Gini index, a measure of inequality

GINI index is a measure of income inequality in a society. A society that scores 0.0 on the Gini scale has perfect equality in income distribution. Higher the number over zero means higher inequality. The Gini coefficient was developed by an Italian statistician Corrado Gini and published in his 1912 paper “Variabilità e mutabilità” (”Variability and Mutability”).

Gini index in most developed European nations is between 24% and 36%, the United States Gini index is above 40%, indicating that the US has greater inequality in income distribution. By looking at the map prepared by Prof. Russ Lopez in 1999, you can see the differences between Gini index in different metropolitans in the US.

Now look at the Gini world map, as you can see most of developing countries have large gini scale indicating not only the nation face poverty, but also the wealth is distributed unequally.

For more info you can visit:

Human Development Report

Wikipedia

Gini index

From Alma Ata to the Global Fund

From Alma Ata to the Global Fund: The history of International health policy is a report prepared by the Italian Global Health Watch, published in the Social Medicine (Volume 3, Number 1, January, 2008). This paper traces the evolution of international health policies and international health institutions, starting from the birth of the World Health Organization, the setting up of the Health for All targets at the Alma Ata conference 1978 and the rise of neo-liberal policies promoted by international financial institution from 1980 to the present. The paper looks at different issues surrounding public-private partnerships and the setting up of the Global Fund to fight AIDS, Tuberculosis and Malaria and the influence of these institutions on the health system in poor countries. For having access to a copy of this report click here.

ASPH Public Health Policy Fellowship

The Association of Schools of Public Health (ASPH) represents the 40 Council on Education for Public Health (CEPH)-accredited schools of public health (SPH) in North America.

The ASPH Public Health Policy Fellow will be placed in either a congressional or committee office, to be determined, on Capitol Hill in Washington, DC. Selected fellows are required to relocate to the fellowship location.

What does the ASPH Fellowship offer you?

This Fellowship will provide a unique opportunity for a motivated and experienced individual to play a role in helping to shape United States health policy. Specific anticipated benefits include:

* Development of a thorough understanding of the public health policy and the legislative process;
* Access and networking with experienced policymakers, public health professionals, and experts in the field of public health; and,
* Obtain hands-on real world health policy experience in the fast-paced environment of Capitol Hill.

In addition to the above benefits, the position includes the following allowances:

* One Year Stipend: $40,500
* Local Travel: $ 500
* Health Insurance: $ 3,600
* Moving Expenses: $ 1,000

When and where are the Fellowships offered?

Fellowship positions are full-time opportunities whose duration is for a one year period (July 2008 - July 2009).



For more info click here.

Strange Fruits in the USA, a country of change

The current presidential race in the United States is one of the exciting episodes of the history of the American nation. This nation as a generous and patriot nation is an example of change for making a difference. If you look at the history of this country you will be impressed with the amount of changes and evolutions that took place in a short period of time. For example lynching of African Americans that had occurred mainly in the South took place in 19th and 20th centuries. Today only 40 years after Dr. Martin Luther king movement, you can see a Black candidate who runs for presidency of the United States is still in the race and has high chance for being a party nominates for November election.

Can you see the magnitude of change, I am from Middle East and I can tell you in some societies of our region if you are from minorities, despite the fact that lynching is not a case, but it is almost impossible for you to be in the office race (if there is any). In this country it is possible and does not need centuries to see it happened.

It is strange, and reminds me the Strange Fruit, a song by Billie Hodiday, a song among the list of Songs of the Century. This song was an objection to lynching of African Americans.



Southern trees bear a strange fruit,
Blood on the leaves and blood at the root,
Black bodies swinging in the southern breeze,
Strange fruit hanging from the poplar trees.

Pastoral scene of the gallant south,
The bulging eyes and the twisted mouth,
Scent of magnolias, sweet and fresh,
Then the sudden smell of burning flesh.

Here is a fruit for the crows to pluck,
For the rain to gather, for the wind to suck,
For the sun to rot, for the trees to drop,
Here is a strange and bitter crop.

Health, market or essential human right that is the question

Last week in a Medical Care Class at the BU school of public health, we discussed about the health market, professor said that the health market is an imperfect market, because it doesn't have the characteristics and assumptions adhered to a perfect market. A perfect market has some assumptions like rationality of the market actors, no transaction cost (no information cost and taxes), no price taking behavior and there is sufficiently large number of participants such that no individual can affect the market and freedom of decision. Professor told us that the health market is imperfect because the following assumption is not a case in this market (1):

• Power Equal
• Real competition and choice
• Full information
• No price fixing
• Transparent to buyer and seller

Patient and doctors don't have an equal power, in most areas competition is not a case since there is no different health providers. For example in some countries only one neurosurgeon works, or because of the insurance policy patients are not allowed to visit any doctor that they wish.

But my question is what about we look at the health care as a fundamental human right, if so; we can not simply analyze the health system from a market perspective. In this case health is not only a commodity with all of characteristics related to goods, it is a right, and we need to take into the account the costs of providing a right for citizens and in some cases it can be an imperfect market.

(1) Courtesy of Professor Bill Bicknell

Opportunity cost

One of the concepts that a health policy maker should be aware about it is the measurement of opportunity cost in a policy or program. For example, if a city decides to build a hospital on vacant land it owns, the opportunity cost is the value of the benefits forgone of some other thing which might have been done with the land and construction funds instead.

Suppose you have a full time job with some years of experiences and you decide to come to school and study Dr PH program, the opportunity cost for pursuing this degree is the full time job, Job promotion and the other valuable things that you will leave behind for participation in the degree program.

Opportunity cost is the center of microeconomics and was developed by Friedrich Freiherr von Wieser (July 10, 1851–July 22, 1926) as an early member of the Austrian school of economics.

Publication Bias

Sometimes investigators and research institutes spend a lot of time and efforts to conduct a study for examining a hypothesis, but it is possible that they reach to a non statistically significant conclusion, in this case, it is most likely to see unpublished the results of these studies. Studies show that the studies that reach a statistically significant conclusion are more likely to be published than those fail to reach significance and studies that reach significance conclusions are published more quickly than studies that do not reach significance. So why this is a case and this problem happen.

Study investigators may self-censor non-significant results, it takes time and energy to write up and publish study results, investigators may not wish to invest their time and energy in publishing studies that they feel are not exciting and instead put their efforts into more promising research. Rosenthal calls publication bias the file drawer problem as busy researchers may have file drawers full of results of no significant and unpublished studies.

In medicine most of the time pharmaceutical companies are sponsor for many clinical trials for evaluating the effects of a treatment, if they reach to non significant results, they are not interested to publish the results since they are the owner of the data and study. Journal editors and reviewer are less likely to accept the studies with non significant results. Publication bias affects the Meta analysis studies as well as any review of literature.

So what is wrong with publication bias?
The problem is that because of a fraction of studies on a subject that is available, it makes the field optimistic toward a treatment or a medicine.

Note: for writing this post, I used the slides of Meta Analysis course by Prof. Michael Lavalley

Global Road Traffic Injury Epidemic

Road Traffic Injuries are responsible for a global health burden similar to malaria and tuberculosis. Tuberculosis and Malaria are in the international global agenda and receive enough attention in media and political community, but Road Traffic Injuries are ignored by most of health policy makers and it doesn't receive enough attention even from academia.

During my study at the school of public health, rarely I heard anything about this important problem that most likely beats the developing countries. One of the reason may related to the lack of research funding and attention, while you can sell your idea about fighting malaria, Tuberculosis or HIV/AIDS easily to donor agencies, why you spend your time and efforts to work on something that suffers from lack of attention and of course funding.

The other reason for ignoring this problem is related to the nature of the problem, the road traffic injuries as a problem, is difficult to address or even understand the roots in any given geo-political context. It is not a kind of "101 problem" it needs a multi stakeholder and multi dimensional approach, which is not common in most health settings in most countries.

Talking about the RTIs, also draw attention to the car industries, it means car industries have to spend a lot of money to deal with safety that is not a case in most countries with lack of resources, also related governmental authorities involved in industries can influence safety ignorance for making more profits.

I think this is the responsibility of new generation of practice based public health policy makers to force global community, governments, car industries and other stakeholders to pay attention on this major and growing public health problem.

Mission Statement Builder; create your mission statement today

"The key to the ability to change is a changeless sense of who you are, what you are about and what you value." -Stephen R. Covey

Have you ever thought to write down your personal mission statement? Do you know how important could be having a clear personal statement to show your meaning of life?
The sense of purpose to your daily decisions can reflect on your own mission statement. Suppose you want to find a new job and interviewer asks you about the reason of selecting this job, you can show him/her in a well defined statement that actually the job is related to your personal mission and your definition of your role in the society has been stated in your personal mission. You want to start your project or dissertation, if you know who you are and what is your personal mission, so you can decide in which direction you should go.

In the era of information age it is not difficult to create your mission statement. One of the tools that I know is Franklin Covey planner, you can go online to Covey website and the wizard will take you step by step through the process of creating a unique, personalized Mission Statement to guide your life. As other tools that I introduce in this blog the Covey planner is free of charge. So hurry up, it is time to write your personal destiny.

Happiness Index an indicator for well being

Are you happy? When do people feel happiness? If they don't have anything to eat make them happy, or if their babies are dying from pneumonia is a happy situation. If they live under Bomb and there is no hope in their country makes them feel as developed and happy nation. Of course, normal human in the mainstream is not happy in any above conditions and circumstances. If you feel free, just, fare, hopeful, sound, safe, with access to food, clean water, education, health care, medicine, shelter, job and security, then you feel fine and it sounds well being and make you happy.

Country of Bhutan came with the idea of happiness index as an indicator for sustainable development. Based on the Global Projection of Subjective Well-being Study, Denmark is the happiest nation in the world, and Switzerland, Austria, Iceland, Bahamas are 2nd to 5th happiest nations. United States is 23rd and United Kingdom 41st. Iran 96th and Sudan, Ukraine, Moldova, Congo, Zimbabwe and Burundi with 173rd to 178th are among less happy nations in the world.

By using GIS 9.2 software and with using data of Human development report of 2007, I compared GDP/capita and happiness index of Eastern Mediterranean countries (EM Regional Office of WHO), unfortunately because of war there is no data about Iraq and Afghanistan.

Look at Yemen, in this poor country it seems people are happier than some countries with much higher GDP/capita.

Lesson learned sharing Blog

I am a Dr PH student in Boston. I am here to share my learning with other Public Health students and professionals in this field. Having the opportunity to study in a graduate school is not always possible for interested people, so I decided to share and disseminate my knowledge with people who are interested. I try to summarize the pieces that I found interesting during my journey in the school of public health.

I was out of school for almost 10 years after I graduated from Medical School in 1995, so I know how difficult could be adjustment with the new applications in the era of information age. My plan is to summarize most of my lesson learned by June 2008 and then I will keep this blog updated with the public health challenges and practice based interventions. I try to write about the controversial aspects in public health, practice based approaches, new findings, and the sources of grants for students and professionals, events, practicum and job opportunities, and everything we need to learn for conducting a professional mission on the ground.

I am from Middle East and I am interested in working on countries in the Middle East and North Africa region, so you may find most of my examples from this region. Also since we are heading to the presidential election in the States in Nov 2008 and one of the most important parts of debates among the candidates is about Health Care in this country I would like to spend time and learn about candidates and parties viewpoints in this aspect.