General Session II ‐ Jon Warkentin April 19, 2017 2017 National TB Conference, Atlanta, Georgia National TB Controllers Association www.tbcontrollers.org 1 1 “TB‐Free Ebeye” and Social Determinants of Health in the RMI Jon Warkentin, MD, MPH Medical Director, TB Elimination Program Tennessee Department of Health April 19, 2017 2 Introduction • A personal perspective from one volunteer • An active TB case-finding project on Ebeye Island, Republic of the Marshall Islands ▫ Where is RMI and Ebeye Island? ▫ Why TB case-finding on Ebeye? ▫ What is the “TB-Free Ebeye” project? • A broader perspective: ▫ Why is there so much TB and diabetes on Ebeye? ▫ Social determinants of health on Ebeye Island 3 Republic of the Marshall Islands (RMI) • Located in the western Pacific Ocean west of the “International Date Line,” midway between Hawaii and Australia • Comprised of 1,156 individual islands and islets, spread among 29 coral atolls • For your information: Total land area: 70 square miles (rank: 213 th ) 2016 estimated population: 53,376 (rank: 203 rd ) Population density: 758.9/sq. mile (rank: 28 th ) Currency: U.S. dollar Drive on the: Right Source ‐ https://en.wikipedia.org/wiki/Marshall_Islands
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General Session II 03 Warkentin 04-19 · (4/19/2017, 1:28 am) 57 In Honor of Dr. Richard Brostrom. General Session II ‐Jon Warkentin April 19, 2017 2017 National TB Conference,
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General Session II ‐ Jon Warkentin April 19, 2017
2017 National TB Conference, Atlanta, Georgia National TB Controllers Association www.tbcontrollers.org 1
1
“TB‐Free Ebeye” andSocial Determinants of Health in the RMI
Jon Warkentin, MD, MPHMedical Director, TB Elimination Program
Tennessee Department of Health
April 19, 2017
2
Introduction
• A personal perspective from one volunteer
• An active TB case-finding project on Ebeye Island, Republic of the Marshall Islands▫ Where is RMI and Ebeye Island?▫ Why TB case-finding on Ebeye?▫ What is the “TB-Free Ebeye” project?
• A broader perspective:▫ Why is there so much TB and diabetes on Ebeye?▫ Social determinants of health on Ebeye Island
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Republic of the Marshall Islands (RMI)
• Located in the western Pacific Ocean west of the “International Date Line,” midway between Hawaii and Australia
• Comprised of 1,156 individual islands and islets, spread among 29 coral atolls
• For your information: Total land area: 70 square miles (rank: 213th) 2016 estimated population: 53,376 (rank: 203rd) Population density: 758.9/sq. mile (rank: 28th) Currency: U.S. dollar Drive on the: Right
• Micronesian colonists settled in 2nd millennium BC, first explored by Spanish explorers (1526), later by British explorer John Marshall (1788)
• Occupied early in WWII by the Japanese army, defeated by US army in February 1944
• A US territory until 1979, full sovereignty in 1986 with “Compact of Free Association”▫ Financial , health and security obligations of the U.S.▫ Current program expires in 2023▫ Uncertain future
2017 National TB Conference, Atlanta, Georgia National TB Controllers Association www.tbcontrollers.org 16
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Relationship Between Kwaj and Ebeye
• Kwaj occupied by U.S. Army since WWII• Strategic military importance to U.S. for anti-missile
defense of the U.S. mainland• Kwaj leased by U.S. from Marshallese landowner(s)• Clearance required for all visitors/workers on Kwaj• Approximately 1,000 Marshallese travel by ferry daily
from Ebeye to work on Kwaj; with few exceptions, no Marshallese are permitted to live on Kwaj
• “Perk” for Marshallese workers is access to potable water to carry on ferry to Ebeye
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Questions
• Why is there so much TB and diabetes on Ebeye Island?• What impact will a 3-month TB case-finding project have
on public health on Ebeye Island?• What sustains conditions of poor health on Ebeye Island?• Who is responsible today for improving public health on
Ebeye and throughout the RMI?
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What are “social determinants of health”?
• The social determinants of health are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness.
• These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.