Inequality is the uneven distribution of resources in a given society through systems that perpetuate specific patterns with regards to distinct categories of people. Inequality is characterized by the presence of unequal opportunities and rewards for different social groups or statuses within a population or society. It encompasses structural and recurrent forms of unequal and unfair distributions of rights, privileges, resources, health care and services, labor market, income sources, freedom of speech, education, political representation and participation and judgments.

Inequalities result when societies are organized by hierarchies of power, religion, kinship, prestige, race, ethnicity, gender, age, sexual orientation, and class that regulate access to resources and rights in ways that make their distribution unequal. Instances of inequalities reflected in several areas include income and wealth inequality, unequal access to education and cultural resources, differential treatment by the police and judicial systems. Inequality in a society leads to stress and status anxiety, which results in poor health. More so, people live longer, are less likely to be mentally ill or obese and have lower rates of infant mortality in societies that are more equal-with less inequality.

Although some level of inequality is inevitable in any society, it can be reduced by decreasing the gaps between the rich and the poor. A major way to reduce, and possibly, overcome inequality in a society is through Education. Education is perhaps the most critical means of improving the welfare of disadvantaged populations, especially as more of the world enters into the global knowledge society. It is the cornerstone for improving both social justice and economic productivity because it increases peoples’ knowledge of their rights, earning potential and social status as well as empowers them to take control of their lives through information. Education is inextricably linked to the health, social, economic and security status of individuals and societies. As such, it is better positioned as a core concern of the entire community, including families, business and other organizations.

To defend human right and reduce the gap between the haves and the have-nots, broad access to quality education must be pursued as one of the strongest social values. The most important level of education is higher education offered by universities. Universities play critical roles in helping countries improve their economic productivity and social quality of life by educating the skilled, internationally engaged and creative individuals needed as entrepreneurs and leaders for businesses to compete effectively. Universities also create the research, scholarship and knowledge that inspire the development of value-added products and processes. They also provide a hub for high-level international networks and partnerships. Consequently, it is vital that the higher education sector focuses on performance and quality, as well as accessibility, to ensure that society reaps maximum value from its investment.

Other approaches to overcome inequality and defend human rights include:

• Increase in minimum wage
• Expansion of the Earned Income Tax
• Building assets for working families
• Reducing tax rate for low income earners while increasing that of high earners
• Making the tax code more progressive

Primary health care (PHC) is healthcare practice that entails rendering health promotional medical care and services to people, communities and populations, rather than simply treating specific diseases or conditions. Healthcare resources include health professionals, equipment, facilities, educational tools and workshops, health promotional programs and drugs. Basically PHC is the core and foundation of public health and global health because it integrates the aims and activities of both preventive and curative medicines. These activities include a spectrum of services that range from prevention (for example, vaccinations and family planning) to management of chronic health conditions including palliative and geriatric care. PHC is composed of three major branches and they include: Empowered people and communities; Multi-sectoral policy and action; Primary care and essential public health functions as the core of integrated health services. PHC is important because it is usually the first point of contact in a community. It is also cost effective and more accessible to people due to its unique design. Ideally, PHCs are designed to be specific to communities such that each local community has a PHC. That way, health problems specific to such communities are well understood so that health promotion and disease prevention strategies are targeted accordingly for effectiveness. PHC can meet the majority of an individual’s health needs over the course of their life.

Health systems with strong PHC deliver better health outcomes, efficiency and improved quality of care compared to other models. On the other hand, health systems with weak PHC do the opposite sadly- deliver poor health outcomes, inefficiency and poor quality of care. Weak PHC systems lack essential drug supply and the capacity to provide basic health-care services. In addition, issues such as poor staffing, inadequate equipment, poor distribution of health workers, poor quality of health-care services, poor condition of infrastructure and inefficient management are markers of weak PHC systems.

PHC provides essential health care which makes universal health care possible and accessible to all individuals and families in a community. In essence, health systems with strong PHC are necessary to achieve universal health coverage and the health related Sustainable Development Goals. In addition, PHC is an approach to health beyond the traditional health care system given that it focuses on health equity-producing social policy. It encompasses all areas that play a role in health, such as access to health services, environment and lifestyle. Therefore, a combination of primary healthcare and public health measures may be considered the cornerstones of universal health systems.

Due to under investment, lack of political will and misconceptions about roles and benefits, the development of PHC has been unequal across the world. Notwithstanding, Universal health coverage requires a renewed focus on primary care and their importance for individuals, health systems and health for all. Consequently, PHC meds complete participation and financial investment so that communities and countries can afford to maintain it at every stage of their development through self-reliance and self-determination.

Challenges are inevitable in a dynamic world like ours; especially in the area of healthcare. Before we take note of some challenging problems of global health in the last decade, it is important to appreciate the progress that global health has made so far. In May 2017, the World Health Organization (WHO) released its annual World Health Statistics report, which monitors countries’ progress on the Sustainable Development Goals (SDGs). In as much as the report highlighted the fact that the international community has more work to do to improve health and achieve the SDGs, significant progress was made collectively by nations, organizations, health workers, companies, individuals and many other partners. Specifically, the following mark significant advancement in global health:

1. Quality of data collection, disease prevention and access to adequate health care have improved in many countries
2. Global rates for under-5 mortality have declined by 44% since 2000 and HIV cases have decreased by 35% since 2000
3. About 60% of the at-risk malaria population had access to insecticide-treated nets, compared to 34% in 2010
4. Approximately 86% of children receive their DTP3 vaccine and the administration of all three doses of hepatitis B vaccine reached 84% in 2015
5. The risk of dying from one of the four major non-communicable diseases – diabetes, cancer, chronic lung disease, and cardiovascular disease – declined by 17% among people aged 30-70 since 2000

Despite these advancements, global health has faced and still faces challenges today. Changing patterns of disease and transformations in global health practice create challenges for practitioners. Below are some of the most pressing global health problems we face today:

1. Building Public Health Systems: One of the most pressing challenges today is the need to invest in patient-centered public health systems that respond timely to the range of factors that shape patterns of health and illness.
2. Coordinating Global Health Initiatives: Bureaucratic rules and regulations in different countries continue to hinder effective coordination, contributing to redundancies and delays in meeting global health targets. Approaches such as partnerships with the government and flexibility in regulations are needed to facilitate the coordination of global health programs.
3. Facilitating Participation: New governing structures that link the range of global health practitioners to state and local stakeholders should be created. More so- beyond receiving aids and funds, programs and workshops that encourage and increase participation are essential.
4. Prioritizing the Needs of the Most Marginalized: The needs of the most marginalized populations have remained neglected. As a result, declining poverty rates have been accompanied by widening inequalities. In the next decade, it is essential to prioritize the health needs of the most marginalized populations, and to devise innovative initiatives to work with these populations to improve their health outcomes.
5. Increasingly fragile health of sub-Saharan Africa:  The last decade witnessed widening gaps in health worldwide to the extent that the entire African continent is left behind in global health progress. For millions of children today, particularly in Africa, the biggest health challenge is to survive until their fifth birthday, and their chances of doing so are less than they were a decade ago. This is a result of the continuing impact of communicable diseases. Overall, 35% of Africa’s children are at higher risk of death than they were 10 years ago.
6. Global increase in non-communicable diseases, especially in Africa: Here, life expectancy is always shorter than almost any part of the world. In some African countries, it has been cut by 20 years and life expectancy for men is less than 46 years. The international community must continue to carry Africa along so that the poor health systems and outcomes stop sabotaging global health efforts and progress.

A “health system” is described as all the organizations, institutions, resources, and people whose primary purpose is to improve health (World Health Organization [WHO], 2010). Health system strengthening (HSS) is a global health term which represents the activities and actions targeted towards the improvement of a country’s health care system. It is a broad term which includes various activities such as funding for health infrastructure, conversations to improve health policy, attempts to achieve universal healthcare and other forms of health improvement measures. It is important to note that strong, flexible and well-resourced health systems are essential to achieving universal health coverage as well as ensuring global health security, including resilience in the context of health and other emergencies.

Lately, there has been a shift in the global health agenda from disease-specific approaches to HSS; this improves the effectiveness of health services. WHO has also placed emphasis on the significance of health systems in delivering effective and affordable care so as to achieve increased health equity, especially for poorer populations. More so, WHO and global partners have developed a framework for measuring HSS; comprised of six core components or building blocks: service delivery, health workforce, health information systems, access to essential medical products, vaccines and technologies, health financing and leadership and governance. Furthermore, USAID in a recent article termed strengthening health systems a strategic imperative and highlighted the importance of investing in HSS in the present time. A strong health system is also the best insurance developing countries can have against an unstable and unpredictable disease burden.

Health systems- being the resources and activities that work together to improve the health of populations, ensures quality across most or all of the six building blocks of WHO mentioned above. The needs of patients and health care professionals are the driving forces for the system to continually improve and evolve. Understanding these needs aid and position governments to prioritize HSS by providing high-quality, comprehensive health care to all citizens. Consequently governments partner with private and public organizations in order support their efforts in strengthening health systems, as well as improve care for all, especially the poor and vulnerable.

A practical example of HSS is the partnership between United States Center for Disease Control and Prevention and Nigeria in a program called: The Nigeria Field Epidemiology Laboratory Training Program (N-FELTP). The N-FELTP is a program designed by CDC to strengthen the public health workforce in Nigeria. N-FELTP trains residents in various fields such as public health laboratory, epidemiology and veterinary epidemiology to work in leadership and technical positions in the Nigeria Federal Ministry of Health (FMOH), Agriculture and Rural Development (FMARD) and state levels. This two-year program helps to strengthen health systems within the country by increasing knowledge and skills in field epidemiology and laboratory science as well as building a team of skilled and well-trained health professionals in Nigeria. Since its commencement in 2008, N-FELTP has assisted in the detection, investigation and response to more than 70 disease outbreaks including lead poisoning in Zamfara State, multi-state outbreaks of Lassa fever and cholera, as well as polio eradication efforts.

Empowerment means equipping and arming people with the knowledge , potential and requirements to become independent or self sufficient in order to achieve a goal. Youth empowerment is a process where young people are encouraged, supported and equipped to take charge of their lives. It requires addressing negative or limiting situations so as to improve access to resources and transform oneself through beliefs, values, and actions. The aim of youth empowerment is to improve the quality of life of young people and increase dependence on oneself. This is achieved by creating and encouraging participation in youth empowerment programs such as training, education and information sessions or workshops.

The importance and benefits of youth empowerment to individuals, families, communities and nations cannot be overstated. The rationale behind empowerment is to enable participation and enhance control through shared decision making by creating opportunities to learn, practice, and increase skills. Empowerment theory predicts that engaging young people in social, knowledge-acquiring and community-enhancing activities which they define and control, allows them to gain essential skills, responsibilities, and confidence necessary to become productive and healthy adults. Youth empowerment ensures the existence of the five competencies of a healthy youth: (1) positive sense of self, (2) self- control, (3) decision-making skills, (4) a moral system of belief, and (5) pro-social connectedness.
Empowerment takes various forms and considers six interdependent areas including individual, community, organizational, economic, social and cultural.

Around the world, several youth empowerment models and programs are used to help youth achieve empowerment. These programs are available through non-profit organizations, government organizations, schools or private organizations, individual foundations. Some youths often take the initiative to empower themselves by seeking and taking advantage of these programs. Over the years, various social action and empowerment movements, including youth empowerment, educate the girl child, poverty alleviation and women empowerment spring up, and become institutionalized. Youth empowerment is often described as a marker of development, as well as a roadmap to economic growth, intergenerational equity, civic engagement and democracy building. This is because many activities such as education, business, media, rights, leadership and activism focus on the youths due to increased youth involvement in community decision-making.

Individual empowerment enhances individual’s consciousness by increasing awareness and knowledge of problems and solutions. This creates self-confidence and sufficiency in decision making and problem solving thereby increasing the quality of life. Community empowerment focuses on community enhancement through leadership development, communication, and networking to address community issues. Organizational empowerment creates a resource base for the community, including organizations and associations that protect, promote and advocate for the less privileged. Economic empowerment provides training and entrepreneurial skills including how have income security. Social empowerment teaches youth about social inclusion and literacy as well as promotes proactivity. Cultural empowerment highlights and emphasizes cultural practices, rules and norms.
These different forms of empowerment help to develop the youth in one or more aspects of their lives. The overall aim of youth empowerment programs is to create healthier and higher qualities of life for underprivileged and at-risk youth.

Fraud, according to the English dictionary, is a form of unjust, deceptive and criminal activity aimed at the perpetrator’s financial or personal gain. A fraudulent person or act is one intended to deceive others, usually by unjustifiable claims or false credits with accomplishments or qualities. The effects and consequences of fraud are far reaching and wide spread in our society, impacting homes, policies and welfare of citizens.

Informally, fraud is often referred to as scam and is of the most common and expensive crimes endured by millions of people across the world. These scammers are so difficult to avoid; they target everyone including businesses, and are present everywhere especially on the internet, and certainly the streets. Fraudsters employ a broad range of techniques while committing these crimes and some common types of fraud include: Mail Fraud, Internet Fraud, Immigration Fraud, Ponzi Scheme Fraud, License Fraud, Debit and Credit Card Fraud, Bank Account Takeover Fraud, Stolen Tax Refund Fraud, Voter Fraud and Identity Theft. Generally, Fraud has negative effects on everyone affected; most people have either been victims of fraud or know someone who has been defrauded. The following constitute some effects of fraud on individuals, and consequently, the society at large:

• Economic downturn due to injuries to individuals or damage to properties
• Loss in public services such as transportation, police and fire departments
• Financial loss endured by corporations due to loss suffered by their clients
• Physical injury or death to victims caught in the middle of a scam gone wrong
• Emotional and psychological burdens on the fraud victims
• Financial loss to individuals and consequent health problems
• Distrust, prejudice and lack of confidence in the system

Fraud is a universal crime which occurs worldwide- in every nation; however, it is more common in countries without adequate anti-fraud strategies or laws to prosecute offenders. In Nigeria for example- a country where 95% of the news from all sources stem from various forms of crime, particularly violence and fraud, the above mentioned impacts of fraud abound. The emotional and psychological effects of fraud on victims are perhaps the most disturbing. Depending on the kind of fraud, these victims may become susceptible to many stress-related complications and trauma, finding it difficult to recover from their financial loss. Other feelings associated with fraud victims are loneliness, embarrassment, suicidal thoughts, incompetence, guilt, lack of confidence and loss of their sense of security and dignity- these may take years to regain.

Fraud has remained persistent in our society- growing and evolving, affecting individuals, businesses and countries alike. As anti-fraud technologies evolve and information security tightens, the cleverness of fraudsters becomes more advanced. Fraudsters are continually striving to be one step ahead of the next fraud-prevention strategy. Furthermore, as more activities move from face-to-face interaction to online and mobile transactions- which increase the likelihood of fraud, it becomes necessary to develop more elaborate and accurate fraud prevention strategies. It is also very essential to remain aware of the probabilities, types and transformations in these crimes so as not to fall victim. Noteworthy, keeping one’s confidential information safe and protecting oneself against fraud is a means of preserving well-being, given the aforementioned impacts.

Yay! The holidays are finally over and it’s time to get back to work. Actually, I’m not quite sure how many people are happy about the holidays being over but well, we don’t really have a choice :). Before we begin, BlessWorld Foundation International is using this opportunity to welcome you to a brand new year… Two thousand and nineteen! We hope you had a fabulous holiday and we wish you a happy and prosperous new year, 2019. In the spirit of the season, our first topic is to discuss the impact of the just concluded Christmas period on our health… I think this will be very interesting, so, stay tuned 🙂

The yuletide period is typically a time of celebration which commemorates the birth of Jesus Christ- a religious and cultural celebration among billions of people around the world. However, some people celebrate this period solely because it’s a general time off work and do not attach any religious or cultural significance to it. It is an annual holiday, primarily observed on December 25^th, and leads on to the beginning of a new calendar year. Christmas is usually the peak selling season for most retailers as sales increase dramatically. People purchase gifts, decorations, and supplies for family, friends and even strangers to celebrate with. In the United States, United Kingdom and Canada, the Christmas sale period begins as early as October and brings in millions of dollars.

Several studies have been conducted to evaluate and assess the impact of the Christmas season on health in general. In 2011, a study titled The Christmas Effect on Psychopathology- the study of mental health, reviewed the available research on whether the Christmas holiday was more difficult than the rest of the year. The authors found that ER visits for mental health issues actually reduced during the week of Christmas. Additionally, Google search data by Christopher Ingraham at the Washington Post revealed that searches for “depression”, “anxiety”, “pain”, “stress” and “fatigue”, were lowest on Christmas Day. This is great news; however, despite the joy and happiness around the yuletide season, it may be accompanied by several detrimental health effects.

More specifically, some studies show that cardiac mortality increases during the Christmas holiday period when compared to other periods in the year. Notably, a New Zealand study which used the Ministry of Health individual‐level daily mortality data for 26 years between 1988 and 2013. These findings have remained consistent among studies of this nature, suggesting that cardiac mortality does not go on holiday. Additionally, a “yuletide effect” on mortality which shows significant increase in deaths from natural causes at both Christmas and New Year’s Day has been established. Although there may be another plausible reasons for this effect; the fact that in Europe and North America, the Christmas holiday coincides with the coldest time of the year when mortality rates are already seasonally high due to low temperatures and influenza. However, some studies that used statistical techniques to eliminate the confounding effect of weather on the holiday effect still found that deaths from natural causes were almost 5% higher than would be expected if the holidays did not affect mortality.

Various factors implicated in this mortality holiday effect include emotional stress associated with the holidays; changes in food and alcohol intake; increased workload at medical facilities; changes in the physical environment; increased stress from planning, outing and partying; over eating and lack of exercise; family conflicts; alcohol misuse; loneliness; over spending and bankruptcy; mental health problems and domestic violence. Most of these factors are preventable, therefore we are encouraged to rest more, plan ahead and stay healthy/active during the yuletide period.

A population that experiences health disparity is one where the health status- disease incidence, prevalence, morbidity and mortality differ significantly compared to the health status of the general population. Rural-urban health disparities are differences in health status between rural and urban regions of a geographic location. It is also called spatial inequality when it involves unequal distribution of resources in space. Globally, rural populations always experience significant health disparities when compared to urban populations, even in the same countries. These disparities are frequently characterized by indicators such as higher incidence of disease and disability, increased mortality rates, lower life expectancies, and higher rates of pain and suffering. Reasons and risk factors for the above indictors are broad and vary from population to population, some of them include geographic isolation, lower socio-economic status, higher rates of health risk behaviors, limited access to healthcare, socioeconomic status, unhealthy behaviors, chronic conditions and limited job opportunities. Research has also shown that residents of rural areas are usually older, poorer, have fewer physicians or resources to cater for them and are less likely to have employer-provided healthcare coverage.

The uneven distribution of healthcare resources between rural and urban areas results from fewer and farther service locations, cultural beliefs, lay understanding of illnesses by patients, reduced funding, limited access to health services, discontinuous education, insufficient health professionals and inadequate mobility in rural areas. Access to health care overall is a challenge to rural residents because they have a lower proportion of the population insured, face greater barriers in traveling to primary, preventative, prenatal, and emergency care providers, and have less diversity in health care resources to choose from. Rural residents are left without or reduced availability of these services, increasing the physical barriers to quality and timely healthcare.

From the preceding paragraphs, it is clear that there has been much progress in understanding rural-urban health disparities; however, some challenges persist. Irrespective of the long history of biomedical treatment of diseases in Africa, culture still informs the understanding and treatment of some chronic and debilitating illnesses such as diabetes, more so in the absence or lack of access to biomedical health facilities. This is a major cause of rural-urban health disparities. Federal, state and non-profit organizations work to reduce these disparities and improve the health and overall well-being of rural residents. Some organizations provide funding, information, and technical assistance to be used at the state, regional, and local level, while others inform state and federal legislators to help improve the understanding of issues affecting population health and healthcare in rural areas. Since 1992, the World Organization of Family Doctors- WONCA has developed specific focus on rural health through the WONCA Working Party on Rural Practice. This Working Party has attracted national and international attention to major rural health issues through World Rural Health Conferences and WONCA Rural Policies. The World Health Organization (WHO) has also formed partnerships to help tackle and solve some rural health challenges. An example is the Memorandum of Agreement between WONCA and WHO which emphasizes the important role of family doctors in primary health care and includes Rural Health Initiative.

Background:

Currently, marijuana is the most commonly used recreational drug in the United States and Canada. The Cannabis Act available on the government of Canada website creates a legal framework for regulating the production, distribution, sale, possession and use of cannabis across the country. The three major goals of this Act include:

• Keep cannabis out of the hands of youth
• Keep profits out of the hands of criminals
• Protect public health and safety by allowing adults access to legal cannabis

Effective October 17, 2018 and subject to provincial or territorial restrictions, adults who are 18 years of age or older would be able legally to possess up to 30 grams of cannabis, share up to 30 grams of legal cannabis with other adults, buy dried or fresh cannabis and cannabis oil from a provincially-licensed retailer in provinces and territories without a regulated retail framework, purchase cannabis online from federally-licensed producers, grow cannabis from licensed seed or seedlings and make cannabis products such as food and drinks at home.

The Act recognizes the use of cannabis for medical purposes and allows access for people who have the authorization of their healthcare provider. Using factors such as age restrictions and restricted promotion of cannabis, the Act limits the accessibility of cannabis by under-age youth. The Act also protects public health by creating stringent safety and quality regulations as well as public education to raise awareness about safety measures and potential health risks. The government has committed about $46 million over the next five years for cannabis public education and awareness activities.

Rationale for legalization:

To reduce criminalization: Criminalizing cannabis does not prevent young people from using the drug; instead, it traps many Canadians in the criminal justice system. Over 50% of all drug offences reported by police are cannabis-related. In 2016 specifically, over 23,000 cannabis-related charges were laid. Arresting and prosecuting these offenses is costly for the Canadian criminal justice system and these charges confer severe long-term consequences on the individuals charged. Decriminalizing cannabis for adults will keep Canadians who consume cannabis out of the criminal justice system and reduce burden on the courts.

Health implications:

Many people argue that legalizing cannabis will do more harm than good since it will become easily available, accessible and misused. The Canadian Pediatric Society and the Centre for Addiction and Mental Health publicly disclosed that marijuana is harmful and can negatively affect the brain, especially that of young people. Marijuana is also toxic to neurons, and its regular use can actually change developing brains. Based on evidence that suggests the human brain continues to mature until age 25, the Canadian Medical Association (CMA) recommends a minimum age of 21 to purchase and use marijuana.

Some Canadians believe that recent legalization of marijuana reflects the fact that the government is only interested in hastening the delivery of a campaign promise without being patient and careful enough to analyze the health impacts of the policy. Many also fear that the legalization of marijuana will significantly increase impaired driving and road accidents.

Impacts of short-term use include impaired memory, judgment and motor coordination, paranoia and psychosis while impacts of long-term use include addiction, impaired cognition and brain development, poor educational outcome and reduced personal and life satisfaction.

Human Genetics Programs use genetic and genomic approaches to improve the understanding of the etiology of rare and complex inherited diseases, to characterize healthy variation in humans of different ancestry and to advance knowledge of human population evolution, demography and history. Research areas include:

• Genomics of biomedical resources
• Complex traits in diverse populations
• Integrated genomics of inflammation and immunity

The first Human Genetics team at the World Health Organization was structurally located in the Division of Biomedical Sciences and was majorly hematological. Following advances and rapid progress in genetic technology and human genome research, WHO set up the Hereditary Diseases Programme (HDP) in the early 1980s to support international activities on the development of medical genetics services. Then, the international Human Genome Project which was introduced in the 1990s increased the scope of the Hereditary Disease Programme at WHO. Consequently, the Hereditary Disease Programme has gradually expanded in focus and includes prevention and control of major hereditary single-gene diseases (such as thalassemia, cystic fibrosis, hemophilia, and hemochromatosis); congenital malformations and common diseases with genetic predispositions.

The HDP was successfully sustained and developed over the years and was renamed the Human Genetics Programme (HGN) in 1995 as a part of the Division of Non-communicable Diseases and Mental Health (NMH). The grouping of the Programme under NMH showed the evolution of genetic discoveries in major non-communicable diseases particularly cancer, diabetes, cardiovascular diseases and asthma. Presently, HGN mainly focuses on

• Providing updated information on medical genetics to countries
• Building capacity for the development of genetic services
• Giving technical advice on national genetic programs to improve genetic health services
• Promoting progress and transfer of experience and knowledge through a global network of collaborating centers, NGOs, regional and country offices and partners
• Standardizing genetic technologies for disease control
• Identifying and responding to the ethical, legal and social issues (ELSI) of human genetics
• Developing genetic approaches for the control of major common diseases