GLOBAL NEUROLOGY REPORT: PROTECTING HEALTH SECURITY

Dr. James Christopher Johnston

Disease outbreaks are no longer confined to small geographical areas, but have the potential to impact any region of the world due to an increasingly interconnected population combined with the dynamic nature of disease patterns.  This creates a global risk that must be managed through a coordinated approach in order to effectively control any type of epidemic.  The World Health Organization (WHO) promulgated International Health Regulations (IHR) to provide an overarching legal framework defining each nation’s duties in handling public health risks that are likely to cross borders.  The IHRs constitute a legal agreement among 194 nations.  These Regulations define when and how a country must report a disease outbreak to WHO, and highlight specific criteria for categorizing an outbreak as a “public health emergency of international concern,” which then triggers a very specific response.  Additionally, the Regulations contain provisions designed to protect the economy of a country that does declare an international emergency.  For example, these provisions preclude other nations from enacting travel or trade embargoes without a clear public health justification.  Neurologist and Attorney Dr. James C. Johnston is uniquely qualified to deal with the very specialized area of international medical law affecting health security.  He recently presented policy recommendations on these security matters to the United Nations High Level Political Forums on behalf of Global NeuroCare®, a non-government organization which holds Special Consultative Status with the United Nations ECOSOC.

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Global Neurology Report: WHO List of Essential Diagnostic Tests

On 15 May 2018, the World Health Organization (WHO) published the first Essential Diagnostics List, providing a catalogue of tests that are necessary to diagnose many common conditions as well as a number of global priority diseases.

This represents a crucial step to improving global healthcare since many people are unable to access diagnostic services, and others are incorrectly diagnosed due to poor quality or improper testing.  As a result, these people do not receive proper treatment and, in some cases, may actually be given the wrong treatment due to a misdiagnosis of their condition.

The list details 113 tests – 58 for common conditions such as diabetes, and the remaining 55 focus on priority diseases such as malaria, tuberculosis, HIV, hepatitis and syphilis.  Some of the tests are designed for primary health facilities in severely resource limited areas, and do not require electricity or trained laboratory technicians.  Other tests are more sophisticated and will necessarily be used in better equipped medical settings.

This Essential Diagnostics List will serve as a reference for countries to develop or update their own protocols within the context of local conditions, ensure appropriate supplies and equipment, and train personnel for the testing.

WHO intends to expand and update the list to incorporate additional non-communicable diseases, neglected tropical diseases, antimicrobial resistance and emerging conditions.

Drs. Mehila Zebenigus and James C. Johnston serve as Directors of Global NeuroCare®, an NGO accredited by WHO and in Special Consultative Status with the UN ECOSOC, and strongly support this initiative.

The full document may be accessed through the following link:

http://www.who.int/medical_devices/diagnostics/EDL_ExecutiveSummary_15may.pdf

Global Neurology Report: The WHO ‘Neurology Atlas’ Second Edition

Emergency Room in Ethiopia

The World Health Organization (WHO) published the first comprehensive report (Neurology Atlas) on the
status of neurological care and services throughout the world over a decade ago. This compilation provided a
unique and invaluable source of data on the rapidly increasing burden of neurological disorders, and the available neurological services in 109 countries. It highlighted the large disparities between neurological care in the developed and developing nations, and provided critical information for medical specialists, healthcare planners, policy makers and national training programs. This Atlas provided the first detailed picture of the global situation for neurology, and the updated second edition was released in September 2017. It may be accessed here (http://apps.who.int/iris/bitstream/10665/258947/1/9789241565509-eng.pdf).

This updated Atlas reviewed 132 countries comprising 94% of the world’s population and the data will continue to be helpful to policy makers, although the findings were not surprising and may be summarized as follows:

(1) Neurological disorders are a significant cause of the global disease burden, which was thoroughly addressed in the Global Burden of Disease studies.

(2) Neurological disorders are disproportionately high in developing regions, which are also plagued by resource limitations and severe shortages of healthcare workers.

(3) Neurological conditions are expected to grow exponentially in the future.

The Atlas report focused on several key areas including legislation for neurological disorders, financing of neurological services, social welfare support, workforce data, available neurological services and informational gathering systems. As expected, sub-Saharan Africa fared the worst, with the lowest proportion of healthcare workers, the most limited services and poorest geographical distribution of those services. There were 0.04 neurologists per 100,000 people in the WHO African region, compared to 4.75 per 100,000 people in high income countries.

In Ethiopia, for example, where Dr. James C. Johnston serves as an Honorary Professor of Neurology with the Addis Ababa University neurology residency training program, there is one neurologist for every 3-4,000,000 people, and most of those neurologists are in the capital city Addis Ababa. This ratio, although exceedingly poor compared to the WHO recommendation of at least one neurologist for every 25,000 – 100,000 people, represents a significant improvement since before inception of the program in 2006 when there was one full time neurologist for the one hundred million people in the country.

Dr. Johnston established the non-profit organization Global NeuroCare (www.GlobalNeuroCare.org) to advance neurological services in developing regions. Global NeuroCare holds Special Consultative Status with the United Nations ECOSOC and fully supports the self-sufficient, sustainable Ethiopian neurology residency program. This program has made a significant and measurable difference in the Horn of Africa, graduating 32 board certified neurologists with 21 more physicians in the three year training, improving the lives of tens of thousands of people.

On behalf of Global NeuroCare, Dr. Johnston discussed the healthcare concerns affecting developing nations at the 2016 and 2017 United Nations High Level Political Forums, the 2017 United Nations Commission for Social Development, and at the World Association for Medical Law conferences in Los Angeles (2016) and Baku (2017). One of the main concerns impeding development stems from academic medical centers with global health programs that engage in short term medical missions which are tantamount to doctor tourism, fail to provide any substantive benefit to the developing nations, and cause more harm than good. He presented guidelines to improve sustainable, ethically congruent, collaborative partnerships focused on capacity building to advance neurological services in sub-Saharan Africa, using Global NeuroCare’s focus on Ethiopia as a model plan.