In this week’s IHP newsletter we cover the Botswana meeting on health in the post-2015 development agenda; the latest episode in the Global Burden of Disease reporting (with the release of national reports) ; International Women’s day (March 8); International Ear care day ( on March 3, although March 9 seems more appropriate – many men require ear care after listening patiently to their wives’ numerous complaints on ongoing gender discrimination the day before); an HIV update with news on an HIV “breakthrough” but also a setback; the 10-year anniversary of SARS, a couple of Global Health Governance papers (including one by Julio Frenk et al.), ….
What happened in the world this week? Hugo Chavez died and the Dow Jones reached a new record – what a shame Chavez can’t comment himself anymore on this devilish coincidence. The most pertinent tweet on the caudillo’s death came from George Monbiot: “Why is #HugoChavez universally described as “controversial” whereas Cameron, for example, is not?” (Maybe because the term ‘controversial’ is too polite for Cameron & Osborne?)
Bill Gates reviewed Acemoglu & Robinson’s bestseller, ‘Why nations fail’. Somewhat surprisingly, the philantropist was fairly critical, which caused some predictable commotion in the blogosphere. For example on Bill’s straightforward view of growth: “This points to the most obvious theory about growth, which is that it is strongly correlated with embracing capitalistic economics—independent of the political system. When a country focuses on getting infrastructure built and education improved, and it uses market pricing to determine how resources should be allocated, then it moves towards growth. … “ Not that we expected him to say anything else. Many people – for example this Economist writer who begged to differ – already chipped in, either endorsing or refuting Bill’s view.
The discussion centred on growth in the Global South, obviously. However, in the North, the more relevant question in this era seems to be: how can we stop growth, which seems necessary for a sustainable world, without sinking our welfare states? The answer of our leaders is well known and comprises a mix of austerity, structural reforms & green growth. Unfortunately, austerity is in serious trouble, structural reforms often have a hidden (neoliberal) agenda, and green growth still feels like a fairytale story ( one day Disney will make a movie about it, with Jim Kim, Christine Lagarde and Shrek in starring roles)). Bill Gates probably has plenty of time on the plane, so I hope he can also review Tim Jackson’s book, ‘Prosperity without growth’, one of these days. It’s an important debate in the run-up to a hopefully sustainable post-2015 world.
By the way, at a recent symposium, Duncan Green (from Oxfam) argued that the post-MDG process is badly off track. It seems to start from the wrong question (“what if I ruled the world?”), and thus ends up with a Christmas tree, he says. Instead, we should focus on ‘how can/does post-2015 influence national policy making’? Watch his interesting presentation on Youtube.
In this week’s guest editorial, our colleague Natalie Eggermont, a member of the People’s Health Movement, reflects on the recent proposal by Carrasco et al. of a DALY global credit market (in Plos). She has a number of ethical and ideological concerns.
Enjoy your reading.
Kristof Decoster, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme
Is a global DALY-credit market desirable?
by Natalie Eggermont, member of the People’s Health Movement
In their recent Plos article, “Who Should Pay for Global Health, and How Much?”, Luis Carrasco et al take on the task of establishing expected financial contributions from each country to achieve the health MDGs. Mirroring the cap-and-trade system in the global carbon permit market, they propose a disability-adjusted life years (DALY) global credit market.
This week, the High Level Dialogue on Health in the Post-2015 Agenda took place in Gabarone, Botswana. It brought together representatives from governments, non-governmental organizations, academic and research institutions and the private sector to debate how to advance health priorities in the post-2015 development agenda. Read this (short) Feature Story on the UNAIDS website, for example if you want to know what Sidibé said. Unicef’s Anthony Lake also gave a keynote speech. An excerpt: “We cannot build and sustain such a case for health if we look at the issue solely through the clear but narrow lenses of our institutional interests ― or if we settle for the blurred vision of a watered down or imprecise goal or goals. Health goals must be universal, explainable, measurable and equitable.” The outcomes of the consultation will guide and inform a report by the UN Secretary-General’s High-level Panel on the post-2015 development agenda which will be submitted to the Secretary-General in May 2013. So far we haven’t come across any outcome document of the Dialogue. Apparently, later this month, Anders Nordstrom and Joy Phumaphi will submit 2 pages proposing health goals post-2015 to the UN High-Level Panel.
The Botswana event on Twitter:
Richard Horton tweeted on his way to the Botswana meeting and from the event. Here you find some of his thoughts, for example on (AIDS) activism: “I remember AIDS activism in New York in the 1990s. We need that spirit now for sustainable development. But the spirit seems to have gone.” “I see more activism and passion for global health from the women’s and children’s and NCD communities than I see from the AIDS community. Have elements of the AIDS community become part of a vast bureaucracy of global health that is more about the status quo than radical change?” Have AIDS activists been so incorporated into the mainstream of global health that they have lost their anger and political edge?” “I expected AIDS advocates and activists, who did more than anyone to “create” global health, to be leading post-2015 debates. Not so. Why?”
Quoting Margaret Chan: “I’m biased…health needs more prominence.” “The most dangerous thing is a Christmas Tree”: 148 post-2015 goals so far.
Horton also had a tweet conversation with Rob Yates, listing some of the proposals being floated in Botswana. “Proposal: 2 post-2015 goals—1. The unfinished MDG agenda. 2. NCDs. Views? “Another proposal: Wellbeing for All. That is, physical, mental, social, and spiritual wellbeing.” Rob Yates promptly reacted: “Too hippy dippy – people won’t take us seriously.”
Some questions emerged in the post-2015 dialogue: is universal health “access” better than “coverage”? How ambitious should the goals be? And HS global tweeted: “In Botswana, interesting and strong support for a life-course approach to health goals: specific targets for separate groups in life cycle.”
In advance of the High-level Dialogue, many organizations had a number of key messages for the participants, for example Lara Brearley in a nice blog post (on behalf of Save the Children), the NCD Alliance, a coalition of civil society organizations (with a letter on the importance of inclusion of UHC in the post-2015 health agenda) , …
Global burden of disease
1. IHME – The Global Burden of Disease: Generating Evidence, Guiding Policy
On Tuesday, Bill Gates & IHME researchers announced ambitious plans to help achieve better measurement of health trends around the world with more-frequent updates to global death and disease statistics that used to take a decade or more to compile and analyze. New results will be issued at least annually, from now on, covering 187 countries. Murray and colleagues unveiled detailed findings from their most recent Global Burden of Disease survey, a massive, country-by-country analysis.
The full range of dynamic visualizations of GBD findings for various countries can be found here. The Lancet focused mostly on the UK results this week, for example in an early online editorial (as well as in a few Comments). IHME released a brief summary of the findings for each country as well as a report on GBD methods and findings called ‘The Global Burden of Disease: Generating Evidence, Guiding Policy’.
Tom Paulson summarized a number of media reports on the GBD national data in this blog post on Humanosphere, from all around the world (for example UK, US, China, India, South-Africa, …).
2. Humanosphere – Visualize global health
Paulson quotes Christopher Murray: “I think these visual tools represent a significant paradigm change for global health. They engage even the most data-resistant people. It’s an incredible revelation to me how profoundly influential it can be to present the data in this way. I think data visualization will be revolutionary for global health.” “I think the combination of having much more powerful estimates combined with these new tools will make all of this information more accessible while also shifting the discussion more into the mainstream.” In other words, visualizing global health data should do the trick, both towards decision makers, media and public opinion.
Women’s and maternal health
3. Lancet (Editorial) – Women’s health—broadening the remit
International Women’s Day on March 8 should be a day of celebration for women around the globe. It should also give pause for thought to all in the health profession. There’s more to women’s health than reproduction, this editorial argues. A lot more.
Some other news on maternal & women’s health:
- For the Statement from the independent Expert Review Group (iERG) on Information and Accountability for Women’s and Children’s Health on International Women’s Day, see here.
- The British government has pledged up to $52.7 million to help eliminate female genital mutilation (FGM) in a generation (see the Guardian ).
- The head of the UN development programme, Helen Clark, said the UN shouldn’t backtrack on women’s reproductive rights. The outcome document of the Commission on the Status of Women (CSW) must not undermine previous agreements that put women’s sexual and reproductive rights central to their empowerment, she said on Wednesday. The negotiations taking place at the CSW in New York during these two weeks focus on eliminating violence against women and girls.
- On International Women’s Day, PHM is launching its ‘Thematic campaign on Gender & Reproductive Justice’.
- The WB published new research on shifting gender norms world wide. See Duncan Green (Oxfam), for a summary, on his blog.
- On March 7, a special session of the UN Commission on the Status of Women (CSW) focused on child marriage. The Governments of Bangladesh, Canada and Malawi jointly sponsored the session. It was held in support of Every Woman Every Child, a movement spearheaded by Ban Ki Moon which aims to save the lives of 16 million women and children by 2015. The session addressed the problems created by early marriages and ways to prevent them.
- The Jadelle Access Program, announced last week, will reduce the price and make this contraceptive more available to more than 27 million women in the world’s poorest countries. (see this blog post on Impatient Optimists)
4. Globalization & Health – Turning dread into capital: South Africa’s AIDS diplomacy
The article first describes the emergence and contemporary practice of health diplomacy; this is followed by a discussion of niche diplomacy, in particular as it applies to the foreign policy agendas of emerging middle powers. It then reviews South African foreign policy and diplomacy, before situating these policies within the context of emerging mechanisms of south-south multilateralism. The article concludes by synthesizing these elements and advocating for a South African AIDS diplomacy, emphasizing its potential to galvanize a global project of emancipation.
5. Reuters – Anti-AIDS pill, vaginal gel unsuitable for Africa: study
Trying to prevent HIV infection through vaginal gels or daily tablets has proven ineffective in the southern African region ravaged by the disease because people did not use the medicines properly, a study released on Monday said. A 2010 study had indicated a vaginal gel containing an HIV drug can sharply reduce infections in women who use it before and after sex. However, a test of the gel and two types of anti-HIV pills among more than 5,000 women in South Africa, Zimbabwe and Uganda showed that, based on blood tests, more than 70 percent did not use the medication as instructed.
On a more positive note, there was the HIV ‘functional cure’ news which you couldn’t miss, even if you tried – see for example Sarah Boseley on this.
And the Lancet also published an early online Comment on monitoring strategies for management of ART in children. “The encouraging results of the ARROW trial, reported in The Lancet , raise the probability of achieving universal coverage of antiretroviral therapy for young children with HIV from poor populations.” “… ARROW provides us with a clear demonstration that excellent clinical outcomes can be attained in children with HIV despite resource constraints that mar our efforts to manage HIV in the settings most affected by this devastating epidemic.”
Global Health Governance
6. NEJM (Review article) – Governance Challenges in Global Health
Julio Frenk et al.;
In this review article, the authors define and discuss the importance of good global governance for health, outline major challenges to such governance, and describe the necessary functions of a global health system.
7. WHO – Public web consultation on WHO’s engagement with non-State actors
In response to the request of the Executive Board of WHO (Decision EB132(11)) to conduct public web-based consultations on the draft principles and policies of engagement with non-State actors, the WHO Secretariat welcomes interested parties to provide comments on the issues and questions related to WHO’s engagement with non-State actors as outlined and described below. Comments are invited from 6 March 2013 to 20 March 2013. Inputs received from this consultation will inform the further development of principles, policies and procedures related to WHO’s engagement with non-State actors, including nongovernmental organizations and private commercial entities.
A BMJ news article reports on a group of public health professionals from around the world urging WHO to stop the alcohol industry influencing its strategy to reduce harmful use of alcohol. The Global Alcohol Policy Alliance has issued a “statement of concern” to WHO.
8. Globalization & Health – The health systems funding platform and World Bank legacy: the gap between rhetoric and reality
Scott S. Brown et al.;
Global health partnerships created to encourage funding efficiencies need to be approached with some caution, with claims for innovation and responsiveness to development needs based on untested assumptions around the potential of some partners to adapt their application, funding and evaluation procedures within these new structures. The authors examine this in the case of the Health Systems Funding Platform, which despite being set up some three years earlier, has stalled at the point of implementation of its key elements of collaboration. The authors feel inadequate scrutiny has been made of the World Bank’s contribution to this partnership, which might have been reasonably anticipated based on an historical analysis of development perspectives. They zoom in on the gap between WB rhetoric and the reality.
9. WHO – WHO welcomes expanded role for United Nations Special Envoy for Malaria
WHO welcomed the announcement of Mr Ray Chambers as the United Nations Secretary-General’s Special Envoy for Malaria and for the Financing of the Health-related MDGs.
10. Congress summary – The European Health Forum Gastein 2012 – Crisis and opportunity – Health in an age of austerity
There were lots of sessions at this Congress which took place in October 2012. The EHFG is the leading health policy event in the EU and it provides a major platform for decision-makers from public health & health care. This document is the official congress summary. One of the key topics was Global Health Governance.
11. Aidspan – Campaign Underway for Fourth Replenishment
The Global Fund is planning a big push for its Fourth Replenishment, a campaign that is appropriately named “The Big Push.” The Fourth Replenishment covers the period 2014–2016. This year, 2013, the Global Fund is organising a replenishment conference. The conference actually consists of two meetings: an initial meeting on 9–10 April in Brussels, hosted by the European Commission; and a final meeting in late 2013 where donors are expected to announce pledges.
Meanwhile, Mark Dybul wrote an op-ed for the Huffington Post, celebrating the launch of the new funding model. For an analysis of the new funding model, see this blog post on Tomorrow Global (by Danielle Parsons).
On Aidspan, David Garmaise also reports that South Africa has stepped up domestic financing for HIV programmes to the point where it now provides 82% of the country’s total expenditure on HIV. The Global Fund said this in a news release (7 March) on the occasion of Dybul’s recent visit to South Africa, which included a meeting with President Jacob Zuma. South Africa is one of the interim applicants identified by the Global Fund for the transition phase of the new funding model.
US & Global health
There’s still quite some fog on the impact of sequestration. You might want to read this article on the Global Health Technologies Coalition’s website (on the benefits of global health research, and why it should thus be protected from sequestration); an article (on “2×2 project”) on the possible impact of sequestration on public health in the US and abroad. “Worse than the short-term impacts of sequestration on public health at home and abroad may be the lasting implications sequestration’s cuts will have for the future of public health. If unabated, these cuts will extend through fiscal year 2021, crippling our public health infrastructure by starving critical organizations, such as the CDC and the Food and Drug Administration (FDA), of the funds they need to carry out even their most basic operations.”
As for how the broader aid community assesses sequestration, see this Devex article.
12. CGD – Trade-offs in FY-14: A case for the Global Fund
Amanda Glassman & Jenny Ottenhoff;
Glassman & Ottenhoff hope the President’s FY14 budget will strongly support the Global Fund at this critical (fiscal) moment, for a number of reasons.
Check out also Victoria Fan’s blog post on why PBF is a major opportunity for PEPFAR.
Health Policy & Financing
13. Sarah Boseley – Leading scientists sign up to global cancer manifesto
The premier cancer research organisations in the world, led by the National Cancer Institute in the US and Cancer Research UK, are speaking out: “It is time to take what we know about basic cancer prevention and care into the poorest countries. It is also time to rethink the way ahead for cancer research, so everybody benefits and money is not wasted on hugely expensive but ineffective treatments.” Their statement was published in the Science Translational Medicine journal and is authored by Harold Varmus, Nobel prize-winning director of the National Cancer Institute in the US and by Harpal Kumar, CEO of Cancer Research UK on behalf of leading institutions from Australia to Argentina and Taiwan to Turkey.
14. Lancet (Comment) – SARS legacy: outbreak reporting is expected and respected
David L. Heymann et al.;
The authors reflect on the SARS legacy, 10 years after WHO declared that severe acute respiratory syndrome was a worldwide health threat. The 10 years since SARS emerged have made a difference, they argue, for example through the IHR 2005. Yet, how the global public health and animal health community responds to the newly emerging coronavirus threat will be a test of what has been achieved and whether the one-health notion can move beyond words to practical action, they emphasize.
15. Guardian – Drug-resistant tuberculosis: we can stop this epidemic in its tracks
For the first time in half a century drugs that could cure DR-TB are being tested (see for example bedaquiline & delamanid), but the global health community needs to act fast, Brigden argues. She’s the TB adviser for MSF’s access campaign.
16. BMJ (Feature) – Andrew Witty: the acceptable face of big pharma?
Following GlaxoSmithKline’s announcement that it will open up its research data, Rebecca Coombes spoke to the company’s chief executive, Andrew Witty, about how he is trying to change the company. He wants to reform GSK in three areas; data transparency, access to medicines, and intellectual property.
17. The Atlantic – Testing Drugs on the Developing World
“Voluntary” participation in clinical trials is a slippery slope in many LICs, Kelley argues. While disclosure of new data from pharmaceutical companies is a good first step, questions remain.
As for the latest news on some of GSK’s rivals, see these articles on Bayer (India rules against Bayer in the cancer drug patent case in India) and Roche (which is dropping the herceptin price in the same country).
18. KFF – World Trade Organization Meeting This Week To Discuss Proposed Extension Of TRIPS Transition Period For LDCs
On March 5-6, the Trade-Related Aspects of Intellectual Property Rights Council of the World Trade Organization met in Geneva to seal the fate of the proposal lengthening the TRIPS transition period for the 49 least-developed countries. The transition period, set to expire July 2013, exempts LDCs from the terms of the TRIPS agreement on patents and test data protection for pharmaceuticals. UNAIDS and UNDP have argued in favour of an extension a few weeks ago.
For the latest & some statements of various countries and stakeholders at the meeting (for example EU, Brazil, …), see Knowledge Ecology International.
19. Healthy Policies – Trade and public health: what’s missing?
McNamara comments on a piece published in the Lancet last Friday, in which public health researchers warned of the negative public health impacts of the Trans Pacific Partnership Agreement (TPP). She says the criticism is valid, but it operates too much within the biomedical paradigm. There are other links & pathways between TPP and health.
20. The Scientist – Bedeviled by dengue
This articles gives a great overview of the dengue pandemic. The author stresses that finding a vaccine against dengue will be helpful but that the focus on vaccination is like treating the symptom rather than the disease.
21. Guardian – Energy poverty deprives 1 billion of adequate healthcare, says report
Energy poverty has left more than 1 billion people in developing countries without access to adequate healthcare, with staff forced to treat emergency patients in the dark, and health centres lacking the power they need to store vaccines or sterilise medical supplies, according to a new (and annual) report, Poor People’s Energy Outlook, published on Wednesday by the NGO Practical Action. Energy poverty deprives 1 billion people of adequate healthcare.
In other social determinants news, check out this Scidev. article reporting on a new Cochrane Review on the link between housing improvements and good health.
Global Health bits and pieces
Yesterday, on March 7, an interesting webinar was organized by the Future Health Systems consortium. It was chaired by FHS CEO Dr Sara Bennett. The webinar presented landscaping reviews undertaken by members of the Future Health Systems consortium along three health market themes: regulation, networks, and learning. Key recommendations outlined in the Bellagio Statement on the Future of Health Markets were also addressed. This was followed by reactions from a variety of stakeholders — from small business leaders, to private sector giants, health funders, and government representatives — some of whom participated in the meeting in Bellagio. We particularly liked the presentation by Gates Foundation representative Guy Stallworthy.
22. International Archives of Medicine – Health financing in the African Region: 2000–2009 data analysis
Luis Gomes Sambo et al.;
The objective of this paper is to examine the changes that have occurred in African countries on health financing, taking into account the main sources of funding over the period 2000 to 2009. The analysis is based on the National Health Accounts data for the 46 countries of the WHO African Region.
23. JAIDS – An Evaluation of the President’s Emergency Plan for AIDS Relief Effect on Health Systems Strengthening in Sub-Saharan Africa
Robert L. Cohen et al.;
This study aimed to evaluate whether PEPFAR activities were associated with system-wide improvements in both proximal and distal indicators of health systems strengthening.
24. The American journal of tropical medicine and hygiene – Impact, Challenges, and Future Projections of Vaccine Trials in Africa
Olubukola T. Idoko et al.;
There is a global effort to deploy new vaccines for disease control and eradication. However, these new vaccines must be tested in the settings in which they will be used. This necessity has required the conduct of many vaccine trials in Africa, where several infectious diseases with significant public health impact are prevalent. This review seeks to highlight the issues surrounding the conduct of clinical trials in resource-constrained settings and suggests some ways of circumventing them.
25. HP&P – new (March) issue
Check out for example the article on “10 best resources on … evidence-informed decision making” (by Kaelan A Moat & John Lavis)
- Jeffrey Sachs has his own opinion on sequestration.
- Tony Blair examined advances made in health and development across Africa since the Gleneagles G8 meeting. “Today, the positive legacy of that summit is still being felt across Africa: aid was doubled and developing world debt dropped. … “when I look back at what we achieved in 2005, I believe the most important story is yet to be told.” He states, “Africa is on the move and if we keep going on the whole Gleneagles agenda — maintain aid but remembering governance and economic growth — the continent will be transformed. … If the last decade of development progress was defined by aid, the next will be defined by governance and growth.” And yes, as you know he intends to play in role in that, through his own organization, the Africa Governance Initiative.
- Meanwhile preparations are beginning for the G8 summit – and Cameron already tweeted this week: #G8 will drive serious debate on tax evasion & avoidance. Tougher standards? Automatic information exchange? Let’s explore them. (don’t know why they make such a fuss then about the EU bank staff bonus curbs)
- A new CSIS report calls for U.S. foreign aid to reorient itself around the private sector and make “broad-based economic growth” its organizing principle. “Private-sector-led, broad-based economic growth is the transformational force in development,” says the report, issued by the center’s Executive Council on Development.
- China suffered some reputational setbacks in Africa, lately.
- Finally, read Rick Rowden on the need to integrate fiscal and finance issues into a transformative post-2015 development agenda.