Student Blogs: Molly Hogan, Global Health Ambassador 2017/18

Molly Hogan is on the University of Manchester Global Health Society Ambassador Programme 2017/18.
She is a fourth year biomedical science student at the University of Manchester and shares with us her experience in global health so far. 


How did you first become interested in public and global health?

Throughout my degree I have studied the scientific basis of many public health aspects.  I think my interest in the field first began during my first year ‘Man, Microbes, and the Environment’ unit. A lecture on epidemiology captivated me as I found it fascinating that diseases, which seem so unpredictable, could be studied, tracked, and prevented when a variety of disciplines work together to improve heath. Since then, other university modules have introduced me to the biology of public health topics and fuelled my interest even further, such as the mechanisms behind antibiotic resistance, and the neuronal basis of many mental health problems such as depression and schizophrenia. I feel privileged to be attaining knowledge on issues that are so frequently in the news and to be in a position to enter a career that tackles issues affecting all ages, genders, social classes, ethnicities and assists these populations to lead a full and happy life.

Have you ever been involved in any public health campaigns?

One of my most enjoyable experiences in the past few years has been working at the University of York, participating in a review which sought to investigate a link between smoking and diabetes, and also to take part in the University’s tuberculosis (TB) and tobacco project.

These projects were very interesting, the literature review provided a step-by-step system for finding a pattern between diabetes and the effect of smoking cessation, by pulling together findings from much of the previous research and literature. The TB and tobacco project was extremely exciting as it aimed to investigate ways that smoking interventions could be introduced into TB control programmes in order to improve the health of TB sufferers, and decrease tobacco-related diseases. The project focussed on Bangladesh, Nepal and Pakistan and was in collaboration with 8 other organisations: ARK foundation, Dhaka, Bangladesh; HERD International Pvt. Ltd., Kathmandu, Nepal; National TB Programme, Islamabad, Pakistan; The Initiative, Islamabad, Pakistan; Heinrich-Heine University, Düsseldorf, Germany; The University of Edinburgh, UK; The University of Leeds, UK and the General University Hospital, Prague, Czech Republic.

This project was therefore on a huge scale, and it was fascinating to see the planning, timelines, communication, hurdles, and intricacies of such a substantial project. It was captivating to see such influential work being carried out and to see the different roles played by the different team members. Alongside the smoking cessation review, I gained vital knowledge on the effects of smoking causes on a whole range of public health topics. The experience at the University of York was invaluable and I cannot thank them enough.

What do you consider the most important public health issues will be in 2018?

A public health issue is an extremely broad description of anything that compromises the health of different populations. There are several that I think will be particularly relevant in 2018.

An aspect which becomes more relevant as technology, pharmaceuticals and healthcare systems improve is the rise in our life expectancies. The world’s population aged 65 and over will grow from an estimated 524 million in 2010 to 1.5 billion in 2050. The majority of this increase occurring in less developed countries (WHO, 2011). As the population ages, the potential for an increase in age-related illnesses increases simultaneously. Examples diseases associated with ageing populations are atherosclerosis and cardiovascular disease, cancer, arthritis, cataracts, osteoporosis, type 2 diabetes, hypertension and Alzheimer’s disease. The incidence of all of these diseases increases rapidly with age (increasing exponentially in the case of cancer). Another important factor to consider is loneliness, which has a huge impact on health and is much more prominent in the elderly. In order to prolong the independence of people who are elderly, life-long health must be promoted; disease prevention methods must be implicated; early disease detection maintained and decent long-term care and support for those who develop illness. This adds huge financial pressures to healthcare systems, and therefore is a very real concern in public health.

The public health aspect which I find most captivating, important and simultaneously horrifying is antibiotic resistance. Dame Sally Davis has described this phenomenon as a catastrophe, stating that within 20 years, minor surgery or routine operations such as hip replacements could be deadly; a truly alarming concept (BSAC, 2013). The rate at which bacteria develop this resistance is rapid, and the emergence of resistance often occurs only years after the deployment of each antibiotic (Figure 1). Antibiotic resistance is rising to dangerously high levels in all parts of the world with new resistance mechanisms emerging leading to common infections such as pneumonia, tuberculosis, blood poisoning, gonorrhoea, and foodborne diseases being increasingly difficult to treat (WHO, 2017).

(Clatworthy et al., 2007)

Owing to the high resistance rates and issues of cost vs benefit, pharmaceutical companies are reluctant to research and develop new antimicrobials, and the farming industry contributes wildly to this issue through use of antibiotics in animal feed in agriculture. This means that there are economic consequences to be addressed when tackling this problem. The other aspect of this topic which is interesting is the role that the public can play in prevention. Medical professionals can advise and encourage patients to finish a course of antibiotics and not prescribe them if unnecessary; but essentially, the patients are responsible for taking antibiotics correctly. Public engagement through advertising, news stories, campaigns and other endorsements are another layer to this problem.

Another slightly less obvious public health concern is associated with travel. I attended a seminar by Professor Peter Piot of the London School of Hygiene and Tropical Medicine who highlighted that our ever-increasing ability to travel is extremely beneficial and valuable, however, is posing new issues that we have never had to deal with before. Communicable disease can spread faster and further than ever, straining prevention systems worldwide. Our ability to restrict disease outbreaks will have to keep up with our ability to jet across the planet, and because prevention systems vary in their effectiveness for different diseases in different locations, this poses a real problem in terms of consistency in approach.

Other aspects of public health which I feel will be extremely important are obesity and its co-morbidities, alcohol related illnesses, HIV, smoking related illness and FGM.

When did you first encounter female genital mutilation (FGM) as a global health concern, and why did it stand out to you?

FGM is a difficult topic to avoid, frequently in the news and, to many, a difficult thought to dismiss. FGM refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or other non-medical reasons. This affects approximately 200 million women and girls worldwide with serious sexual and reproductive implications (UNFPA). I first encountered FGM during my later years at secondary school in an article in the British Medical Journal. My understanding of the complexity of the topic and the cultural implications has grown since then, which makes it an even more thought-provoking concept.

The issue has stood out for me owing to the polar opposite connotations that it has for separate societies, making it a delicate and sensitive issue. Girls and women who have undergone FGM live predominately in sub-Saharan Africa and the Arab States, but FGM is also practiced in select countries in Asia, Eastern Europe and Latin America. It is also practiced among migrant populations throughout Europe, North America, Australia and New Zealand. For the societies which practise this procedure, it embodies many positive traits such as cleanliness, womanhood, belonging and purity. Often, women are outcast if it is known that they have not undergone the procedure, a very different attitude to the majority in the UK who feel that it is a violation of women that needs to be avoided at all costs. This huge imbalance is what makes this issue so prominent to me.

What do you think are the relevant factors to consider when addressing FGM?

As previously stated, FGM is a sensitive subject pertaining to the cultural implications of the procedure. There are many factors that need to be considered when addressing this issue. For example, an important aspect is the reason that communities want to practise the procedure in the first place. FGM is seen as part of a girl’s initiation into womanhood, and often there are myths about female genitalia such as that the uncut clitoris will grow to the size of a penis, or that FGM will enhance fertility, promote child survival or increase male sexual pleasure. It is often seen as something to be celebrated in communities that practise FGM. Frequently ‘FGM parties’ are held by families to celebrate the event it is frequently requested by the children themselves in order to by accepted by the other children in their society.

Religion is another aspect that needs to be considered. Although no religion endorses FGM, religious doctrine is often used to justify the procedure. Certain hadiths have sometimes been interpreted as suggesting the procedure, however this is strongly debated and no definite religious endorsement has ever been found.

Health consequences of the procedure need to be considered also. There are a variety of implications dependent on which of the four FGM procedures are performed; the conditions the procedure takes place in, including the experience of the practitioner; the health of the girl undergoing FGM and the level of resistance she has to the procedure. The main health implications include: severe pain, shock, haemorrhage, tetanus or infection, urine retention, ulceration of the genital region and injury to adjacent tissue, wound infection, urinary infection, fever, and septicaemia. Haemorrhage and infection can be severe enough to cause death. There are also other, longer term, health consequences such as childbirth complications, cyst formation, scarring, anaemia, damage to the urethra, painful sexual intercourse, hypersensitivity of the genital area, and increased risk of HIV transmission. These are serious health concerns and as a result, the primary reason that FGM is illegal in the UK.

Psychological implications of either undergoing or not undergoing the procedure are also important to consider. For girls undergoing FGM who did not want to, there can be behavioural disturbances from a young age, such as loss of trust and confidence in guardians and other authorative figures. In the longer term, women may suffer feelings of anxiety and depression. Sexual dysfunction may also contribute to marital conflicts or divorce. However, the psychological implications of not undergoing the procedure for girls who did want it must also be considered if they are to be truly protected. Girls can be outcast from their communities and relationships with family members can breakdown, leaving them lonely, depressed and vulnerable. If FGM is to be properly tackled, programmes need to be in place in order to protect those girls who may require help after resisting the procedure.

Overall, FGM is an extremely complex issue, which although to many people is viewed as an abuse of human rights, damaging and wrong, is strongly tied up with sociological and cultural beliefs. Therefore, tackling FGM requires a sensitive approach, which takes into account these beliefs and traditions, and is adapted to an individuals’ experience.

The World Health Organisation launched a Global Action Plan in 2016 to address the global epidemic of violence against women. The University of Manchester’s Global Health Society has a team of 10 ambassadors running a project on Violence Against Women. We will be running a two day exhibition in March which will cover many aspects of violence against women, one day will focus on institutionalised violence and FGM will be considered in more detail here. If anything in this blog was of interest, this would be an interesting event to attend.


BSAC. 2013. Antimicrobial resistance poses ‘catastrophic threat’, says Chief Medical Officer [Online]. Available: http://bsac.org.uk/antimicrobial-resistance-poses-catastrophic-threat-says-chief-medical-officer/ [Accessed 21/12/2017 2017].

CLATWORTHY, A. E., PIERSON, E. & HUNG, D. T. 2007. Targeting virulence: a new paradigm for antimicrobial therapy. Nat Chem Biol, 3, 541-8.

UNFPA. Female genital mutilation (FGM) frequently asked questions [Online]. Available: http://www.unfpa.org/resources/female-genital-mutilation-fgm-frequently-asked-questions [Accessed 21/12/2017 2017].

WHO. 2011. Global Health and Aging [Online]. Available: http://www.who.int/ageing/publications/global_health.pdf [Accessed 21/12/2017 2017].

WHO. 2017. Antibiotic resistance [Online]. Available: http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/ [Accessed 21/12/2017 2017].


 

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