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Attaining a higher level of education is considered to be important in order to keep up good cognitive functioning in old age. Moreover, higher education also seems to decrease the risk to develop dementia. This is of high relevance in so far that dementia is a terminal disease characterized by a long degenerative progression with severe impairments in daily functioning. Despite a great amount of research emphasizing the relevance of education, it is not entirely clear how education protects cognitive functioning in old age and how much education is possibly ‘enough’.

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Depression, substance abuse, and suicide have long been associated with homosexuality. In the decades preceding the gay liberation movement, the most common explanation for this association was that homosexuality itself is a mental illness. Much of the work of gay liberation consisted of dismantling the pathological understanding of homosexuality among mental health professionals.

The post Mental health inequalities among gay and bisexual men appeared first on OUPblog.

Imagine that there is a disease that claims more than 30,000 lives in the United States each year. Imagine that countless more people survive this disease, and that many of them have long-lasting effects. Imagine that there are various methods for preventing the disease, but there are social, political, and other barriers to implementing these preventive measures.

The post Lift the congressional ban on CDC firearm-related deaths and injuries research appeared first on OUPblog.

While the common image of a "restaurant employee" is the server, there are others in the restaurant industry who also face the hardships of working in the restaurant industry: discrimination, low wages, and lack of benefits. All these contribute to a dark side of the restaurant industry, and some restaurants are fighting to change the status quo. Do you know the truth behind the restaurant industry?

The post The truth behind the restaurant industry [quiz] appeared first on OUPblog.

In an ideal world, each household would have their own toilet for privacy, practicality, and a sense of ownership—you’re much more likely to clean and maintain the facility if the toilet is yours. A toilet, latrine, or sanitation facility—these are several words to describe the same thing, namely the safe disposal of human waste, whilst providing privacy, dignity, and easy accessibility to all that need it (including young children or less abled individuals).

The post The continuing conundrum of shared sanitation in slums appeared first on OUPblog.

When heads of state and other leaders of 195 nations reached a landmark accord at the recent United Nations COP21 conference on climate change in Paris, they focused primarily on sea level rise, droughts, loss of biodiversity, and ways to decrease greenhouse gas emissions in order to reduce these consequences. But arguably the most serious and widespread impacts of climate change are those that are hazardous to the health of people.

The post Climate change poses risks to your health appeared first on OUPblog.

Do DUI prevention laws actually deter driving under the influence? Authors Lorne Tepperman and Nicole Meredith argue that punishments like fines, imprisonment, and license suspension are not as effective as we like to think. They have found that people are more likely to be changed by constructive influences (e.g., alcohol counseling) and social taboos than they are by threats of punishment.

The post The reality of DUI prevention laws [infographic] appeared first on OUPblog.

‘Ebola is a wake-up call.’ This is a common sentiment expressed by those who have reflected on the ongoing Ebola outbreak in West Africa. It is a reaction to the nearly 30,000 cases and over 11,000 deaths that have occurred since the first cases of the outbreak were reported in March 2014.

The post Most powerful lesson from Ebola: We do not learn our lessons appeared first on OUPblog.

Canadians have a vast lexicon of phrases they use to diminish accidents and their negative consequences. We acknowledge that “accidents will happen,” and remind ourselves that there’s “no use crying over spilled milk.” In fact, we’ve become so good at minimizing these seemingly random, unpredictable incidents that they now seem commonplace: we tend to view […]

The post Rethinking the “accidents will happen” mentality appeared first on OUPblog.

In 1933 in the midst of Great Depression, President Franklin D. Roosevelt, in his first inaugural address, wisely stated, “The only thing we have to fear is fear itself.” That wisdom has as much relevance today as it did during the Depression.

The post “The only thing we have to fear is fear itself” appeared first on OUPblog.

Two studies published this year yield conflicting results on whether fortifying flour with essential vitamins and minerals improves anemia prevalence. One study published in the British Journal of Nutrition (BJN) showed that each year of flour fortification was associated with a 2.4% decrease in anemia prevalence among non-pregnant women.

The post Can flour fortification programs reduce anemia? appeared first on OUPblog.

Although soda companies such as Coca-Cola and PepsiCo are recognized around the world - the history, politics, and nutrition of these corporations are not as known. In her latest book, Soda Politics: Taking on Big Soda (and Winning), Marion Nestle exposes the truth behind this multi-billion dollar industry. Check out these hard hitting facts and see how much you actually know about the soda industry.

The post The soda industry exposed [Infographic] appeared first on OUPblog.

The history of soda is full of Norman Rockwell paintings, nostalgic Americana, athletes and other celebrities—so many familiar faces that soda companies seem like the industry next door. But these are the same companies that use municipal water supplies in drought-stricken areas and spend large amounts of money on lobbying. So how much do you actually know about the soda industry? Take the quiz and find out.

The post How well do you know the soda industry? [quiz] appeared first on OUPblog.

Perhaps one of the most politically unpopular truths about violence is that it is young people who are most vulnerable to it, not the elderly or children, but youth. Global estimates from the World Health Organization are that, each year, 200,000 young people are murdered.

The post Youth violence appeared first on OUPblog.

“I had been out for a walk and got caught in the rain,” says Sen, smiling as he walks in to greet us. His knees do not permit him to pedal around Santiniketan as he once did. He is in a pleasant mood, in spite of the controversy surrounding his ouster from Nalanda University and his latest book, The Country of First Boys: And Other Essays, out next month.

The post Amartya Sen on the Modi government, education, health care, and politics appeared first on OUPblog.

Sanitation has evinced considerable interest from policy-makers, lawmakers, researchers and even politicians in recent years. Its transformation from a social taboo into a topic of general conversation is evident from the fact that one of the central themes of a recent mainstream Bollywood production (Piku, 2015) was the inability of the protagonist’s father to relieve himself.

The post Toilet paradigms and the sanitation crisis in India appeared first on OUPblog.

When making decisions about health interventions in whole populations, many people believe that the best evidence comes from analysis of the results of randomized control trials (RCTs). This belief is reinforced by the notion of a hierarchy of evidence in which the RCT is close to the pinnacle of evidence. It has that position because the RCT is a powerful tool for eliminating bias.

The post What evidence should be used to make decisions about health interventions? appeared first on OUPblog.

Today is the 60th anniversary of the polio vaccine being declared safe to use. The poliovirus was a major health concern for much of the twentieth century, but in the last sixty years huge gains have been made that have almost resulted in its complete eradication. The condition polio is caused by a human enterovirus called the poliovirus.

The post An interactive timeline of the history of polio appeared first on OUPblog.

As Ebola recedes from the headlines, amid long awaited declines in incidence in West Africa, a long overdue commitment to developing vaccines and adequate health care infrastructure is underway. The importance of these approaches should not to be minimized.

The post Preparing for the next Ebola appeared first on OUPblog.

Last year was an important year in the field of public health. In 2014, West Africa, particularly Sierra Leone, Liberia, and Guinea, experienced the worst outbreak of the Ebola virus in history, and with devastating effects. Debates around e-cigarettes and vaping became central, as more research was published about their health implications. Conversations surrounding nutrition and the spread of disease through travel and migration continued in the media and among experts.

We’ve chosen a selection of articles that discuss public health issues that arose in 2014, their effects on the present and implications for the future.

Header image: US specialist helping Afghan nomads by Sfc. Larry Johns (US Army). Public domain via Wikimedia Commons.

The post Public health in 2014: a year in review appeared first on OUPblog.

        

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Is it better to be positive or negative? Many of the most vivid public health appeals have been negative – “Smoking Kills” or “Drive, Drive, and Die” – but do these negative messages work when it comes to changing eating behavior?

Past literature reviews of positive- or gain-framed versus negative or loss-based health messages have been inconsistent. In our content analysis of 63 nutrition education studies, we discovered four key questions which can resolve these inconsistencies and help predict which type of health message will work best for a particular target audience. The more questions are answered with a “Yes,” the more a negative- or loss-based health message will be effective.

Is the target audience highly involved in this issue?

The more knowledgeable or involved a target audience, the more strongly they’ll be motivated by a negative- or loss-based message. In contrast, those who are less involved may not believe the message or may simply wish to avoid bad news. Less involved consumers generally respond better to positive messages that provide a clear, actionable step that leaves them feeling positive and motivated. For instance, telling them to “eat more sweet potatoes to help your skin look younger” is more effective than telling them “your skin will age faster if you don’t eat sweet potatoes.” The former doesn’t require them to know why or to link sweet potatoes to Vitamin A.

Is the target audience detail-oriented?

People who like details – such as most of the people designing public health messages – prefer negative- or loss-framed messages. They have a deeper understanding and knowledge base on which to elaborate on the message. In her coverage of the article for the Food Navigator, Elizabeth Crawford, noted that most of the general public is not interested in the details and is more influenced by the more superficial features of the message, including whether it is more positive or attractive relative to the other things vying for their attention at that moment.

Is the target audience risk averse?

When a positive outcome is certain, gain-framed messages work best (“you’ll live 7 years longer if you are a healthy weight”). When a negative outcome is certain, loss-framed messages work best (“you’ll die 7 years earlier if you are obese”). For instance, we found that if it is believed that eating more fruits and vegetables leads to lower obesity, a positive message (“eat broccoli and live longer”) is more effective than a negative message.

Is the outcome uncertain?

When claims appear factual and convincing, positive messages tend to work best. If a person believes that eating soy will extend their life by reducing their risk of heart disease, a positive message stating this is best. If they aren’t as convinced, a more effective message could be “people who don’t eat soy have a higher rate of heart disease.”

These findings show how those who design health messages, such as health care professionals, will be impacted by them differently than the general public. When writing a health message, rather than appealing to the sentiment of the experts, the message will be more effective if it’s presented positively. The general public is more likely to adopt the behavior being promoted if they see that there is a potential positive outcome. Evoking fear may seem like a good way to get your message across but this study shows that, in fact, the opposite is true—telling the public that a behavior will help them be healthier and happier is actually more effective.

Headline image credit: Newspaper. CC0 via Pixabay.

The post Which health messages work? appeared first on OUPblog.

        

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Although the number of Ebola cases and deaths has jumped dramatically in the short time since we wrote our December Briefing on the epidemic, there are signs of hope. Ebola is slowing down in areas where there was previously high transmission, in Liberia and in Eastern Sierra Leone for example. The lesson from past Ebola epidemics is that learning and local adaptation has played a central role in controlling previous outbreaks; now in West Africa the curve of the epidemic seems to be turning as people alter their behaviour. The apparent avoidance of continued exponential growth is a relief but it is no cause for complacency.

Freetown and the North of Sierra Leone are still suffering heavily. There is likely to be ongoing transmission for some time with sporadic clusters of cases as the epidemic moves into its next phase. The message, that local people should be involved and that their perspectives and knowledge are both valid and valuable, is still essential. Now is the time to find a balance between medical interventions, emergency thinking, and more humane and localised approaches based on collaboration.

As and when the epidemic ends, there should also be no complacency about the structural violence which produced this crisis. Structural violence refers to the way institutions and practices inflict avoidable harm by impairing basic human needs. The long term view — which locates this epidemic in the context of economic, social, technical, discursive and political exclusions and injustices — needs to be at the forefront of recovery and ‘development’ post-Ebola. The stark evidence of violence, in the form of distrust, the collapse of already dysfunctional health services, the catastrophic costs of Ebola on families and countries, the unpaid salaries of nurses and burial teams, the lack of protection – whether in the form of plastic gloves or welfare nets in times of crisis – must not fade with a return to business as usual. The Ebola crisis should be a game-changer for development.

In pointing to structural violence, we aren’t talking of a single social institution, but of overlapping institutions and practices that have produced interlocking inequalities, unsustainabilities, and insecurities. Aid and development have failed to address these conditions. Sierra Leone and Liberia attract considerable foreign direct investment and record some of the world’s highest growth figures yet most of their populations live in continued or worsening poverty. The emerging field of global health emphasizes networks and shared vulnerabilities, but in practice — through disjointed programmes and a tendency towards ‘quick wins’ — has neglected dire inequalities, which mean a virus like Ebola can tear a country up due to an absence of the most fundamental public health and state capacities. These structural and related socio-cultural conditions are not quickly or easily addressed, but Ebola has highlighted how vast disparities, internationally and within countries, are not sustainable. A greater focus on inclusive institutions and economies, and on conceiving of health as a global public good, is needed in order to build trust and resilience. Achieving that will involve asking difficult questions about aid and development as practiced in this region.

Both the crisis response and efforts to address its structural underpinnings are strengthened by recognition of the complex and historically-embedded logics and relationships which shape people’s lives. The Ebola Response Anthropology Platform has been set up to network anthropologists and other social scientists across the world with fieldworkers and communities, and to provide an interface with those planning and implementing the Ebola response so that such perspectives can be integrated into the response. Complementary initiatives, like one supported by the American Anthropological Association, mean that there is now a groundswell of debate and commentary on these critical dimensions. Much of this is building on research conducted over decades of post-colonial development and post-conflict reconstruction that, with the benefit of hindsight, is revealing of the fault-lines of the Ebola epidemic. As ‘the response’ transitions into another phase of reconstruction it is critical that these lessons, and the complexities they reveal, are fully appreciated to prevent further disasters for this region.

Headline image credit: Conakry, Guinea, 2011. Photo by CDC Global. CC BY 2.0 via Flickr.

The post Ebola: the epidemic’s next phase appeared first on OUPblog.

        

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Oxford Dictionaries has selected vape as Word of the Year 2014, so we asked several experts to comment on the growth of electronic cigarettes and the vaping phenomenon.

Vaping is the term for using an electronic cigarette (e-cigarette). Since e-cigarettes involve inhaling vapour rather than smoke, it is distinct from smoking. The vapour looks a somewhat like cigarette smoke but dissipates much more quickly and has very little odour since it mostly consist of water droplets.

E-cigarettes started to become popular around 2010 and it is estimated they are currently being used by more than 2 million people in the United Kingdom and more than 5 million in the United States. Their sale is banned in many countries, including Australia and Canada, although surveys show that use in these is widespread since they can easily be obtained via the Internet.

E-cigarettes are devices in which a battery-powered heating element vaporises an ‘e-liquid’ usually containing propylene glycol or glycerol, nicotine, and flavourings. They are designed to provide much of the experience of smoking but with much lower risk, less annoyance to bystanders, and usually much more cheaply. Because they do not involve burning of tobacco, the concentrations of toxins in the vapour are typically a tiny fraction of those in cigarette smoke. The precise risk from using them is not known, but based on the vapour constituents it would be expected to be between 1% and 5% that of smoking.

Data on e-cigarette use are not available for most countries. By far the most complete data come from England where the ‘Smoking Toolkit Study’ (STS) collects data on usage from nationally representative samples of adults every month enabling this to be tracked closely over time. This study was established to track ‘key performance indicators’ relating to smoking and smoking cessation and has been going since 2007. Action on Smoking and Health also conduct large national surveys of adults and young people each year. Large scale surveys are also being conducted in the United States and some other countries. The data show that most people use e-cigarettes in an effort to protect their health either by stopping smoking altogether or cutting down. Despite misleading claims by some anti- e-cigarette advocates, use by never-smokers and long-term ex-smokers is extremely rare in the UK and US at present, and in England its prevalence in never-smokers and long-term ex-smokers is similar to the use of ‘licensed nicotine products’ (LNPs) such as nicotine patches, gum, or lozenges.

E-cigarettes come in many different forms. In England, the most commonly used ones at present are known as ‘cigalikes’ because they look something like a cigarette and often have a tip that glows when the user takes a puff. Becoming more popular are devices that involve a refillable ‘tank’. There are also more sophisticated ‘mod’ systems which are highly customised. These are often the choice of aficionados.

Most e-cigarette users probably obtain less nicotine from these devices than people typically do from cigarettes, but experienced vapers using tank systems or mods can obtain at least as much nicotine from their devices as do smokers.

When used in a quit attempt, on average e-cigarettes seem to improve the chances of successful quitting by about 50%, similar to licensed nicotine products when used as directed. The main difference appears to be that these devices are much more popular, and they seem to be effective when people use them without any support from a health professional. Currently the evidence still indicates that use of the drug varenicline or a licensed nicotine product with specialist behavioural support provides the best chance of quitting for those smokers who are willing to use this support and where such support is available.

When used for cutting down, daily (but not non-daily) use of e-cigarettes seems to be associated with a modest reduction in cigarette consumption on average. Use of licensed nicotine products for cutting down has been found to be associated with an increased likelihood of later smoking cessation. This has not yet been demonstrated for e-cigarettes, although smokers who use e-cigarettes daily do try to quit smoking more often than those who are not ‘dual users’.

Despite claims from some anti- e-cigarette advocates, in England and the United States, e-cigarettes are currently not acting as a ‘gateway’ to smoking in adolescents or ‘renormalising’ smoking. Youth and adult smoking have continued to decline steadily as e-cigarette use has grown and in England adult smoking cessation rates are somewhat higher than they were before e-cigarettes started to become popular. E-cigarette use in indoor public areas has not led to any increase in smoking in these areas in the UK and compliance with smoke-free legislation remains extremely high.

Some e-cigarette advertising seeks to glamorise vaping and in some countries appears to blur the boundaries between smoking and vaping. This has led to concern that it might make vaping attractive to non-smokers and countries such as the UK have regulated to prevent this.

There is some controversy over vaping. A number of high-profile public health advocates have engaged in what appears to be a propaganda campaign against them, creating an impression in the public consciousness that they are more dangerous than they are and that they are undermining tobacco control efforts when the evidence does not support this. It is reasonable to be concerned about what may happen in the future with tobacco companies dominating the e-cigarette market and being incentivised to maximise tobacco sales, but much of the anti- e-cigarette propaganda appears to be motivated more by a puritanical ethic than a dispassionate assessment of the evidence. Maximising the public heath opportunity presented by e-cigarettes, while minimising the potential threat, requires collecting good data, using this information to construct an appropriate regulatory strategy, and monitoring the situation closely to adjust the strategy as required. England appears to be leading the way in this approach designed to encourage smokers to use e-cigarettes to stop smoking, while not undermining use of potentially more effective quitting methods, and preventing e-cigarettes becoming a gateway into smoking. The Smoking Toolkit Study, the ASH surveys, and other research will continue to provide essential information needed to inform this strategy.

The post Vaping and the data on e-cigarettes appeared first on OUPblog.

        

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Oxford Dictionaries has selected vape as Word of the Year 2014, so we asked several experts to comment on the growth of electronic cigarettes and the vaping phenomenon.

A new report from the US Centers of Disease Control and Prevention shows that use of e-cigarettes among high schools students has tripled in two years. The finding raises the question is vaping—the use of tobacco-free electronic cigarettes—an important tool for helping smokers quit or a ploy by Big Tobacco to addict another generation of young people to nicotine? Public health experts are poring over the modest evidence on the health consequences of e-cigarettes to find guidance for policy.

What is clear is that vaping—inhaling and exhaling vaporized nicotine liquid produced by an electronic cigarette—is on the rise not only in the United States but elsewhere. In the United Kingdom, the percent of current smokers had ever tried electronic cigarettes rose from 8.2 in 2010 to 50.6 in 2014.

Big Tobacco has jumped into the e-cigarette business with gusto. By the end of 2013, British American Tobacco, Lorillard, Philip Morris International and Reynolds—key players in the multinational tobacco business—had each bought e-cigarettes companies. While e-cigarettes still constitute a fraction of the tobacco business, their market share has grown rapidly. Retail sales value of e-cigarettes worldwide for 2013 was $2.5 billion and Wells Fargo estimates sales will top $10 billion by 2017.

Supporters of e-cigarettes argue that by satisfying the craving for nicotine these devices can wean smokers from tobacco, reducing the harm from inhaling more than 5,000 chemicals—many of them carcinogenic. Some studies have found that e-cigarettes were modestly effective at helping tobacco smokers to quit. Proponents believe that some tobacco use is inevitable for the foreseeable future so making e-cigarettes available helps reduce the world’s main cause of premature death. They compare e-cigarettes to offering injecting drug users free clean needles, a policy demonstrated to reduce HIV transmission.

Critics reject these arguments. They point to evidence that vaping exposes users to dangerous toxics, including cancer-causing formaldehyde. Of greatest concern, opponents fear that vaping will addict new users to nicotine, serving as a gateway to tobacco use. Some preliminary evidence supports this view. They also worry that e-cigarettes will re-glamorize smoking, undermining the changing social norms that have led to sharp declines in tobacco use.

The inconclusive evidence raises some basic questions. How do we make policy decisions in the face of uncertainty? In setting e-cigarette policy, what are appropriate roles for the market and government? Finally, in a political system where corporate interests have shown a growing capacity to manipulate the rules to achieve their goals, how can the public interest be best protected?

Over the past century, two warring principles have guided policy on consumer rights. The first, caveat emptor, let the buyer beware, says consumers have the obligation to find out what they can about the products they choose to consume. The more recent precautionary principle argues instead that producers should introduce only goods that are proved safe. For e-cigarettes, this would put the onus on manufacturers to demonstrate in advance of widespread marketing that the alleged benefits of vaping outweigh its potential costs. Few researchers believe that such evidence now exists.

The history of Big Tobacco suggest that no industry is less qualified to set public health policy than the corporations that are buying up e-cigarette companies. In her 2006 decision in the United States racketeering trial against the tobacco industry, Judge Gladys Kessler wrote that the tobacco industry “survives, and profits from selling a highly addictive product which causes diseases that lead to … an immeasurable amount of human suffering and economic loss, and a profound burden on our national health care system. Defendants have known many of these facts for at least 50 years or more. Despite that knowledge, they have consistently, repeatedly and with enormous skill and sophistication, denied these facts to the public, the Government, and to the public health community.”

Already the industry’s e-cigarette practices raise concerns. For example, companies have marketed products in flavors like cherry, vanilla, and cookies and cream milkshake. Their advertising has used the same sexual and risk-taking imagery employed to market tobacco to young people. Significantly, manufacturers decided not to promote their products primarily as smoking cessation devices, an approach that would have emphasized public health benefits, but instead as a glamorous, sophisticated new product. This strategy increases the likelihood that the product will create new generations of nicotine addicts rather than help smokers to quit.

Leaving e-cigarette policy in the hands of industry invites Big Tobacco to continue its deceptive practices and use its political resources to undermine public policy. The 2009 Family Smoking Prevention and Tobacco Control Act gave the US Food and Drug Administration the authority to regulate tobacco. In 2014, the FDA proposed new rules to regulate e-cigarettes. These rules would set the minimum age of 18 to use e-cigarettes, prohibit most sales in vending machines, mandate warning labels, and ban free samples. As these rules work their way through the system, advocates have suggested the need for additional rules including a ban on flavored e-cigarettes, limits on marketing, and strict oversight of the truthfulness of health claims.

Lax public health protection from lethal but legal products such as tobacco, foods high in sugar and fat, alcohol, firearms, and automobiles has produced a growing burden of premature deaths and preventable injuries and illnesses. Around the world, chronic diseases and injuries are now the main killers and impose the highest costs on health systems and tax payers. Allowing Big Tobacco to use e-cigarettes to write a new chapter in this sorry history would be a step in the wrong direction.

The post The rise of electronic cigarettes and their impact on public health appeared first on OUPblog.

        

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How did the international community get the response to the Ebola outbreak so wrong? We closed borders. We created panic. We left the moribund without access to health care. When governments in Liberia, Sierra Leone, Senegal, Guinea, Mali, and Nigeria called out to the world for help, the global response went to mostly protect the citizens of wealthy nations before strengthening health systems on the ground. In general, resources have gone to guarding borders rather than protecting patients in the hot zone from the virus. Yet, Cuba broke this trend by sending in hundreds of its own health workers into the source of the epidemic. Considering the broader global response to Ebola, why did Cuba get it so right?

Ebola impacted countries, and the World Health Organization (WHO), called out for greater human resources for health. While material supplies arrived, many countries tightened travel restrictions, closed their doors and kept their medical personnel at home. At a time when there has never been greater knowledge, more money, and ample resources for global health, the world responded to an infectious pathogen with some material supplies, but also with securitization, experimental vaccines, and forced quarantines – all of which oppose accepted public health ethics. The result is that without human resources for health on the ground, the supplies stay idle, the vaccines remain questionable, and the securitization instills fear.

The Global North evacuated their infected citizens. These evacuations spawned donations to the WHO and then led to travel bans. The United Kingdom provided £230 million in material aid to West Africa. The United States committed $175 million to combat the virus by transporting supplies and personnel, with an estimated 3,000 soldiers to be involved in the response. Canada’s government provided some $35 million to Ebola, including a mobile testing lab, sanitary equipment and 1,000 vials of experimental vaccines that have yet to arrive in West Africa or even be tested on humans. Canada then followed the example of Australia, North Korea, and other nervous nations, in imposing a visa ban on persons traveling from Ebola affected countries. Even Rwanda imposed screening on Americans because of confirmed cases in the United States.

Despite this global trend, Cuba — a small and economically hobbled nation — chose to make a world of difference for those suffering from Ebola by sending in 465 health workers, expanding hospital beds, and training local health workers on how to treat and prevent the virus. Cuba is the only nation to respond to the call to stop the Ebola epidemic by actually scaling up health care capacity in the very places where it is needed the most. Even with a Gross Domestic Product per capita to that of Montenegro, Cuba has proven itself as a global health power during the 2014 Ebola outbreak. Many scholars and pundits have been left wondering not only how a low-income country, with its own social and economic challenges, could send impressive medical resources to West Africa, but also why they would dive into the hot zone in the first place — especially when nobody else dares to do so.

Cuba is globally recognized as an outstanding health-care power in providing affordable and accessible health services to its own citizens and to the citizens of 76 countries around the world, including those impacted by Ebola. Cuba’s health outreach is grounded in the epistemology of solidarity — a normative approach to global health that offers a unique ability of strengthening the core of health systems through long-term commitments to health promotion, disease prevention and primary care. Solidarity is a cooperative relationship between two parties that is mutually transformative by maximizing health-care provision, eroding power structures that promote inequity, and by seeking out mutual social and economic benefit. The reason for the general amazement and wonder over Cuba’s Ebola-response stems from a lack of depth in understanding the normative values of solidarity, as it is not a driving force in the global health outreach by most wealthy nations. The ethic of solidarity can even be seen on the ground in West Africa with Cuban doctors like Ronald Hernandéz Torres posting photos of his Ebola team wearing the protective gear, while giving the thumbs and peace sign — an incredible snapshot of humanity that contrasts the typically frightening images of Ebola health workers.

Solidarity is not charity. Charity is governed by the will of the donor and cannot be broad enough to overcome health calamities at a systems level. Solidarity is also not pure altruism. Selfless giving is based on exceptional, and often short-term, acts for no expectation of reward or reciprocity. For Cuba, solidarity in global health comes with the expectation of cooperation, meaning that the recipient nation should offer some level of support to Cuba, be it financial or political. Solidarity also means that there is a long-term relationship to improve the strength of a health system. Cuba’s current commitment to Ebola could last months, if not years.

Cuba’s global health outreach can be approached through the lens of solidarity. This example implies engaging global health calamities with cooperation over charity, with human resources in addition to material resources, and ultimately with compassion over fear. This approach could well be at the heart of wiping out Ebola — along with every other global health calamity that continues to get the best of us because we have not yet figured out how to truly take care of each other.

Heading image: Ebola treatment unit by CDC Global. CC-BY-2.0 via Wikimedia Commons.

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