Dear Colleagues,

 

Tomorrow – Friday November 1st – is a holiday in Belgium, so for once we send out the IHP newsletter on Thursday. We remember our loved ones tomorrow, who passed away recently or years ago. Most of us don’t need a special day in the year to do this, but it’s a good tradition anyway.

 

Having said that, if they were still alive (or if they could chuckle in their graves), I would definitely recommend them the following lovely read on the disease of ‘public health’ (by Chris Snowden). He argues in marvelous prose we’re in the midst of “an epidemic of lifestyle moralism”. Just a few excerpts to make you salivate… Talking about the trend of “de-normalisation”: “It is time to ask whether the assortment of neurotics and authoritarians that make up the modern ‘public health’ movement is best placed to decide what is normal.” (guilty!)

 

“Although ‘public health’ is still popularly viewed as a wing of the medical profession, its enormous funding and prestige has attracted countless individuals whose lack of medical qualifications is compensated by their thirst for social change. The movement is dominated by sociologists, engineers, psychologists, lawyers, epidemiologists and other academics whose contempt for consumer capitalism is often more conspicuous than their concern for people’s health and wellbeing.” (guilty big time!)

 

Instead of ‘health for all’, Snowden talks about ‘health at all costs’, and in the process he likens public health people to the priests of previous times: “ It is not a novel observation to note that health has taken the place of religion in modern society. It can scarcely be coincidence that the main targets of the public-health movement are the same vices of sloth, gluttony, smoking and drinking that have preoccupied moralists, evangelists and puritans since time immemorial.” In other words: he deems us the 21st century equivalent of the Inquisition. The read of the week, no doubt, for the ones among you who are still alive.  

 

However, as most of us are public health people, and arguably do love a bit of pontificating, you should probably read this essay together with Lawrence Gostin’s recent essay on the ‘new Public Health’, ‘Bloomberg’s Health Legacy: Urban Innovator or Meddling Nanny?, also a great read. Somehow, the public health community will have to find a middle way between the (necessary) fight against Big Tobacco, Big Food, Big everything, and the perception of being a totalitarian nanny. It won’t be easy. In addition to injecting some humor in our guidelines and press releases, perhaps we also have to learn how to say things in a more straightforward – in your face – way, like Horton did on Twitter this week, for example, complaining about contemporary activism: “Civil society has become so collusive with power in global health that it is little more than a vestigial organ full of corrupt infection.”  ““Civil society needs to stop being flattered by invitations to join the orgies of the powerful. Create your own bordellos of activism.”  Yes, this is the editor-in-chief of the Lancet, apparently eager to become the pimp of global health activism. Or maybe he’s just getting tired of all these global health governance and complex adaptive systems discussions. It would be interesting though, a peer reviewed paper or a blog post with a mapping of global health architecture, trying to find out who plays the role of Heidi Fleiss in the network, who are the star “escorts”, who are the main clients, etc.  

 

But back to reality. This week GAVI’s mid-term review (accountability) meeting took place in Stockholm; apparently the meeting was very successful. The tension is also rising for the Global Fund’s replenishment, scheduled for early December, as Jeffrey Sachs noted. UNFPA issued its annual world report, on teen pregnancies this time. And as you know by now, polio cases in Syria were detected, which inspired calls for a vaccination ceasefire.  And Ilona Kickbusch claims in a new paper that ‘the best is yet to come for global health’. You read it all in this newsletter.

 

In this week’s guest editorial, Meena Daivadanam, EV 2010 gives some key messages from her phd-thesis,  ‘Public Health Interventions: Community-based dietary behaviour change for reduction of non-communicable risk factors’,   which she successfully defended a few months ago.

 

 

Enjoy your reading.

Kristof Decoster, An Appelmans, Peter Delobelle, Basile Keugoung & Wim Van Damme

 

Editorial

 

Did I really need a PhD to find out that changing dietary behaviours to reduce NCD risk factors is no mean task? Apparently yes.

 

Meena Daivadanam, Health Systems and Policy research group, Department of Public Health Sciences, Karolinska Institutet

 

 

How often do you think about health when you are trying to decide whether to make a vegetable curry or a fried fish preparation for lunch? Or will you go with whatever is affordable and what your husband or children are more likely to eat? Well, among women in rural households in Kerala, the answer to the first question was ‘apparently never’ and to the second was ‘yes, definitely more likely’….   Did I really need to do a PhD to understand this? Well, seems like it…

 

Dear friends, it is with great pleasure that I share the news of the successful defence of my thesis titled, ‘Public Health Interventions: Community-based dietary behaviour change for reduction of non-communicable risk factors’ on 12th August 2013 at Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.

 

The study was carried out over four phases: pre-trial and phase I-III to develop and implement a context-specific dietary intervention focusing on changing behaviors related to fruit and vegetable intake and procurement, and salt, sugar and oil consumption. The work culminated in a cluster randomized controlled trial (CRCT) to test the effectiveness of the developed intervention to improve the defined behavioral outcomes. Here is my key take-home message: a contextually appropriate intervention delivered through community volunteers using existing community infrastructures and networks was able to change key household dietary behaviours to reduce non-communicable diseases (NCD) risk factors in rural Kerala and could potentially do so in similar settings elsewhere.

 

I obviously hope many of you will read the PhD thesis in full (it sure makes for some good night time reading) but, let me just share with you some of the insights I gained during this process. Firstly, we often talk about different levels of prevention (primordial, primary, secondary and tertiary) in medical and epidemiological circles, but prevention (secondary and below) as a concept was almost non-existent in the study setting. ‘NCDs, specifically diabetes could be treated or controlled once you get the disease, but preventing or delaying the onset, can it really be done?’ was the response from our rural participants. Secondly, we researchers and medical professionals develop such fabulous health interventions without considering the fact that otherwise healthy people do not consciously consider health while making day-to-day decisions (food-related decisions in this case), unless their health is already compromised or threatened in some way. A wife and mother in rural Kerala would first and foremost consider whether her husband or children would even eat the stuff, and whether it was affordable. Why would she think something like ‘Is this going to contribute to our health?’ unless she, her spouse or someone in the family was sick in the first place? Food decision-making in this setting, we found, had a greater collective component and took place at the household level. Therefore, the intervention was also targeted at that level, and all levels of the study, including planning, piloting and tool development incorporated the household aspect. This has been fully justified by the results of our CRCT. We developed a conceptual model combining three existing health behaviour theories (Health Belief Model, Theory of Planned Behaviour, and Trans Theoretical Model) with findings from primary qualitative data using a modified framework analysis methodology that provided a platform to develop effective interventions at the household level. We also developed and validated an innovative household staging tool to differentiate households based on their readiness to change behavior. The developed intervention was thus dynamic, stage-matched and sequential at three time-points and this was tested in the CRCT. The intervention was delivered to rural households of Chirayinkeezhu taluk, Thiruvanathapuram district, Kerala (about 250 each in intervention and control arms), through community volunteers (all women with a minimum of 10 years of schooling residing in the selected rural communities), using neighbourhood groups or ayalkootams, which are a part of the extensive women’s self-help group network called Kudumbasree.

Thanks in part to a household kit with containers and spoons to measure salt, sugar and oil among other things, developed in response to the exploratory research findings, the intervention was able to demonstrate significant reductions in their consumption at the household level. For fruits and vegetables, the story was slightly different. The increase in consumption in the intervention group was significantly higher only for fruits, and that too was very modest. However, here we were able to show a difference in the procurement of locally available fruits and vegetables. While this was a specific strategy taught during the intervention, we have to admit that the flattering response was in part a coping mechanism against the concomitant price-rise observed for commonly used vegetables over the past two years (see Times of India). Affordability was a key limiting factor in most households. Hence, stabilizing supply of fruits and vegetables against the backdrop of rising prices would be essential for demonstrable and sustained impact.

Of course, there is a lot more I can write about my thesis, but let me stop here for now and try to put this in global perspective. There is a lot of (and increasing?) debate globally that the promotion of NCDs is a promotional gimmick, and not a true priority in some regions; including claims that NCDs sideline the social determinants of health and the rights based approaches. I would really contest that claim. How can NCDs be tackled in a sustainable manner without addressing either of these two? Social determinants of health in particular are at the core of any effort, either explicitly stated or strongly implied, to develop sustainable solutions for the NCD problem. While infectious diseases remain a priority in many LMIC settings, the emerging NCD burden if not tackled in a timely manner threatens to undo all the work that has been done so far and might also divert scarce resources away from these issues. Over-nutrition and NCDs are the flip side of under-nutrition; diabetic mothers (not to mention fathers!) give birth to children at risk of NCDs in later life; NCDs in a family lead to catastrophic health spending with all the dire consequences we know. All these elements contribute to a continuous and vicious cycle of malnutrition, poverty and illness. Will the under-fives really be spared from malnutrition and infectious diseases if the NCDs were neglected in favor of these diseases? Can we shield them from a secondary vicious cycle owing to a spillover: never-ending debt and lack of options for future generations or even interactions between infectious diseases and NCDs, leading to more of the same i.e., more ill-health, especially malnutrition and infectious diseases?

Fifty percent of diabetes in the world remains undiagnosed, with Sub-Saharan Africa contributing 80%. Can the world afford this pandemic even in pure monetary terms? We cannot close our eyes to this reality. So, the solution lies not in trying to overthrow this ‘new kid on the block’, rather in finding ways to join forces. Can we look for unified solutions for optimal nutrition, combining both under- and over-nutrition; after all, both are threats to health? Can we expand reproductive and sexual health, and maternal and child health to include both extremes of malnutrition, and both groups of diseases, communicable and non-communicable? Can we link tuberculosis or HIV, AIDS care and management where possible with that of diabetes and hypertension, so that we are sharing and not dividing much-needed resources? Similar to the HIV model, any health systems’ strengthening that occurs in the name of NCDs can be used to address other health problems as well. Would it not be more fruitful to look for potential opportunities and synergies rather than engage in never-ending debates on real versus imagined priorities? After all, we are all in the business of saving lives…

 

 

NB: Since I completed my PhD at a university where we follow the system of having a monograph, that is neither published in print or online, I am afraid I cannot provide a web-link. Apologies for that! However, the hardcopy will be available at ITM shortly, for those in Belgium and I will circulate the papers related to the food decision-making process in households, the development of the conceptual model, and the development and validation of the household staging tool, that are currently in various stages of submission, once they get published (whenever that is!).

 

 


 

Gavi meeting in Stockholm & other vaccine news

 

 

1.    GAVI (press release) – GAVI Alliance partners reaching more children than ever before with accelerated access to vital vaccines

http://www.gavialliance.org/library/news/press-releases/2013/gavi-alliance-partners-reaching-more-children-than-ever-before-with-accelerated-access-to-vital-vaccines/

This press release gives a pretty good overview of the day in Stockholm. You can also check out the GAVI  website of course, which features the presentation by Seth Berkley, among others.

 

On Twitter, we also learnt that Tim Evans explicitly linked immunisation coverage with UHC.

 

2.    MSF  -Global Vaccine Community Must Make Major Changes to Reach More Children

http://www.doctorswithoutborders.org/press/release.cfm?id=7125&cat=press-release

Ahead of the meeting in Stockholm MSF wrote several key policy changes are urgently needed at the GAVI Alliance to help reduce the number of children not benefiting from vaccination globally. MSF described four key areas where changes at GAVI could make an important difference.

 

3.    Guardian – Child immunisation to avert 4 million deaths by 2015, says Gavi report

Mark Tran;

http://www.theguardian.com/global-development/2013/oct/30/child-immunisation-avert-4-million-deaths-gavi-vaccines

Also in the run-up to the meeting in Stockholm, The Guardian’s Mark Tran gave the necessary background and key messages of the mid-term review report.

 

4.    Impatient Optimists – A New Partnership to Accelerate Vaccine Research and Development

Trevor Mundel; http://www.impatientoptimists.org/Posts/2013/10/A-New-Partnership-to-Accelerate-Vaccine-Research-amp-Development

Trevor Mundel, president of global health at the Gates foundation, examines the Vaccine Discovery Partnership, “a new initiative that will lead to better and more effective approaches to vaccine research and development.” The new effort will be a way for the foundation to work directly with pharmaceutical companies on promising new vaccines for global health. GlaxoSmithKline and Sanofi are the first two companies with whom the Foundation has signed agreements.

5.    Reuters – Brazil to produce measles and rubella vaccine for poor countries

http://in.reuters.com/article/2013/10/28/us-brazil-measles-idINBRE99R0IQ20131028?feedType=RSS&feedName=health&utm_source=dlvr.it&utm_medium=twitter&dlvrit=309303

Brazil’s top biomedical research and development center announced plans earlier this week to produce a combined measles and rubella vaccine for developing countries, mainly in Africa. The first Brazilian vaccine developed specifically for export will be made by Bio-Manguinhos, a unit of the Oswaldo Cruz Foundation (Fiocruz), in partnership with the Gates Foundation.

 

6.    Lancet Global Health – The drug and vaccine landscape for neglected diseases (2000—11): a systematic assessment

Belen Pedrique et al.;

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70078-0/fulltext

In 1975—99, only 1·1% of new therapeutic products had been developed for neglected diseases. Since then, several public and private initiatives have attempted to mitigate this imbalance. The authors analysed the research and development pipeline of drugs and vaccines for neglected diseases from 2000 to 2011. Their findings show a persistent insufficiency in drug and vaccine development for neglected diseases. Nevertheless, these and other data show a slight improvement during the past 12 years in new therapeutics development and registration.

 

UHC

 

7.    BMJ Editorial – Meeting the challenges of providing universal health coverage

Albert Mulley, Tim Evans, Agnes Binagwaho;

http://www.bmj.com/content/347/bmj.f6485?etoc=

If you read this newsletter, you’ll probably know UHC has been rising on the political agenda in recent years. The improvement in people’s health cannot be achieved by merely expanding and scaling up the healthcare delivery models of today, however, the authors of this viewpoint argue. New approaches to service delivery must produce greater value for patients.

 

8.    Health Matters – Universal Health Coverage: leaving no one behind?

Marielle Hart; http://www.healthmatters.org.uk/?p=2061

From the HIV/AIDS Alliance’s perspective, UHC will be a success if it serves the marginalized populations the Alliance works with across the world.

 

Global health governance & thinking

 

9.    Public health reviews – A Game Change in Global Health: The Best Is Yet to Come

Ilona Kickbusch;

http://www.publichealthreviews.eu/show/a/125

Not sure whether Ilona would be pleased if we called her ‘the Heidi Fleiss of global health’ (and there is arguably some stiff competition), but for sure, every paper she produces is a must-read. This one is no exception. An influential, visionary and very erudite Heidi J, to say the least.

 

Read also her short article for Medicus Mundi, From Charity to Rights: constructing global health in the 21st century.   The key aim of the global public health community must be to establish health as a global public good and a right of global citizens. Together with a strategy of empowerment and community involvement such an approach acts as a spearhead to enable and support individual health behaviours.

 

10. Global Policy – Trojan Multilateralism: Global Cooperation in Health

Devi Sridhar et al.;

http://onlinelibrary.wiley.com/doi/10.1111/1758-5899.12066/abstract

This article argues that recent global health cooperation has been marked by two trends. First, there has been a highly successful proliferation of vertical funds to fight specific diseases. These are characterized by narrower problem-based mandates; multistakeholder governance; voluntary and discretionary funding; no in-country presence for the delivery of assistance; and an output-based legitimacy (based on effectiveness, not process). The rise of new initiatives with these characteristics has dovetailed with an increase in the funding of international organizations. However, the latter has not necessarily strengthened multilateralism. Instead, rapid increases in discretionary earmarked funding to the WHO and World Bank, which Sridhar et al call Trojan multilateralism, has replicated features of the vertical funds. What are the consequences for international cooperation?

 

 

11. ISGlobal – A Non-State Centric Governance Framework for Global Health

Rachel Kiddell-Monroe;

http://www.isglobal.org/en/web/guest/publication/-/asset_publisher/ljGAMKTwu9m4/content/a-non-state-centric-governance-framework-for-global-health

This paper argues that the current system of global health governance is outmoded and inherently unable to provide a comprehensive and coherent approach that guarantees health for all. Addressing this crisis requires new normative and institutional frameworks suited to the global health reality of today’s world and that have equity and social justice at their core. The paper looks at global health governance from the perspective of institutional innovation and political creativity. It explores the idea of a non-State-centric or multicentric global governance framework as a challenge to the current geopolitical power structure, and builds on the practical wisdom drawn from the reality of governance issues encountered through the access to medicines debate.

 

12. ISGlobal – A Global Social Contract for a Healthy Global Society: Why, What and How

Suerie Moon;

http://www.isglobal.org/en/web/guest/publication/-/asset_publisher/ljGAMKTwu9m4/content/a-global-social-contract-for-a-healthy-global-society-why-what-and-how

This paper by Suerie Moon (Harvard Global Health Institute and Harvard School of Public Health) argues that health is a compelling theme around which a global social contract could begin to take shape. The contract should encompass four elements: resource pooling for social protection, regulation, provision of global public goods, and legitimate processes of global governance.

13. Collège de France – Géopolitique de la santé mondiale – Leçon inaugurale prononcée le jeudi 14 février 2013

D. Kerouedan ;

http://books.openedition.org/cdf/2291

We usually don’t refer to articles in French in this newsletter, but occasionally we make an exception. This is the text of the inaugural lesson by Dominique Kerouedan at the Collège de France, on the geopolitics of global health.

 

14. Journal of Epidemiology & Community health (Commentary) – The World Bank and global health: time for a renewed focus on health policy

Jennifer Prah Ruger;

http://jech.bmj.com/content/early/2013/10/18/jech-2013-203266.short?g=w_jech_ahead_tab

Now that Jim Kim & Tim Evans occupy top positions at the World Bank, Ruger argues that, in order to achieve health sector-wide results on the ground, the Bank should focus on health policy and health systems in developing countries and leave narrow technical control of specific diseases to other global health institutions.

Infectious disease

 

15. Speaking of Medicine – Why Infectious Diseases Still Matter

Sara Gorman;

http://blogs.plos.org/speakingofmedicine/2013/10/25/why-infectious-diseases-still-matter/#more-15139

Sara Gorman explores the interconnectedness of infectious and chronic diseases.

16. CGD – A Question of Quality: Why Retention Matters for AIDS Treatment

Mead Over & Yuna Sakuma;

http://international.cgdev.org/blog/question-quality-why-retention-matters-aids-treatment

By adopting the “HIV treatment cascade” as its theme for the October 2 meeting of its Scientific Advisory Board meeting, PEFPAR has signaled its willingness to be judged by a much more comprehensive metric (i.e. than  number of patients on treatment) of its on-the-ground success.   A vivid metaphor, the “AIDS treatment cascade” provides a snapshot assessment of the quality of AIDS treatment across the stages of care, and shows that there is room for improvement in Africa.”

 

In other HIV news, more than 50 African judges and magistrates met at a workshop in Nairobi, Kenya to share HIV/AIDS-related experiences with human rights and the law.  “Kenya’s Supreme Court President Willy Mutungai said the meeting will provide an opportunity for judges and magistrates to discuss effective strategies and programs for judicial education so as to help ensure the various judiciaries are able to make informed decisions on HIV-related human rights issues. The dialogue held from Monday to Thursday aims to bring forward recommendations of the Global Commission on HIV and the Law in increasing awareness among key constituencies on issues of rights and law with respect to HIV and boosting civil society’s ability to campaign, advocate and lobby. The workshop is organized by the Judiciary Training Institute and Kenya Ethical and Legal Network in partnership with the United Nations Development Programme (UNDP-Kenya) and UNAIDS.”

 

17. Treatment Action group – 2013 Report on Tuberculosis Research Funding Trends, 2005–2012

http://www.treatmentactiongroup.org/tbrd2013

Funding for research and development of new drugs, vaccines and rapid diagnostic methods for TB declined 4.6 percent in 2012 to $627.4 million after rising annually every year from 2005 to 2011. Most of last year’s cuts came from private sector donors. Reductions are likely this year as well, especially due to the budget situation & political environment in the US.

 

18. Smart global health – US role critical to addressing increases in drug-resistant TB

Nellie Bristol;

http://www.smartglobalhealth.org/blog/entry/u.s.-role-critical-to-addressing-increases-in-drug-resistant-tb/

Bristol comes back on WHO’s yearly global TB report, released last week.

 

19. Lancet (Comment) – Point-of-care diagnostics for tuberculosis elimination?

Christian Wejse;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62003-6/fulltext

Wejse comments on a new Lancet study by Grant Theron and colleagues which reports the outcome of a randomised trial comparing point-of-care Xpert MTB/RIF with smear microscopy in the management of tuberculosis. The study assesses the new molecular tuberculosis diagnostics from a public health perspective by measuring the clinical effect in several real-life situations, comparing nurse-managed Xpert MTB/RIF with a standard set-up of diagnostics with smear microscopy and radiography in well managed settings in four countries.

 

20. Foreign Affairs – A Cure for Africa’s Common Cold

Soniah Shah;

http://www.foreignaffairs.com/articles/140219/sonia-shah/a-cure-for-africas-common-cold

Sonia Shah examines why malaria persists in Africa. She discusses the relationship between poverty and malaria, and highlights a lack of political will as a major challenge to fighting the disease. And the pendulum is swinging: “The donor-driven campaign against malaria gained momentum by arguing that attacking the disease would spur development. Now, it seems advocates are saying that the opposite may be true: development is required to attack malaria“.

 

In other malaria news, WHO Regional Director for the Western Pacific Shin Young-Soo  said last week in a statement at least $450 million over the next three years is needed to close a funding gap for efforts to prevent and treat malaria, particularly the emergence of drug-resistant forms of the parasite.

 

 

Global Fund update

21. GFO new issue 230

http://www.aidspan.org/gfo_article/gender-equality-experts-criticise-implementation-global-fund%E2%80%99s-ge-strategy

The new GFO issue contains, among other articles, information on a donation by an Indonesian foundation (65 million dollar) to the GF, a first, and info on the appointment of Kate Thomson as the head of its new Critical Enablers and Civil Society hub.

In other GF news, (see the GF News Flash ), the strategy committee of the Board of the Global Fund decided that, going forward, any country with high rates of TB and HIV co-infection that applies for funding treatment programs will have to design its programs in a single unified application for joint TB and HIV programs, rather than submit separate proposals for each disease. The new requirement in application for funding will lead to better streamlining of programming for countries heavily burdened by the two diseases, which kill millions of people every year.

22. Science Speaks – Sachs: As Global Fund replenishment comes to Washington, “The money is not in the bag”

Rabita Aziz; http://sciencespeaksblog.org/2013/10/30/sachs-as-global-fund-replenishment-comes-to-washington-the-money-is-not-in-the-bag/

As already mentioned in the Intro, the GF replenishment is going less smooth than anticipated by Jeffrey Sachs and others. Among other things, Sachs says “Activists should put pressure on Wall Street foundations to contribute as well. Citing that Wall Street executives alone receive Christmas bonuses between $20-30 billion every year, even as they take bail outs from the government, he said “they owe it big time to the world.”

(As we public health people are a bunch of authoritarian neurotics – and some even  psychopaths in the making – we think it’s time to shoot a couple of them, to set an example J – We can obviously hire Chinese consultants first)

23. AFGH – Geneva, we have a problem !

http://www.actionforglobalhealth.eu/blog/?p=2148

In this blog post, Tobias Luppe and others explain how the Global Fund’s Reform might have deadly side effects for Most at Risk Populations in middle-and high-income countries.

 

Health policy & financing

 

24. UNFPA report – Facing the challenge of adolescent pregnancy

http://www.unfpa.org/swp

Around 7.3 million girls under the age of 18 give birth each year in developing countries, risking death and suffering that can only be addressed by changing social attitudes. In the new 2013 State of World Population (UNFPA) report, particular alarm was expressed about the dangers facing girls 14 or younger, who account for two million of the 7.3 million births to women under 18 in developing countries. The report offers a new perspective on adolescent pregnancy, looking not only at the girls’ behavior as a cause of early pregnancy, but also at the actions of their families, communities and governments.

25. Smart Global Health – Global Mental Health comes of age

Layla McCay;

http://www.smartglobalhealth.org/blog/entry/global-mental-health-comes-of-age/

This month’s launch of WHO’s Mental Health Action Plan 2013-2020 – adopted by the World Health Assembly in May and officially launched this month – was highly anticipated, McCay contends. That this Action Plan comes as the Post-2015 Development Framework is starting to take shape may have interesting implications for how mental illness is prioritized in the coming years, she says. Anyhow, it’s clear the political conversation around mental health is changing, and the mantra ‘no health without mental health’ might get some flesh in the coming years. (Which was about time, especially in a field dominated by neurotics.)

26. CGD – How Open Are US Development Agencies? The Good, the Bad, and the Ugly

Ben Leo et al.; http://www.cgdev.org/blog/how-open-are-us-development-agencies-good-bad-and-ugly

Ben Leo, Charles Kenny and Will McKitterick discuss last week’s Aid Transparency Index rankings and classify U.S. agencies’ performance into the good, the bad, and the ugly.  They examine, among others, the Millennium Challenge Corporation (n° 1), USAID, and PEPFAR.  PEPFAR is not doing very well, as was also noted in a  “Science Speaks” blog post.

 

27. Change@WHO – New approach to financing

http://www.who.int/about/who_reform/change_at_who/new_approaches_financing_full/en/index.html#.UnJTu_m6dz5

Former Director-General of the Swiss National Health Authority and Secretary of Health of Switzerland, has a long history as an innovative and progressive leader in national and international public health. In June, WHO Director-General, Dr Margaret Chan appointed Professor Zeltner as her Special Envoy. Andrew Cassels, WHO Director of Strategy, met Professor Zeltner to talk about his role and perspectives on WHO financing.

 

28. Global Health Governance – Impact Investing and Global Health: The Future of Global Health Financing?

Courtney M. Page;

http://blogs.shu.edu/ghg/2013/10/21/impact-investing-and-global-health-the-future-of-global-health-financing/

Page comes back on the recently launched Global Health Investment Fund (GHIF). “The GHIF has been hailed as the first-of-its kind; the fund, with $94 million already committed, is the first to allow individuals and institutions the opportunity to finance late-stage research and development of high-impact technologies and vaccinations that have the potential to save millions, with the potential earnings for investors.”

Courtney is a fan – The last time that happened, the adored icon shot himself in the head J.

 

29. Deutsche Welle – Public Health: A Global Challenge

http://www.dw.de/public-health-a-global-challenge/a-17156782

Globalization is changing the world and the changes are affecting human health. An interview with Prof. Rainer Sauerborn, director of the Institute of Public Health in Heidelberg and a lead author for the IPCC.

 

30. World Bank – Polio’s End Game

Tim Evans;

http://blogs.worldbank.org/health/polio-s-end-game

In this blog post related to World Polio Day last week, Evans discussed the polio end game. More in particular, he discussed the so called ‘legacy planning’, which is aimed at identifying ways in which the staff, expertise and infrastructure built up over decades through the Global Polio Eradication Initiative (GPEI) can be absorbed in national health sectors.

 

31. Foreign Policy – Biological Attack

Laurie Garrett;

http://www.foreignpolicy.com/articles/2013/10/22/biological_attack_polio_spreading_across_middle_east

Meanwhile, polio’s so called “end game” begins to look like a horror movie, with sequel after sequel. Polio is back from the brink of extinction, ravaging the battlefields of Syria and spreading across the Middle East, argues Laurie Garrett. The public health version of Freddie Krueger. (polio, that is, not Garrett J)

 

32. Humanosphere – The incredible shrinking Gates Foundation annual report

Tom Paulson;

http://www.humanosphere.org/2013/10/incredible-shrinking-gates-foundation-annual-report/

The Gates Foundation is not shrinking, but its annual report is, according to Tom Paulson. He considers why.

 

He also notes: “Global health is no longer the biggest slice – global development is.” But: “This might look like a big shift in emphasis, but it is actually just a reflection of the Gates Foundation’s recent reorganization. The reorganization reduced the scope of the global health program under former Novartis executive Trevor Mundel to focus on ‘product development’ – finding new and better drugs, vaccines or medical technologies. The other (often much bigger) Gates-funded health initiatives focused on ‘delivery’ – getting kids vaccinated, preventing deaths in childbirth and so on – were moved over to the development program run by Chris Elias. It’s not yet clear if the dust has settled after turning around the battleship (that’s a weird metaphor to mix), but it has been regarded as a positive sign to many outsiders that the world’s leading philanthropists see global health as a subset of the much bigger fight against poverty and inequity.”

 

33. Foreign Affairs – Biology’s Brave New World

Laurie Garrett;

http://www.foreignaffairs.com/articles/140156/laurie-garrett/biologys-brave-new-world

Garrett lays out the promise and perils of the synthetic biology revolution.

 

In a separate CFR  policy memorandum, Garrett discusses two new revolutions in biology – the ‘gain-of-function’ revolution as well as synthetic biology.

 

34. Scidev.net – Synthetic biology’s malaria promises could backfire

Claire Marris;

http://www.scidev.net/global/biotechnology/opinion/synthetic-biology-s-malaria-promises-could-backfire.html

Claims about the benefits of a biotech project to make artemisinin are overblown, says Claire Marris.

 

35. Globalization & Health – Sharing the British National Health Service around the world: a self-interested perspective

Kalipso Chalkidou et al.; http://www.globalizationandhealth.com/content/9/1/51/abstract

As the UK reiterates its commitment to protecting and growing its development aid budget amidst an adverse economic environment for the UK and Europe, the authors discuss the potential to use the country’s National Health Service (NHS) model as a vehicle for promoting the country’s economic as well as global health diplomacy and development priorities, through a coordinated cross-government plan of action.

36. Lancet (Global Health) – The Basel Convention and e-waste: translation of scientific uncertainty to protective policy

Oladele A Ogunseitan; http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70110-4/fulltext

The UN Basel Convention on the Control of Transboundary Movement of Hazardous Wastes and their Disposal represents global leadership to address the problem of e-waste. Ogunseitan comments on a new Lancet Global Health Study (by Kristen Grant and colleagues) which shows major gaps and uncertainties in the understanding of the risks associated with exposure, vulnerability, and causal linkage of e-waste to disease burden. However, “the UN’s leadership through the Basel Convention needs to survive the uncertainties in epidemiological data and the arrival of new research to advance our knowledge, especially regarding the toxic effects of e-waste on children who sometimes handle and dismantle this hazardous waste.”

37. Scidev.net – The pros and cons of social media in global health

Nick Ishmael Perkins; http://www.scidev.net/global/icts/scidev-net-at-large/the-pros-and-cons-of-social-media-in-global-health.html

Perkins comments on a session at the recent World Health Summit in Berlin on the role of social media in global health.

The World Health Summit also produced a statement by the M8 Alliance – see here. The Alliance calls for action in four areas. You also find keynote welcomes –  by the likes of Barroso and others, on the website. Presentations have now also been posted (but you need a login).

 

38. Plos – Complexity in Mathematical Models of Public Health Policies: A Guide for Consumers of Models

Sanjay Basu et al.;

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001540;jsessionid=D09BA776B592C879CA072D1E8C42C781

Sanjay Basu and colleagues explain how models are increasingly used to inform public health policy yet readers may struggle to evaluate the quality of models.

 

 

 

Global Health announcements

 

  • A Seminar on “Nutrition and Sustainability : A practical approach to integrating climate change, biodiversity and ecosystems, nutrition and health agendas” co-organized by the UN System Standing committee on Nutrition (UNSCN), Bioversity International, the Food and Agriculture Organization of the United Nations (FAO) and the Government of the Republic of Malawi will be taking place one day prior to the International Conference on Nutrition Technical Preparatory Meeting (ICN2), on Tuesday 12 November 2013, in FAO Headquarters, Rome, Italy.
    This seminar will bring together about 300 high level people and stakeholders of different backgrounds, engaged in different sectors : policy makers, leading experts and practitioners  need to respond to countries’ requests to answer the “why?” and “how?” question of linking nutrition, sustainability and the tradeoffs.  Throughout the day participants will be enabled to exchange and acquire knowledge needed to ensure that future national plans on nutrition, agriculture and food systems are sensitive to nutrition, biodiversity, ecosystems and climate change. In order to receive an invitation to attend the Seminar in person, please contact the UNSCN secretariat by email (scn@who.int) and explain your motivations to attend.   Please note that travel costs must be covered by the participant. The Nutrition and Sustainability Seminar will be conducted and livestreamed in English, French, Spanish and Portuguese. Live discussion will be happening on Twitter with the hashtags #sustfoodsystems and #sustdiets. More info under : http://www.unscn.org/en/nutrition_and_climate_change/nutrition_and_sustainability_seminar_12_november.php

 

  • Check out the newsletter on global health diplomacy, issued by the Graduate Institute Geneva.

 

  • ITM’s Public Sector Care Unit, in cooperation with the Catholic University of Louvain, is organising the 2013 conference of the International Association of Health Policy (IAHP), from 16 to 18 December in Antwerp, ‘Health care and financing, non-commercial goods’.  For more info on this upcoming event, stay tuned!

 

 

 

Research

 

39. CGD (Policy Paper) – HIV/AIDS Intervention Packages in Five Countries: A Review of Budget Data

Victoria Fan et al.;

http://international.cgdev.org/publication/hivaids-intervention-packages-five-countries-review-budget-data

More than ever, global health funding agencies must get better value for money from their investment portfolios; to do so, each agency must know the interventions it supports and the sub-populations targeted by those interventions in each country.” In this study Fan et al examine the interventions supported by the Global Fund and PEPFAR.

 

40. Health Research Policy & Systems – Assessing communities of practice in health policy: a conceptual framework as a first step towards empirical research

Maria Bertone et al.;

http://www.health-policy-systems.com/content/11/1/39

Communities of Practice (CoPs) are groups of people that interact regularly to deepen their knowledge on a specific topic. CoPs in global health are growing in number and activities. As a result, there is an increasing need to document their progress and evaluate their effectiveness. This paper represents a first step towards such empirical research as it aims to provide a conceptual framework for the analysis and assessment of transnational CoPs in health policy.

 

41. International journal of health services – Africanizing the Social Determinants of Health: Embedded Structural Inequalities and Current Health Outcomes in Sub-Saharan Africa

Hyacinth Eme Ichoku , Gavin Mooney , John Ele-Ojo Ataguba;

http://baywood.metapress.com/app/home/contribution.asp?referrer=parent&backto=issue,9,15;journal,1,172;linkingpublicationresults,1:300313,1

The discipline of health economics needs to refocus its energy on the social determinants of health, the authors of this article argue, and in doing so, must dig deeper into the reasons for structurally embedded inequalities that give rise to inequalities in health outcomes. Especially is this the case in Africa and other low- and middle-income regions. This article seeks to provide empirical evidence from sub-Saharan Africa, including Ghana and Nigeria, on why such inequalities exist, arguing that these are in large part a product of hangovers from historically entrenched institutions. It argues that there is a need for research in health economics to embrace the social determinants of health, especially inequality, and to move away from its current mono-cultural focus.

 

The new issue of the International journal of Health services also features a number of articles on the public health impact of mining in SSA.

 

42. Globalization & Health – Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities

Johann Cailhol et al;

http://www.globalizationandhealth.com/content/9/1/52/abstract

Sustainable Human Resources for Health (HRH) strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. Global Health Initiatives could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.

 

43. Plos – Psychosocial Interventions for Perinatal Common Mental Disorders Delivered by Providers Who Are Not Mental Health Specialists in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Kelly Clarke et al.;

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001541;jsessionid=D09BA776B592C879CA072D1E8C42C781

In a systematic review and meta-analysis, Kelly Clarke and colleagues examine the evidence for the effect of psychosocial interventions delivered by non-mental health specialists for perinatal common mental disorders in low- and middle-income countries.

44. Plos – Predicting Patterns of Long-Term CD4 Reconstitution in HIV-Infected Children Starting Antiretroviral Therapy in Sub-Saharan Africa: A Cohort-Based Modelling Study

Marie-Quitterie Picat et al.;

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001542;jsessionid=D09BA776B592C879CA072D1E8C42C781

Using data from the ARROW (Anti-Retroviral Research for Watoto) trial, Joanna Lewis and colleagues investigate the CD4 cell count recovery profiles of children infected with HIV who are starting antiretroviral therapy in Sub-Saharan Africa.

45. Global Public health – Social capital and health in the least developed countries: A critical review of the literature and implications for a future research agenda

William T. Story;

http://www.tandfonline.com/doi/abs/10.1080/17441692.2013.842259#.UnIPDfm6dz4

Research on the linkage between social capital and health has grown in recent years; however, there is a dearth of evidence from resource-poor countries. This review examines the association between social capital and physical health (including health behaviours) in the least developed countries (LDCs). The literature reviewed suggests that social capital is an important factor for improving health in resource-poor settings; however, more research is needed in order to determine the best measures for social capital and elucidate the mechanisms through which social capital affects health in the developing world.

Miscellaneous

 

 

 

  • Sustainable Development Financing: Background Papers from UN Task Team on Financing for Sustainable Development (see here ). The UN Task Team on Financing for Sustainable Development, created to inform post-2015 deliberations and to provide inputs for the Intergovernmental Committee of Experts on Sustainable Development Financing, has prepared a number of papers as backgrounds to coming deliberations. In the article, you can find the key points from the  executive summary.  What struck me most, was point 1: “Financing needs for sustainable development are enormous. Different estimates of financing needs all confirm that there are large requirements across all critical sectors. For example, investment requirements for an energy transition respecting agreed climate targets are of the order of trillions US$ per year.”    Must-read.

 

  • Essay by Naomi Klein in the New Statesman – How science is telling us all to revolt (see here )  Research shows that our entire economic paradigm is a threat to ecological stability. And indeed that challenging this economic paradigm – through mass-movement counter-pressure – is humanity’s best shot at avoiding catastrophe.     Must-read.

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