Dear Colleagues,

 

Last week was ‘World no Tobacco day’ –  you might recall we also paid quite some attention to the theme of the day (with a nicepieceby EV 2014 Swati Srivastava). At first sight, raising taxes on tobacco seems like a no brainer, both for health reasons and to raise money for public health (and even pro-poor) related purposes, including forUHC financing.The trouble is, whenever I read that these taxes are very effective, “especially for the poor” – who indeed change their behavior to a higher extent than less poor people, I wonder where are the effective taxes for the rich? Taxes that actually change théir behavior too, if this behavior is not very healthy (if not for themselves, then perhaps for the planet). Taxes they actually feel, that would have a proportional (i.e. substantial) impact on their lifestyle (and on rather destructive investments too in some cases, but that’s another story).

Levies on business class plane tickets, even if for UNITAID,  for example, don’t really seem to keep a lot of the Very Important Frequent Fliers on the ground, they feel more like a token contribution. Melinda Gates, just to name one prominent example, described a hectic two weeks in a recent blog post, going fromGeneva to Berlin to London to Toronto. Might be good for the maternal health cause but not sure the same is true for the planet (and I’m being diplomatic here). And how about some of the global health people who actually signed the Lancet’s ‘Planetary Manifesto’, wholeheartedly even? Is it really not possible to set up more teleconferences or record Youtube videos and dedicate the money saved from plane tickets and fancy hotel rooms to a worthy global health cause?  Or how about raising effective taxes on Ryanair, Easyjet & Vueling tickets for the middle class that would actually make them change their holiday or other city trip plans ? Good for the planet and bad for Michael O’Leary’s pockets, can’t argue with that.

So the argument about raising taxes on tobacco because it’s very effective to change the poor’s behavior for the better is one you can only accept, in my opinion  (I make abstraction here of taxes and regulation to deter the young from smoking, which is obviously something you can’t argue with)  if you (1) provide alternatives to the poor that are equally satisfying (a cigarette can provide some comfort on an otherwise hard day) and (2)  WHO also starts equally forcefully arguing for effective taxes on middle, upper class & “1 %” behavior, lifestyles and/or investments that are not very beneficial to the planet’s health. For every escort whose services people with big pockets use, let them pay a hefty tax (50 % or so), for example to finance GAVI or the Global Fund, as chances are that they have been flying all over the globe before they have this hot encounter – with the exception of Hugh Grant or (if we want to be politically correct) George Michael, perhaps, who engage in more ecofriendly behavior. Every business class flight, every menu in a three star restaurant with ingredients from all over the world, … should be taxed to an extent that, if added up, rich people actually begin to think about it and “ration” their consumption.  The ideas of the New Economics Foundation are interesting in this respect – they try to measure how low wage workers (like cleaners in a hospital) that are numerous and thus cheap, can actually have a lot of (till now unrecognized) societal value, by preventing dangerous hospital acquired infections for example. And vice versa, people with fat pay checks can do a lot of damage, investment wise – which would require them to “pay” for their sins (although we don’t want to go as far as in the movie ‘Seven’).

For now, sin taxes reek of paternalism towards the poor, if one abstains at the same time from pushing the higher income quintiles towards more sustainable behavior. By the way, I’m fully aware that the argument that tobacco and other sin taxes are regressive, is enthusiastically used by industry. Nevertheless, it’s a bit like the pope saying to heterosexual people: ”have children, not pets”. We find that paternalizing, for good reason. But saying to a poor man, “too bad but if you want to smoke, you’ll pay for it”, while saying to a rich man “hey, you can go everywhere you want, and do whatever you want to do in this world, but if you could just give us some small change for a global health cause or to buy an ecological good conscience, you’re fine” isn’t the message WHO and other global health stakeholders should convey at this crucial point in time. If we want to make this a healthy planet, with healthy people who lead fulfilling lives, then we should all contribute, and first of all the 1 % or the 0.01 %. Which is why I’d argue for a new global health role model like Michael Bloomberg to actually adopt a humble Uruguayan president-kind of lifestyle, if he really wants to set a healthy example for the 21st century.  The same goes for overpaid football stars, actors & rock stars who often behave as if they own the place and feel like they have the right to do anything, anywhere – and preferably with a lucrative financial deal. An effective sin tax for Bono, Abramovich and Rooney, is more than overdue? As for Sepp Blatter, we probably have to come up with something really special.

Don’t get me wrong, I also want poor people, as well as other people, to lead healthier lives, with less soda drinks, less burgers, French fries, little or no smoking, … you name it. But we can only ask them to make this sacrifice – and let’s face it, it is a sacrifice to quit smoking or give up your daily cheese burger if you’re used to them – if the not so poor make comparable lifestyle sacrifices. Right now, some of us have the feeling that the game is rigged – and some WHO priorities would seem to reflect this. In other words, a WHO that lives up to its Alma Ata reputation should play a crucial role in making the lifestyle of all people healthier and sustainable, from all income deciles, post-2015. If this smells like socialism, so be it.

 

In this week’s guest editorial, Charl Swart (UWC) reflects on the new government in South Africa, again an ANC government, and its likely health impact. A Lancet Letter in this week’s issue also dwelled on one of the contentious public health points in South-Africa, liquor advertising. The stakes are high in South-Africa, just like anywhere else.

 

 

 

Enjoy your reading.

 

The editorial team

 

 

Editorial

 

A healthier South Africa through continued ANC dominance?

 

Charl Swart (PhD Political Science, Post-Doctoral Fellow, School of Public Health, University of the Western Cape)

 

On the 7th of May 2014, South Africans took to the polls in the country’s 5th national democratic election. The African National Congress (ANC) recorded its 5th victory securing 62.15% of the national vote. The Democratic Alliance (DA) secured 22.23% of the national vote, the most ever by the party confirming further its status as the official opposition. Although the ANC secured substantially fewer seats in the National Assembly than in any previous term, the party still holds enough seats to continue its parliamentary dominance. Therefore, despite stronger opposition and a decline in votes, the ANC remains firmly in power. What, if any, are the implications of continued ANC dominance for health outcomes and the organization of the health sector in South Africa?

South Africa’s health indicators illustrate the enormous health challenges facing the country. The health challenges include a quadruple burden of disease as well as addressing the legacies of colonialism and apartheid. The first signs from the newly elected ANC have, thankfully, been positive. The highly respected Aaron Motsoaledi, under whose supervision the South African Anti-retroviral (ARV) programme has become the largest in the world, has been retained as the Minister of Health. The minister and government have stated their commitment to enlarging the ARV programme to eventually include 4.6 million people on treatment. Continuity in the top government health position and a commitment to the ARV programme is a great step forward considering the history of ‘AIDS-denialism’ under previous regimes.

Similarly the (previous) government had committed itself to combating the TB epidemic by dramatically scaling up the Xpert MTB/RIF diagnostics testing system to the largest of its kind in the world. In the same vein, government has taken decisive steps to combat the three other disease burdens, namely maternal and child mortality, non-communicable diseases and violence and injury. The increased government commitment to these elements comes in the wake of South Africa’s regression in MGDs 4 and 5. Political continuity is thus probably a good thing for the response to these challenges.

A further positive element for the health sector can be found in the continued government commitment to the National Development Plan (NDP) launched in 2011. The NDP includes a chapter dedicated to improving health and health systems in South Africa. However, the commitment to  “radical socioeconomic transformation policies and programmes” captured under the NDP has been met with some concern due to the economic realities in South Africa. The proposed accelerated implementation of black economic empowerment, land reform and other forms of empowerment may further adversely affect the already struggling economy. Nevertheless, the commitment to a development plan, which includes a dedicated health focus, can be viewed as a positive step towards addressing South Africa’s health challenges.

The retention of the Minister of Health also bodes well for the implementation of the proposed National Health Insurance (NHI) introduced as a green paper late in 2011. Although the NHI has reached the pilot stage, there is still uncertainty about many aspects thereof. Despite this uncertainty, there is consensus that the South African health system is in need of restructuring.  My greatest concern is that the government views the NHI as a catch-all concept for much needed health systems reform and in doing so fails to successfully implement the NHI.

A further positive health development has been the retention of Rob Davies as minister of the Department of Trade and Industry. His retention may facilitate the speedier creation of a South African IP policy, which could increase access to cheaper generic drugs.

Whether the developments highlighted will translate into concrete improvements for the health of South Africans remains to be seen. The government is however displaying a commitment to pro-actively taking on South Africa’s health problems on the levels of rhetoric, leadership, policy and programmes. This commitment is unfortunately not always clear-cut, as illustrated by the issues and problems confronting the NHI. The results of the recent elections, ministerial leadership continuity and continued commitment to improving the health system is, at the very least, a step in the right direction.

 

 

 

 

Highlights of the week

 

1.    WHO Bulletin (June issue) – Collection of articles on BRICS and global health

http://www.who.int/bulletin/volumes/92/6/en/

The new WHO Bulletin issue provides a number of articles on BRICS and global health.  Many of them are must-reads.

 

We especially want to draw your attention to the perspective by Martin McKee et al, BRICS’ role in global health and the promotion of universal health coverage: the debate continues. In the piece, they argue that ‘a grouping of countries that makes sense in the coordination of global macroeconomic policy cannot be assumed to be relevant in the development of any global health policy’. Anyway, the debate continues.

 

But check out also the other articles and perspectives, including an article by Ilona (sometimes a first name provides enough info) on the BRICs’ contributions to the global health agenda, a  Perspective by Victoria Fan, ‘Tracking the flow of health aid from BRICS countries’, the Editorial (BRICS and global health)  and an interview with Andrew Harmer, on whether the BRICS countries are a new force in global health.

 

By the way, the latest I heard on the BRICS is that they’re trying to open up to Argentina. But with the World Cup coming up, that’s probably just common sense.

 

2.    BMJ (news) – Obama administration highlights health benefits of carbon plan

Michael McCarthy;

http://www.bmj.com/content/348/bmj.g3734

Rather important news on the climate front, this week, with announcements coming both from the US and China, within the space of a few days. “In an apparent effort to make its plan to cut US power plant carbon emissions more relevant to the average person, the Obama administration has focused firstly on the plan’s purported health benefits and secondly on its effects on climate change.” So the Obama administration frames the climate challenge now, first and foremost, as a challenge with health “win-wins”, if addressed properly.  Not everybody is convinced about the importance of the ‘breakthrough’, but it’s a start, I guess. I personally agree with the Economist’s assessment of the announced measures, coming one week before important climate talks in Bonn.

 

As for the Chinese, this Yale Global article  is a good overview read, but see this NYT blog article for some nuancing of the ‘China cap’ announcement. It’s not (yet?) an official government position.

 

3.    Open Working Group SDGs (zero draft)

http://sustainabledevelopment.un.org/focussdgs.html

 

The UN working group devising the sustainable development goals has pared down its list of proposed target areas from 19 to 16, raising hopes of a more concise framework for challenges such as eradicating poverty, ensuring equality and tackling climate change.  For Guardian coverage, see here.  CGD ‘s Charles Kenny also assessed the latest draft, and came to the conclusion ‘never ask a Commission to write poetry’.

 

For our purpose, you probably want to focus on proposed goal 3, ‘attain a healthy life at all ages’. Under it you find 9 suggested SDG health targets, with UHC being just one of them. And yes, if all goes well, we will end HIV/AIDS, tuberculosis, malaria, and neglected tropical diseases by 2030!   (let’s all think of ourselves as global health Terminators from now)

 

4.    World Bank (paper) –  Progress Toward the Health MDGs: Are the Poor Being Left Behind?

Adam Wagstaff et al.;http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2014/05/28/000158349_20140528155646/Rendered/PDF/WPS6894.pdf

I personally prefer Adam’s witty blog posts, but I guess  the scientists among you differ. Anyway, a must read. This paper looks at differential progress on the health MDGs between the poor and better-off within countries. In most countries, the poorest 40 percent have made faster progress than the richest 60 percent. On average, relative inequality in the MDG indicators has been falling. However, the opposite is true in a sizable minority of countries, especially on child health status indicators, and on some intervention indicators. Absolute inequality has been rising in a larger fraction of countries and in around one-quarter of countries, the poorest 40 percent have been slipping backward in absolute terms.

 

5.    Plos Medicine (Policy Forum) – HIV Treatment-as-Prevention Research at a Crossroads

Till Bärnighausen et al.;

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001654;jsessionid=E7D7DEF5FFBB3DA5712A7C6CFF14DD6B

In light of changing WHO guidelines for HIV treatment Till Bärnighausen and colleagues consider how large-scale HIV treatment-as-prevention trials can be adapted so that they can remain viable. On the difficult trade-offs between science and policy…

 

UHC & post-2015

 

6.    Global health watch – Health in the post-2015 development agenda

David Legge;http://www.ghwatch.org/sites/www.ghwatch.org/files/Legge(2014)HealthPost2015(TWResurgence283-284).pdf

Excellent analysis by this PHM watcher (must-read). If we want to reach health for all, we need to tackle the root causes of the global health crisis, including the global economic and political architecture, as the starting point for designing the post-2015 development agenda. But there’s much more in this article, so do read it!

 

 

7.    WHO Bulletin (Editorial) – Making fair choices on the path to universal health coverage

Trygve Ottersen, Ole F Norheim on behalf of the WHO Consultative Group on Equity and Universal Health Coverage. http://www.who.int/bulletin/volumes/92/6/14-139139/en/

From the new WHO Bulletin issue, an editorial giving some key messages of the final report of the WHO Consultative Group on Equity & UHC, entitled Making fair choices on the path to universal health coverage, which was launched in London on 1 May 2014.

8.    Global Health Check – Let’s be clear: UHC must mean health coverage for all

Charlotte Soulary; http://www.globalhealthcheck.org/?p=1618

Oxfam cannot possibly support the coverage target proposed by the World Bank and WHO. Let’s take a step back. For Oxfam, UHC is anchored in the right to health and an answer to people’s asks for Health For All. For Oxfam, UHC means Health Coverage For All. Therefore, we need a strong commitment of the international community in the post 2015 agenda on this goal. By stating the coverage target at 80%, the monitoring framework gives to the international community the signal that UHC cannot, in fact, be universal, because it is unrealistic. We disagree.”

We also want to draw your attention to another nice blog post  (by Luis Ortiz Hernandez) on Global Health Check,‘Different roads to UHC in Latin America’, which compares Costa Rica & Chile, based on a new study. The post criticizes ‘the continued focus on insurance schemes in the push for UHC, which all too often includes significant private sector participation.’

 

9.    Global Public health – Taking ICPD beyond 2015: Negotiating sexual and reproductive rights in the next development agenda

Françoise Girard;

http://www.tandfonline.com/doi/full/10.1080/17441692.2014.917381#.U42v7Pl_uuI

On the twentieth anniversary of the International Conference on Population and Development (ICPD), activists, governments and diplomats engaged in the fight for sexual and reproductive health and rights (SRHR) are anxious to ensure that these issues are fully reflected in the post-2015 development agenda. In inter-governmental negotiations since 1994 and particularly in the period 2012–2014, governments have shown that they have significantly expanded their understanding of a number of so-called ‘controversial’ issues in the ICPD agenda, whether safe abortion, adolescent sexual and reproductive health services, comprehensive sexuality education or sexual rights. As in the past and in spite of an increasingly complex and difficult multilateral environment, countering the highly organised conservative opposition to SRHR has required a well-planned and determined mobilisation by progressive forces from North and South. (must-read!!)

10.BMJ (blog) – UHC back on the global health agenda

Kevin Watkins; http://blogs.bmj.com/bmj/2014/06/05/kevin-watkins-universal-health-coverage-back-on-the-global-agenda/?g=widget_default

Kevin Watkins (ODI) calls for UHC with ‘progressive universalism’. See also a similar blog post by him on the ODI website (and guess who already replied to Kevin… – somebody should come up with a UHC equivalent to the “Unabomber”).

ODI published a series of global health reports this week. Their series of case studies and related material looks at a range of stories of remarkable progress in different areas of health, looking at how progress has been made, why it is important and what lessons can be drawn from these stories. Four case studies (on Nepal, Cambodia, Sierra Leone, Mozambique), two on neglected tropical diseases, one on maternal health and one on primary health care are available to download. See here.

 

Global Health Initiatives

 

 

Not much news on this front this week – GAVI  thanked  Norway for its support to the polio endgame strategy. Australia alsopledged some money – to GPEI.

 

11.Health Affairs – ‘Big Push’ To Reduce Maternal Mortality In Uganda And Zambia Enhanced Health Systems But Lacked A Sustainability Plan

Margaret E. Kruk et al.;http://content.healthaffairs.org/content/33/6/1058.abstract

In the past decade, “big push” global health initiatives financed by international donors have aimed to rapidly reach ambitious health targets in low-income countries. The health system impacts of these efforts are infrequently assessed. Saving Mothers, Giving Life is a global public-private partnership that aims to reduce maternal mortality dramatically in one year in eight districts in Uganda and Zambia. The authors of this article evaluated the first six to twelve months of the program’s implementation, its ownership by national ministries of health, and its effects on health systems.

 

Infectious Diseases

 

12.Lancet (World Report) – Uganda takes “another step backward” with HIV bill

Sharmila Devi; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60941-7/fulltext

Uganda recently passed a highly controversial HIV Prevention and Control Act that experts say will set back efforts to control HIV/AIDS in the country. Sharmila Devi reports. (covered before already, but a good overview of recent events in Uganda)

Meanwhile, the UN is facing plenty of criticism over the inauguration as president of its general assembly of Uganda’s foreign minister, Sam Kutesa, just four months after that country enforced a widely denounced anti-gay law.

13.Lancet Global health (Correspondence) – Assembling an effective paediatric HIV treatment and prevention toolkit

Lucie Cluver et al.; http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70267-0/fulltext

The world has woken up to the importance of antiretroviral treatment and HIV prevention for children and adolescents. But stand-alone clinical services are insufficient: uptake of antiretroviral therapy and adherence remain suboptimal, and adolescent HIV incidence remains high. To improve paediatric survival, several psychosocial and economic barriers to treatment and prevention must be overcome. Such barriers include depression and stigma, which inhibit treatment adherence; psychological and community barriers to the prevention of vertical transmission; and severe poverty and child abuse, which are risk factors for transactional sex in adolescent girls.”

14.BMJ (news) Novel drug combination for tuberculosis to be tested across 50 sites

Sanjeet Bagcchi; http://www.bmj.com/content/348/bmj.g3535

A new phase III clinical trial of a novel combination of three drugs for tuberculosis  is set to be launched by the end of the year in 50 sites across Africa, Asia, eastern Europe, and Latin America, the charity TB Alliance has said. The STAND (Shortening Treatments by Advancing Novel Drugs) trial will evaluate the drug combination known as PaMZ, which contains two candidate drugs that are not yet licensed for the treatment of tuberculosis, PA-824 (Pa) and moxifloxacin (M), and one existing antituberculosis drug, pyrazinamide (Z).”

Meanwhile, the Guardian reports a vaccine for leprosy is being developed by American researchers and is set for toxicology tests towards the end of 2014 and for phase I clinical trials in human volunteers by 2015.

15.Guardian – New wave of drug-resistant malaria threatens millions

http://www.theguardian.com/society/2014/jun/05/new-wave-drug-resistant-malaria-burma

Scientists in south-east Asia call for a “pre-emptive strike” in Burma jungle to contain resistant strain spreading to India and Africa. (Bring on Putin and Dubya !)

16.Equinet (editorial) – Antibiotic resistance – are we driving our own extinction?

Constance GK Walyaro; http://equinetafrica.org/newsletter/index.php?issue=160#1

From the new Equinet newsletter. Focusing on the (dire) antibiotic resistance (surveillance) situation in Africa.

17.Lancet (Editorial) – Ebola in west Africa: gaining community trust and confidence

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60938-7/fulltext

This Lancet Editorial explores why there has been an Ebola surge again in west Africa, somewhat surprisingly (many observers thought the outbreak was in decline) and what needs to be done.

18.NYT – Fighting Deadly Disease, With Grains of Rice

Yuriko Naganon;http://www.nytimes.com/2014/06/02/business/international/fighting-deadly-disease-with-grains-of-rice.html?_r=2

Yoshikazu Yuki and other researchers at the University of Tokyo are bioengineering rice in a bid to turn it into an easy and low-cost storage and delivery medium for drugs to combat common infectious and contagious illnesses. The immediate target is to develop new treatments against cholera and rotavirus, two causes of severe and often fatal diarrhea.

19.Scidev.net – Focus on migration: the downside of polio vaccine checks

http://www.scidev.net/global/disease/analysis-blog/focus-on-migration-the-downside-of-polio-vaccine-checks.html

In response to the cross-border spread of polio in Asia and Africa during the typically low-transmission season of January-April, the WHO has called for a coordinated international response. A key recommendation is making polio-vaccination documents mandatory for anyone travelling out of ten countries in these regions where polio has been detected recently.  But mandating vaccination certificates could cause (discrimination) problems for migrants. Vaccination facilities for refugees could be one alternative solution.

20.NEJM – Evidence for Camel-to-Human Transmission of MERS Coronavirus

Esam Azhar et al.; http://www.nejm.org/doi/full/10.1056/NEJMoa1401505?query=featured_home

It’s the camels, stupid! Camels are a source of the MERS coronavirus, it appears.

NCDs

 

21.Globalization & Health (Review) – The role of law and governance reform in the global response to non-communicable diseases

 

Roger S Magnusson and David Patterson; http://www.globalizationandhealth.com/content/10/1/44/abstract

Addressing NCDs and their risk-factors is one of the most powerful ways of improving longevity and healthy life expectancy for the foreseeable future – especially in low- and middle-income countries. This paper reviews the role of law and governance reform in that process.

22.BMJ (Blog) – Global NCDs: the second in a series of reflections on NCDs

KM Venkat Narayan;  http://blogs.bmj.com/bmj/2014/06/02/k-m-venkat-narayan-global-non-communicable-diseases-the-second-in-a-series-of-reflections/?g=widget_default

Very nice series. As you might recall, Narayan’s first reflection, was: “Keep the growth of NCDs in perspective by acknowledging the incredible positive changes in life expectancy and economic wellbeing the world over—thanks to development and mechanization.” In the second one, he acknowledges the increasing convergence of health and economic challenges worldwide .

23.CGD – What’s New in Tobacco Control?

William D. Savedoff; http://www.cgdev.org/blog/what%E2%80%99s-new-tobacco-control

World No Tobacco Day prompted William Savedoff to ask: “What’s new?” Not that much, unfortunately, he argues. Nice blog post though.

24.World Obesity (zero draft) – Recommendations towards a Global Convention to protect and promote healthy diets

http://www.worldobesity.org/site_media/uploads/convention_supporting.pdf

This set of recommendations towards a Global Convention to protect and promote healthy diets has been developed to encourage policy makers to build on the work of the United Nations to combat obesity and non-communicable diseases (NCDs). It has been modelled on the WHO Framework Convention on Tobacco Control (WHO FCTC).

25.Guardian – Fructose in Coke, Pepsi and other US sodas – the industry fightback?

Sarah Boseley; http://www.theguardian.com/society/the-shape-we-are-in-blog/2014/jun/05/obesity-food-and-drink?CMP=twt_gu

Are we witnessing a new episode in “Fructose gate”? A new study raised – not for the first time – concerns on high fructose levels in sodas but industry is fighting back, including by ‘research’.

26.Lancet Editorials on Diabetes & cancer

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60937-5/fulltext

Prevention of type 2 diabetes is of crucial importance, this Lancet editorial argues. This week’s Lancet issue pays quite some attention to diabetes, with content chosen to coincide with the 74th scientific sessions of the American Diabetes Association (ADA) on June 13—17, in San Francisco.

 

Another Lancet editorial welcomes new guidelines for the planning and development of population-based cancer registries in LMICs produced by the International Agency for Research on Cancer (IARC), WHO, and the International Association of Cancer Registries.

 

27.Lancet (comment) – Global implications of cancer and diabetes

Yuankai Shi et al.;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60886-2/fulltext?_eventId=login

 

Overall, the link between diabetes and increased cancer incidence and progression is firmly established, although the underlying biological mechanisms are not well understood. The rapidly increasing global diabetes epidemic has several important implications for cancer occurrence and prevention.”

 

Reproductive, maternal, neonatal & child health

 

28.Lancet – Offline: Canada’s big promise

 

Richard Horton ;

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60927-2/fulltext

Reflecting on Harper’s pledge of 3.5 billion for maternal & child health last week in Toronto, Horton concludes: « What, then, should we conclude about Canada’s place in global health? Prime Minister Harper’s commitment to mothers and children is generous and sincere. He is the only G7 leader to make maternal and child health his government’s top international development priority. But we should also say firmly and respectfully that the scope of his commitment remains too narrow, that he needs to deepen his financial promise still further if he is to meet the international commitments his nation has signed up to, and that his actions in other domains of science and development seem disappointingly contrary to the values he was garlanded for last week. »  You might want to re-read ITM’s Rachel Hammond on the same issue, who largely agreed with Richard Horton (or is it the other way around?)

29.UNFPA – State of the world’s midwifery 2014

http://unfpa.org/public/home/pid/16021

Annual report on the “unsung heroes of global health”.Midwives can prevent about two thirds of deaths among women and newborns. And midwives deliver much more than babies: They are the connective tissue for communities, helping women and girls care for their health, from family planning all the way through the postpartum period.

UNFPA and partners produced this 2014 edition of The State of the World’s Midwifery report to shed light on the important role of these healthcare professionals. The report shines a light on the vast shortage of midwives across low- and middle-income countries, and on the progress made since our inaugural report in 2011. For some coverage, see also Tom Murphy on Humanosphere.

 

30.UN News – ‘It is time to act,’ Ban declares at launch of video campaign to end sexual violence

http://www.un.org/apps/news/story.asp?NewsID=47948#.U5GbdvnV-IN

Speaking at the launch of a video campaign on ending sexual violence through gender equality, Secretary-General Ban Ki-moon said  … that it is time to demand action to eliminate a scourge that harms millions of women and girls around the world.”

Next week,  a global summit will be held on the issue. And that it’s sorely needed, as was evidenced again this week with horrific news coming from India – a gang rape of two Dalit girls (who were then hanged). Besides highlighting rampant sexual violence in India, the case was also linked to the lack of toilets, see AP. And yes, ‘boys will be boys’ is fast becoming a thing of the past, fortunately, even if some Indian politicians still think otherwise.

31.WHO Bulletin (Early online) – Success factors for reducing maternal and child mortality

Shyama Kuruvilla et al.; http://www.who.int/bulletin/online_first/BLT.14.138131.pdf?ua=1

Reducing maternal and child mortality is a priority in the MDGs, and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women’s and Children’s Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and

country-specific reviews in 10 fast-track countries for MDGs 4 and 5a.

 

In other women’s news, Devex reported that UN Women works increasingly with the private sector to address women’s and girls’ issues.

32.Reproductive health matters – A three-pronged approach to advocacy for sustainable national funding

Karen Hoehn;

http://www.sciencedirect.com/science/article/pii/S0968808014437698

By and large, the financial commitments 179 nations made to the family planning and reproductive health components of ICPD in 1994 were not kept. While donors ramp up support for civil society advocacy in developing countries, in hopes of improving national funding and outcomes, recent trends in advocacy evaluation leave unanswered the broader question of whether/how international campaigning can appropriately and effectively strengthen national-level decision-making. This article provides background regarding the challenges in monitoring developing country contributions; summarizes current donor initiatives to strengthen civil society advocacy; and reviews theoretical approaches to assessing advocacy.

 

Human resources for health

 

33.CGD (essay) – The WHO Global Code of Practice: A Useful Guide for Recruiting Health Care Professionals? Lessons from Germany and Beyond

Steffen Angenendt et al.; http://www.cgdev.org/sites/default/files/who-code-lessons-from-germany_1.pdf

More and more countries are recruiting doctors and nurses overseas, unleashing global debates on the proper regulation health worker migration. WHO has advanced a “Global Code of Practice” on health worker recruitment. Numerous countries are internally debating adoption of the Code—formally or in practice—including the United Kingdom, Germany, the United States, Canada, and Australia. A pillar of the Code discourages active recruitment from countries with a “critical shortage” of health workers. The authors of this essay show that the WHO definition of “critical shortage” has little medical or statistical basis, and that the Code’s contradictions pave the way for arbitrary and counterproductive implementation. As an alternative to categorical bans on recruitment from entire countries, they propose alternative frameworks for approaching recruitment regulation. They offer examples of these global lessons from the German context.

34.Health workers 4 all – European call to action

https://interact.healthworkers4all.eu/pages/viewpage.action?pageId=4620385

We hereby call on European and national decision-makers to show leadership in this issue (i.e. the health workforce) and to apply a coherent approach to the sector policies currently in place in order to develop and maintain sustainable health workforces both in and outside Europe. This Call to Action provides recommendations to EU institutions and member states in achieving this aim.

Now let’s see whether Juncker, Lagarde or any other “white rabbit” found by Merkel & Cameron get this on their plate.

 

Health Policy & Financing

 

35.Forbes – Why has philanthropy failed to take off in China?

Yanzhong Huang; http://www.forbes.com/sites/yanzhonghuang/2014/05/30/why-has-philanthropy-failed-to-take-off-in-china/

Gambling still prevails over philantropy in China, just have a look in Macao. For a more profound analysis of why philanthropy has failed to take off so far in China, see this CFR fellow.

36.Oxfam – Jamie Love’s Next Big Idea: Making the WTO into a force for good in Public Health

 

Duncan Green;

http://oxfamblogs.org/fp2p/jamie-loves-next-big-idea-making-the-wto-into-a-force-for-good-in-world-health/

It sounds too good to be true – turning the WTO into a Force for good in Public health, but Jamie Love (from Knowledge Ecology International) has an interesting idea about how to make this happen.   ( might give directors some ideas, for turning the WTO public health saga into a Star Wars series)

 

37.Impatient optimists – Bold ideas for Big shifts in Global Health

Steven Buchsbaum;

http://www.impatientoptimists.org/Posts/2014/06/Bold-Ideas-for-Big-Shifts-in-Global-Health

Bold, Big, Grand, innovative, ground breaking,  … You guessed it, this must be a disruptive Gates Foundation blog post.

 

In the post, Buchsbaum announces the Phase 1 and Phase 2 winners of the 12th round of the Grand Challenges Explorations grants – some for $100,000 for Phase I grants and others for $1 million for phase II grants – to fund scientific work on unproven ideas that could potentially be ground breaking in solving major global health and development problems.

 

38.Intrahealth International – Youth Can Take the Lead in Health Governance and Accountability

Kate Tulenko & A A Foster; http://www.intrahealth.org/blog/youth-can-take-lead-health-governance-and-accountability#.U5B8A_nV8pA

Very interesting blog post. Reporting on youth at the World Health Assembly, the authors of this blog post argue: “The global health community will continue to support young voices. But when youth are able to report the impact they have had, then will they be taken more seriously and have true equal seats at the table.”  Their view is in line with an opinion expressed by Dr. Anders Nordstrom, Swedish Global Health Ambassador and former WHO Assistant Director General. “Dr. Nordstrom felt that young people’s  main value added would be their accomplishments rather than their advice. Rather than recommendations on how to do things better, contributions that actually make things better are always valued and far more sustainable.”

Not sure everybody agrees.

 

Global health announcements

 

The New Voices in Global Health (NVGH) is a competitive abstract submission and selection program designed to highlight important research, policy and advocacy initiatives of new and future leaders in global health, and empower participants with global health advocacy skills. Selected participants will have the opportunity to make a presentation at the World Health Summit 2014.

  • Emerging Voices 2014: this week the distance coaching phase started for the Emerging Voices 2014 who will have their say at the Cape Town  Health Systems Research Symposium (Sept-Oct 2014). And mind you, unlike Obama and co, we even have a Russian on board this time! Welcome Vladimir, and all other EVs!
  • New Alliance Call: The Alliance, in collaboration with the WHO Department of Service Delivery and Safety (SDS), Canada’s International Development Research Centre (IDRC) and the Rockefeller Foundation, is launching a new research program focused on the role of non-state providers in strengthening health systems towards the achievement of UHC. See here.
  • For the latest HS Global newsletter, see here. With info on satellite sessions in Cape Town, a webinar on Social Media capacity building, thematic groups, etc.

 

 

Research

 

39.Global Public Health – Complexity versus the technical fix or how to put sexuality back into sexual health

Barbara Klugman;

http://www.tandfonline.com/doi/abs/10.1080/17441692.2014.917196#.U42ubvl_uuI

Sex can be fairly complex, I guess for once we all agree. But this article is not going into that.  Instead, ‘These reflections consider the failure of the public health establishment to invest in evaluations of interventions that support community groups to shift individual and community behaviours in favour of sexual well-being, sexual rights and sexual satisfaction. This article queries the willingness to invest substantially in researching technical interventions without simultaneously assessing their potential unintended consequences for sexual health well-being; the associated lack of will to invest in social research is also queried. The paper proposes that part of the challenge is the research paradigm that fears complexity, despite growing recognition that sexuality and sexual health are products of a complex intersection of factors, and they require research and evaluation methodologies that recognise such complexity.”

 

40.Health Research Policy & Systems – series on institutional capacity for health systems research in East and Central African schools of public health

http://www.health-policy-systems.com/

With a number of articles.

 

We also want to draw your attention to an  articlein the same journal, “Scientometric trends and knowledge map of global health systems research”, not because it’s rocket science, but because Martin McKee comes out as the ‘King of global health systems research’. King Kong, if you want.

41.WHO – Social determinants of mental health

http://apps.who.int/iris/bitstream/10665/112828/1/9789241506809_eng.pdf?ua=1

This publication is part of a broader series of thematic papers, co-produced by the World Health Organization and the Calouste Gulbenkian Foundation’s Global Mental Health Platform. The series consists of four publications and covers the following topics. Innovation in deinstitutionalization: a WHO expert survey; Integrating the response to mental disorders and other chronic diseases in health care systems; Social determinants of mental health; Promoting Rights and Community Living of Children with Psychosocial Disabilities (forthcoming).

 

42.AfroAids Info – Surveillance of mother-to-child transmission of HIV risk or rate in Sub-Saharan Africa

Alliance Nikuze;

AfroAidsInfo;

Alliance is an EV 2013. Monitoring and evaluation of Prevention of Mother-To-Child Transmission of HIV interventions in programmatic settings is part of the strategy towards elimination of new paediatric HIV infections. MTCT risk/rate is one of the recommended outcomes and its validity depends on the data collected (testing, weaning, death, loss to follow-up) as well as the statistical methods used. A systematic review conducted in 2013 highlighted that these data are not always collected, particularly weaning, and that the most appropriate analytical tools are not usually used. To improve estimation of MTCT risk/rate, PMTCT programmes should collect quality data on feeding choice and age at weaning.

 

Check out also another recently published article from Alliance, ‘Risk of Mother-To-Child Transmission of HIV among Women on Triple Antiretroviral Drugs in Sub-Saharan Africa: Limitations of a Systematic Review and Meta-Analysis of Observational Studies’.

 

43.TMIH – Community-supported models of care for people on HIV treatment in sub-Saharan Africa

Marielle Bemelmans et al.;

http://onlinelibrary.wiley.com/doi/10.1111/tmi.12332/abstract

Further scale-up of ART to those in need while supporting the growing patient cohort on ART requires continuous adaptation of healthcare delivery models. The authors of this article describe several approaches to manage stable patients on ART developed by Médecins Sans Frontières together with Ministries of Health in four countries in sub-Saharan Africa.

 

44.Speaking of Medicine – When 2 Become 1: Integrating the Health Care needs of Mothers and Infants, the New MHTF-PLOS Collection on Maternal Health

http://blogs.plos.org/speakingofmedicine/2014/06/02/2-become-1-integrating-health-care-needs-mothers-infants-new-mhtf-plos-collection-maternal-health/#more-17333

In November 2013, PLOS Medicine and the Maternal Health Task Force (MHTF) called for submissions to Year 3 of the MHTF-PLOS Collection on Maternal Health. This week, they launched the Year 3 Collection and included 10 research articles recently published by PLOS.

45.Gates Foundation – Methods for Economic Evaluation Project (MEEP) : Final Report

http://www.york.ac.uk/media/che/documents/MEEP%20report%20final%20PDF.pdf

From January already. The final report of a partnership between Bill and Melinda Gates Foundation, NICE International,  the Health Intervention and Technology Assessment Program (Thailand), and the University of York, Centre for Health Economics.

Global health videos

 

  • An AIDS free generation – which generation might that be? See  here for the video. A talk from former UN Special Envoy for HIV/AIDS in Africa, Stephen Lewis.

 

 

Miscellaneous

 

46.EC Communication – A decent Life for all: from vision to collective action

http://ec.europa.eu/environment/international_issues/pdf/2_EN_ACT_part1_v5.pdf

The EU and its Member States have emphasized their commitment to work

inclusively with all partners and stakeholders to build consensus for a new transformative post-2015 agenda. In the ongoing work at the UN Open Working Group on SDGs, the EU has been providing, and will continue to provide, input on the way forward through interventions by the EU and by the Member States that are members of the OWG.

This Communication builds on the existing EU position, as laid down in the Council

Conclusions of June 2013. The document also features a health target, with UHC as just one of 4 potential target topics (bring on the UHC Unabomber!).

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