Articles and Reflections

With abundant groves of coconut palm trees and a motley of colorful bananas hanging from nearly every storefront, the south Indian village of Karakulam enjoys a rich food culture. 

Dr. Lusajo Kajula spent nearly 16 years working as a lecturer at the Muhimbili University of Health and Allied Sciences (MUHAS) and a psychologist at Muhimbili National Hospital (MNH), the national referral hospital as well as the teaching facility for MUHAS, in Dar es Salaam, Tanzania. In her role at MUHAS, Dr. Kajula was involved in multiple international research collaborations that addressed adolescent and youth sexual health and behavior in sub-Saharan Africa. At MUHAS, she was also part of the team that established Tanzania’s first master’s program in clinical psychology.

#’s, emojis, likes, GIFs, handles – 10 years ago none of us would have understood these terms as forms of communication. Today, they enhance our communication with people around the world, connecting us but also contributing to our 21 century identities, both real and perceived.

In 2018, I was playing a game in Hayes Hall on UB’s South Campus as a part of the CGHE Global Innovation Challenge. This game requires all participants to form a circle, and one by one attempt to eliminate their opponents by tapping an appendage in one, swift motion. Players were dwindling, but - perhaps due to my years of dance training, or my super human mom skillz – I was dodging my opponents and still “in.”

This year, 2020-21, is the year of reckoning of all kinds. We are in the middle of a global pandemic that has exacerbated economic and gender inequalities, as well as those along other dimensions, making clear how unfettered global capitalism is a system of oppression, how certain groups are marginalized for the economic and social benefit of others; how racism, classism, ableism, and sexism are intensified under this economic system that teaches us to value certain traits over others, certain behaviors over others, certain occupations over others, certain people over others. 

It is not every day that you meet someone who studies the one thing that surrounds us all. Dr. John D. Atkinson, Associate Professor in the Department of Civil, Structural, and Environmental Engineering, spends his day thinking about how to control air pollution – one of the most complex, important problems facing our world today.

For over 125 years, the UB School of Dental Medicine has been educating students and serving the community. Nearly 6,000 alumni now work around the world providing dental care to patients. 

At the height of the COVID-19 outbreak in China, Dr. Lina Mu, Associate Professor in the Department of Epidemiology and Environmental Health at University at Buffalo, sought to understand how the global crisis was affecting mental health. Using her network of partners, Dr. Mu quickly launched a survey to pin point different factors that seemed to be buffering mental health problems. In one short week, 3,200 people responded. 

In 2002, President George W. Bush enacted the No Child Left Behind Law (NCLB), which increased the federal government’s role in holding schools accountable for student outcomes. The aim was to improve American competitiveness and to close an achievement gap between low-income and students of color, and their peers. However, critics suggest that by adding an additional layer of scrutiny, districts, schools, and classrooms around the country began teaching to the test and narrowing their curriculum to focus solely on math and reading.

Sex Ed. What do you picture? My own experience included a room full of my giggling peers and an uncomfortable teacher trying to communicate the science behind procreation and reproduction.

Economists are quite familiar with a term that may be unfamiliar to most. Neoliberalism, the ideology that our social and economic world is characterized by free market capitalism, drives our policies and relationships. An April 2016 article in The Guardian suggests it is the root of all our problems: the 2008 financial meltdown, slow degradation of public health, epidemic of loneliness, and the collapse of the ecosystems. Neoliberalism applauds competition, defines citizens as consumers, and suggests that the market delivers all that we need. As consumers, “we internalize and reproduce its creeds.” While the rich blame the poor for their failures, they often ignore the structural barriers (education, economic status, gender, class, race, etc.) that put them at an advantage.

Agriculture provides the livelihoods for approximately one-third of the world’s labor force. However, urbanization, globalization, and extreme weather events are placing their livelihoods at risk. By 2050, for example, wheat yields are expected to fall by 13% and rice by 15% due to temperature rise.

According to the World Health Organization, 2 billion people cannot access clean water to drink. Contaminated water leads to diarrhea, dysentery, typhoid, and polio and causes an estimated 485,000 deaths each year. With the climate warming and fresh water sources disappearing, half of the world’s population will live in water-stressed areas as early as 2025.

By 2030 antimicrobial resistance (AMR) could force 24 million people into extreme poverty; by 2050, up to 10 million deaths each year may be attributable to antimicrobial resistant infections. 

Although Dr. Kim Griswold did not know it at the time, her early training and career in theater provided her with the skills she would need as a clinician many years later. In theater, Griswold had to become adept at communicating with other actors – reading their body language, listening carefully to their lines, and responding appropriately. These skills are essential to quality patient care.

One of the 17 Sustainable Development Goals adopted by the United Nations General Assembly in 2015 is to provide universal access to “affordable, reliable, sustainable and modern energy.” Dependence on solid fuels in low- and middle-income countries impedes this goal, creating a source of household air pollution that harms primarily the health of women and children directly exposed to it.

In 2015, the UB GRoW Home won 2 place in the Solar Decathlon, an international competition sponsored by the U.S. Department of Energy that brought together sixteen collegiate teams to design, build, and maintain sustainable solar powered houses. The UB team spent two years designing and constructing a house for the competition. Martha Bohm, Associate Professor and Associate Dean for Academic Affairs for the Department of Architecture, led the team of students, representing four different schools and every academic level.

“I liked to build and break things as a child” Dr. Samina Raja lightheartedly responded when I asked what led her to pursue an undergraduate degree in Engineering. 

“For apart from inquiry, apart from the praxis, individuals cannot be truly human. Knowledge emerges only through invention and re-invention, through the restless, impatient, continuing, hopeful inquiry human beings pursue in the world, with the world, and with each other.” 
― Paulo Freire, Pedagogy of the Oppressed

When I started my first week of primary care as a resident physician, I was not expecting to use greetings such as “Bonjour” and “Ahlan wa Sahlan” as part of my interactions with my patients, but that was the reality of working in a city that is ranked among the top ten places for refugee resettlement.

Collaborative, interdisciplinary work is urgently needed to confront the greatest challenges facing earth and humanity. However, working in interdisciplinary teams means learning new methodological and theoretical language and, more importantly, translating concepts and processes in conversation to advance new knowledge. I am familiar with the conundrum of working across epistemological divides to improve school food policy development (Robert & Kovalskys, 2011), so I felt well prepared for the challenge to produce knowledge about globally integrated food systems, land use change and the double burden of malnutrition in the Dominican Republic.

The developmental, economic, social, and medical impact of undernutrition is serious and lasting for individuals and their families. Around 45%, nearly half of deaths among children under 5 years of age are linked to undernutrition – primarily in low- and middle-income countries. Children and families suffering undernutrition face increased health care costs, reduced productivity, and slow economic growth – three things that perpetuate a cycle of poverty and ill health. 

Almost half of Ghana’s labor force are farmers. The crops they grow – cocoa, cassava, yams, bananas, and corn – are largely dependent on rain-fed water sources. With a dry season that typically lasts seven to eight months, agricultural productivity has rapidly declined and farmers face chronic seasonal unemployment, fruitless seasonal migration to urban regions, and food insecurity. Many leave their farms to seek jobs in urban regions.

The prevalence of diabetes worldwide has doubled over the last 30 years and is projected to be the 7 leading cause of death in 2030. Cardiovascular disease contributes to 31% of deaths worldwide with 75% of those deaths occurring in low- and middle-income countries. The populations at most risk live in remote, rural environments where physicians are sparse. There, patients must travel long distances to seek care, missing work and daily wages. Those who cannot travel suffer complications and poorer health.

Each year, monsoon season causes considerable damage to the traditional mud homes of rural farmers in India, requiring time-consuming and labor-intensive repairs. In addition to climatic issues, traditional home designs create unhealthy indoor environments due to air pollution from kitchen smoke, poor insulative performance, and water damage. Typical government homes, built from brick or concrete, are highly prevalent “solutions” since they are cheap, durable, and easy to construct. However, these homes overheat to unlivable temperatures during hot summer months, negatively impact the environment with high production emissions and embodied energy,  and consist of unaffordable materials for most rural families, especially those 82% who make a living off of subsistence farming.

Before going to India, I approached planning issues from a narrow framework. Traveling anywhere forces you to re-evaluate your own viewpoint. In my case, although I researched urban planning in India, I did not really understand how different it could look until I went there. 

5 billion people worldwide lack access to timely, safe, and affordable surgical care. In many places, the challenges to provision of this care are daunting. Health systems lack basic human and material resources, rudimentary education regarding congenital anomalies and need for referral at the primary care/midwife/rural medical center level, and safety and transportation logistics. 

Each time we enter our research site, teachers and students welcome and seek to help us feel at home within a well-established community that is flourishing behind old school doors. Warm, inviting faces fill the halls, wherein school leadership and staff seek to uplift students who have escaped economic destitution, identity-based violence, and war to resettle as refugees in the United States. Given the school mission and established programming, more recently staff also work to address the needs of an influx of Puerto Rican students displaced because of Hurricane Maria.

Solid fuel combustion – in the form of biomass and coal – is a dominant energy source for household heating and cooking in low and middle-income countries. As a result, nearly 3 billion people worldwide are exposed to household air pollution, causing four million premature deaths annually.

1981 marked the beginning of the HIV epidemic. Between 1982-1988 AIDS became prominent in the United States and Europe, but the world lacked therapeutic drugs that could suppress the virus. 

In the United States, students suffering mental health issues related to trauma can often find help from school social workers. Unfortunately, many countries lack these services. In the Dominican Republic, less than 1% of the country’s health care finances are allocated to mental health. Social work is not an available career, therefore children suffering mental health issues have limited access to care.

The majority of the population living in the state of Odisha, India, earn a living as cultivators – 53% work their land for more than 6 months a year. In 2013, these farmers produced a surplus of 124 million tons of rice, yet the population still suffers from undernourishment (21%) and poverty (32%), and 40% of children under five are underweight. 

In 1996, Dr. Pavani Ram, associate professor of epidemiology and environmental health, observed the care for two patients who have impacted her life to this day. In Tamil Nadu in South India, a woman at 43 weeks pregnant – 3 weeks post due date – delivered a stillbirth, likely due to a lack of sufficient antenatal care. Another patient, a woman dying of congestive heart failure, was suffering alone in a small hut in a remote, rural community. These encounters caused Dr. Ram to reflect: what are the barriers to care for populations living in communities where health services are not available and what does it take to deliver high quality care in these types of low resource settings? These questions have formed the basis of her life’s work – using public health’s power as an instrument of social justice for women and children.

Small-holder farmers around the globe use about 8% of all agricultural land, yet account for 70% of all farms. Many farmers live off what they grow and have limited access to capital, markets, land, and technology.  Subsequently, large-scale changes like urbanization, a globalizing food system, and climate change, intensely affect their economic, social, and physical health and wellbeing. 

With the support of the Community for Global Health Equity (CGHE), in January 2018, Medical Sciences students Arsalan Haghdel and Aye Bay Na Sa, Environmental and Civil Engineering double major Matthew Falcone, and Architecture and Planning graduate student Nicole Little traveled to India to conduct research through Amrita University’s Live-In Labs (LILA) program.

China’s Cultural Revolution (1966 – 1976) brought chaos to every aspect of life in the country. In particular, educational opportunities for youth essentially came to a grinding halt. 

Dr. Kasia Kordas, associate professor of epidemiology and environmental health, describes her entrance to public health and epidemiology as serendipitous. In fact, looking back she feels very lucky to have “stumbled upon it.” 

As a participant of the Community for Global Health Equity’s (CGHE) first Global Innovation Challenge, I learned that children with disabilities around the world often do not attend school because they cannot access water and sanitation facilities. These facilities are not being monitored or assessed, leading to a large portion of the population uneducated and unable to find quality work.

Economic and environmental sustainability is a critical challenge for populations around the world, but the obstacles are diverse, reflecting the politics, cultural identities and geographies of each nation. One method to improve a nation’s sustainability is Green building, or the efficient use of resources, safeguarding occupant health and preventing environmental degradation.

Rising household incomes, multi-scalar supply chains – regional, national, transnational – women’s labor force participation, state food programs, and changing trade rules are altering food systems in middle-income countries across the globe. These factors shape and are shaped by dietary practices, as consumption shifts away from fresh foods prepared at home towards highly processed goods of low nutritional quality. As a result, populations face a “double burden” of malnutrition: undernourishment, on the one hand, and overweight and obesity, on the other.

Dr. Lanre Omotayo, postdoctoral associate for the Community for Global Health Equity, has come to see that improving public health requires more than improvements in medicine; this perspective results not from an epiphany, but a step-by-step pursuit of his core convictions.

As an undergraduate student pursuing a public health degree at the University of California, Irvine, Yeeli Mui had not yet heard about the field of urban planning, much less considered the relationship between urban planning and public health.

The South Sudan civil war has led to an influx of approximately one million refugees to Uganda, one of the poorest countries in the world. Unlike most nations, Uganda welcomes refugees with the right to land, freedom to travel, ability to work, and access to food, water, and shelter. Unfortunately, limited water sources in Northern Uganda, where most refugees settle, are generally not safe for consumption. Currently around 8 million people in Uganda, 20% of the population, do not have access to safe water. Without access, subsistence farmers struggle to feed their families and earn a living, and children under the age of five die from diarrheal disease caused by poor water and sanitation.

Surrounded by a circular river system that receives the wastewater discharge of a population approaching 20 million, the physical geography of Bangladesh’s capital city, Dhaka, contributes to a number of significant public health hazards, including the interaction of pathogenic bacteria with antibiotic residues and chemicals.

The data and projections are alarming. 70% of infections in babies with sepsis were multi-drug resistant in a private, metropolitan hospital in India. 

How do you make decisions about the food you eat? Do you look at the price? The list of ingredients? Perhaps you pay particular attention to whether your food is non-GMO, gluten free, or certified organic?  

In Ghana, a newborn child receives the names of both parents, which are often aspirations for the child’s future. Dr. Emmanuel Frimpong Boamah, the most recent faculty hire for the UB School of Architecture and Planning, is on a path to live up to his father’s name, Boamah, Helper of Nations.

Access to essential medicines is not only about the development and cost of pharmaceuticals but also supply chain logistics. The "last mile" plays a particularly important (and challenging) role in low- and middle-income countries, such as Uganda. Industrial and systems engineering research reveals major disparities in access to essential medicines.

Since its independence from Britain in 1948, Burma has been embroiled in one of the longest-running civil wars in the world, mainly due to its complex ethno-political tensions that resulted in ongoing conflicts between its military government and ethnic minority groups. As a result, many refugees from Burma, members of the Karen ethnic group in particular, fled to refugee camps along the Thai-Burma border, where these refugees have lingered for years before being granted resettlement to the United States in the early 2000s.

Buffalo's diverse populations must be considered when designing public assistance programs. Diverse diets do not always include whole-grain bread, infant formula, baby food, and milk, foods chosen through a "rigorous science-based process".

According to reports from the 2014 United Nations Data, India has an “urban slum population” of 98.4 million people (i.e., people living in urban informal settlements that do not have legal recognition of tenure of the land they live on). In parallel, according to the 2011 Census of India, the total urban population with some form of disability was over 8 million. 

In the spring of 2016, 13 master’s students from architecture, urban and regional planning, environmental engineering and public health enrolled in a course to help develop a city sanitation plan for Maradu, India. Co-taught by Drs. Samina Raja (urban planning) and Korydon Smith (architecture), and in partnership with the Centre for Science and the Environment and the College of Engineering at Trivandrum, the group traveled to Maradu for three weeks in January 2016 to conduct preliminary fieldwork. As a teaching assistant along with Smitha Gopalakrishnan, I traveled to Maradu, to help facilitate the fieldwork portion of the studio.

Sitting on the veranda outside of my room at the Mata Amritanandamai Math Ashram, I am serenaded by a chirping cricket, the rustling of leaves in the gentle cool breeze. In the distance, I can hear the soft whispering of the Bagivati River, a tributary of the Ganga, as it rushes past us on its daily journey. After four long days on a train, then 6 hours winding through the Himalayas by taxi, I took a few moments to soak up the beautiful scenery surrounding us before beginning our work in Dunda, a small village in the Uttarkashi district of Uttarakhand.

Cancer control in low and middle income countries will not be effective without a multifaceted, innovative approach that includes the lay public and the medical community.

The Havana confab brought together public health and social scientists from sixteen different Latin American countries, and focused on three interrelated themes: the social determinants of health; food security and nutrition, and the prevention and control of disease. 

Preeclampsia is a pregnancy complication that can begin at around week 20 and may present a wide range of symptoms, such as high blood pressure, weight gain, presence of high amounts of protein in urine, and abdominal pain. Due to diverse and inconsistent symptoms, it is often misdiagnosed as hypertension.

At the start of 2017, the number of people worldwide forcibly displaced was over 65 million, an increase of nearly 30 million people since 2011. “Forcibly displaced persons” includes refugees, internally displaced persons (IDPs), asylum seekers and stateless persons. Violence, persecution, conflict, or human rights violations contribute to displacement. 

Communities in every nation are increasingly faced with the need to provide competent, equitable and culturally appropriate services for resettling refugees. 

Culture plays a major role in defining disabilities. Concepts and types of disabilities vary widely across cultures, and many societies do not have linguistic equivalences for “disability,” “impairment”, or the now pejorative “handicap" [1]. 

The United Nations General Assembly has reaffirmed that clean drinking water and sanitation are vital to human health and has explicitly stated that access to water and sanitation is a fundamental human right [1]. From this principle, the UN sought to double the proportion of people around the world with sustainable access to basic sanitation from 2000 to 2015. The target was missed by almost 700 million people [2].

From September 26 to October 6, 2015, Brandon Stanton, the photographer behind the popular blog and Facebook page, “Humans of New York,” posted photos of Syrian refugees with captions that told a small part of each individual’s story. The photos, which have garnered hundreds of thousands or more “likes,” left viewers to reflect on their lives and the lives of those affected by the Syrian Civil War.

One billion people around the world have some form of disability, and of these, 360 million do not have access to improved sanitation facilities [1,2].

In an effort to reduce open defecation in low- and middle-income countries, there has been a focus on increasing latrine coverage and, more recently, motivating people to use them.