Could out of pocket drug costs be responsible for pandemics? In this Public Health Perspectives article, Marcella Alsan discusses how copayments for antibiotics can cause people in poor areas to turn to unregulated markets.

On May 26, 2016, researchers at the Walter Reed National Military Medical Center reported the first case of what they called a “truly pan-drug resistant bacteria.” By now, the story has been well-covered in the media: a month earlier, a 49 year old woman walked into a clinic in Pennsylvania with what seemed to be a urinary tract infection. But tests revealed something far scarier—both for her and public health officials. The strain of E. Coli that infiltrated her body has a gene that makes it bulletproof to colistin, the so-called last resort antibiotic.

Most have pinned the blame for the impending doom of a “post-antibiotic world” on the overuse of antibiotics and a lack of new ones in the development pipeline. But there’s another superbug incubator that hasn’t gotten the attention it deserves: poverty.

Last month at the IMF meeting in Washington, D.C., UK Chancellor George Osborne warned about the potentially devastating human and economic cost of antimicrobial resistance. He called for “the world’s governments and industry leaders to work together in radical new ways.” But Gerry Bloom, a physician and economist at the Institute for Development Studies, argued that any measures to stop overuse and concoct new drugs must be “complemented by investments in measures to ensure universal access to effective antibiotic treatment of common infections.”

“In many countries, poor people obtain these drugs in unregulated markets,” Bloom said. “They often take a partial course and the products may be sub-standard. This increases the risk of resistance.”

For at least fifteen years, we’ve known about these socioeconomic origins of antimicrobial resistance. Other studies have revealed problems with mislabeled or expired or counterfeit drugs. But the clearest link between poverty and the rise of antimicrobial resistance is that poor people may not see a qualified health care provider or complete a course of quality antibiotics. Instead, they might turn to unregulated markets for substandard drugs.

But why do people resort to unregulated markets or take drugs that aren’t that great if they are available? Marcella Alsan, an assistant professor of medicine at the Stanford School of Medicine who studies the relationship between socioeconomic disparities and infectious diseases, led a study that answered this question. In last October’s Lancet Infectious Diseases, Alsan and her colleagues showed that it might have a lot to do with requiring copayments in the public sector. To show this, they analyzed the WHO’s 2014 Antibacterial Resistance Global Surveillance report with an eye toward the usual suspects, such as antibiotic consumption and antibiotic-flooded livestock.

Read More

In collaboration with the Center for Latin American Studies (CLAS) at Stanford University, SPICE hosted a professional development seminar for elementary school teachers that focused on strategies to incorporate Latin American and Latino children’s literature into the K–5 classroom.

On February 6, 2015, 32 teachers from across the Bay Area gathered at Stanford University to listen to guest lectures, participate in curriculum demonstrations, and collaboratively explore issues related to immigration and identity.

The workshop commenced with a presentation by children’s book author and illustrator Duncan Tonatiuh, whose most recent book, Pancho Rabbit and the Coyote: A Migrant’s Tale, was a 2014 recipient of the Americas Book Award. The Americas Book Award was founded in 1993 by the Consortium of Latin American Studies Programs (CLASP) to encourage and commend authors, illustrators, and publishers who produce quality children’s and young adult books that portray Latin America, the Caribbean, or Latinos in the United States.

Mr. Tonatiuh shared the inspiration for Pancho Rabbit and the Coyote, which tells the story of a young rabbit’s journey from Mexico to the United States in search of his father. According to Mr. Tonatiuh, the book can be read as an allegory of the experiences that undocumented immigrants endure in order to reach the United States. During his talk, Mr. Tonatiuh played a short video created by an elementary school teacher in which students shared their own immigration stories in response to the book. The moving video was a reminder of the importance immigration issues have in many students’ lives. Each teacher at the workshop received a copy of Mr. Tonatiuh’s book.

Tomás Jiménez, Associate Professor of Sociology and Director of Chicana/o-Latina/o Studies at Stanford University, followed Mr. Tonatiuh’s talk with a lecture on the recent history of immigration to the United States. Professor Jiménez’s educative overview of the economic, social, and political forces that have led to the current state of immigration in the United States perfectly complemented the personal stories shared earlier by Mr. Tonatiuh.

In the afternoon, Keira Philipp-Schnure, Supervisor of Community Education Programs, and Katrina Dillon, Project Assistant, at the Latin American and Iberian Institute at University of New Mexico, shared an educator’s guide for Pancho Rabbit and the Coyote. The educator’s guide offers a plethora of lessons and activities that teachers can use when teaching the book.

As a final activity, workshop participants assembled in small groups to discuss the content and pedagogical strategies that had been shared at the workshop. Jonas Edman, Curriculum Writer at SPICE, facilitated the activity in which teachers offered their own ideas for lesson plans and activities to go along with Mr. Tonatiuh’s book.

In her closing remarks, Elizabeth Saenz-Ackermann, Associate Director at CLAS, expressed heartfelt gratitude to the teachers for their participation in the workshop and for their commitment to incorporating Latin American and Latino themes and topics into their teaching.