Category: 2021 Summer Blogs

A global practicum in times of COVID-19 doesn’t feel as new as expected

Posted on by nayavill

Hi! My name is Keely and I’m an MPH candidate at Gillings School of Global Public health with a concentration in nutrition. This summer, I’m working with the London-based Institute of Alcohol Studies (IAS) to develop reports which will be used to help guide future alcohol research and inform evidence-based alcohol policy in the UK.

Prior to my studies at Gillings, I received my bachelors in German studies and taught English with Fulbright Austria before working for a short time with a major health insurance company as a health advocate—I’ve jumped around a bit in fairly different areas, but the accumulation of all of these experiences is what led me to pursue public health nutrition. This past year has taken a slight turn, however, as my interest in nutrition education and community involvement has shifted to one of bringing change through policy advocacy. I’ve also grown more interested in alcohol consumption and misuse as a public health issue—two of my major projects last year focused on alcohol misuse. As a result, I’ve reflected a lot on alcohol’s role in my life and in my surrounding community, and on the social responsibility of the alcohol industry. When it came time to search for a practicum, I fortuitously stumbled upon my current position with the IAS and knew that it was the perfect fit for my developing interests.

Over the past three weeks, I worked on a briefing for alcohol use and harms among UK-based LGBTQ+ people, intended to identify gaps in knowledge (spoiler, there are a lot), and guide future research. Ultimately, this should help tailor health messaging and provide evidence behind advocacy for safer, more inclusive spaces for queer people within healthcare and alcohol treatment services. I had a slower start than I’d planned for—my job is fully remote, and I meet with my team for only one hour per week. Because of this, I found it really difficult to feel like a part of the organization and find the momentum to start during my first week (luckily that didn’t last long!). Aside from a slow start, my practicum hasn’t felt so out of the ordinary as I was expecting; I’m learning new things and my work is meant to contribute to more than a grade on my transcript, but I feel comfortable and confident working from my living room. Now that I’ve settled in and finished up my first product, my attention has turned to my second project, which will be a rapid review on the calorie labeling of alcoholic beverages.

Currently, the alcohol industry is not required to label beverages with nutritional information; UK government has announced a consultation to consider requirement of calorie labeling on alcoholic beverages as part of their new Obesity Strategy. The review that I’m putting together will be used to guide IAS’s work on the consultation. I thoroughly enjoyed my areas of research in alcohol use for last year’s academic, skill-building projects, but it is such a different (read: more enjoyable) feeling to begin work on something that will hopefully help create real societal impact. It’s somewhat intimidating, but in a good way that also makes me incredibly excited to begin a career in less than one short year.

For both projects, my days have consisted of and will continue to consist of literature reviews and writing. I’m excited to continue learning about this topic and the alcohol industry, and how the UK parliamentary system works. I’m considering pursuing a career in alcohol research/policy following graduation, so it’ll be interesting to build this base of knowledge and identify potential areas for alcohol research and policy advocacy within the US. I’m very grateful for the opportunity to improve upon my research and writing skills and work within a small, female-run research organization that has significant influence in the UK policy sector.

The rest of this summer will be quite busy, as I’m working a second job atop my practicum, but it’s already shaping up to be one of the best I’ve had— from the meaningful work and connections I’m building, to making the most of my free time and weekends. I’m looking forward to what’s to come!

– Keely

Nutrition Lessons from Peru

Posted on by nayavill

Well, just like that, June is coming to an end and so is my internship. You’ll recall that I spent my spring and summer Working from Home with the World Bank. During my practicum I performed a literature review of several low- and middle-income country’s health care systems and how they are working towards universal health care for all and incorporating nutrition services within these models. There are a multitude of learnings and moments of insight I could expound on, but I’ll focus on Peru’s efforts to reduce stunting in youth under-five years of age.

Stunting is a form of malnutrition that results from chronic undernutrition. Broadly speaking, undernutrition can present in four forms: wasting, stunting, underweight and micronutrient deficiencies. Stunting is diagnosed when a child presents with low height-for-age two standard deviations below the WHO Growth Standard deviation median. Wasting is low-weight-for-age and a sign of acute undernutrition; by definition one is wasted if he or she is more than two standard deviations below the WHO Child Growth Standard deviations weight-for-age median. Globally, the prevalence of under-five stunting and wasting are on the decline, but an unacceptable number of youths still suffer from undernutrition. In 2020, 149.2 million of the world’s under-five youth were affected by stunting and 45.4 million were affected by wasting. Among the global health and nutrition community, Peru is best known for its achievements in reducing the prevalence of under-five stunting from 28% to 13% in just eight years (2008-2016).

Stunting affects physical and mental growth. Early deficiencies in cognitive development can be catastrophic for an individual’s lifetime quality of life, educational opportunities, and economic earning potential. This has implications for the prosperity and development of nations at the population level. The economic cost of undernutrition is projected to be 2-3% of gross domestic product (GDP) on average and as high as 11% of GDP in some African and Asian countries each year. Figure 1 shows the effects of stunting on white matter tracts in the brain of a stunted infant (left) versus brain development of a healthy child (right) at two to three months of age. The density and richness of neural networks differ in the images and by the time a stunted child gets past their first thousand days they have up to 40% less brain volume compared to non-stunted children.

Figure 1: Representation of Neural Networks in a Stunted and Non-Stunted Infants.
Figure 1: Representation of Neural Networks in a Stunted and Non-Stunted Infants.
Source: Nelson, C. 2016. Brain Imaging as a Measure of Future Cognitive Outcomes: A study of children in Bangladesh exposed to multiple levels of adversity, Presentation at the Grand Challenges meeting, London, October 2016 and 2017

There is no silver bullet that fully accounts for Peru’s success in reducing under-five stunting. It can be attributed to a combination of grassroots advocacy, political commitment, and systemic changes in how nutrition services are prioritized and delivered. The details of this effective combination are too nuanced to delve into during a blog post, but the short version is: Peru’s government and leaders recognized the need to reduce stunting, it allocated money and resources to this end, and it iterated on programs and policies to reach its goal. One of my biggest learnings from the Peru case study is that health care is about trade-offs! I’ve read that health care is a triangle of tradeoffs between health, wealth, and equity. I certainly believe that to be true and it should be front-of-mind as more countries explore the means to provide a basic level of healthcare to their citizens.

Signing off,

Ashley

Addressing global threats in our own backyards

Posted on by nayavill

When faced with difficult choices, I often come back to a central question: what is my intention, and how can this decision help me work toward that? In March 2020, I was happily living in Guatemala, serving as the on-ground Director of Operations for a small birthing center, run by local midwives and funded by a US organization. What followed that month is now well known to all of us, and I had a difficult choice to make about whether I would return home to begin my Master of Public Health. My final choice to start the program had many factors, but one thing became crystal clear in my mind: my home had become the global epicenter for a public health disaster. There was so much work to be done, and I needed to figure out how I was going to serve my home country.

Part of the reason I felt passionately about my work in Guatemala is that I believe that investment in healthier families is a critical in working to end poverty in the region, and ultimately a necessary factor to stem migration. No one wants to leave their home to embark on a dangerous journey; it is borne out of necessity. Issues affecting immigrants and refugees in the U.S. (especially Latinx communities) have always been one of my major interest areas, and I hoped that I would be able to integrate this into my practicum. As a student in the Applied Epidemiology concentration of the MPH, I also intended to use my summer to beef up my skills in data analysis.

End TB pin
Ending TB from my backyard in NC!

The pandemic has made it abundantly clear how public health departments are critical infrastructure in the US, and I was hoping to learn more about what it would be like to work for one. That’s why I was excited about the opportunity to work with the Tuberculosis (TB) Control Program at the North Carolina Department of Health and Human Services. For this project, I will be helping to strengthen community partnerships to prevent active tuberculosis. As part of the process to seek permanent resident status, applicants are required to undergo a medical exam which includes a test for latent TB. Latent TB can turn into TB disease, which requires much more difficult treatment and can spread to others. After COVID-19, it has become abundantly clear how important it is to prevent the spread of respiratory infections like TB and pay special attention to vulnerable populations who often bear the greatest burden.

This project will have two major components: compiling a database of all active practitioners that provide these exams (civil surgeons), and using this database along with existing data to estimate how many potential latent TB infections are detected annually, along with how many “status-adjusters” are seen each year. These data will bolster the case for funding for an educational program for civil surgeons on how to counsel those with latent TB and encourage them to treat the infection before it progresses.

I’m excited to dive into this project because it really embodies the reason I came back to the U.S.: global health issues are local issues. If the U.S. public health infrastructure was better equipped, we might have been able to stem the spread of COVID-19 in this country and around the world. TB is a growing threat globally and it’s critical to address it at home in North Carolina.

-Jaclyn