Today, our discussion is about mental health- a very important topic in every society, yet often shied away from due to stigma. According to Centers for Disease Control and prevention (CDC), mental health is a significant part of our overall health and includes our emotional, psychological and social well-being. It influences how we think, feel, act, handle stressful situations, relate to others, and make decisions.

Mental health is important at every stage of life, from childhood through adolescence to adulthood. Here are some facts and statistics from World Health Organization that emphasize the impacts and implications of mental health:

• About 20% of adolescents worldwide suffer mental health disorders or problems, usually beginning at the age of 14
• Mental illnesses such as alcohol and substance use disorders are the leading cause of disability worldwide
• Approximately 800,000 people die from suicide yearly, mostly due to mental disorders such as misuse of alcohol and drugs
• Disasters impact mental health and psychosocial well-being given that rates of mental disorders tend to increase afterwards
• Mental disorders are risk factors for other diseases and injuries
• Stigmatization, isolation and discrimination of people faced by mental illnesses and their families prevent them from seeking help
• Mentally ill people are sometimes violated and deprived their right as humans through physical restraint, seclusion and denial of basic needs and privacy
• Financial and human resources are insufficient to meet the growing needs of mental healthcare

Mental health disorder or illness is used to describe a wide range of disorders that affect and influence the mind including mood, thoughts, comprehension, attitude and actions. Some common examples of mental health disorders include depression, anxiety, schizophrenia, post-traumatic stress disorder (PTSD), substance use disorder, panic attack, bipolar disorder, eating disorders, obsessive-compulsive disorder, personality disorders, psychosis, self-harm, suicide ideation, gambling and addictions. Mental health disorders are associated with stress, and the symptoms vary from mild to severe. Globally, similar types of disorders are reported across countries and cultures with neuropsychiatric disorders being the leading cause of disability in young people.

Despite the availability of effective treatments for mental disorders, it is wrongly believed that they are untreatable. People with mental disorders are also perceived to be difficult and dumb. However, these assumptions are false, unfair and uninformed and consequently lead to abuse, rejection, shame, fear and isolation and prevent people from seeking the help and support they need.

Sadly, some regions of the world still lack the required resources for mental health. For instance; low-income countries have 0.05 psychiatrists and 0.42 nurses per 100 000 people which translate to 170 times and 70 times less than what is obtainable in high-income countries. Dearth of qualified and adequate human resources for mental health such as psychiatrists, psychiatric nurses, psychologists and social workers constitute major barriers to the availability and provision of treatment and care in low- and middle-income countries. Other barriers include non-prioritization of mental health in the public health agenda, lack of funding, decentralization of mental health services, lack of integration within primary care and lack of public mental health leadership.

In conclusion, mental illnesses like most illnesses are preventable and treatable. Depending on your location or region, resources, help and support are available and accessible online and onsite, so, don’t shy away from getting help.

The World Health Organization identifies and recognizes suicide as a major public health problem to which about 800,000 deaths is attributed worldwide, annually. For each of these individuals who take their lives, there are much more people who attempt suicide. Among adolescents and young adults aged 15-29 years, suicide was the second leading cause of death in 2015. Suicide is a global phenomenon which occurs in every country and region of the world with its most significant predisposing factor being a previous failed attempt. Despite being mostly associated with high-income countries, approximately 78% of global suicides in 2015 occurred in low- and middle-income countries. The most common methods of suicide around the world are ingestion of pesticides, hanging and use of firearms. In fact, up to 30% of global suicides happen by the use of pesticide to poison oneself, especially in rural agricultural areas where these chemicals are easily accessible.

Suicide, like every loss and death, is a tragedy that affects families, friends, communities and countries at large. It leaves many questions and long-lasting effects on the people left behind. People commit suicide for many different reasons. There is a well-established link between suicide and mental health disorders such as depression and drug or alcohol misuse. In addition, many suicides happen in moments of crisis, pain and thoughtlessness when people feel overwhelmed, swamped and unable to carry on with life. Loss of loved one, failure in the ability to deal with life stresses, financial problems, relationship break-up or chronic pain and illness are some of the many reasons why people have taken their own lives, with hopes to leave it all behind. Furthermore, factors such as war, conflict, disaster, violence, abuse, meltdown, failure, loss, discrimination, loneliness and isolation are strongly associated with suicidal behavior. Rates of suicide are highest amongst vulnerable groups who are more likely to experience the above situations such as refugees and migrants; persons who are perceived as different for any reason and prisoners.

It is important to note that suicides can be prevented using well-timed, evidence-based and effective interventions. To ensure the reduction of suicide rates globally, national suicide prevention strategies must be comprehensive, multi-dimensional, efficient and sustainable. Being a complex problem, understanding the most common reasons for suicide as well as the common suicide methods are important for developing effective prevention strategies. The following are measures that can be taken at population and individual levels to prevent suicide and suicide attempts:

• Regulating access to suicide aids such as pesticides and firearms
• Establishing drug and alcohol policies to reduce misuse
• Support, follow-up and care for people who have attempted suicide
• Training health workers to effectively assess and manage suicidal behavior
• Promoting awareness to erase stigma surrounding depression, mental illness and suicide so as to enable people seek help without shame and prejudice
• Identifying, treating and caring for people with mental health problems, substance use disorders, chronic pain and emotional distress

Currently, over one billion people around the world are unable to access the basic primary healthcare they need. Common reasons for this inability to access healthcare include unavailability of care, poor quality of care, limited number of healthcare providers and high cost of healthcare. The high cost of healthcare particularly presents a significant barrier because an estimated 100 million people are forced into poverty yearly when they pay out-of-pocket for health services.  When more people become poor, income inequality and other inequities across the world increase- the very problems that public and global health are trying to solve. To avoid these systemic problems, which are social determinants of health, an all-encompassing global vigorous health financing systems must be created to achieve universal health coverage (UHC).

Healthcare financing is a system of providing prepaid collective funds for the delivery of vital health services to prevent placing unnecessary financial burdens on families. The importance of health financing systems cannot be over emphasized. It is essential for achieving universal health coverage (UHC), a World Health Organization’s sustainable development initiative that aims to ensure everyone everywhere has the ability to access essential quality health services without any financial barriers. The successful attainment of UHC is dependent on the understanding of past and present trends of health financing, and using this information to predict and implement better financial methods for the future.

World Health Organization continues to promote UHC in various countries by:

• Supporting the development, implementation and monitoring of national health policies, strategies and plans
• Supporting the provision and availability of equitable and affordable patient-oriented health services
• Facilitating access to affordable, safe and effective medicines and health technologies through health plans, accreditation and subsidies
• Strengthening the health information systems and evidence based policies in order to provide information and facts on health-related matters
• Ensuring the existence of resilient and comprehensive health systems in place including having motivated healthcare workers, appropriate funding, safe medicines, research, and information systems

Thanks to globalization and technology, mobility around the world has become very rampant and can happen in a matter of hours. Travelling internationally has the capacity to pose various risks to people’s health, depending on the health status of the traveler, the health conditions of people encountered in the course of the journey and that of the people in the country being traveled to. Some travelers may experience unexpected and substantial fluctuations in altitude, humidity, microbial biome, and temperature, which can result in changes in their health status. Furthermore, detrimental changes such as poor ventilation, hygiene, accommodation, water supply, sanitation and medical services encountered during travel can result in serious health risks. For these reasons, international travelers should always be careful and concerned about their health and safety especially because of the increased likelihood to contract infections or diseases that may be uncommon in their home country.

Most countries have resources for travelers which gives important information on current endemics, epidemics and pandemics in other countries as well as how to access international health facilities and remain safe and healthy during the travel period. In the US and Canada, the Center for Disease Control and Prevention (CDC) and Immigration Refugees and Citizenship Canada (IRCC) provide lots of information and resources for travelers. These resources are important to review and seriously consider before embarking on any journey internationally. Some of the resources that may be available in various countries include:

1. Notices

Health notices outline potential health risks in different countries to travelers and recommend ways to avoid or reduce them. Notices may also provide country-specific information on safety and security, local laws, customs, entry requirements, health conditions and other important travel issues.

2. Vaccinations and travel health kit

A health care provider may recommend vaccination against one or more diseases before travel, depending on the destination. Travelers are encouraged to visit their doctors before travel and to carry a basic travel health kit in case of emergencies, irrespective of the travel destination.

3. Clinic and medical care in other countries

Medical practices, health insurance, access to healthcare and services, health standards and infection control measures are usually different for various countries. Travellers should be well informed about how these factors differ in the countries they’re travelling to, and what to do to remain healthy and safe.

4. Foods and drinks

Food poisoning, flu and travelers’ diarrhea are some of the most common forms of illness in travelers. These can be prevented by avoiding unfamiliar foods or trying them with caution and ensuring meals are cooked and eaten following proper hygiene

5. Travelling with special needs

Pregnant women, children, older people and persons with disabilities may require special care, different travel needs and medication during travel. When applicable, travelers are encouraged to read up on the information necessary to minimize risks and stay healthy while travelling.

Globally, cancer remains one of the major causes of morbidity and mortality. It is projected that by 2020, cancer incidence may substantially increase by about 15 million new cases. Although cancer affects many communities worldwide, the prevalence, causes and types differ significantly among communities.

Cancer used to be associated with countries with advanced economies until recently- developing countries have succeeded in attaining lifestyles closely related to those in advanced economies. Now, the disease once associated with affluence has its highest burden on developing countries. The incidence, death and health burden of cancer is projected to rise in the developing world, whereas, these stats are expected to remain fairly stable in the developed world. Even though the total cancer burden may remain highest in advanced societies, less developed economies are closing the burden gap quickly.

This increase in cancer incidence in developing countries reflects a much broader evolution in the global burden of disease from infectious diseases to chronic diseases. Being acute and easily detected, infectious diseases such as HIV, malaria and tuberculosis are more preventable and at such have become less fatal when compared to the progressive long-term chronic diseases such as cancer and diabetes. Globalization of chronic diseases is evident in the fact that for years now, deaths due to chronic diseases have surpassed those from acute and infectious diseases.

The complexity of cancer control has changed and increased significantly given the shift of the disease burden. According to World Health Organization, 70% (about 5.5million) of all deaths resulting from cancer occur in the developing world. If nothing is done, cancer deaths in the developing world are projected to rise to 6.7 million in 2015 and 8.9 million in 2030. These values are more than the projected deaths for HIV, malaria, and tuberculosis combined.

The evolution of cancer globally, and  the increased incidence in developing countries can be attributed to several factors including globalization, aging population, diet, urbanization, lifestyle, tobacco and other substance use and infectious agents. Specific types of cancer, such as breast, colon, and prostate cancers, have remained common in the developed world while developing countries are plagued with mostly preventable cancers caused by infectious diseases. Cancer is particularly fatal in developing countries due to late detection, and lack of access to advanced diagnostic technologies and cancer therapies. Additionally, the financial resources, facilities, equipment, infrastructure, staff and training required to cope with chronic care for cancers can be crippling for developing countries. There is also lack of response capacity regarding prevention, health education and promotion, screening and early detection, diagnosis and treatment of cancer. Even when available, the cost of treatment such as surgery, chemotherapy and radiotherapy is often too high. This further contributes to poverty because in these countries, healthcare is paid for out-of-pocket. Epidemiological data, which is not often available in developing countries, are useful to identify trends in cancer burden, morbidity, mortality, detection and prevention, as well as treatment outcomes such as survival. These epidemiological trends showing cancer burden can also show associated economic and policy factors and eventually help in the reduction of cancer cases in these countries.

The preceding paragraphs emphasize the menace of cancer in low and middle income countries especially the fact that it kills more people worldwide than HIV/AIDS, tuberculosis, and malaria combined. Despite this fact, cancer care and control in these countries is lacking in global health programs, including the United Nations Millennium Development Goals (MDGs). It is important to tackle cancer as a public health priority that it is starting by establishing functional primary care health infrastructures, particularly for cancers that are preventable, creating awareness and promoting early detection as well as investing in cost–effective generic drugs.

There is compelling evidence that our planet- Earth is changing in many different ways that affect human existence. The various forms and range of human activities continue to alter the physical and chemical characteristics and composition of the Earth’s land, water and air. These changes, which negatively affect global health, include weather variations, heat waves, heavy precipitation, flooding, droughts, storms, rise in sea levels and air pollution. Although the effects of a changing planet are global issues, their specific incidence and impact vary across geographic regions and populations. Given the projected world population of 10 billion people by 2050, it is crucial to ask and comprehend the “what, why, how and where” questions about the Earth’s alterations so as to reduce the impacts and the potential population burden on the planet. To save, sustain and efficiently manage Earth, there must be an understanding of these changes and how they influence our (all) lives, particularly, in relation healthcare and global health.

The major and most common terms used to describe our changing planet are climate change and global warming. Climate change refers to the changes in the global climate, resulting from increasing average global temperature while Global warming describes the long-term patterns of rising global temperature- sometimes, these terms are used interchangeably. How exactly does a changing climate affect global health? Technically, the increase in human-made carbon dioxide levels in the atmosphere creates a “greenhouse effect,” causing the world to become warmer. This warmth results in the melting of the arctic ice sheets and rise in sea levels which can cause flooding.  Flooding in-turn leads to major public and global health emergencies such as homelessness, infectious diseases outbreak, poverty, and psychological trauma. Additionally, the warmer the earth becomes, the more unstable weather patterns become and the more regular violent storms, droughts, heat waves, and wild fires become. For instance, wild fires across Canada consume an average of 2.5 million hectares yearly; destroy thousands of properties and render hundreds people homeless. Higher CO₂ in the atmosphere increases ocean acidity, causing harm to marine life. Droughts damage farmlands and hinder food production, leading to poverty, malnutrition, and starvation.

The fields of global health, as well as geological and geographical sciences have been instrumental in the advancement of knowledge in climate change, environmental pollution, sustainability, and the impacts of our rapidly changing planet, economy and society. The consequences of our changing planet increase conflict and create political, economic and social instability- all of which are detrimental to human health. The scientific evidence of the impacts of climate change abounds and so much is happening on a global level to counter these impacts. About 196 countries have signed the Paris Agreement, committing signatories to work toward keeping temperatures from rising above 2 degrees Celsius (3.6 degrees Fahrenheit). As individuals, choosing options that reduce carbon footprint are beneficial to our health and that of our planet. For example, walking or biking rather than driving prevents burning fossil fuels, provides exercise, and helps maintain a healthy weight. Also, opting for renewable energy prevents air pollution and results in fewer cases of asthma and lung cancer.

Fact is, it is impossible to live in an unhealthy planet and live a healthy life because a changing planet is a changing health. Therefore, it is our responsibility to do our part to take care of our planet home, Mother Earth.

Exercise and nutrition are major determinants of global health and wellbeing, particularly for adolescents and youths who are still in the developmental stage of life. Physical activity and healthy eating in adolescence are significant to growth and development, and can prevent, or delay several health conditions- specifically chronic conditions. The lack of appropriate nutrients and physical activity has become a global health challenge that hinders the growth, development and overall health of adolescents and youths. Given the inventions and fast pace of the 21^st century, most adolescents are caught up with too much screen time and fast foods which are major barriers to physical activity, healthy eating and ultimately, global health.

According to an article by the American Heart Association (AHA), physical activity improves both mental and physical health as well as the overall quality of life. AHA recommends 30 minutes of moderate activity for 5 days weekly- at least, a total of 150 minutes of physical activity or exercise in a week. For nutrition, fruits and vegetables, whole grains, fat-free or low-fat dairy products, proteins and oils are healthy eating options proposed and recommended by the Dietary Guidelines for Americans. Additionally, reduced sodium intake and calories from fats and sugars are also recommended for healthy growth and development.

Many adolescents go to school, this makes the school environment one of the best places to provide students with opportunities to learn and practice healthy behaviors. Having a healthy breakfast and sufficient hydration are associated with improved memory function and overall mood, which are important for learning and comprehension. Physical activity causes a “feel good” sensation which can instantly relieve tension, stress, anxiety, depression and anger. Exercise also improves blood circulation, maintains healthy weight, boosts good cholesterol level, boosts energy level, inspires positivity, improves sleep, improves healthy self-image and increases muscle strength. In general, chronic conditions such as diabetes, high blood pressure, cancer, osteoporosis, heart disease and other health conditions can be prevented by engaging in physical activity (exercise) and adequate nutrition.

Just like poor diet, lack of physical activity and increased sedentary lifestyle can increase the risk of cardiovascular disease. Studies have shown that adults who spend more hours watching television have an increased risk of death from cardiovascular disease. More so, absence of regular physical activity leads to loss of physical strength, stamina and possibly, reduced life expectancy- all which are detrimental to global health.

Public Health Ontario (PHO) describes Health Promotion as the procedure or means of developing and implementing a broad variety of social, health, behavioral and environmental interventions that encourage change of attitudes or actions, create supportive or enabling environments and advocate healthy public policies. The purpose of health promotion is to empower and enable people to gain or increase control over their lives, so as to improve their health.  Health promotion interventions typically occur in settings such as schools, hospitals, workplace and communities with partnership and capacity building across multiple stakeholders, sectors and organizations. Compared to clinical health, health promotion focuses beyond the care and treatment of patients and individuals. It consists of a wider range of social and environmental interventions addressing prevention of disease and protection of health across populations.

School and youth health promotion- as the name illustrates, are means of ensuring health and behavior-change interventions are carried out in schools and specifically targeting youths. The rationale of promoting health in schools is that schooling happens at the crucial age of childhood and adolescence where personal character, skills, attitude, physique and behavior are developed. Schools play significant roles in health education and promotion at the most crucial, addressing health, social, educational, psychological needs of children. A team made up of parents, teachers, administrators, students and health professionals should be formed and trained to develop values, activities and new direction for health education and promotion in schools. Health promoting schools (HPS) are schools that consistently strive to strengthen their capacity to promote and enable healthy living, learning and working conditions through education, program development and service provision. HPS promotes physical, emotional and intellectual development of students through healthy and hygienic practices. Making schools an environment for health promotion is an effective approach for early prevention of non- communicable disease risk factors.

HPS is a World Health Organization (WHO) Global School Health Initiative with the aim of strengthening health promotion and education activities at every level- locally and internationally. Important factors involved in effective HPS include health policies, physical and social environment, community involvement, healthy skills development and health service provision. School and youth health promotion provide an important opportunity to empower young people to make informed choices regarding their health behaviors such as tobacco and substance use, risky behaviors, alcohol use, dietary and hygienic practices, sedentary lifestyle, sexual activities and physical activity.

Social inclusion is related to mental health in that its absence can lead to poor mental health, and poor mental health can also result in social exclusion. People with mental health problems are often stigmatized and excluded socially in the community… this should not be the case. Given their condition, they need all the support they can get from everyone around them, especially in their community.

Social inclusion is a phrase used to describe the extent to which people are carried along or feel engaged and involved in the activities within their community, based on their choices and preferences. To be socially included means to actively participate, have a sense of belonging, be accepted for whom one is, be valued, have significant roles and have social relationships. It is possible to be born, grow, work, school and live in a community without being, or feeling socially included- especially for people with poor mental health conditions. Social inclusion is a significant social determinant of health which increases the likelihood of happiness, healthiness, peace of mind and longevity. Simultaneously, the lack or absence of social inclusion results in depression, isolation, poor self-esteem and poor health- particularly poor mental health. Mentally challenged people experience life very differently as they are often ignored and do not have any “sense of presence or belonging” in the community. They may also lack access to information, facilities and activities they need, including education and healthcare- which in turn results in lack of opportunities to work, play, learn and participate socially or develop social relationships with people in the community.

Mental health consists of, and influences various components of an individual including the emotional, psychological, and social well-being. It determines one’s thoughts, feelings, action and participation as well as how a person handles stress, relates to others and makes choices. Everyone- including children, adolescents and adults, can be affected by mental health at any stage of life. Factors that affect mental health include genetic composition, life experiences, such as trauma or abuse and family history of mental health problems. Broad symptoms that may suggest an impending mental health problem include poor eating habit, low energy, numb feeling, unexplained aches, hopeless or helpless feelings, excessive use of drugs and alcohol, confusion, forgetfulness, anxiety, anger, worry, severe mood swings, hallucination, hearing voices, self-harm or the thought of it and fear.

Social inclusion can help youth with already existing mental health condition lead a healthier and happier life. It allows them reach their full potential, cope with the stress, work productively, participate and contribute meaningfully to their communities- irrespective of their condition. Connecting with people (social inclusion), in addition to inspiring positive thoughts, physical activity, sleeping and skill development are some common ways to support youths with mental health conditions. Since social inclusion is crucial for positive mental health, it is very important to address the barriers and challenges that reinforce it. Various pathways to social inclusion exist, and of particular significance is recreation due to the meaningful connections that recreation can facilitate.

An early pregnancy is typically classified as any pregnancy occurring in teenagers and adolescents, usually between the ages of thirteen and nineteen (13 and 19). Girls at this age are too young, unprepared and uniformed to manage their situation and progress towards safe delivery. Furthermore, their emotional, psychological and social needs are greater, and more delicate than those of older women. Early pregnancy is a global problem present in all social classes, and in many countries including high, middle, and low income countries. Worldwide, majority of teenage and adolescent pregnancies occur in developing countries, rural areas and marginalized communities. This is mostly caused by poverty, lack of education, early marriage, lack of employment and absence of relevant public health information. Over 20 million girls, below the age of 19 years, become pregnant and give birth in developing regions annually.

Many teenage and adolescent girls face social pressure to marry and have children; about 15 million girls marry by the age of 19 yearly, and they account for 90% of early pregnancies. For others, pregnancy and childbirth occur out of wedlock, so are neither planned nor wanted. Irrespective of marital status and intentions, the leading cause of death for 15-19-year-old girls globally is complications from pregnancy and childbirth. About 23 million girls in developing countries lack access to modern contraceptive; consequently, half the pregnancies among girls in these countries and regions are estimated to be unintended.

Despite the 0overall progress in the decline of global adolescent birth rate from 65 births per 1000 women in 1990 to 47 births per 1000 women in 2015 due to the growth of global adolescent population, projections show that the number of adolescent pregnancies will go up by 2030- particularly in Africa. More so, there has been unequal progress in reducing adolescent birth rates in various regions as shown below:

• 115 births per 1000 women in West Africa
• 64 births per 1000 women in Latin America and the Caribbean
• 45 births per 1000 women in South-Eastern Asia, to a low of 7 births per 1000 women in Eastern Asia

There are several health, social and economic consequences of early, teenage or adolescent pregnancy. It remains a major cause of maternal and child morbidity and mortality, it also results in intergenerational cycle of ill-health and poverty. Adolescent mothers have higher risks of infections, eclampsia and puerperal endometritis, compared to older women. In addition, about 3.9 million unsafe abortions occur among them each year, contributing to maternal mortality and long-term health problems. Babies born to adolescent mothers may have higher risks of low birth-weight, premature delivery and serious neonatal conditions. Adolescent pregnancies also have negative social and economic effects on girls, their families and communities at large. Single pregnant adolescent girls may experience stigma and rejection by their families and friends leading to school drop-out and limited opportunities for employment and self-development, often perpetuating cycles of poverty. Similarly, their married counterparts are more likely to experience domestic violence compared to older women.

The following can reduce early pregnancies and corresponding consequences:

• Delaying marriage until after the age of 18 years; it is estimated that about 10% reduction in child marriage could contribute to a 70% reduction in a country’s maternal mortality rate
• Creating awareness and providing support to reduce pregnancy in females less than 20 years
• Promoting abstinence or the accessibility and use of contraception by adolescents at risk of unintended pregnancy; this could avert a total of 2.1 million unplanned births, 3.2 million abortions, and 5600 maternal deaths annually
• Reducing forced sex and unsafe abortions among adolescents
• Increasing the use of skilled antenatal, childbirth and postnatal care among adolescents
• Introducing stern punishments for rape