An estimated 1.5 million Haitians were displaced in January's earthquake. Six months later, the majority of that population is still living in tent settlements and the medical infrastructure is still fragile. A reporting team from the PBS NewsHour, including senior correspondent Ray Suarez, has returned to Haiti to assess where things stand.

The slideshow below offers a snapshot of scenes from Port-au-Prince. And stay tuned to the NewsHour online and on-air to see reports from Haiti in the coming days.

Five years ago, Frontline/World correspondent Amy Costello reported on a new kind of water pump being developed in southern Africa. The "PlayPump" operated like a merry-go-round, with the added benefit of pumping clean water into a tower that the whole village could access. The original report attracted international investors and PlayPumps started rolling out to villages throughout southern Africa. But, when Costello returned for a follow-up report, she found a less promising scene.

"Troubled Water," which airs tonight, explores where the PlayPump fell short.

Also on Frontline/World Tuesday, Adam Davidson of NPR's Planet Money reports on Haiti's economic troubles and you'll also see a profile of a painter whose subject, the bowerbird, can only be found in the jungles of West Papua.

Five years ago, Frontline/World correspondent Amy Costello reported on a new kind of water pump being developed in southern Africa. The original report attracted international investors and the so-called "PlayPumps" started rolling out. But, when Costello returned for a follow-up report, she found a less promising scene.

Alexis Matsui and Ria Misra

Pakistan's aging irrigation infrastructure and years of little rain are adding up to major problems for farmers, prompting the government to subsidize a new drip-style irrigation system. But some farmers still find it too costly to install.

ISLAMABAD -- On a small patch of farmland just outside of Pakistan's capital city of Islamabad, Karmran Ali Kiyania is warily looking at the sky, scanning for clouds. A wheat and corn farmer, Kiyania has no water source on his land and is dependent on the rain to keep his crop alive.

When water is scarce, like in the past year, he explains, he has nothing to harvest. The situation on Kiyania's farm is also playing out on a national scale.

With shrinking rainfalls, depleting reserves, a growing population, aging infrastructure, and an economy that depends largely on agriculture,the water shortage is raising alarms all over Pakistan and forcing the government to act.

More than 90 percent of the country's water supply is dedicated to agriculture -- and much of it ends up going down the drain due to poor infrastructure and storage capabilities.

Pakistan only stores 9 percent of its annual water flow, while the world average is 40 percent, said Muhammad Ashraf of Pakistan's International Center for Agricultural Research in the Dry Areas. Further, he added, 60 percent of Pakistan's water is lost due to a decades-old canal system and dams that are constantly building up silt, which can't be filtered and makes water undrinkable.

"In 1947, we were at 5,600 cubic meters per person," he said. "Now, we are at 1,000 per person." The World Bank measures water scarcity as levels that drop below 1,000 cubic meters per person.

Many small farms depend on rain or use a form of irrigation that entails flooding their fields, which critics say wastes water because much of it evaporates.

As a result, said Shahid Ahmad of the Pakistan Agriculture Research Council, farmers have little flexibility to accommodate weather change.

"The farmer, he needs money every time at the time of planting, and he pays back only at harvest," he said, adding that when water is unavailable, "farmers will turn into beggars."

Much of Pakistan's water supply comes from glacial reserves in the Himalayas, which are shrinking. This limited supply of water, combined with a growing demand from a burgeoning population, has raised fears that the problem will only become worse.

"The resources are not going to increase," said Ahmad.

The water shortage is also being painted as an international political problem. A treaty between Pakistan and neighboring India has governed water rights between the two countries since 1960. But as supplies dwindle, Pakistan is accusing India of unfairly controlling the flow.

"The water issue is probably the most politicized issue between the countries," said Michael Kugelman, editor of a report on Pakistan's water supply for the Woodrow Wilson International Center for Scholars, "and a major reason for that is the Kashmir issue. The water that flows into Pakistan flows through India controlled Kashmir. I think it's important to be mindful that India has its own water crisis, too. Both sides have a lot at stake."

Since so much of the water is wasted or unavailable through human error or unrepaired infrastructure, the role of governance becomes more important, Kugelman said.

A Pakistani government program is taking aim at the problem with what it calls "high efficiency irrigation systems" that use less water. Ahmad said the goal is to implement 250,000 acres of the systems over the next five years.

The new irrigation program, modeled off those that have proven successful in Israel and Germany, allows the government to subsidize the installation of sprinkler, drip and bubble irrigation systems throughout the country.

Shahnawaz Khan heads a company that manufactures the systems -- the first of which he installed on his own 3,000 acre farm in Pakistan's Punjab province to cut down on water waste. He says he is using half the water he would have if he used flood irrigation.

"Farmers are getting 40 percent of the water they used to get," said Khan. "It is as precious as gold."

Two years into a five year program, encouraged by former Pakistani President Pervez Musharraf, officials have installed systems across farms of all sizes in all four provinces of Pakistan.

The new system works with small private businesses to manufacture, install and maintain the machines on each farm.

Khan said the improved water supply systems yield 70-90 percent more crops.

Supporters of the program hope the higher and better quality yield will convince more farmers to implement the system on their land.

Khan feels the government is finally stepping into a much-needed role in the education of farmers and others in the agriculture business about the value of water.

"It's the responsibility of the government to make (citizens) aware of their social responsibilities," he said.

But an informal survey of five small farmers, including Kiyania -- all with less than five acres of land -- showed that they were unaware of the program and even if they knew about it, the price would be prohibitive. Although the government will pay for machine installment, farmers need at least a few hundred dollars to develop private water sources on their land and contribute to the maintenance costs.

Kiyania said he liked the idea of installing machines to help with irrigation, but he just didn't have the money for it.

Under the program, the government would pay for the first installation of the machinery, which can range from a few hundred dollars to more than US$2,000 depending on the size of the system. Subsequent repairs, parts, and growth would be the farmers' responsibility.

Because of the economic burden, the government has had most success with middle-class farmers with between 20 and 200 acres of land. Farmers with less land sometimes cannot afford the operational costs, and farmers with large plots have been slower to attempt major change, since they have so much at stake.

Ahmad of the Pakistan Agriculture Research Council said the government effort is not enough to change farmer's actions across the country, but the farmers must communicate among themselves and work together to combat the problem.

"The government alone cannot do it. Farmers in Pakistan are an under-utilized resource," he said.

Editor's Note: Reporting for this story was funded by a fellowship from the South Asian Journalists Association.

Pakistan's aging irrigation infrastructure and years of little rain are adding up to major problems for farmers, prompting the government to subsidize a new drip-style irrigation system. But some farmers still find it too costly to install.

Fake drugs manufactured to resemble dozens of well-known pharmaceutical brands are making their way across international borders and threatening lives, the World Customs Organization said Thursday.

"Countries across the globe, in particular those in Africa, suffer the scourge of being flooded with fake and sub-standard medicine," WCO Secretary General Kunio Mikuriya told the group's 176 member countries.

Malaria tablets, heart treatment medication and H1N1 vaccines are among the drugs being sold in counterfeit form, making up 10 percent of worldwide pharmaceutical sales, according to former French President Jacques Chirac, who spoke to the organization.

"Men, women and children are dying because criminal networks are making money from the trafficking of fake medicines," said Chirac. "No one knowingly buys a product that could threaten his life or that of one of his loved ones."

Chirac noted that in developed countries more and more people are buying medications over the internet and through channels that are difficult, if not impossible, to regulate.

Roger Bate, an economist who writes about the issue at the American Enterprise Institute for Public Policy Research, said in an email that although the scale of the problem is much bigger in the least developed countries, the counterfeit manufacturers are focusing their efforts on wealthier nations because of the value available in those markets.

The U.S. Food and Drug Administration warned last week that fake versions of the flu drug Tamiflu were being sold without prescription through internet pharmacies, and that the drug contained an active ingredient that could be deadly to people allergic to penicillin.

The fake and substandard drugs being sold for profit sometimes contain a little of the genuine active ingredient but often contain a random mix of cheaper pharmaceuticals that could have dangerous effects.

Ilisa Bernstein, deputy director of the office of compliance at the FDA said the agency regularly monitors online pharmacies and will sometimes make purchases and test products. Complaints from pharmaceutical companies or consumers can lead to an investigation.

"It's very challenging, there are a lot of different ways that products that have poor quality, that are not safe, that are not effective, can get to U.S. consumers," said Bernstein, who recommended staying away from internet purchases and any informal sale of drugs.

China and India are major sources of the fake drugs hitting the U.S. market, but they can come from anywhere said Bernstein, and the range of fake drugs is wide, from Viagra to the over-the-counter weight-loss pill Alli.

Vice President Biden announced a plan this week to target intellectual property infringement of all kinds, including fake drugs. The plan proposed creating an interagency committee focused on fake medicines and products, as well as legislation to require companies to alert the FDA when they learn of a counterfeit medication on the market.

WCO is also aiming to crack down on the growing industry. Mikuriya signed the Chirac Foundation's Cotonou Declaration Thursday, as a symbol of the organization's commitment to beef-up border enforcement operations.

Bate applauded the move but said it would likely only have a small impact on the trade, because many active pharmaceutical ingredients are traded over borders, then manufactured into poor quality medications in country.

Fake drugs manufactured to resemble dozens of well-known pharmaceutical brands are making their way across international borders and threatening lives, the World Customs Organization said Thursday.

There are still unanswered questions about cell phone use and cancer risks, but a new study could alleviate parents of at least one fear.

Children whose mothers lived near cell phone towers while they were pregnant do not have an increased risk of developing cancer at a young age, according to new research published in the British Medical Journal this week.

The study looked at nearly 7,000 children ages 4 years and younger in the United Kingdom, 1,400 of whom had cancer, including leukemia, brain tumors, central nervous cancers and non-Hodgkin's lymphomas. The researchers compared the cases with the distance each child's mother lived from a tower.

"The study found no association between the risk of cancer in early childhood and exposure to a mobile phone base station during pregnancy," BMJ wrote.

Exactly how cell phone technology is affecting modern lives and health has attracted a lot of attention from the consumer and scientific communities in recent years.

The results from the BMJ study do not indicate the risk a transmission tower poses to a child later in life, or the risk to adults. And the exposure levels from a tower are much lower than what a person receives from actually using a cell phone.

A major 13-country study on the cancer risks of using a cell phone was released in May of this year, but the results were down-right confusing. It concluded that most cell phone users have no increased risk for some of the most common types of brain tumors, but a small proportion of study participants who reported heavy use of cell phones had some increased risk of glioma tumors. Most baffling of all for the researchers, some cell phone use levels appeared to protect for certain types of cancers.

The results were deemed inconclusive and the researchers themselves noted flaws in the methodology but the National Cancer Institute still calls it the "most significant study of long-term use" of cell phones to date.

While the cancer question lingers, one city is trying to take precautions with or without overwhelming and conclusive scientific evidence. San Francisco passed an ordinance Tuesday requiring cell phone sellers to disclose the phones' specific absorption rate, which is the maximum amount of radiation a person would absorb using the phone without a hands-free device.

"From our perspective, this is a very reasonable and quite modest measure that will provide greater transparency and information to consumers for whom this is an area of interest or concern," said Mayor Gavin Newsom's spokesman Tony Winnicker, according to the Associated Press. "We're playing a role that we've often played, which is to be at the forefront of a debate."

There are still unanswered questions about cell phone use and cancer risks, but a new study could alleviate parents of at least one fear.

Talea Miller

NOAA is projecting a busy 2010 hurricane season.

An active hurricane season could make life even more difficult for earthquake-battered Haitians and Gulf coast residents still dealing with the Deepwater Horizon oil spill disaster.

Hurricane season runs from June 1 to Nov. 30 in the Atlantic and from May 15 to Nov. 30 for the Eastern Pacific. The first hurricane of the Pacific season, Hurricane Celia, formed over the weekend but was not projected to make significant landfall.

According to experts, there are a few key things to watch for this season:

More intense storms expected | The National Oceanic and Atmospheric Administration projects with a 70 percent probability that there will be 14 to 23 storms given names, which happens when winds reach 29 mph. Of those, eight to 15 could be hurricanes, and three to seven could be major, with winds of at least 111 mph.

An average six-month season sees 11 named storms, six of which become hurricanes, two of them major.

Hurricane likely to make U.S. landfall | Researchers at Colorado State University say the probability of a major hurricane making landfall along the U.S. coastline this season is 69 percent, compared with a 52 percent average from the last century.

There is a 44 percent chance that a major hurricane will make landfall on the Gulf Coast, which is struggling with the ongoing oil leak disaster.

"The water temperatures are very warm right now … and since hurricanes live off warm ocean water that means there is more fuel for them to live off of and intensify," said Phil Klotzbach, lead forecaster on the CSU Hurricane Forecast Team.

Klotzbach said El Nino conditions, which create a lot of wind sheer and disrupt storms, kept the 2009 hurricane season activity low but those conditions have neutralized.

Gulf oil could spread faster | A hurricane or tropical storm could delay Gulf oil cleanup efforts and increase the impact on coastlines.

"If you get a storm tracking to the west of the oil … it could push the oil further inland and make a real mess," Klotzbach said. "That is our primary concern."

Gregory Stone, director of the Coastal Studies Institute at Louisiana State University, agreed with the prognosis.

"There is no question in my mind, given a storm surge, that tributaries would funnel that water laden with oil further inland than a non-tropical storm situation," Stone said.

The storm could also generate waves and currents that would break up the spill, Stone said, meaning the oil would spread over a much larger area. The group is trying to model how a storm might redistribute the oil in the Gulf.

Many Haitians vulnerable | Haiti is no stranger to hurricanes — a 2008 storm killed 76 people there — but after the January earthquake left an estimated 1.5 million people homeless, Haitians are particularly vulnerable this hurricane season.

"Hundreds of thousands are still living in these spontaneous camps, under tarps and tents, nothing like hurricane-proof shelters," said Julie Sell, an American Red Cross spokeswoman in Haiti.

She called hurricane season "a very big concern" especially since many of those tent camps are on hillsides that could be at risk of landslides or are in areas that could easily flood.

The group is employing Haitians to dig ditches through some camps to help divert water in the case of heavy storms or hurricanes.

"We are working to move people into more durable shelter, but that is very complicated," said Sell because there is little land available for construction. "Haiti has a long history of being hit by devastating storms, but it looks like things could be bad."

NOAA is projecting a busy 2010 hurricane season.

The State Department and USAID announced eight focus countries that will get extra help from Obama's proposed six-year, $63 billion Global Health Initiative Friday.

The new plan aims to better integrate health services and in particular improve mother and child health in countries around the world. Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal, and Rwanda will serve as labs to help determine how the GHI is implemented throughout the 80 countries where the U.S. is involved in global health work.

"These countries are about that learning opportunity," said Amie Batson, USAID's deputy of the Global Health Initiative, and were chosen for geographic diversity, local government interest and because of promising existing initiatives on the ground.

The countries will receive extra management guidance and technical support in working to strengthen their health systems, said Batson, but details about how much funding will be allocated are not yet known.

The new health initiative is intended to build on the existing President's Emergency Plan for AIDS Relief, PEPFAR. Ambassador Eric Goosby, United States Global AIDS Coordinator, told the NewsHour in an interview earlier this year that the GHI will help make better use of country resources.

"Think of your own health care. Does it make sense for you to address your health care one disease at a time, or does it make sense for you to go to one spot that looks at the whole picture of your health care needs?" Goosby said.

"That's really what the GHI is doing. It's taking the next step and allowing services to meet the needs of the patient in front of them."

Goosby cited a hypothetical where PEPFAR workers treating an HIV positive woman could not help with immunizations or other health concerns, because of the "vertical," disease specific funding line.

Despite Goosby's arguments, AIDS advocates are concerned the plan is detrimental to providing and expanding access to life-saving antiretroviral medications around the world. While the proposed GHI budget expands global health funding, the PEPFAR budget request for this year is only a 2.2 percent increase, short of the annual growth the program has seen since its inception.

The result of this slow down, said Paul Zeitz, executive director of the Global AIDS Alliance, is that people are beginning to be turned away from some programs in Africa.

"The President has requested basically a flat lining of funding for the emergency AIDS program," said Zeitz. "New patients are not being enrolled, people are being told 'we're full' and we're seeing a real backlog of people--women, and pregnant women, and other kinds of vulnerable people--that are medically eligible for life-saving AIDS medicines being turned away."

David Apuuli, director of the Uganda AIDS Commission told a panel discussion at a global health conference earlier this week Uganda "is headed for a crisis" as global AIDS funding flattens from all sources. The New York Times reported in May, "Uganda is the first and most obvious example of how the war on global AIDS is falling apart..it is the first country where major clinics routinely turn people away."

Goosby acknowledged there is a huge unmet need for ARVs around the globe and said the many international players in the fight against AIDS and the individual countries will have to work together.

"We need to change the way we think about response to this unmet need, and acknowledge that one program is not going to successfully meet that unmet need," Goosby said.

As for the GHI as a whole, Goosby said the U.S. is doing everything it can to "increase the number of lives that we are able to impact and save."

The State Department and USAID announced eight focus countries that will get extra help from Obama's proposed six-year, $63 billion Global Health Initiative Friday.

As Haiti continues to rebuild from January's earthquake, educating and training more Haitian doctors and nurses is essential to reviving and restructuring the country's hobbled health system, says the country's health minister.

"The state of New York has more Haitian physicians than Haiti itself," Health Minister Alex Larsen said at a panel discussion on the health system's future, held in Washington, D.C., Wednesday.

Speaking through a translator, Larsen emphasized the need to train and retain health care workers by providing better salaries and incentives to stay in the country, and by keeping foreign recruiters from luring Haitian trained workers away as soon as they receive diplomas.

Even before the earthquake, the country's health system was in dire straits, relying heavily on NGO assistance. According to 2009 World Health Organization statistics, Haiti had one nurse and three doctors for every 10,000 people, and that was before the quake killed as many as 300,000 people and left 1.5 million homeless.

The emergency medical response to the earthquake has "stabilized," Larsen said, and the ministry has developed an 18 month recovery plan that emphasizes even "more attention to the human resources than the physical infrastructure."

Already a public health school is being created to train mid-level workers, meaning community health workers, midwives and nurses. The country also hopes to capitilize on increased interest from outside medical universities willing to play an educational role in Haiti.

Andre Vulcain, faculty liaison of the Haiti Project at the University of Miami Miller School of Medicine, said the new focus is important because the mid-level work force, "that's where you win or lose the battles usually."

The earthquake has also shone a light on the mental health needs of Haitians, especially in working to address the stress and trauma caused by the disaster.

"We are starting to address mental health needs, mental health is an area that was incredibly neglected before the earthquake," said Donna Barry, advocacy and policy manager for Partners in Health, an NGO that has worked in Haiti for decades. The group is training community health workers to reach out to families, hiring social workers and psychologists as well.

But no broader and long lasting improvements to the system will be possible without the full commitment of the international community, said Barry.

"We have seen over and over and over that donors conferences happen, billions of dollars are pledged, then maybe 30 to 40 percent of what was pledged [will] actually get to Haiti."

In early June, Haiti's President Rene Preval told a donor's summit that little of the more than $5 billion pledged by governments had actually been delivered and that only Brazil had fulfilled its full commitment of $55 million.

In the last few decades, much of the decision making and responsibilities of the health system have been transferred to NGOs, said Vulcain. The health system has not been able to provide the level of services required for the population in the past, but those responsibilities need to be restored to the Health Ministry to make progress, he said.

"I really think that we are at defining moment for the health care system of Haiti," Vulcain said.

Larsen agreed, and thanked the international community for reaching out after the quake.

"From every corner of the world people were coming to help Haiti, we are forever in debt for this type of assistance," Larsen said. "It's never too late to do good, so we are going to try to do the good now."

Training more Haitian doctors and nurses is essential, says the country's health minister.

Listen to the Audio

As Cape Town, South Africa, prepares to host eight World Cup soccer matches, Jonathon Miller of Independent Television News reports on the drugs, poverty and gangs that lie in the shadows of the city's soccer stadium.

JIM LEHRER: Now: drugs and despair in South Africa.

Jonathan Miller of Independent Television News reports from Cape Town, the nation's second largest city and the host for eight World Cup soccer games.

JONATHAN MILLER: In the city where the mountain is transcendent, the rich and the white live on its towering flanks. Cape Town's poor -- and there are millions more of them -- occupy the sprawling flats, these the tin roof shanties of the cape of no hop, where gangster gun law rules.

But there's a diva in this Khayelitsha Township. And she refuses to accept her fate.

JONATHAN MILLER: Bongiwe sings a Baroque aria. "Follow, Follow My Heart," it's called, her philosophy of hope.

BONGIWE NAKANI, opra stdent: I feel like I'm in another place where there's no one, just you and your voice. So, you have to be happy, forget about where you come from, forget about the crime, the drugs and all that. You just have to be somebody else.

JONATHAN MILLER: Bongiwe's mother gave her four daughters a ticket out of their violent township. They have all been to university. And now the diva has set her sights on Europe.

BONGIWE NAKANI: Living here is not good, very bad, because you would go to the shop and you would get mugged in a very few minutes. And you would lose your wallet and phone and everything. Shootings do happen here in the daylight.

JONATHAN MILLER: Murders?

WOMAN: Yes. The country can kill you. It's the young boys. They just take the cell phones and the wallet and going to sell them.

BONGIWE NAKANI: For the drugs.

WOMAN: For the drugs.

BONGIWE NAKANI: Yes.

JONATHAN MILLER: Drugs and poverty are a dangerous mix. Four out of five of all the murders and armed robberies are drug-related. Addiction to crystal meth, which locals call tik, is a playing.

Cape Town's metro cops describe themselves as the hardest gang of the lot. They wield their guns legally. Acting on police intelligence, they're raiding a suspected drug dealer's house right next to a World Cup training ground.

Stealth is everything, lookouts everywhere. They nail a man on the stairs and they cuff him. In the family sitting room, they were certainly surprised by their unwelcome guests. Children looked on as the metro police turned their home inside out, no tik and no gunmen. But, in a backroom, they pick up a wanted gang member.

He's a known gangster? And do you know what the warrants were served for?

MAN: I think it's for crystal meth, like you guys know it in England. Personally, we know it as tik.

JONATHAN MILLER: As tik.

I briefly spoke to the man they had arrested. He told me he had been in and out of prison all his life. Ask people around here privately what they make of the metro police, and they scoff. They pick up the little guys, we were told.

Nowhere is safe from tik and tik crime. And the contagion just gets worse. More than half the population down here are of mixed race. Under apartheid, they were labeled cape coloreds. The country used to be ruled by whites. Now it's blacks. The mixed-race community remains an underclass in this so-called rainbow nation. Gangs offer the sense of belonging they lack.

Wolf is a human canvas. Hit tattoos tells the story of gang life on the streets and in jail. Extreme sexual violence is depicted, conquests, kills, and wishful exultations.

Say no to tik, yes.

All three of these men have been convicted of multiple murders. Between them, they have spent a lifetime in prison. All three told me of their violent deprived childhoods and anarchic family life.

FABIAN JACOBS, gang leader: Even my own family treat me like a piece of (EXPLETIVE DELETED). I don't mean anything to my own family. That's why I look up to these guys, to show me the way.

I spent 12 years in prison. I stabbed a (INAUDIBLE) someone 18 times, to get what? To get this. To get this.

JONATHAN MILLER: Six tattooed stars on each shoulder, Fabian Jacobs, captain of the 28s, the most vicious and fierce prison gang of the lot.

We're in another broken drug-infested neighborhood. A man trains his fighting dog, strengthening its jaws for a weekend kill. This is about as poor as South Africa gets. Two-thirds of adults are unemployed, a quarter HIV-positive. The murder rate is one of the highest in the world. Much of the crime goes unreported.

All those I met, with no exceptions, told me the World Cup would mean nothing to them. A short bus ride from meth central, and you're at Cape Town's new stadium -- 1.3 billion pounds has been lavished on this city for the tournament. The authorities boast of the social legacy, but expectations of trickle-down have not been met.

PIETER CRONJE, city of Cape Town authority: The World Cup will not be a magic wand that will cure poverty, build houses, schools, home, and touch every suburb.

Right here, in Cape Town, we have 220 informal settlements, people living in shacks, where we, in a concerted fashion, are upgrading those settlements with infrastructure, sewage, water, electricity. This is an enormous task. So, the World Cup was never capable of solving all of that or making that disappear.

JONATHAN MILLER: Ellen Pakkies' son, Abi, would have loved the World Cup. He had been a sporty teenager, until he started doing tik, which turned him into a psychotic monster.

She showed me the shack she had built for him just to keep Abi out of the house. She would have to put up burglar bars on the windows and doors because her junkie son would steal everything, even her clothes, to buy tik. Abi was extremely violent, attacking his mother with scissors, a bread knife, even an axe.

ELLEN PAKKIES, mother of addict: I just wanted somebody to help me. But there was nobody who could actually help me with him. And, so, I gave up.

JONATHAN MILLER: It had gone on for years, before Ellen Pakkies finally snapped. Early one morning, she took some rope and entered the shack.

ELLEN PAKKIES: It's like I put extra courage together and just put the rope around his neck. And he then -- you know, you wake him up. And he got this board in his hand, and he wanted to hit me with the board. I just pull the rope tight and tight. I just said, "Father, forgive me for what I did." And I was standing there just looking at him, because he was lying so peaceful.

JONATHAN MILLER: Ellen Pakkies strangled her own son. The judge gave her a three-year suspended sentence and ruled that she was the victim.

JONATHAN MILLER: Stories of hope on the cape are few. The catastrophe wrought by crystal meth is now felt more harshly here than anywhere else in the world.

The cape cops continue to wage their war of attrition. The government says it's trying. It hopes the World Cup will change lives for the better, but there will be a chilling contrast between this celebration of the beautiful game and the ugly reality of life in the murderous ghettos.

As Cape Town, South Africa, prepares to host eight World Cup soccer matches, Jonathon Miller of Independent Television News reports on the drugs, poverty and gangs that lie in the shadows of the city's soccer stadium.

Ray Suarez hosts an online forum with obesity experts and authors Barry Popkin and Michael Power on the causes of weight gain in societies around the world.

Listen to the forum or read the transcript below:

RAY SUAREZ: Welcome to a special global health NewsHour forum. I’m Ray Suarez.

Obesity used to be seen as a health problem of wealthy countries – countries like the United States and Britain – where food is plentiful, most of the population can afford lots of it and lifestyle changes have cut physical activity levels. But low- and middle-income countries are also seeing a dramatic rise in obesity, particularly in urban areas.

Last week on the NewsHour, I explored this trend in China, where 19 million people are now considered obese. But that rate is expected to grow by 30 to 50 percent a year. By 2015, the World Health Organization is predicting there will be 700 million obese people around the globe.

So what’s happening in societies where rates are rising? And what are the biological factors contributing to global weight gain?

To address those questions and others, we have with us Dr. Barry Popkin, director of the UNC Interdisciplinary Obesity Center and author of “The World is Fat: The Fads, Trends, Policies and Products that are Fattening the Human Race,” and Dr. Michael Power, a research associate at the Smithsonian National Zoological Park and the American College of Obstetricians and Gynecologists. He’s co-author of “The Evolution of Obesity.”

Well, we’ve got a lot of questions, as you might imagine, because this is such a pressing topic for so many in so many places. Let’s start with some of the basic ones.

Kiko writes to ask, “What is it that makes human beings overeat the wrong foods? How does the human brain get triggered to overeat certain foods? What is in human brains that leads us to override our ability to control our eating habits? Do animals have this problem? If not, why not?” Dr. Michael Power?

MICHAEL POWER, co-author, "The Evolution of Obesity”: Those are a set of really, really good broad-ranging questions. One of the things is, food is obviously rewarding. All animals enjoy eating, we enjoy eating; we eat food for a lot of different reasons. And there are clearly interactions between what we eat and chemical signals that get sent to the brain and interactions in the brain that react to this sort of rewarding stimulus.

So there are certain things – high-fat, high-sugar foods do certainly seem to – in many animals and, it seems, in human beings as well – interact with what’s called the dopamine system in the brain, which is usually associated with the rewards systems. So food can be rewarding in that sense.

So one of the things that I always like to tell people when they worry about this overeating is that human beings eat food for many reasons. We don’t just eat food for nutrition. So many of the things looking at appetite have always sort of settled on this why-can’t-we-stay-within-energy balance? Why don’t we simply eat only what we need to? But the point is, we eat for more reasons than just for nutrition and health.

RAY SUAREZ: Dr. Barry Popkin, it would seem that it’s just been the blink of an eye in human history that constantly overeating was even an option.

DR. BARRY POPKIN, UNC Interdisciplinary Obesity Center: That’s right, that’s right. We’re really talking about a mismatch between the biology that’s been created, as Michael was describing, over, really, hundreds of thousands of years. And all of a sudden, modern technology found ways to shift it from drinking water to sugar-sweetened beverages, and the same with our inactivity and the same with the fatty foods.

This is all modern, post-1950, learning to change our food supply and manipulate it in very quick ways and make it accessible to the globe. So we’re talking about changes in an evolutionary sense that are not even in the blink of an eye. It’s kind of like a nanosecond, as they would say.

RAY SUAREZ: Well, I guess in human societies, there has always been a small number of people – or, frequently been a small number of people – who have the option of overeating, but the reality of daily life for the broad mass of people in societies around the world was that overeating was not an option. And being hungry was an episodic reality as well.

BARRY POPKIN: That’s right, and being hungry probably led to the overeating. We know it does. We need it to protect reproduction and we need it to do lots of things that Michael could talk about.

But to me, to think in the modern reality, I started working, for example, as you mentioned, China. And I started doing national surveys there in the ’80s. No one was overweight. But today, almost 30 percent of Chinese adults are overweight. Chinese kids – five or six in the last four years – have grown so much, they’re actually fatter at the highest level than our kids, and they weren't five years ago. It’s just such a huge shift in the access to food supply and the income and distribution system to get it to everybody, while taste and biology haven't changed.

MICHAEL POWER: And one of the things I would add in here is a big thing that has changed in human eating is that we have completely separated from exertion. It used to be through most of our evolutionary history, if you wanted to eat, you had to exert; you had to get out there and get the food and do actual hard work and expend energy. Now, we’ve basically taken that part of the equation out. Basically, eating is no longer even related to exertion in many cases.

RAY SUAREZ: Shawn writes to ask, “Are some ethnicities or countries more prone to be obese? Or with enough money and access to fatty foods, does everyone eventually get fat?” And I think since we’ve seen this problem rise in certain places sooner than others, it’s an interesting thing to think about. Who wants to pick that one up? Dr. Power?

MICHAEL POWER: I’ll start with just saying that there are several different issues that get in to this. One is, we think there may be some, amongst different peoples of the world, a different propensity to put on fat and also a different propensity of how that fat is going to affect health. And that’s actually, in some ways, a more important issue – the fact that we may have variation in the reaction to excess fat – that made health issues in there.

If you eat more food than you’re going to burn off in calories, everybody will gain weight and everybody will go that way. So I don’t think there’s a broad difference in that way. But it’s also clearly true, in this society, we don’t all get fat. There are some people that seem to be more vulnerable to gaining weight systemically than others.

BARRY POPKIN: But the other side of Shawn’s – of that question is we have many populations today, like, take some of the Western Pacific islands, take Mauritania a few years ago, take others, that for a range of reason, fatness was good. Girls in Mauritania used to be fattened when they got to puberty because that made them more desirable for men. And now, the queen is stopping that and they’re cutting it.

So I’m not sure that there’s a thinness gene or that – I think there are different ways people can deal with the food supply. Some can control what they eat; some can do more exercise to deal with it. The complexity of this whole topic is even if you don’t get diabetes when you get fat but you just are fat, it affects your whole system.

And pretty soon, even those places that have lower levels of diabetes for the fatness, like some of the Western Pacific and a few other locations, they can’t move because the weight is kept controlling them. So we’re in a world today where we see many populations going around in computerized cars – little chairs – because they can’t even move.

And so we have to realize fatness is not just going to affect our weight. It’s going to affect our bone health; it’s going to affect our mobility; it’s going to affect our ability to function in daily living in that we don’t seem to know if there’s a limit.

And despite people saying, oh, we’ve reached our limit in this country and that, the countries that haven’t addressed it, like the U.S. or a lot of the Asian and other countries we’re talking about today, they’re just accelerating and accelerating. The rate of increase of overweight actually in most of the world, from a new paper I have coming out, has accelerated in the last decade. So among the four or 5 billion people that are outside the U.S. and Europe and Japan and South Korea, they’re getting fatter quicker.

RAY SUAREZ: So wait, if we took a Tongan or a Samoan, a Masai herder and an American Indian from the Southwest and put them on the same diet, one wouldn’t put on weight in a different way from the other?

MICHAEL POWER: I think you’d get a lot of variation within those populations as well, but you would also see – in other words, you wouldn’t be doing one. If you had a thousand of each, you would probably see different effects between those groups.

BARRY POPKIN: But the effects on disease would be different than the effects on their weight. And it starts with their height. When you have a very tall person, you can add a lot more weight before your mobility and such is affected and you get really fat. And the Masai are taller. But, they’re gaining weight now – the Masai going into urban areas and slowing down. It’s not like these populations that historically we thought of as being tall, lean, or short and lean.

In India, we’re getting in the squatters where I lived 20, 30 years ago, in those populations, the 10 to 15, now up to 18 percent of the adults in those poor, urban areas are getting heavy. And it’s happening in rural India.

MICHAEL POWER: And Barry made a very good point about there really – no good evidence for there being a thinness gene. And if you look at it from an evolutionary perspective, there is probably a lot of genetic variation in our population that would lean us toward gaining weight and relatively little towards keeping people from gaining weight.

There’s an asymmetry in how selection would have acted in the past. And in the past, many of these traits would simply not have been expressed because there was no option, no ability to cut your energy expenditure to such a low level and to get access to so much food that you would end up gaining that much weight. So there’s going to be an asymmetry in the situation, in which there’s probably far more genetics that would lead us to overeat and to put on more fat than there is for us to stay lean.

RAY SUAREZ: One of our online visitors asks: “I am the third generation of obese adults in my family. Considering some genetic factors, our processed-food environs and a sedentary lifestyle, what hopes do the obese, by genetics, have to eat like normal humans?”

First of all, given what you’ve just been saying, is our questioner – Metuchen Blues – even right when she refers to obese by genetics?

BARRY POPKIN: My perspective is, no. We have only identified fat genes for a handful of people that directly cause this. We have lots of leads, but it’s a very complex issue, just like diabetes. And there are probably multiple genes that go together. What we have are family behaviors and proclivities of parents who are heavy to have heavier offspring and to have different dietary and activity patterns that create the problem.

But we have no real clarity that the comment is correct that there’s a genetic side. It’s probably more a combination of a whole lot of behaviors that go on and that are intergenerationally passed through, both in terms of your weight and height at birth and onwards. And even in the fetal environment.

RAY SUAREZ: But is she right – is she onto something, Michael Power, when she talks about, what hope do we have to eat like normal humans? If you have been nurtured, grew up in a household that laid down your relationship to food for your adult life and laid down the way you think about food and the way you process it, is it hard to change that once you’re an adult?

MICHAEL POWER: Changing behaviors is always very difficult and hard, but the human mind has the capacity to do that. And getting information and having motivation, certainly people can do that. I agree with Barry that, in terms of looking at straight genetics, at best we’ve maybe found genetics that maybe relate to 5 percent of the population that’s getting obese. So it’s a relatively low number. They’re continually finding more, but again, it’s probably multiple gene effects.

The one issue Barry did relate to, in utero effects, there is a worry in there in that you have not just changes in the genetics and the DNA itself, but changes in the expression of the DNA, what we call epigenetic effects. And those could be passed in utero and those can be inherited down the – from mother to offspring. And so that may be changing metabolism in such a way as to increase the probability that a person will put on fat.

But we’re getting a better understanding of what some of the proximate mechanisms are and there’s certainly always hope, in that sense. The main thing I would always say is, worry about exercise and cardiovascular fitness, since that’s actually an independent risk factor for health, as well as anyway – but people raising their energy expenditures would probably be one of the best ways to start.

RAY SUAREZ: As you might imagine, we got a lot of questions about China, given the series last week. Max writes, how has food changed in China? In addition to food changes, does pollution – air and water – and additives, fillers, including nonedible plant material, have an impact on both lifestyle and fitness? Barry Popkin?

BARRY POPKIN: Probably the two most important changes for creating the hypertensive, diabetic, heavy Chinese of today are really the massive change in the food supply – and by that, they shifted from not eating very much fat to consuming an enormous amount of cheap vegetable oil.

And they’ve been shifting more and more to dense – they had no sugar in their diet in the ’80s – essentially, one or two grams a day, the lowest in the globe. Today, China has a pork reserve and a sugar reserve. And it has been sold on sugar in the diet and it’s really accelerating. That’s a shift from water to sweetened beverages and adding sugar to lots of foods. So the fat and the sugar and the shift away from healthy eating and drinking are pronounced.

But at the same time, there’s not a single place in China – urban or rural, any province – where the technology of how they move at work and what they do at work – and I mean little tiny tractors that cost $100 for a farmer, or ways to cut backbreaking work in construction and mining – have changed. In the urban sector, the kind of activity has gone down to a fourth or fifth, in terms of metabolic equivalence, from what it was in the ’80s to today. Also, how they move – they aren’t biking anymore and walking. They’re taking buses and using tractors.

The same at home, home production: The amount of time spent on food in China, in producing it and getting it, has gone down by about a fourth of what it was. And the same for leisure. All of these have had a marked effect on the decline. The difficulty is they didn’t cut their calories.

Now, you add to that – there are pollution effects in different parts of the country. There are chemicals in the food supply. Those have a lot to do with certain cancers and certain cardiovascular problems, but they only exacerbate the energy imbalance and the weight problem for certain kinds of diseases.

So you start off with this huge change in lifestyle. In two to three decades, the Chinese – really, in two decades – have gone from no overweight to close to a third of adults – when I have my new data, it’s actually going to be, when I publish it, higher than that – the data we just collected last year – and for kids, going from thin kids a decade ago to really heavy ones today.

Every school in China today – rural areas are growing faster in obesity than urban areas. And now you find the schools there have the same vending machines we do here and they don’t have water supplies anymore. It’s a remarkable change in the last decade, even.

RAY SUAREZ: Michael Power, is there a slingshot effect? When you look at the litany of factors that Barry Popkin just laid out, when you talk about a society that, throughout history, knew episodic food insecurity, even famine, where millions died – does the bounce that you get become even more significant when getting food is easy, when calorie-dense food is more plentiful? Have their bodies been programmed to lay on fat even faster to get them through the lean times – but there aren’t going to be any more lean times.

MICHAEL POWER: It’s certainly quite possible. I think the quicker reaction that’s going to happen here, though, is probably in the minds of the older people that passed on behaviors and ideas about food and about what’s good, based on those sorts of things.

RAY SUAREZ: How do you mean?

MICHAEL POWER: Well, you get it in the United States in some Hispanic groups, in which they like the fact that they’re getting fat babies, now, and fat children. And Hispanic immigrants coming in – there’s good evidence that they want to have the richer foods. The richer foods, to them, turn out to be high-fat foods and high-sugar foods – the foods that they were not able to have when they were younger and when they – before they came to this country.

And so this is a change in which they perceive an advantage and a benefit to these high-calorie foods. And in a sense, if they were still working extremely hard and exerting extremely hard, that would be absolutely true. But they’re passing on a belief that these are the important and valuable foods to have.

Now, certainly, you also do get an evolutionary aspect in that too, in that these things were very rare in the past. And what’s rare is, in a sense, considered valuable and then people inevitably have high motivations to try to get them.

The other thing that I see is that if you just – Barry alluded to that, of just adding oil and simple sugars into the diet – you’re so increasing the nutrient density and you’re taking out, in a sense, taking out some of the water of the diet in that way, that the mere amount of food that you used to have to eat – if you ate the same amount of food by weight that you had to eat hundreds of years ago, it’s going to be massively larger numbers of calories. So quantities of food that you had to eat in the past because the foods were much lower in caloric density are absolutely not appropriate now, even if you are exerting a fair amount.

RAY SUAREZ: Ms. Jamaica asks: “I wonder how much of China’s obesity problem can be attributed to globalization and the importation of non-local foods?”

BARRY POPKIN: That’s a rather complex issue, but the simple answer is, yes and no. By that, I mean that the technologies that brought to China Wal-Mart. They didn’t start with Wal-Mart. They started with their own equivalent and their own equivalent of a 7-Eleven. And one of the top four chains in the world is a Chinese chain that’s just like Wal-Mart. And it’s just in China.

Similarly, Coke isn’t the dominant beverage company in China nor is Pepsi. There are Chinese equivalents. But they use the same technology that we’ve developed and they did it themselves. The same goes for the – how they’ve computerized their world, how they’ve automated it, how they’ve moved to cars and vehicles and buses and trains. That’s available technology.

The difference is, it’s starting in the ’80s the Chinese economy opened up. They opened up to Western goods and Western technology and it hit them lickety-split. And they adapted very quickly. Nobody wants to do back-breaking work. Nobody wants to eat rice and vegetables all their life if they can add oils and sugars and tastier foods. And what happened is it changed day and night.

But it didn’t change because Coke, McDonald’s and Wal-Marts changed them; it’s because they had access to the same technology. The percentage of food in China that comes from Western companies probably about four to 8 percent. The rest comes from their own production of commodities they take from us and reprocess and deal with.

So it’s – the answer is, yes, the technology, it came from us, often. But now they’re creating their own and it all was driven by internal companies adapting.

RAY SUAREZ: Michael Power, let’s talk a little bit about dairy. I had always heard as a young reporter that dairy products were not much consumed in China. And when I saw a long line outside a major American fast-food brand’s ice cream window out onto the street with happy Chinese people walking away with ice cream cones, I said to my translator, isn’t that kind of new? I mean, I thought that a lot of people would have gotten a stomachache in the old days. Have people gradually been eating more ice cream?

And she was a young person and hadn’t heard about this at all and had to ask older people to find out that, yeah, we didn’t used to drink milk or eat ice cream, but now we do. What’s going on there? Is that an adaptation? Was there really a higher predisposition to getting an upset stomach from dairy products that just goes away if you expose yourself to more of it? What – is it biological, cultural, social? What’s going on?

MICHAEL POWER: There is a relatively – in terms of adult mammals, there is very, very few of them that can actually properly digest milk because the lactose – lactose is a combined sugar, galactose and glucose linked together. And you need this lactase enzyme to be expressed to be able to break it up so that you can absorb it in your system. Obviously all baby mammals can produce that – at least all baby mammals in whose milk has lactose in it.

There are relatively few human populations that as adult continue to produce that lactase enzyme. In most adult humans the lactase enzyme basically starts going away, shutting down after age 3 or 4. And by age 6 or 7 it’s pretty much very minimal levels if at all.

I’m not aware that it can be induced particularly. It still doesn’t mean that milk couldn’t be drunk as long as it’s in small quantities. I don’t know whether they’re doing anything with their ice cream to break up the lactose in that. You certainly have plenty of dairy products in which the lactose has already been predigested. Yogurt is a classic example. It’s been used for thousands of years.

RAY SUAREZ: When I went to a grocery store, just to sort of check this out, the shelves were filled with reduced-lactose milk.

MICHAEL POWER: Well, then that’s basically what they’re doing is they’re using a technological change, a technological fix to be able to overcome the biological constraints.

BARRY POPKIN: But let me come in on that. There is a little bit of the low lactose. But for the first 15 years – the Chinese started exploding between around ’90 to the current decade in their milk consumption and their dairy consumption in general – it was looked at as a very chic commodity. But the levels of intake are really tiny.

RAY SUAREZ: So maybe it’s an urban thing then.

BARRY POPKIN: No, and even in the urban areas, these new lactose-reduced kind of items are brand new. As people have gone up in their level of intake they efface it. But populations can consume – I’m lactose deficient but I grew up in Wisconsin and I drink every day in the morning a glass of milk. And I can do it. But if I drink two glasses then I have a problem. There are dose levels. And the Chinese intake levels are so minimal today.

It looks like a lot in aggregate because there are a billion, 300 million Chinese, but it is so tiny yet. And these new products are reaching a tiny piece of that market. I have kind of consumption data from the stores of China, from like 3 million of them. It’s a tiny piece of the product line. It’s mainly regular dairy products, whole fat, that have more of the lactose but they’re not consuming very much.

RAY SUAREZ: Let’s close with –I’m sorry. Go ahead.

BARRY POPKIN: No, so it’s a – it’s looked – I should add two points. Chinese don’t breastfeed very long anymore. And the old products they gave children afterwards were really low energy and horrible products: starchy gruels, you know, like a little rice and water. And so shifting to even regular milk – not as good as shifting to formula, which is perfect for a child four or six months old, has been beneficial. And now they’re starting to consume more of the products that infants should consume. And stunting has gone way down as they have.

So these dairy products are really now being consumed not by infants, but by 1-year-olds to 7-year-olds generally. It’s looked at as being a healthy way to take a kid when they’re off formula forward. It would be okay except those same kids are getting fat because they’re having too much sugar and they’re not moving and they’re having a whole lot of other things in their diet. The milk is a teeny piece of the Chinese child’s diet.

RAY SUAREZ: To close, gentlemen, I want to get a short list of prescriptions from both of you. The numbers in China are daunting; the numbers in the United States are horrifying. The WHO is talking about “globesity” as one of the looming public health challenges of the 21st century. What does planet Earth with the manifestations of this problem being different in place to place to place, what’s the short list of things that people should be thinking about as we try to wrestle with a problem that nature didn’t prepare for us to deal with? Michael Powell?

MICHAEL POWELL: The first thing I would attack on this is truly on the exertion, energy-expenditure side of that. I mean, as Barry says, we don’t all want to go back to back-breaking work. I have no interest in living the incredibly hard life that our long-ago ancestors did. But, at the same time, making it much easier for people to walk, to use bicycles, to take stairs – you walk into any kind of major building in the United States, you can find the elevator instantly. You have to search to find the stairs. And the stairs often dump you out into inconvenient places that are difficult to get at.

And even during this interview, I mean, I know I’m sitting in a chair. I don’t know if Barry is or not, but we’re probably all sitting in chairs. We’re not standing as much as we do – most of our basic activities in work time have been put down into very, very low energy levels such that we are operating not much above basal metabolic rate. And that just lowers the bar for overeating. It’s extremely, very easy to overeat if your energy expenditure is less than one-and-a-half times your basal metabolic rate.

So, to me, the simplest thing is attacking the built environment to make it easier and safer for people to do simple exertion – walking, walking up stairs, standing, things like that.

RAY SUAREZ: Barry Popkin?

BARRY POPKIN: Water – drink water, not all of the sugary and caloric beverages we’re drinking. Really move to change the food supply in terms of the pricing and availability. Right now we cut the prices of animal foods and dairy products and sugars down to about 20 percent of what they were in real terms in 1950. And, in contrast, beans, fruits and vegetables’ prices have gone up. We need – we’re doing this in some countries. England is actually turning around its obesity. I’m involved on the beverage and some other sides. And they’re doing 20, 40 – they’re teaching kids who are in middle school to cook and drink – cook again. All kids, all schools are going to have kitchens. We need to go back and learn about food. We need to figure out ways to eat healthier and cut our calories at the same time.

RAY SUAREZ: That’s all the time we have for today’s forum. Thank you to our guests and thank you to all of you who sent in questions. We got so many; we never could have gotten to all of them. So thank you for participating and please know that we did try to get to a lot of the things you had to ask. And thanks also Barry Popkin. Good to talk to you.

BARRY POPKIN: A pleasure.

RAY SUAREZ: Michael Power, thanks for joining us.

MICHAEL POWER: Thank you

Ray Suarez hosts an online forum with obesity experts and authors Barry Popkin and Michael Power on the causes of weight gain in societies around the world.

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Spencer Michels reports on the campaigns to fight hepatitis B among Asian populations worldwide. The potentially fatal liver disease is100 times more likely to afflict Asians than non-Asians.

JUDY WOODRUFF: And to another story affecting millions of Chinese, as well as one in 10 Asian Americans.

"NewsHour" correspondent Spencer Michels looks at the disease called hepatitis B.

DR. SAMUEL SO, Stanford University: Good morning, Mr. Zhang. How are you?

GREG ZHANG, patient: Good morning, Dr. So.

DR. SAMUEL SO: How's your appetite?

GREG ZHANG: Very good. Very good.

SPENCER MICHELS: Forty-six-year-old Greg Zhang, who works in California's Silicon Valley, is recovering from a recent operation to remove a tumor from his liver, a result of his lifelong infection with hepatitis B. It's a disease that strikes Asians 100 times more than non-Asians.

DR. SAMUEL SO: The incision is well-healed. Everything looks good. No problem.

GREG ZHANG: Yes. Yes.

SPENCER MICHELS: Zhang's surgeon, Stanford liver specialist Dr. Samuel So, was concerned about a C.T. scan which revealed several new growths.

DR. SAMUEL SO: On this side, you can see one, two, three, four, at least.

GREG ZHANG: Wow.

SPENCER MICHELS: The hepatitis B virus is found in blood and bodily fluids. Many people can live with the virus and never get sick, but 25 percent of those infected get severe liver damage or cancer.

The virus can be transmitted by unsafe sex and unsterile needles, but most people who suffer from the disease, like Zhang, who was born in China, became infected at birth from their mothers.

GREG ZHANG: This is my brother with his two kids.

SPENCER MICHELS: His younger brother, Haiyang, also became infected at birth, but, like many of those with the disease, he had no symptoms until it was too late.

Two years ago, at the age of 42, he went to see a doctor about a pain in his side. He was told he had advanced liver cancer, and there was nothing that doctors could do. Zhang flew his brother to Shanghai to try to get a liver transplant, but he died three days after arriving there.

GREG ZHANG: Well, he passed away. My sister-in-law and his two kids were on a plane going from here to Shanghai. He didn't make it.

DR. SAMUEL SO: This is a cancer which often affects people at the prime of life, between 30 to 60 years of age.

SPENCER MICHELS: Dr. So has been leading efforts in the San Francisco Bay area and around the world to raise awareness about hep B. He has a research lab at Stanford focused on finding new ways to diagnose and treat liver cancer.

There's no cure for hep B, although the virus can be kept in check with antiviral medicines. Those infected need to have yearly ultrasounds and blood tests to screen for early stages of liver cancer.

Dr. So is the founder of the Asian Liver Center, dedicated to creating awareness about hep B both in the U.S. and overseas, especially in China.

DR. SAMUEL SO: A hundred million people in China are chronically infected. So, there's a huge burden of disease in China. Every, you know, two, three minutes, someone in China is dying from liver cancer caused by this virus, which could be prevented by a vaccine. And, still, most people in the world are not vaccinated against it. It's just ridiculous.

SPENCER MICHELS: An effective vaccine for hep B has been available for almost 25 years.

Newborns need a vaccination within the first day of life to prevent transmission of the virus from their mother. Two more doses are needed within the first six months for full immunity. And about half the babies in the U.S. do get vaccinated.

But, in many countries where hep B is endemic, like China, vaccination programs for infants are often spotty. And there are hundreds of millions of adults worldwide born before the vaccine was developed who are infected.

A recent documentary highlighted a program in China's Qinghai Province aimed at vaccinated more of the population, a campaign inspired by Dr. So. But one big hurdle in enacting reform in China has been the enormous social stigma associated with the disease.

WOMAN (through translator): If our neighbors knew our kids have hepatitis B, they wouldn't dare let their kids play with our kids.

SPENCER MICHELS: Those who test positive for hep B in China are often denied jobs, and infected children can be rejected from schools.

Along with the disease itself, that stigma has crossed the ocean with immigrants to this country. Many Asian Americans don't want to discuss it or even learn their own status.

What is unsettling is that many carriers of the hepatitis B virus are unaware that they are infected because the symptoms don't appear for many years. But what also bothers health officials in San Francisco and other cities with large Asian populations is that many Asians don't see the need to be tested for hepatitis B.

With one of the largest Asian populations in the U.S. and the nation's highest rate of liver cancer, San Francisco is now waging an aggressive campaign to bring the disease out of the shadows at events like the Asian Heritage Festival.

WOMAN: There's free hepatitis B screening to the right over here. It's free. They just take a little bit of blood.

SPENCER MICHELS: The city's Hep B Free campaign offers free testing and vaccinations.

KEN MURRA, San Francisco: I believe myself, you know, I don't have that kind of problem, but I'm just making sure.

SPENCER MICHELS: Not only does the general population lack knowledge and awareness of the disease, but so does the medical community, according to a recent report from the Institute of Medicine.

That's something that concerns Janet Zola, who is heading up the campaign for San Francisco's Department of Health. She says everyone, not just Asian Americans, should be aware of the disease.

JANET ZOLA, San Francisco Department of Health: It affects everybody. People intermarry. People have a large employee base of Asian employees who can get sick. So, it isn't really just about one isolated sector of the population, even though they're at highest risk.

NARRATOR: One in 10 Asian Americans is infected with hepatitis B.

SPENCER MICHELS: A controversial ad now running on local TV stations and on billboards asks which of these 10 Asian beauty pageant contestants deserves to die.

But, in the Asian community, such frankness is shocking. That attitude is something that California Assemblywoman Fiona Ma from San Francisco, who is hep B positive, is working hard to change.

FIONA MA, California assemblywoman: My cousin, who was born in China, actually got very upset and said, please don't talk about it. People are going to think that you're sick, and they're not going to vote for you.

And my message was, I am a public figure. This is my responsibility.

SPENCER MICHELS: Ma says San Francisco's program is working well, but the state needs to do more. She sponsored a bill to get the state to pay for hep B vaccinations and treatment, but was unsuccessful

FIONA MA: We should be trying to cover hepatitis B folks earlier in the process, instead of later. In California, Medi-Cal only covers you if you're in your last stages of liver cancer or require a liver transplant. Clearly, that's too late and it costs too much.

SPENCER MICHELS: Hep B is slowly starting to get more attention on a national level.

SPENCER MICHELS: Participants at a recent rally on Capitol Hill called for more federal funding for the disease. But Stanford's Dr. So, whose mother-in-law died from liver cancer, believes there's still not enough being done by the global health community or in the U.S.

He says other diseases get more public attention and, therefore, more money.

DR. SAMUEL SO: One in 20 people in the world are chronically infected, one in 20, 10 times more than people in the world infected with HIV. There's huge advocacy for the HIV community and very few advocates for hepatitis B.

SPENCER MICHELS: For now, the battle against hepatitis B is concentrated in communities with large Asian populations. Philadelphia and Los Angeles are among a handful of cities planning to replicate San Francisco's efforts.

JUDY WOODRUFF: Spencer's story was part of a partnership with NPR. Their report will air on "Morning Edition" tomorrow.