Sustainable Development:the Holy Grail of Global Health

Stephen Berman, MD, FAAPDirector, Center for Global Health, Colorado School of Public HealthProfessor of Pediatrics and Public Health, University of ColoradoEndowed Chair, General Pediatrics, Children’s Hospital Colorado

Stephen Berman has no relevant financial relationships to disclose

or conflicts of interests

Tales of 2 Global Experiences

• Mountains Beyond Mountains– Biography of Paul Farmer by Tracy Kidder

• Three Cups of Tea: One Man’s Mission to Promote Peace…One School at a Time– Autobiography of Greg Mortenson

Lessons Learned • Passion• Perseverance• Principles IntegrityCredibilityFairness and a sense of social justice

Reflections on My Personal Global Health Journey

Cali Colombia: 1976-78 Study of ARI in 5

community health centers with blood cultures and viral culturesDirector of the Universidad Del Valle Emergency DepartmentCase history of a boy presenting with a rigid abdomen

Reflections on My Personal Global Health Journey

WHO 1980-1990• WHO Case Management of Acute

Respiratory Infections• Program Implementation

Philippines Brazil Egypt

• Research Infant pneumonia Respiratory rate thresholds Otitis media studies

• Global Burden of disease (ARI and Otitis)

Reflections on My Personal Global Health Journey

BOSTID 1987-1988• Research: clinical coordinator

for 12 country etiology study of pneumonia Data on pneumococcal

serotypes

What is Global Health?

Health care issues and concerns that transcend

national boundaries and are best addressed by cooperative

actions and solutions.

Global Health and “America First”How do we benefit?

New therapies developed and tested abroad: ORS, HIV therapies

New vaccines developed and tested abroad:Rotavirus, Pneumococcal, Ebola, Dengue

Understanding emerging diseases:Zika, Ebola, Dengue

International Health

• Excessive Morbidity and Mortality• Low Income Countries

Global Health

• Sustainable Development• Low and Middle Income Countries

Planetary Health

• Planetary Ecosystems • Human Race (all countries)

Perspective• MDGs• SDGsTargets

• Family• Community/country/region• Human race

Population

• Lifetime• Generations• Millennium

Time

Millennium Development Goals - 2015

Maternal mortality Child mortality HopelessnessViolenceCorruptionPolitical instabilityConflict

Water Sanitation

Food InsecurityNutrition

InfectionHealth care access

Environ-mental

conditions

Disaster preparedness and response

Gender Inequality

Family composition

Education

Jobseconomic

growth

Extreme Poverty

Dysfunctional community-based systems

(size)

MDG 1

MDG 2

MDG 3

MDG 4,5

MDG 6

MDG 7

MDG 8

Sustainable Development Goals

September 2015 UN General Assembly ratified 17 goals with 169 proposed targets

Sustainable Development Goals

StarvationEpidemicsDisastersViolence

Political instabilityConflicts

Failed StatesRising mortality

Rising oceans/ flooding

Decreased useable land

Decreased soil nutrients

Expanded vector borne disease areas

Melting glaciers

Land degradation

Water Scarcity

Decreased Biodiversity

Global Warming

FisheriesExploited

Ocean Acidification

Social Justice and Fairness

Disproportionate Burden of Global Warming

Commoners (LMICs) versus Elites (HICs)

Women and their children and families

IN 2011

Promote the comprehensive improvement of health and human development of the population in El Trifinio region

• Large agribusinessenterprises for crop export

EL TRIFINIO REGION

• SAN MARCOS

• RETALHULEU• QUETZALTENANGO• Lack of community

cohesion• High migration

Timeline of the UCD-CHCO Trifinio Guatemala Site

June2011

RNAOct2011

Child developmentAnd growth studies

July 2012-13Clinic Opening

March 2014

The Trifinio Guatemala Project:Implementing the SDGs at the Community Level

• Community nursing program: home and group visits for pregnant women, neonates, and children to age 3 years

• Family clinic• Dental clinic• Birthing Center• Research programs• Education programs• Community Development

Trifinio Clinic2014

Care groups: teaching mothers to help their children grow and develop

“The greatest capital that you can invest in is human capital, and, of that, the most important component is the mother.”-James Heckman, Nobel Laureate, Economist

Research• Surveillance of Dengue, Chick, and Zika• Neurodevelopmental impact of post-natal Zika

infection• GIS mapping of the community• SMS text messaging for immunizations• RCT of new product to treat diarrhea• Child development studies

Education• Students, residents, fellows from medicine,

pharmacy, nursing, dental, and public health schools.

• Trifinio nursing, pharmacy and laboratory staff• Sex education programs in the schools• Youth leadership school program