Dear Colleagues,

Now that the holidays are over – at least, for me that’s the case – many of you might start to prepare for the Beijing Health Systems Research symposium. To get already a bit in the mood, we would like to recommend the Foreign Policy cover story on the cities of the future, with heavy emphasis on Chinese cities (many of whom are among the most dynamic cities in the world). Of course, Beijing is no average Chinese city, but you will get a feel anyhow. And if you want to know what a Chinese big city really feels like in summer, check out my own laowai perspective.

In this week’s guest-editorial, Ildikó Bokros introduces the Global Health Observer website to you. Ildikó joined our editorial team a few months ago as online media steward – we’re happy to have again a woman on board. The GHO website is intended for dissemination of the INCO-GHI project.

Enjoy your reading.

Kristof Decoster, David Hercot, Ildikó Bokros, Basile Keugoung & Wim Van Damme




Introducing the Global Health Observer


by Ildikó Bokros, online media steward, editor IHP newsletter

As part of the online dissemination plan at the Public Health department of ITM, we have recently set up a website to support an INCO-GHI project that has entered its last phase in 2012. This EU-funded research project in four Southern African countries (Angola, Lesotho, Mozambique and South Africa) aims to understand how the rise of global health initiatives has impacted the architecture of development partnerships and country-level health systems’ functions. The core of the study is to research how changes in development partnerships practices and the emergence of Global Health Initiatives (GHIs) have impacted on health systems at the global, national and district level. The study is focusing on the effects of several large GHIs (PEPFAR, Global Fund, …) on aid recipient sub-Saharan African countries.

Read the rest of the editorial here


Neoliberalism and global justice


1.    International Journal for Health Services – Neoliberalism is Bad for Our Health

Gavin Mooney;

Let us kick of this week’s newsletter with a message that is not exactly ‘news’ to most of you: “Neoliberalism is bad for our health”. But you can’t repeat it enough, if you ask us. Gavin Mooney examines some of the concerns that arise from the impact of neoliberalism on health and health care. “He also examines the way that global institutions such as the WHO and the WTO, having been captured by neoliberalism, fail to act decisively to reduce poverty and inequality and thereby do all too little to promote population health at a global level.” Recommended reading for Paul Ryan.


2.    Health Policy & Planning – Interrogating scarcity: how to think about ‘resource-scarce settings’

Ted Schrecker;

The idea of ‘resource scarcity’ permeates health ethics and health policy analysis in various contexts. However, health ethics inquiry seldom asks—as it should—why some settings are ‘resource-scarce’ and others not. In this article Ted Schrecker describes interrogating scarcity as a strategy for inquiry into questions of resource allocation within a single political jurisdiction and, in particular, as an approach to the issue of global health justice in an interconnected world.  (some more recommended reading for Paul Ryan).
We also would like to draw your attention to an excellent Epianalysis blog post on the number of lives that could be saved if offshore tax havens were closed. Value for money, it is safe to say. (Recommended reading for Mitt)




3.    Lancet (editorial) – Mexico: celebrating universal health coverage

This Lancet editorial states “Crucially, Mexico has demonstrated how UHC, as well as being ethically the right thing to do, is the smart thing to do. Health reform, done properly, boosts economic development.”   In a Health Policy paper a group of public health experts – including Julio Frenk – highlight the progress that Mexico has made towards achieving UHC, and discuss some of the healthcare challenges that lie ahead for this country.

A recent JAMA viewpoint (by Lawrence D. Gostin) explores whether the American Supreme Court’s decision ensures the ACA’s economic viability and might fulfill the promise of universal coverage.




4.    Smart Global Health – Final reflections on AIDS 2012

J. Stephen Morrison; http://www.smartglobalhealth.or

J. Stephen Morrison, Senior Vice President & Director of the Global Health Policy Center at CSIS, gives his (four) final reflections on IAC. He sees two camps now, the ‘realists’ and the ‘optimists’, with very influential people in both camps – check out whom he situates in which camp. As for the ‘pessimists/cynics’, they were probably watching the Simpsons at home.

Bob Roehr, a freelance journalist who wrote a BMJ Feature article, “The slow and unknown route to a cure for AIDS” most probably belongs to the realist camp.

CGD fellows wrote a couple of interesting HIV related blog posts this week, not just on IAC, with a post on two sessions on financing universal access to ART, but also on the possible role of cash transfers, and whether allocating money ex ante (as now seems the Global Fund’s new aim) really implies less country ownership.

The Global Fund Observer published a new issue, with among others an article on two new reports documenting the adverse impacts of cancelling round 11.


5.    Science Speaks – US Funding for Global AIDS and TB for the Next Fiscal Year?

Christine Lubinski;

“With Congress adjourned until after Labor Day and not a single funding bill for the federal fiscal year beginning October signed into law before the recess even began, the virtual standstill of legislative action could have a mixed impact on global health funding.”


6.    TMIH (Editorial) – Defining retention and attrition in pre-antiretroviral HIV care: proposals based on experience in Africa

Matthew P. Fox et al.;

The authors of this editorial examine the challenges in developing clear definitions of attrition and retention in each stage of pre-ART care, propose definitions and discuss the data required for accurately measuring retention.


7.    Plos – What Is the Optimal First Line Antiretroviral Therapy in Resource-Limited Settings?

Chris Kenyon & Robert Colebunders;

Chris Kenyon and Robert Colebunders discuss the policy implications of first line antiretroviral therapies in resource-limited settings, which emerge from a new research study conducted by Campbell and colleagues.
Related to this issue, Science Speaks has an interesting blog post covering a letter advocating for a switch away from toxic sub-standard first line ART drugs in Malawi. “In a letter to Gabriel Jaramillo and Eric Goosby, the Centre for Development of People (CEDEP), Health GAP (Global Access Project), and the Malawi Network of People Living with HIV/AIDS (MANET+) are asking the Global Fund to find a way to switch to first line treatment in Malawi that is acceptable to patients and World Health Organization standards. They are also asking the President’s Emergency Plan For AIDS Relief, which supplies technical assistance but currently does not play a role in supplying treatment in Malawi to support the switch, and to focus on paying for treatment coverage expansion and health worker salaries.”




8.    Lancet (Comment) – Curtailing tobacco use: first we need to know the numbers

Jeffrey P. Koplan et al.;

Koplan and Mackay comment on a new Lancet study by Gary Giovino and colleagues that describes the acquisition of high-quality data for tobacco use from 16 countries through the employment of well-designed and well-implemented surveys, the Global Adult Tobacco Survey (GATS). They reckon the main challenge is how to translate the findings from GATS and other surveys into health policy.

Some encouraging ‘tobacco control’ news came from Australia this week. “Tobacco companies have failed in a critical legal challenge to Australia’s pioneering introduction of plain packaging of cigarettes, in a development described as “the worst defeat yet for Big Tobacco.” (who’s next?)


9.    Lancet – Hypertension in developing countries

M. Mohsen Ibrahim et al.;

This article was the third in a Lancet series on hypertension published last week. “Data from different national and regional surveys show that hypertension is common in developing countries, particularly in urban areas, and that rates of awareness, treatment, and control are low. Several hypertension risk factors seem to be more common in developing countries than in developed regions.”




India celebrated its own Independence Day this week. Don’t know whether there’s already a patriotic Bollywood movie, but there is quite some public health news from India this week.


10. BMJ (news) – Experts question proposals to use private sector in India’s health reforms

Ganapati Mudur;

India’s most influential government think tank, the Planning Commission, has agreed to revise a draft document for healthcare reform after some experts claimed that it reflected an intent to hand over virtually all clinical services to the private sector.

Last week, the Lancet reported that India’s government plans to launch the National Urban Health Mission (NUHM), which “will focus on improving health care delivery and public health systems,”.  This was hailed as a new step towards UHC in the country. (The Planning Commission was probably not aware.)


11. HP&P – The making of a public health problem: multi-drug resistant tuberculosis in India

Nora C. Engel;

This paper examines how actors construct the public problem of multi-drug resistant tuberculosis (MDR-TB) in India. (For the political scientists among you)


Health Policy and Financing


12. Lancet (Editorial) – UK leads a global effort to tackle hunger and malnutrition

A Lancet editorial comes back on last week’s Hunger Summit in London. Other relevant viewpoints on the Summit came from Owen Barder, George Monbiot, and the Guardian’s Mark Tran. Suffice to say that interpretations differ.

Richard Horton covered the first ‘Global Health Policy summit’ in his Offline article last week, a summit that took place in London two weeks ago. The Summit aimed to bring international health leaders together to discuss the urgent challenges facing health systems around the world. Horton considered the meeting a great success, but wondered whether the UK government uses global health as a convenient vehicle to sell Britain. (and that was just after listening to David Cameron; imagine what Boris Johnson could deliver for UK Big pharma! The London mayor seemed to have quite some attention for the reproductive health of the Olympic athletes in his final Olympics speech).


13. Lancet (Comment) – Untreated surgical conditions: time for global action

Lohfa B. Chirdan;

Commenting on a Lancet article on the prevalence of untreated surgical conditions and deaths potentially preventable with surgical care in Sierra Leone, the authors of this Comment call on governments, policy makers, the international community and donor agencies to consider surgical health-care delivery in LMICs as a priority. Funding is also needed for surgical conditions.

A recent Opinionator article also argues it’s urgent to repair the surgery deficit (with the article covering taskshifting for surgery in Zambia).


14. Global Public Health – Special Supplement

In late 2010, a conference on ‘The Changing Landscape of Global Public Health’ was held in New York City, bringing together 125 public health leaders, including researchers, policy-makers, practitioners and advocates from 33 countries and 5 continents around the world. The conference was initiated and led by Columbia University’s Mailman School of Public Health, in partnership with the London School of Hygiene and Tropical Medicine and the Association of Schools of Public Health.
The conference was intended to provide a working forum in which to tackle and identify the way forward on these key questions, and determine key leadership directions for global public health in the early twenty-first century. This Global Public Health Special Supplement brings together a set of articles that resulted from the conference, and that outline many of the key debates that emerged as a result. Many of them are already available online for a while – we covered some in the past -, but do check out also articles on ‘The changing landscape of global public health’ and on ‘Global public health leadership for the 21st century’. Peter Piot is among the authors.


15. Guardian – Crowdsourcing reveals life-saving potential in global health research


An increasing number of organizations are turning to crowdsourcing competitions to outsource innovation to the general public. For example, the electronics company Nokia has partnered with a California-based NGO to offer $2.25m to encourage the innovative use of digital tools, particularly mobile health applications. In order to meet health challenges more quickly and with tight budgets, we can certainly expect more of these ‘open innovation partnerships’ to come into being. But will this new commercial approach to partnerships work for global health projects in the long run?


16. TMIH – The 2012 world health report ‘no health without research’: the endpoint needs to go beyond publication outputs

Rony Zachariah et al.;

The upcoming World Health Report should be about more than just publication outputs, it should also focus on translation of research outputs to policy and practice.


Global Health bits and pieces


*  Gates & sanitation: a solar powered toilet designed by the California Institute for Technology has won first prize in a competition for next-generation toilets to improve sanitation in the developing world.

* A NYT article mentioned a new circumcision device, PrePex, a bloodless circumcision device for adults. It will be tested in at least nine African countries in the next year. PEPFAR and the Gates Foundation will be the sponsors.

* Scientists researching the Ebola virus say that due to funding restraints it is becoming unlikely that there will ever be a vaccine.


Emerging Voices


17. World Journal of Vaccines – Breaking the Barriers to Access a Low Cost Intra-Dermal Rabies Vaccine Through Innovative “Pooling Strategy”

Omesh K. Bharti et al.;

In India every year an estimated 20,000 patients die of Rabies. A major reason for poor compliance to anti-rabies prophylaxis is the high cost of anti-rabies vaccine that is routinely being prescribed intramuscularly (IM). This article showcases a clinic in Shimla, where the main author, Emerging Voice Omesh Bharti, was able to successfully introduce a new cost effective intra-dermal method of rabies vaccination, overcoming all odds, the vested interests of companies as well as the conservative mindset of doctors who had all blocked this technique till now.


Development & Aid


US presidential elections

  • Paul Ryan is Romney’s Vice-President (or is it President?), and we better pay attention. Devex and Tom Murphy (on Humanosphere) both wonder what the two scenarios (an Obama win and a Romney victory) would mean for foreign aid.



  • Kate Higgins and Stefanie Di Domenico give an overview of the wheels in motion for establishing the post-2015 development framework
  • A new ODI paper explores what the post-2015 MDG for education could be


Complexity and development

  • Owen Barder wrote the first of a couple of blog posts on the possible implications of the complexity theory for development thinking, based on a recent lecture by himself. You can also watch the full lecture.
  • Ben Ramalingam brings together some of Elinor Ostrom’s ideas on the implications of complexity science for development aid.



  • An ‘IDS in focus policy briefing’ by Andy Sumner gives global poverty projections for 2020 and 2030.   Yes, there will still be many poor in MICs then.
  •  An ODI Background note explores the possible role of the corporate sector in development.
  • Rosa Brooks wonders in Foreign Policy what exactly America’s Africa Command (aka Africom ) is doing in Africa, for example killing mosquitos and trying to circumcise African men.
  • A NYT article explored Brazil’s increasing tentacles in Africa
  • Humanosphere’s Tom Paulson covers a bunch of Seattle activists whose aim it is to make the Trans-Pacific Partnership acronym (TPP) as infamous as the WTO’s at the end of the 90s. They have their work cut out.
  • Finally, a NYT article wonders why China’s media focus so much on Africa these days.
  • In the Guardian, Mark Tran gives a great overview of a recent (lively) debate on the future of NGOs in development, kicked off by a  blog post by Oxfam’s Duncan Green. Duncan didn’t fancy a recent paper by a few academics. Obviously he has a point. NGOs are not all the same, see for example MMI’s Thomas Gebauer’s  eloquent  case for re-politicizing NGOs, based on his presentation in Cape Town (PHA3).


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