily decipher the meaning of the text, as well as retain elements of the story. Often, students’ self-esteem can be brought down by low test scores in reading and writing, which can be a factor in deciding to drop out of school: “By providing students with tools to increase their reading and writing ability, teachers can promote student success” (Mannion, 2008)

2.   Vocabulary development among students with language and learning disabilities can be aided by the use of graphic novels.

Students who identify as having learning disabilities have self-reported that graphic novels motivated them to read and aided their comprehension. As part of a recent study, several students with learning disabilities at Avon High School in Indianapolis, IN, were asked to read graphic novels in their free time over the course of a year.  Of the 20 students in the study, 16 reported liking and reading the books, with many saying the pictures helped them better understand the text.

3.   Bringing youth culture, including graphic novels, into the classroom can motivate and engage youth.

Utilizing popular cultural elements of contemporary students demonstrates to the students that their lives and interests are respected by their teachers. This demonstration of respect can help students to be more receptive to other curriculum content. “We’re not talking about co-opting superficial trappings of youth,” says Nancy Frey, herself a teacher and author of Using Graphic Novels, Anime, and the Internet in an Urban High School. “What we are talking about is acknowledging to our students that we care about their interests and recognize the value of their contributions to the classroom community.”

4.   Graphic novels used for pleasure reading help improve literacy among second language learners and reluctant readers.

Pleasure reading is critical in the development of literacy among second language learners. According to Collen MacDonnell’s Making the Case for Pleasure Reading, many English learners (ELs) choose graphic novels for pleasure reading. Kay Hones, a high school librarian, has seen firsthand how otherwise reluctant readers have been drawn to graphic novels. “My students love graphic novels,” she says. “I display them near the periodicals and new books, grouping them with comics and drawing books, forming a magnet area for reluctant readers.”

5.   Graphic novels can be used to improve “traditional” literacy, as well as be valued as its own form of reading, with its own benefits.

Although the popularity of graphic novels—and the use of them as a learning tool—has been steadily increasing, there still remains a certain level of “snobbery” when it comes to the value of graphic novels as its own form of literature. Despite the endorsement by many librarians, many teachers have been reluctant to include graphic novels in their curricula, according to this article. However, the combination of traditional and visual literacies in which graphic novels have been shown to aid can “teach students new perspectives on better grasping plot, character, theme and other story elements through visual cues that aid comprehension.”


What are the youth you work or live with reading?  If they are reading graphic novels, what graphic novels seem to interest them most?

How do you work to incorporate youth culture into your programming or interactions with youth?

Healthy Teen Network is in the process of developing a graphic novel with award winning author/illustrator Jonathon Scott Fuqua. The graphic novel will explore important issues of bullying, self-esteem, and peer relationships. This week, we will launch a crowdfunding campaign on WeDidIt to support the distribution of the book—and a Teacher’s Guide—to Baltimore City Middle School age students this fall. We’ve set a goal to raise $10,000 in six weeks to make this happen and we’ll need your help. Can we count on you?

kellyKelly Connelly is the Marketing and Communications Manager at Healthy Teen Network.

On Slowing Down to Get Ahead

Valerie Sedivy

Valerie Sedivy

Summer is a time when many of us have traditionally tried to slow down. We know intuitively that we need to recharge and reflect, both personally and professionally. Summer can be a time when you slow down and take a close look at your plans to implement programs with youth, so you can be sure you are using or recommending the right programs for your group.

But have you ever ended up rushing to select a program before you’ve taken the time to reflect on whether it really is the right program for the group you’re trying to serve? Or have you used the same program year after year without confirming that it’s working? I know I have been in this situation, and I also know that there are many good reasons why this happens. Funders want lots of youth served ASAP, and we worry about losing momentum if we don’t get going right away. But many of us have also seen consequences of rushing in with a program that doesn’t quite fit—youth don’t react in positive ways to the program, implementation is spotty, and results of evaluations are lackluster.

I’d like to suggest that this summer is a perfect time to enlist your colleagues in an effort to reflect on the programs you are implementing or helping others to implement. Are the programs a good match with the characteristics of the population you are trying to serve? (Have you checked those characteristics lately to make sure they haven’t changed?) How has the program been received in the past? Do youth stop coming after one or two sessions? What do the facilitators think of the program? How would they like to see it improve? Are there other issues that need to be addressed (like trauma, access to care, or substance use, just to name a few) so that your pregnancy/STI/HIV message can get through?

Why do this in summer? One reason is that you may be able to get better feedback from youth, who are less likely to be busy with academics or other school-related activities. Another reason is that summer is a time when program directors and administrators are in planning mode; decisions about programs to offer in the next academic year are getting finalized now.

Healthy Teen Network can help you to reflect on your programs in a systematic way. Those of you who have been connected with our organization for awhile know we use the Getting to Outcomes (GTO) framework to help organizations select, implement, evaluate, and sustain programs. Even if you just use this framework to check for fit or conduct continuous quality improvement (CQI), you will be taking a step toward making sure you’ve got a program in place that actually makes a difference in the lives of the youth you want to serve.

What has been your experience with reflecting on programs you have in place? Is it challenging to make it happen? Has it ever resulted in positive changes?

Valerie Sedivy, PhD, is a Senior Project Manager at Healthy Teen Network.

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