This week we focus on WHO’s Executive Board Meeting, Davos (both events were already covered to some extent last week), the PMAC 2014 conference in Bangkok, Obama’s State of the Union, but the newsletter also contains the usual headlines and journal articles.
In this week’s (rather provocative) guest editorial, two Emerging Voices, Alliance Nikuze and Jean-Paul Dossou, discuss the backdrop of homophobic laws in their countries, and whether international actors can play a constructive role through advocacy or not. You might not agree with everything they say, but that’s the whole point of a debate, we reckon. It’s a very tricky issue, for sure, with issues of human rights, sovereignty, donor-recipient relationships, religion, ‘Africa rising’, political motives, … all in the mix. I think there’s at least one constructive thing the Obama administration could do: bring (some of) the boys back home. In this case the evangelical priests who preach hatred towards our gay brothers and sisters. Some American evangelical preachers no doubt do great work all around the world, and by all means, let them continue their work, but the ones who actively encourage homophobia in their churches should be brought home, sooner rather than later. Maybe we could even start a global health initiative for this purpose, chaired by Elton John.
Far less tricky is Chinese New Year, which I celebrated with my wife and son yesterday. It’s now the year of the horse, which doesn’t sound very much like a Chinese animal, if you ask me. Anyhow, a horse is, at least for me, a symbol of freedom. At some point in our life, we all want to run for miles and miles, not just the Kenyan first lady. Some run for a good purpose, others to recharge their batteries, others aim for a marathon, and still others just want to run away from it all. It’s against this backdrop that I want to share my hope for the ‘year of the horse’. Call it my “Martin Luther King moment”J. My dream would be that all young people have the chance to experience once in their life, but preferably in their teens, a few months in relatively unspoiled nature, say the Himalaya mountains, Scandinavia, Patagonia,… All people should have the right to go to one of these places for a sustained period of time, once in their life (a bit like Muslim people go to Mecca), to enjoy the stunning scenery (as long as it’s still there) and, more importantly, to begin to understand the quote by the Indian mystic J Krishnamurti: “When you lose your relationship with nature and the vast heavens, you lose your relationship with man.” Boys and girls from all social backgrounds – not just Prince Harry or other gung ho jihadi fighters – should have the right to walk for a few months in pristine mountain scenery, without aiming for any results. Just for the sake of it. The really fucked up young kids can go with Prince Harry to the Antartic, or perhaps Ayman Al Zawahari can take care of them in Afghanistan.
Some pressure could even be used to get these young kids on the move, although we don’t want this to become a bootcamp. But no gadgets allowed, obviously. No news from home. They might miss their apps, games and Facebook updates, for a while, and complain of the freezing nights in their tents or the endless kilometers. Yet, after a few days, I’m pretty sure most of them would begin to see the point of such a venture. When they come home, months later, they might still have big dreams, become one day venture capitalists and be results-oriented for the rest of their life. But chances are the results they aim for will be different.
So for the venture capitalists and philantrocapitalists who really want to make a difference for the next generation, the generation that will most probably decide on this planet’s fate, this is where I would invest some of my money, rather than in commercial space flights. Let kids from slums in Mumbai or Lagos, poor neighbourhoods in the US and the UK, but also middle class kids who grow up with GTA and Snapchat, discover nature, if only for once in their life. Not nature as in family outings on a lazy Sunday afternoon, or skiing in Sochi, but wild, brutal nature, nature that blows us human beings away. There are many places like that in the world, still.
If we fail to reconnect our kids with nature, the way many of us have lost a proper connection, no ‘circular economy’, ‘shared economy’ or other fancy “New Economic Model” will save us, I’m afraid. What about the fact that our fragile ecosystems wouldn’t survive such an attack by the young, and the emissions of the planes to bring them there? Well, we’re already destroying our habitat. My hope would be that, after a few weeks, they’d realize what the human species is destroying. And anyhow, we owe it to them to have a last look at the beauty of the planet.
Having said that, for the moment, I fail miserably to convince my own teenage son of the merits of nature J. So may the year of the horse be different.
Enjoy your reading.
Kristof Decoster, Werner Soors, Peter Vermeiren, Basile Keugoung & Wim Van Damme
Homo-“phobia” in sub-Saharan Africa: How much more time are we going to postpone the real therapy of the “disease”?
Alliance Nikuze (EV 2013) and Jean-Paul Dossou (EV 2012, Centre de Recherche en Reproduction Humaine et Démographie (Cotonou, Benin) & MPH at ITM, Antwerp )
The debate on homophobia, following the voting of anti-gay bills in several countries in Africa (with Nigeria as the latest example) is more intense than ever. The reaction of some donors to the passing of these bills, whereby some of them hint at (or downright threaten with) possible ODA “consequences”, raises several questions and divides opinions. In this editorial, we try to provide the local and community backdrop for the debate, drawing some lessons for international stakeholders in the process. We don’t aim for comprehensiveness – impossible in a short piece like this – but will offer some key messages. Among others, we will make the case that the current donor stance, which seems to ignore or at least underestimate the reality of the smoldering furnace in societies against homosexuality, is inefficient and even potentially harmful.
Homophobia in sub-Saharan Africa
Among all the explanatory theories of homophobia in Africa, one in particular has captivated our attention. The theory suggests homophobia is fear that the hetero-patriarch will lose control and power over women and children. We see quite some evidence for this theory in our communities: the traditional perception of men as the “strong sex”, for example, or the established gender roles for men and women in society, a pillar of the overall set-up of many sub-Saharan African societies. According to this theory, homosexuality is perceived by many as a phenomenon which endangers the entire foundation of the society. This could explain the harsh rejection of gays, contrasting with a more tolerant attitude towards lesbians.
In the book “African sexualities, A reader”, edited by Sylvia Tamale in 2011, Makau Mutua makes the following statement: “Tribalists, racists, sexists, homophobes, exploiters, misogynists and religious zealots and extremists of all kinds have one thing in common – they are hateful and live by controlling others“. This correlates with the different kinds of violent reactions by some societal groups or by a group of people. The strength and extent of hatred in society varies, though. Yet, it is relatively poorly documented in this part of the world. There are some stats on homosexuality though.
A recent survey conducted by the Pew Research Center showed that 90% of respondents or more said society should not accept homosexuality in countries as diverse as Kenya, Uganda, Ghana, Senegal and Nigeria. In South Africa the figure was somewhat lower, but still a majority of the people (61%) did not accept homosexuality. It is possible to have some doubts about the representativeness of these (sad) results, or the methodology, but if you often talk with people about same-sex relations, you will agree that this 90+ percentage is probably close to reality in these countries. You can even go further: the picture is probably the same in most countries in Sub-Saharan Africa (SSA). Are all the people who do not accept homosexuality also “homophobes”? Can 90% of survey respondents really be hateful? It seems unrealistic but if that is the case, then our societies are truly sick.
The theologist Mika Mfitzsche described three failures in sub-Saharan Africa that characterized the post-colonial period according to him: the political failure, the economic failure and the cultural failure. The latter he described as the loss of the anthropological identity of the overall society, lost between its roots and the pressure of globalization. If we try to analyze homophobia from this angle, some questions arise. Are we perhaps, at least partially, trying to come to terms with our postcolonial “identity disorder” through oppression of other human beings? Why are we putting so much energy in this issue that seems so far removed from our daily and burning problems (like poverty, diseases, unemployment, inadequate payment, corruption, low quality education) ? What is it that lets a society allow itself being led (astray) by a handful of fearless extremists? Or does our inaction mean we are also extremists? Is homophobia a stand-alone problem or do we need to see it in the context of other challenges? Can we, for a moment, take the time to think about our own actions (or inaction) as no single person has an answer to these questions/issues – they need collective attention.
Some political commentators suggest that governments and some political parties use the issue as a smokescreen: it diverts attention from some of the bigger socio-economic challenges and the role of government in the perpetuation of them. Other pundits perceive homophobia as a remnant of colonial times, and still others see the predications of some imported religions in sub-Saharan Africa as a key factor. There is some truth to all of these perspectives, which suggest at different levels friction between globalization and the sub-Saharan African society. But what explains the near unanimous opinion (more than 90% of the community) against homosexuality, we still don’t know. This highlights the need to work on this question at the community level, within the population, where homophobia seems, unfortunately, deeply embedded.
Is there a role for the international community?
In this context full of uncertainty and unsolved deep questions, let’s explore how the international community could have an impact (for the better, that is) or could be more efficient.
Let’s start by asking, what would it mean to have a homophobia-free society? It is clear that the absence of anti -gay laws or the presence of laws allowing same-sex relations or gatherings of homosexual persons are not sufficient to declare a country or society free of homophobia. In fact, we observe in West-Africa, as in many other regions in sub-Saharan Africa, a gap between the laws of the State and people’s practices. Institutional mechanisms and representation are weak due to a fragile democratic process, laws written in inaccessible languages to the public, …. Whether it’s about children’s rights, women’s rights, codes of family or work, social realities are far from being a reflection of the laws passed in the legislative institutions.
Because of this gap, in extreme cases of insecurity and turmoil, when society thinks it is abandoned by the state, parts of society start to rebel against some of their own people, the ones they reject for some reason, for example by adopting mob strategies, a phenomenon that is unfortunately very common in West-Africa. This form of social violent reaction without trial, is already happening against homosexuals. And we fear that it will only get worse, as the advocacy of the international community often seems to make nationalist “pure African” ideologies even more virulent.
Against this backdrop, we think a society free of homophobia needs a shift in people’s minds towards a new and more tolerant perception of homosexuality, accepting gay people the way they are, and in favour of their integration. Whether outspoken international advocacy and/or ODA cuts can help realize this (necessary) shift, remains to be seen. On the contrary, we feel that the advocacy of the international community, at this stage, is useless. Even more so as the contradictions within some western countries themselves are still huge (see the massive recent protest in France for example against Hollande’s same sex marriage law). Also, the pressure put on African governments seems a bit ad hoc – sometimes there is pressure, sometimes not. So international pressure will probably not accelerate the process towards more tolerance for homosexuals in society, in our opinion. Worse, it might even be counterproductive in the short term, as we explained above. But we might be wrong.
Is there any room of manoeuvre to go forward, nevertheless?
Perhaps the term homophobia in itself carries part of the solution. Perceived as a “phobia”, homophobia could be yet another expression of the collective suffering of societies in crisis, torn, nostalgic of the almost lost Africanity but suffering to find new value references and anchor points faced with seemingly overwhelming globalization – a bit like xenophobia among some groups in European society?
This phobia, like all human phobias, requires therapy. It would thus be more appropriate to consider homophobia as a social construct, a complex, and treat it as such. To do this, we must put our societies “on the couch” and let them express their suffering. This can happen in various ways but in any case a well-defined strategic plan for the long term seems needed. In this process, the role of the state and the international community must be, first and foremost, to organize, promote and guarantee free expression, without violence. The international community should focus its actions more on the community level, perhaps, and should encourage the government to promote a healthy debate (instead of deciding for the government, as seems the case now). The nasty “debate” there is now, in the tabloid press and the political arena, is obviously not what we have in mind. And yes, it’s easier said than done. But there’s no other way.
This requires a different mindset among donors, long-term thinking and action to help promote healing of the social suffering caused by globalization and pressure on traditional societies, well beyond the current vogue of chasing quick impacts . Otherwise, the suffering will remain there, as a latent fire, ready to reappear in one form or another at every opportunity. This time popular anger is directed at gay people, next time another marginal group might be the victim or the scapegoat of the tabloid press or some populist politicians.
There are many countries in this world, but it’s a small world now, due to our increasing interconnectedness. It is important to notice how homophobia (and the ‘free expression’ of it) has risen in some regions of sub-Saharan Africa, just when same-sex marriage was being legalized in some western countries, as if, all of a sudden, states and people wanted to prove to themselves, maybe, that the trends in the West won’t affect their traditional way of life: another contradiction which characterizes our society’s sickness?
Obviously, there’s much more to be said about this issue, but to conclude: which individual or institutional advocacy is likely to have a positive impact on today’s homophobia then? Well, courageous advocacy that comes from individuals, organizations or states who/which have not supported/practiced (or remained silent to) any form of human rights abuse (including economic, cultural, …) and have rejected any form of discrimination (the likes of Desmond Tutu) throughout their lives, careers and institutional policies. So let these people, organizations and institutions come forward and take a stance. The others better shut up.
WHO Executive Board in Geneva
1. IP Watch – a number of articles on the Board meeting
To get a fairly good idea of the discussions, resolutions, and main clashes at the Board meeting, we suggest you take a good look at the following articles on the IP Watch website: on (the controversial) R&D model projects; WHO reform and engagement with nonstate actors; turmoil around the campaign by Big Pharma against South-Africa’s IP law changes; substandard medicine debate; other access to medicines debate.
You might also want to review the PHM watching activities around the 134th EB session.
2. Times of India – Access to medicines issue splits the world, developing vs developed
Still on the access to medicines clash: “The recently concluded meeting of the World Health Organisation’s executive board saw a sharp divide between developing and developed countries on the issue of South Africa’s reforms of its intellectual property laws to enable affordable access to medicines. While several developing countries including India and Brazil came together to express support for the reforms, not a single delegate from the developed world expressed a word of solidarity for South Africa on the issue.”
An Economist article also zooms in on the new drug pricing war and the looming Big Pharma Campaign against South-Africa.
3. WHO – First ever global atlas identifies unmet need for palliative care
Palliative care was also a key concern at the Board meeting. The Board called on countries to strengthen palliative care and to integrate it into their health-care systems. It is expected that the Sixty-seventh World Health Assembly will discuss the subject in May 2014. Only 1 in 10 people who need palliative care is currently receiving it. This unmet need was mapped for the first time in the “Global atlas of palliative care at the end of life”, published jointly by the WHO and the Worldwide Palliative Care Alliance (WPCA).
As for the resolution on palliative care, which will be discussed at the WHA, see here.
The Guardian also zoomed in on this Atlas, see here. Almost 80 % of the need for palliative care is in LMICs.
A few things we didn’t cover yet about last week’s Davos meeting, and some other relevant articles:
- A GAVI Alliance press release reported that the GAVI Matching Fund “has secured more than $150 million in just 30 months.” Since the GAVI Matching Fund was established in June 2011, 12 private sector partners have donated $76 million, an amount matched by the U.K. Government or the Gates Foundation.
- Gates & Summers put up a show in Davos on the Lancet 2035 Grand Convergence idea. (see here).
- For a Summary of the ‘Health is wealth’ session, moderated by Arianna Huffington, see here.
- Storify (of series of tweets) by Eldis of health at the WEF.
4. IHP – Gates doesn’t get it
In this blog post, I wonder why Gates doesn’t get within-country inequality as much as he gets between-country inequality, for example with respect to the minimum wages debate in the US. On this issue, I think he’s out of sync with the times, unlike Obama and the pope. (As for the ones on Twitter, re-tweeting doesn’t necessarily mean you endorse my view J.)
5. New Internationalist – Global inequality is about power, not just wealth
Yet another nice viewpoint on why the governance model of Davos is problematic.
The theme of this year’s Prince Mahidol Conference (PMAC) was ‘Transformative learning for global health equity’. (The kind of wording that turns on people like Julio Frenk and Tim Evans, and they duly showed up)
Although the country is in the midst of a lot of political turmoil, Jim Kim carefully avoided this topic altogether. Instead he gave a nice speech on Thai leadership with respect to the HIV response and UHC. Our favorite part of the speech, in which he refers to WHO opposition to Thai UHC plans early 2000s: “Yes, I used to work at the World Health Organization, too. I’ve tried to imagine what those conversations must have been like. “I’m sorry Thailand, but when we talked about ‘Health for All’ by the year 2000, that was actually a typo. We actually meant Health for All by the year 3000.” (if anybody ever feels like writing an essay on all the “typos” in global health, we’ll be happy to host it on IHP)
You might want to watch the opening video on health workers as central change agents (with Lincoln Chen taking up a new career on Youtube; Lady Gaga, you might want to retire).
There was plenty of tweeting from Bangkok – follow #PMAC2014. Politics might be a mess, but apparently internet is still reliable over there.
The Laureates of the Prince Mahidol Award his year were professor Dr. David D. Ho, Dr. Anthony Fauci, Baron Peter Piot and Dr. Jim Yong Kim.
Obama’s State of the Union
- Obama said (again) some nice words about the War on Inequality (which replaces the War on Terror, presumably, although not everybody is sure that one is abolished), and what he intends to do to make progress (for example, with respect to minimum wages in the US).
- For a Devex Analysis of aid priorities, according to the speech, see here.
- Trans-Pacific Partnership: Not sure how the TPP fits in the War on Inequality, but apparently Obama wants to move fast (as in “fast track”) with the negotiations. MSF, meanwhile, urges members of the US Congress to reject the proposed TPP, arguing that it causes harm to medicines in developing countries.
6. IP Watch – In State Of The Union, Obama Highlights Need For Patent Reform, Trade
In his speech, President Obama described an innovation race, and highlighted the importance of trade agreements and passage of patent reform legislation. Interesting emphasis: “On trade, Obama pitched it in relation to small businesses rather than the corporations that stand to gain. He referenced the Trans-Pacific Partnership (TPP) agreement and the Transatlantic Trade and Investment Partnership (TTIP) with Europe, as well as renewal of fast-track trade promotion authority in which Congress limits itself to an up-or-down vote on trade agreements negotiated by the administration.” Meanwhile, Harry Reid (from his own party) doesn’t think fast tracking is the way to go.
Post-2015 & UHC
7. Huffington Post – To Achieve Good Health We Need Good Education
The wife of a former UK prime minister (not the former wife of a president, as it would be in France) argues for linking education with the Lancet’s Grand Convergence idea. “In this ‘Grand Convergence’, let’s not leave education outside the door. Investing in health without investing in education is a non-starter if we are serious about success. So alongside the 16-8-4 convergence plan targets for reducing infant mortality and AIDS infections and TB, we should add a new figure – 16-8-4-0. A zero exclusion rate from education.”
8. The Brown Journal of World Affairs – Governance and Financing of Global Public Health: The Post-2015 Agenda
Devi Sridhar et al.;
The article probably does what the title promises to do, but so far I couldn’t get hold of a copy. (Better ask my Go4 Health colleaguesJ).
9. Global Health and Diplomacy – Financing the future of Global health
With plenty of interesting contributions on the future of global health financing (including one by M Chan). Not sure whether you manage to print the journal, though.
10. Lancet (Early online) – Data, children’s rights, and the new development agenda
Tessa Wardlaw et al.;
“The coming year will mark the 25th anniversary of the Convention on the Rights of the Child and the culmination of the MDGs. As people look to the future of human wellbeing, data will play an increasingly important part in identifying inequities and in informing and evaluating interventions so these are responsive and accountable to the world’s 2·2 billion children, especially those so far excluded from the benefits of development.”
For a related article, see also Claire Melamed on “Data Revolution, Development’s next frontier” (in World Politics Review)
11. Lancet Global Health (blog) – Rethinking health in international development
Instead of a system of fragmented health policy targets, we need a life course approach for the post-MDG health goals, argues this man, named like a character in Keeping up Appearances.
12. Maternal Health Task Force – Setting the post-2015 maternal mortality target globally and for each country: A proposal
What does the future hold for international maternal mortality targets? The MHTF will host a blog series on post-2015 maternal mortality goal setting in the coming weeks. In a first guest post by Marge Koblinsky, senior maternal health advisor at USAID, she proposes some targets.
13. Scidev.net – Focus on disability: a chance to fill the data gap
Disabled people are often excluded from data gathering, and this hinders decision-making. The debate on the post-2015 development goals offers a chance to boost inclusion of disabled people.
14. AFGH – Health in the post-2015 framework: Analysis of the positions of key European countries with case-studies of the United States and Senegal
15. IHP- Nigeria’s long walk to Universal Health Coverage
Great article by Emerging Voice 2013 Abubakar Kurfi, on what it will take to get to UHC in Nigeria. What he says, is also relevant for other countries on the path towards UHC.
16. The Economic Times – Congress set to promise universal healthcare coverage in its election manifesto
The Congress party in India is set to promise in its election manifesto universal healthcare coverage, including free medicines at government hospitals and health centres. Now they still have to win the elections.
17. Aidspan – Watchdogs or critical friends?
Bourgoing, a communications specialist, was in Nairobi a while ago to help Aidspan facilitate a meeting with the representatives of about 30 organizations from East and Southern Africa involved in the monitoring of global health programs. (see also a previous IHP newsletter). Bourgoing reports on the discussions. Africa Health Watch was set up there – and instead of “watchdogs”, partners want to be critical friends. See also this Aidspan newsarticle on the same meeting in Nairobi. Organisations will help monitor GF supported programmes, in countries.
18. Speaking of Medicine – HIV Viral Load Testing in Africa – No Longer Why but How?
Helen Bygrave from MSF considers the challenges of making HIV viral load testing an effective reality in sub-Saharan Africa.
19. UNAIDS – The M∙A∙C AIDS Fund, Rihanna and UNAIDS team up to reach nearly 2 million young people in need of lifesaving HIV treatment
From the press release: “UNAIDS announced today the expansion of its Treatment 2015 initiative with a US$ 2 million grant provided by the heart and soul of M∙A∙C Cosmetics, the M∙A∙C AIDS Fund. The Fund is fully supported from the sale of VIVA GLAM Lipstick and Lipglass with global superstar Rihanna lending her celebrity to spur purchase and awareness. Leveraging this new funding, UNAIDS will build on Treatment 2015 by advancing global, regional and country level policies and programs to expand HIV testing and treatment to young people worldwide.”
(Now we still have to find a good cause for Miley Cyrus to support. Maybe something with infrastructure in developing countries.)
20. Lancet (World Report) – Uptake of PrEP for HIV slow among MSM
Tony Kirby et al.;
Prescriptions of the pill for HIV pre-exposure prophylaxis have been slow in the USA. But trials of the therapy are gathering pace worldwide. Tony Kirby and Michelle Thornber-Dunwell report.
21. Health Affairs – Don’t put the brakes on ending AIDS
Chris Collins & Matthew Kavanagh;
Continued PEPFAR cuts will slow HIV treatment enrollment, reverse gains, and postpone the end of AIDS. See also this Science Speaks article.
22. Global Aids response guidelines released
The 2014 Global AIDS response progress reporting (GARPR) guidelines were released on 24 January. The guidelines provide countries with technical guidance on how to measure progress towards the ten targets set in the 2011 United Nations Political Declaration on HIV and AIDS. They include the detailed specifications of the core indicators, the data required, and how data will be interpreted.
23. Lancet – Intimate partner violence and HIV: unwelcome accomplices
Intimate Partner Violence (IPV) is a barrier to prevention, and population-level behaviour change programmes are needed as part of the global effort against HIV.
24. Plos – The Failure of Screening and Treating as a Malaria Elimination Strategy
Lorenz Von Seidlein;
In a cluster randomized controlled trial in PLOS, Katherine Halliday and colleagues investigate the effect of intermittent screening and treatment of malaria on health and education in Kenyan school children. In this related Perspective, Lorenz von Seidlein explores the reasons why a school-based screening and treatment strategy for malaria might have failed.
25. FT – Hepatitis C: Treated – at a price
The launch in recent weeks of sofosbuvir, the first of a series of new drugs for hepatitis C virus set for regulatory approval, raises the prospect of curing and potentially eliminating a disease that levies a heavy global burden. But the price is hefty…
26. Science Speaks – GeneXpert use still hobbled by high pricing, Treatment Action Group, TB Community Advisory Board say
A Letter from TAC & the TB Community Advisory Board to Cepheid, manufacturer of GeneXpert, cites the continued cost of machines, cartridge costs of five to six times the negotiated price, and more problems.
27. Lancet (Comment early Online) – Polio in Syria
R Bruce Aylward et al. ;
In a Comment just published today in The Lancet, Ala Alwan and Bruce Aylward from WHO respond to recent allegations that UN agencies including WHO have blocked vaccination campaigns and obstructed the testing of polio samples.
28. International Health – The polio eradication campaign: time to shift the goal
Emmanuel Baron et al.;
The social rejection of the polio eradication campaign in endemic countries challenges an assumption underlying the goal itself: the full compliance of an entire population to a public health programme. The polio campaign, which has been an extraordinary public health enterprise, is at risk of becoming irremediably unpopular if the eradication goal is pursued at all costs. The Global Polio Eradication Initiative (GPEI) should not be driven by the fear of failure, because the greatest benefit of the polio campaign is that it has demonstrated how simple, community-wide actions can contribute to a dramatic decrease in the incidence of a disease.
29. BMJ (Observation) – When will the tobacco industry apologise for its monstrous harms?
Marvelously written piece. To give you an idea: “My wife is a primary school teacher with 35 years’ experience. She has often described incidents where 5-9 year olds with poorly developed moral compasses have been caught red handed while bullying, stealing, cheating, or lying but have unblinkingly denied their wrongdoing regardless of the evidence before them. More than once she’s suggested that such a child might one day make an ideal applicant for a job in a tobacco company.”
30. Think Africa Press – Blowing Smoke in Africa: Big Tobacco and Child Smokers
This article gives a good overview of the strategies big tobacco firms use to entice new – and mainly young – smokers in Africa. Obviously, children shouldn’t be smoking in this world, but having said that, when you read the paragraphs of young teenagers smoking cigarettes while watching the stunning ocean in Kenya and having a few beers with their friends, you know public health (and education, for that matter) face an uphill battle. (Most overworked white collar employees in the West would probably sign up for such a relaxed way of life…)
31. MMI – Who’s afraid of NCDs?
Reflecting on last week’s Executive Board meeting, awareness on NCDs is growing, but there is strong resistance against regulating the marketing and supply of unhealthy food and beverages, coming from corporations and several governments concerned about protecting their export markets, argues Mariska Meurs from Wemos – the piece is the editorial of the new MMI newsletter.
32. Huffington Post – Chagas Disease: Urgent Measures Are Needed
A Global Chagas Disease Coalition of organizations has been established. The coalition is calling for urgent measures to increase access for patients to diagnostic testing and essential medicines to treat Chagas disease, support for research and development for new and improved drugs, diagnostics, vaccines and other health technologies, and expanded efforts for transmission control.
In related news, a post in the Global Network for Neglected Tropical Diseases’ “End the Neglect” blog examines the potential impact of increased U.S. funding for NTD programs. In the federal FY 2014 budget, funding for USAID’s NTD Program was ramped up from $85.5 million to $100 million, representing the greatest increase in U.S. NTD funding since FY 2010.
33. Euractiv – Funding for ‘neglected’ tropical diseases goes from ‘rags to riches’
Euractiv; Dengue fever, chikungunya and other “neglected tropical diseases” have attracted growing media attention – and international funding – as global warming helped them spread to Europe. But money isn’t everything, especially for deprived populations in Africa’s remote regions that are the most affected by them, warns Jean Jannin, a WHO expert, in an interview with EurActiv. Logistics matter.
Access to drugs
To begin this section properly, we want to refer to a book review of a book by Peter C Gotzsche in the Lancet, in which Big Pharma is likened to “organized crime”. The latest gang fight is around South-Africa, it appears (see before in this newsletter).
34. BMJ (news) – Protecting intellectual property is vital for medical innovation, says UK report
But as we’re always trying to be ‘fair and balanced’, you should probably also read this BMJ news article: “Protecting intellectual property rights is vital to ensuring biomedical innovation and protecting patients’ interests, a report from University College London’s School of Pharmacy has concluded. The report said that, without intellectual property rights, private investment in high risk biomedical research would be very unlikely to take place and that this would have negative knock-on effects on public funding for fundamental research. It added that additional changes should be introduced to incentivise research in neglected fields such as drugs for rare diseases (& diseases of the third world).” So it turns out our public academics and other ‘centres of excellence’ need organized crime to survive.
35. Lancet Global Health – Is the pharmaceutical industry improving with regard to access to essential medicines?
Hans V. Hogerzeil et al.;
And yet, the record of the pharmaceutical industry is improving with regard to access to essential medicine, longitudinal research of the Access to Medicine Index (the Index ranks the 20 largest research-based pharmaceutical companies according to their efforts in making relevant products more available, affordable, and accessible in developing countries ) between 2008-2012 shows.
36. IHP – Wanted: a new model to encourage pharmaceutical innovation
You might also want to read this related blog post by our ITM colleague Brecht Ingelbeen. Unlike many of us, he was a “Big Pharma’ Insider before.
For a number of Intellectual Property articles, related to India, including the consideration of a new series of compulsory licences, see also BMJ (see
Maternal, newborn, child and adolescent health
37. Lancet Comment – Next steps for adolescent health: a Lancet Commission
George G Patton et al.;
Adolescent health is rising on the agenda. The establishment of a new Lancet Commission is further evidence of this. The Lancet has partnered with four academic institutions (the University of Melbourne, University College London, London School for Hygiene and Tropical Medicine, and Columbia University) to establish a Commission on adolescent health and wellbeing.
38. Plos – Soon PLOS Medicine Will Be Ten: A Call for Papers on the Health of Pre-adolescent Children
Even pre-adolescent children get more attention. The PLOS Medicine editors issue a call for papers on the health needs of pre-adolescent children (5- to 10-year-olds) in the build up to PLOS Medicine’s ten year anniversary later this year and explain why they want to highlight this neglected group of children.
39. Guardian – Is $17.5bn incentive enough for more mothers to breastfeed?
To go from pre-adolescents to babies, is a big step for parents, but just a small step for public health people. The International Baby Food Action Network (Ibfan) launched a global report in December 2013 calling for an investment of more than $17bn annually to preserve and raise the bar on breastfeeding practice.
40. Guardian – Female genital mutilation affects a fifth of young girls in sub-Saharan Afric
Almost one in five young girls in sub-Saharan Africa are still forced to endure female genital mutilation (FGM), according to a UNICEF report that paints a grim picture of the state of the world’s children.
- 41. WHO report – New WHO report explores role of civil society in accelerating progress on RMNC
The WHO has published a new report, ‘Strategies, tactics and approaches: Conducting and evaluating national civil society advocacy for reproductive, maternal and child health’, based on 2012 consultation on the role of civil society advocates in addressing the complex challenges for advancing health throughout the RMNCH continuum.
Health Policy & Financing
42. State Magazine – A healthier world: office strengthens global health diplomacy
State Magazine profiles the U.S. Office of Global Health Diplomacy (GHD). The article describes how the office was established. The article summarizes GHD’s activities and presents comments from several employees. Some look funny.
43. Forbes – J&J will share clinical data
In a major victory for advocates of open access to data from clinical trials, Johnson & Johnson earlier this week announced that it will make all of its clinical trial data available to outside researchers. The company said that the Yale University Open Data Access (YODA) Project will serve as an independent third party “to review requests from investigators and physicians seeking access to anonymized clinical trials data.
A related research article in Social Science & Medicine relates to the issue of outsourced clinical trials in India. “Fast, cheap, and out of control? Speculations and ethical concerns in the conduct of outsourced clinical trials in India”
44. Lancet: Offline – The path from anarchy to justice
Reflecting on the Series on Arab health, Horton says: “Here is one important lesson the Arab World can offer. That countries with a common language, connected cultures and traditions, a shared history and memory, can, despite enormous difficulties, devise original perspectives on global predicaments, perspectives that have the potential to redefine accepted ways of thinking and move that thinking forward. One of the most important contributions of Arab scholars is to challenge dominant notions of human health and development. Where else do you hear in global health about how political systems affect health, about the consequences of conflict on the lived experiences of peoples, and about ecosystems as important determinants of our collective survival?” Earlier in the piece, Richard lashes out at the culture in our societies: “Most schools of public health and medicine are … guilty of “abandoned contracts of trust”—this time between their faculty and the societies in which they live. The incentives shaping the lives of most academics are perverse and distorting, characterised by aims and objectives often remote from human concerns.” If only they listened.
45. IPS – U.S. Tightens Development Safeguards
Development activists and rights watchdogs are applauding a surprise strengthening of environmental and human rights policies governing U.S. development funding and overseas financial assistance. Under the new provisions, the US will be required to vote against multilateral funding for large-scale hydroelectric projects in developing countries, as well as push for redress of rights violations resulting from development initiatives by international financial institutions. In addition, Washington will be barred from offering any bilateral assistance that could facilitate certain rights abuses, extractive industries or industrial logging in primary tropical forests.
46. Guardian – South African traditional leaders attack graphic male circumcision website
A Dutch doctor in South Africa has published graphic images of penises mutilated during botched circumcision ceremonies, angering community leaders who accuse him of meddling in their culture. (The Dutch have balls, that’s well known – although the expression feels a bit awkward in this case.)
47. Economist – Reinventing the wheel
Making roads safer in developing countries isn’t that costly, this Economist article argues. And this would not only bring health but also growth.
48. Panafrican Medical Journal – Barriers to emergency obstetric care services: accounts of survivors of life threatening obstetric complications in Malindi District, Kenya.
Elizabeth Echoka et al.;
Pregnancy-related mortality and morbidity in most LMICs can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. The authors used the three delays framework to explore barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya.
49. Plos – Developing a Sustainable Nutrition Research Agenda in Sub-Saharan Africa—Findings from the SUNRAY Project
Patrick Kolsteren et al.;
Patrick Kolsteren and colleagues present the findings of a collaborative effort by stakeholders in sub-Saharan Africa to identify priorities for nutrition research. They propose a new approach that stimulates demand from policy makers for research and holds them accountable for incorporating research into policy and practice.
50. BMC Health Services Research – How to improve patient retention in an antiretroviral treatment program in Ethiopia: a mixed-methods study
Yibeltal Assefa et al.;
Patient retention is one of the crucial indicators for monitoring and evaluating the performance of ART programs. It has been identified that suboptimal patient retention in care is one of the challenges of ART programs in many settings. ART programs have, therefore, been striving hard to identify and implement interventions that improve their suboptimal levels of retention. The objective of this study was to develop a framework for improving patient retention in care based on interventions implemented in health facilities that have achieved higher levels of retention in care.
51. International Health – Infectious disease research investments follow colonial ties: questionable ethics
Joseph R. Fitchett et al.;
International financing of infectious disease research by UK funding organisations follows former colonial ties. Funding institutions should review their funding policies to ensure that they also assist LMICs without colonial ties to address their disease burden. A global investment surveillance system is needed to map and monitor funding for international research and guide the allocation of scarce resources to reduce the global disease burden.
52. Community Mental Health Journal – Informal Home Care for Elderly in Belgium: A Study on the Features and Challenges of Informal Care at Local Level
Bart Criel, Veerle Vanlerberghe, Benedicte De Koker, Bieke Decraene, Elke Engels & Riet Waltens;
(Summary by ITM colleagues Bart Criel and Veerle Vanlerberghe on the relevance of this article for Low income countries)
It’s a universal phenomenon that households are by far the most important providers of care to sick family members. When individuals are disabled or sick for a prolonged period of time, they need more than “ad hoc” care. This care, provided by volunteers at least once a week outside the context of their normal occupation, is called ‘informal’ care. It is, however, only recently that the extent and intrinsic worth of informal care are being acknowledged and that the provision of informal care is explicitly recognized in health and social policies, certainly in High Income Countries (HICs). In Low and Middle Income Countries (LMICs), such an explicit recognition is still timid… The interest in informal care is however not without ambiguity and contradictions: there is a danger of over-romanticizing informal care on the one hand and the need to guard the notion against becoming a sort of (politically correct) makeshift strategy to cope with the deficits and costs in professional care on the other. In LMICs, the ongoing epidemiological transition will without any doubt boost the need for informal care at household level. Hence the relevance of reflecting on the place of informal care in a broader health policy perspective and on the policy instruments to optimize it. The paper by Criel et al. on informal home care in Belgium investigates the features and challenges of informal care for the elderly. The study indicates that informal care can be a substantial burden for the caregivers and that there is a need to reflect on how to organize support for them when they provide informal care for a sustained period of time. Finally, it highlights the need for a coordinated and integrated approach to elderly care in the local social and medical system and points to the crucial role of local authorities in this endeavor.
53. Health Policy & Systems research – Networking among young global health researchers through an intensive training approach: a mixed methods exploratory study
Lindsey M. Lenters et al.;
Networks are increasingly regarded as essential in health research aimed at influencing practice and policies. Less research has focused on the role networking can play in researchers’ careers and its broader impacts on capacity strengthening in health research. The authors used the Canadian Coalition for Global Health Research (CCGHR) annual Summer Institute for New Global Health Researchers as an opportunity to explore networking among new global health researchers.
54. Public Health Genomics: The impact of genomics on public health practice: the case for change.
Public health practice will not be able in the 21st century to ignore the impact of genomics, cell and molecular biology. It will need to take into consideration issues that include, among others: the complementary nature of social and biological models of disease, genetic exceptionalism, the readiness of public and patient to respond to genomic information, the relationship between individuals and populations, and concepts of population stratification. Health systems will need to adapt their practice and organisation to include new sequencing technologies, bio-informatic expertise and proper evaluation of genetic and molecular tests. Links with the commercial sector will increase in importance. The impact on developing countries cannot be ignored and will require special attention.
Global health announcements
- The Civil Society conference in Senegal is coming up on UHC (17 – 19 February) – see here.
- For an overview of all the HS Global Thematic Groups (as well as contact information, scheduled activities, see here).
- The World Bank pledged 2 billion for Myanmar.
- On Project Syndicate, Mahmoud Mohieldin (WB special envoy) examines the 4 pillars of financing that should underpin the post-2015 development agenda.
- You might want the read all about the latest battle between Sachs & Easterly (for example in FT, or in Foreign Policy), but you probably have better things to do.
- Claire Melamed on the accuracy of Development data (see the Guardian ).